Anxiety as a Mediator of the Relationship between Implicit Bias and Health Care Disparities: A Multi-Method Approach

焦虑作为隐性偏见与医疗保健差异之间关系的中介：一种多方法方法

• 批准号: 10470816
• 负责人: Katherine E Manbeck
• 金额: $ 4.46万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-16 至 2023-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10470816
• 关键词: Address; Adherence; Affect; Anxiety; Anxiety Disorders; Attention; Attitude; Behavior; Behavioral; Belief; Black American; Black race; Client satisfaction; Clinical; Clinical Psychology; Code; Cognitive; Communication; Communication Research; Complex; Development; Disease; Educational Curriculum; Effectiveness; Ensure; Etiology; Eye; Foundations; Future; General Population; Goals; Health; Health Disparities Research; Health Personnel; Hydrocortisone; Impairment; Individual; Institutes; Intervention; Justice; Light; Measures; Mediating; Mediator of activation protein; Medical; Medical Students; Methods; Modeling; Nonverbal Communication; Patient Self-Report; Patient-Focused Outcomes; Patients; Persons; Physicians; Physiology; Policies; Provider; Public Health; Race; Recommendation; Research; Residual state; Resistance; Role; Sampling; Scheme; Scientific Advances and Accomplishments; Social Psychology; Standardization; Stereotyping; Strategic Planning; Students; Testing; Training; Treatment Refusal; Verbal Behavior; anxiety reduction; anxiety treatment; base; behavior change; black patient; care outcomes; career; caucasian American; communication behavior; compliance behavior; design; disparity reduction; evidence base; expectation; experience; health care disparity; health communication; health disparity; implicit bias; improved; indexing; innovation; interest; medical schools; minority health disparity; minority patient; mortality; negative affect; patient-clinician communication; provider behavior; psychologic; racial bias; racial disparity; racial health disparity; response; satisfaction; social; social group; social health determinants; social vulnerability; therapy design; treatment disparity

Project summary. Health disparities are a matter of grave public health significance, and advancing scientific understanding of the causes of health disparities is part of the National Institute of Minority Health Disparities strategic plan. Racial health disparities have complex etiologies and correlates, but remain when controlling for other social determinants of health and patient factors such as treatment refusal. Residual disparities reflect differences in provider treatment of White and minority patients. One factor contributing to disparate treatment of minority patients is provider implicit bias—non-conscious biases that alter behavior. Provider implicit bias predicts subtle behavioral differences in interactions with minority patients, including more anxiety-related word usage, more negative affect, and different nonverbals. These provider behaviors predict lower patient satisfaction and adherence, with health and mortality consequences. Despite haste to target implicit bias in disparity reduction interventions, the research on implicit bias reduction efforts is weak and mixed; most studies show no impact of implicit bias interventions. Furthermore, implicit bias is difficult to measure and demonstrates only moderate test-retest reliability. Nevertheless, there are clear public health implications of even weak effects of implicit bias when considering the number of people affected. Effects of implicit bias on disparities may be clarified by articulating and examining more complex models of the relationship between implicit bias and provider behavior. This proposal examines intergroup anxiety (anxiety that manifests in interracial interactions in response to negative expectations) as a mediator of the relationship between implicit bias and provider behavior. It is well known that anxiety affects behavior in the general population, and provider anxiety impairs patient outcomes, such as satisfaction and adherence, but no research has examined the effects of intergroup anxiety on provider behavior. To ensure a comprehensive analysis of the innovative association between intergroup anxiety and provider behavior, we propose to measure both constructs at multiple levels. We will assess anxiety through both self-report affect and physiology. We will examine three classes of behavior: verbal behavior (anxiety-related word use), global behavior (warmth) and nonverbal behaviors (using indicators identified by expert tape analysis—recent pilot, and aim 1). We will conduct this research in medical students (N=70). Medical school is a key window-of- opportunity when biases may be more malleable, students are accessible, and training is expected. Many medical schools use implicit bias reduction trainings to decrease disparities, but intergroup anxiety may represent a more consistently alterable and easy-to-measure construct. Disparity-reduction trainings based on evidence-based models such as the proposed may have large impacts on health disparities; my long-term career goal is to study factors that contribute to health disparities across multiple social determinants of health and design, test, and disseminate interventions on evidence-supported targets such as intergroup anxiety.

项目摘要。健康差距是一个具有严重公共卫生意义的问题， 对健康差异原因的科学理解是国家少数民族健康研究所的一部分， 差异战略计划。种族健康差异有复杂的病因和相关性，但当 控制健康的其他社会决定因素和患者因素，如拒绝治疗。残余 差异反映了提供者对白色和少数民族患者的治疗差异。其中一个因素 对少数民族患者的不同治疗提供了内隐的偏见-改变行为的无意识偏见。 提供者内隐偏见预测与少数民族患者互动中的微妙行为差异，包括更多 焦虑相关的词的使用，更多的负面影响，和不同的非语言。这些供应商行为 预测较低的患者满意度和依从性，健康和死亡率的后果。尽管匆忙 针对差异减少干预中的内隐偏见，关于内隐偏见减少努力的研究很薄弱 和混合;大多数研究表明没有影响的内隐偏见干预。此外，隐性偏见很难消除， 测量并证明只有中等重测信度。然而，有明确的公共卫生 当考虑到受影响的人数时，即使是微弱的内隐偏见效应也会产生影响。 内隐偏见对差异的影响可以通过阐明和检查更复杂的模型来澄清 内隐偏见和提供者行为之间的关系。本研究旨在探讨群际焦虑 （焦虑，表现在种族间的互动，以回应负面的期望）作为调解人的 内隐偏见和提供者行为之间的关系。众所周知，焦虑会影响行为， 一般人群和提供者的焦虑损害患者的结果，如满意度和依从性， 但还没有研究探讨群体间焦虑对提供者行为的影响。确保 综合分析组际焦虑与提供者行为之间的创新关联， 建议在多个层面上衡量这两种结构。我们将通过自我报告和情感评估焦虑 和生理学。我们将研究三类行为：言语行为（与焦虑相关的词语使用）， 行为（温暖）和非语言行为（使用由专家磁带分析确定的指标-最近的试点， 目标1）。我们将在医学生（N=70）中进行这项研究。医学院是一个关键的窗口- 当偏见可能更具可塑性时，学生是可访问的，并且期望培训。许多 医学院使用内隐偏见减少训练来减少差异，但组间焦虑可能 代表一个更一致的可变和易于测量的结构。减少差异的培训， 基于证据的模型，如拟议的可能有很大的影响健康的差距;我的长期 职业目标是研究在健康的多种社会决定因素中导致健康差异的因素 设计、测试和传播针对证据支持的目标（如群体间焦虑）的干预措施。