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

项目总结。健康差距是一个严重的公共卫生问题，而且还在不断扩大 对健康差距原因的科学理解是国家少数民族健康研究所的一部分 差异战略规划。种族健康差异有复杂的病因和相关性，但在以下情况下仍然存在 控制健康的其他社会决定因素和患者因素，如拒绝治疗。残渣 差异反映了提供者对白人和少数族裔患者治疗的差异。其中一个因素 对少数族裔患者的不同治疗是提供者的隐性偏见--改变行为的无意识偏见。 提供者的隐性偏见预测在与少数族裔患者的互动中存在细微的行为差异，包括 与焦虑相关的词汇使用，更多的负面情绪，以及不同的非言语。这些提供商行为 预测患者满意度和依从性较低，从而导致健康和死亡后果。尽管匆忙 针对缩小差距干预中的内隐偏差，对内隐偏差减少努力的研究还很薄弱 而且是混合的；大多数研究表明，隐性偏见干预没有影响。此外，隐性偏见很难 只测量和展示中等的重测可靠性。尽管如此，有明确的公共卫生 当考虑到受影响的人数时，即使是隐性偏见的微弱影响也会产生影响。 内隐偏见对差异的影响可以通过阐述和研究更复杂的模型来阐明 内隐偏见和提供者行为之间的关系。这项建议考察了群体间的焦虑。 (在种族间的互动中表现出来的对负面期望的焦虑)作为 内隐偏见与提供者行为之间的关系。众所周知，焦虑会影响老年人的行为。 一般人群，而提供者焦虑会损害患者的结果，如满意度和依从性， 但还没有研究考察群体间焦虑对提供者行为的影响。为了确保 综合分析了群体间焦虑和提供者行为之间的创新关联，我们 建议在多个层面上衡量这两个结构。我们将通过两种自我报告情绪来评估焦虑 和生理学。我们将考察三类行为：言语行为(与焦虑相关的用词)、全局行为 行为(热情)和非语言行为(使用专家磁带分析确定的指标-最近的试点， 和目标1)。我们将在医科学生(N=70)中进行这项研究。医学院是一个关键的窗口 当偏见可能更具延展性，学生容易接近，并且需要培训的时候，就有机会。许多 医学院使用内隐偏见减少训练来减少差异，但群体间焦虑可能 表示更一致的可更改和易于测量的构造。基于WEB的缩小视差训练 像提议的这样的循证模型可能会对健康差距产生很大影响；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 并设计、测试和传播针对证据支持的目标的干预措施，如群体间焦虑。

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.