Schnierle Jeanette, Christian-Brathwaite Nicole, Louisias Margee
Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Ohio State University College of Medicine, United States.
Riverside Community Care, 270 Bridge Street, Dedham, MA 02026, United States.
Curr Probl Pediatr Adolesc Health Care. 2019 Feb;49(2):34-44. doi: 10.1016/j.cppeds.2019.01.003. Epub 2019 Feb 6.
Implicit bias has entered modern discourse as a result of our current sociopolitical climate. It is an area that has been largely explored in the social sciences, and was highlighted in the landmark 2003 IOM report, Unequal Treatment, as a contributor to racial/ethnic health disparities. Implicit bias is the process of unconscious societal attitudes affecting our individual understanding, actions and decisions, thus leading to assumptions about groups. Immigrant populations are particularly at risk in our present-day environment, and as a result experience limited healthcare access and higher levels of psychological distress. There are many measures of implicit bias, but the most highly regarded tool is the Implicit Association Test (IAT), as it is valid and reliable. Some level of pro-White/anti-Black bias has been found in most systematic reviews and studies, although there are less studies on bias towards Latinx populations. Limited evidence exists about the association between implicit bias and health outcomes. However, existing publications have demonstrated clear associations between bias and treatment recommendations, nonverbal communication, adverse birth outcomes and provider communication styles. Implicit biases can be unlearned via debiasing strategies, but these have not been examined extensively amongst health care providers. Future research must rely on more than pre- and post-IAT measurements to examine the effect of these strategies on improving patient outcomes. Additionally, healthcare system leadership must prioritize implicit bias trainings for students and medical staff and make greater tangible efforts to improve workforce diversity as a debiasing strategy.
由于当前的社会政治环境，隐性偏见已进入现代话语体系。这是一个在社会科学领域已得到大量探讨的领域，并且在2003年具有里程碑意义的医学研究所在《不平等待遇》报告中被强调为种族/族裔健康差距的一个促成因素。隐性偏见是无意识的社会态度影响我们个人理解、行动和决策的过程，从而导致对群体的假设。在当今环境中，移民群体尤其面临风险，因此他们获得的医疗保健有限，心理困扰程度更高。有许多衡量隐性偏见的方法，但最受认可的工具是内隐联想测验（IAT），因为它有效且可靠。在大多数系统评价和研究中都发现了一定程度的亲白人/反黑人偏见，尽管针对拉丁裔群体偏见的研究较少。关于隐性偏见与健康结果之间的关联，证据有限。然而，现有出版物已经证明了偏见与治疗建议、非语言沟通、不良出生结局和医疗服务提供者沟通方式之间存在明显关联。隐性偏见可以通过去偏见策略消除，但这些策略在医疗服务提供者中尚未得到广泛研究。未来的研究必须依靠比内隐联想测验前后测量更多的方法来检验这些策略对改善患者结局的效果。此外，医疗系统领导层必须将针对学生和医务人员的隐性偏见培训作为优先事项，并做出更大的切实努力，以改善劳动力多样性作为一种去偏见策略。
