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<i>Background.</i> In the United States, people of color face disparities in access
to health care,
the quality of care received, and health outcomes. The attitudes and behaviors of
health care providers have been identified as one of many factors that contribute
to health disparities. Implicit attitudes are thoughts and feelings that often exist
outside of conscious awareness, and thus are difficult to consciously acknowledge
and control. These attitudes are often automatically activated and can influence human
behavior without conscious volition.
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<i>Objectives.</i> We investigated the extent to which implicit racial/ethnic bias
exists among health
care professionals and examined the relationships between health care professionals’
implicit attitudes about racial/ethnic groups and health care outcomes.
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<i>Search Methods.</i> To identify relevant studies, we searched 10 computerized bibliographic
databases
and used a reference harvesting technique.
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<i>Selection Criteria.</i> We assessed eligibility using double independent screening
based on a priori inclusion
criteria. We included studies if they sampled existing health care providers or those
in training to become health care providers, measured and reported results on implicit
racial/ethnic bias, and were written in English.
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<i>Data Collection and Analysis.</i> We included a total of 15 studies for review
and then subjected them to double independent
data extraction. Information extracted included the citation, purpose of the study,
use of theory, study design, study site and location, sampling strategy, response
rate, sample size and characteristics, measurement of relevant variables, analyses
performed, and results and findings. We summarized study design characteristics, and
categorized and then synthesized substantive findings.
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<i>Main Results.</i> Almost all studies used cross-sectional designs, convenience
sampling, US participants,
and the Implicit Association Test to assess implicit bias. Low to moderate levels
of implicit racial/ethnic bias were found among health care professionals in all but
1 study. These implicit bias scores are similar to those in the general population.
Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people
were relatively similar across these groups. Although some associations between implicit
bias and health care outcomes were nonsignificant, results also showed that implicit
bias was significantly related to patient–provider interactions, treatment decisions,
treatment adherence, and patient health outcomes. Implicit attitudes were more often
significantly related to patient–provider interactions and health outcomes than treatment
processes.
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<i>Conclusions.</i> Most health care providers appear to have implicit bias in terms
of positive attitudes
toward Whites and negative attitudes toward people of color. Future studies need to
employ more rigorous methods to examine the relationships between implicit bias and
health care outcomes. Interventions targeting implicit attitudes among health care
professionals are needed because implicit bias may contribute to health disparities
for people of color.
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