Johns Hopkins University School of Nursing, Baltimore, MD (Drs Bower and Warren).
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Ms Kramer and Drs Stierman and Creanga).
Am J Obstet Gynecol MFM. 2023 Apr;5(4):100872. doi: 10.1016/j.ajogmf.2023.100872. Epub 2023 Jan 20.
Implicit bias among maternal healthcare professionals contributes to disrespectful care and racial and ethnic disparities in patient outcomes, and there is growing consensus that implicit bias training is a key component of birth equity initiatives. A requirement for implicit bias training for healthcare professionals has become more widespread, but the impact training has is largely unknown, in part, because of a lack of validated instruments. Therefore, there is an urgent need for a psychometrically valid instrument for use in the evaluation of implicit bias training.
This study aimed to develop a valid and reliable instrument to assess implicit bias awareness and mitigation practices among maternal care professionals and that can be used to evaluate interventions aimed at mitigating such bias in clinical practice.
We conducted an instrument development and validation study in 3 phases. In phase 1, item development, we generated a 43-item bank from literature and consultation and established content validity with subject matter experts. In phase 2, instrument development, we administered a revised set of 33 items to 307 nurses and midwives and conducted exploratory factor analysis to demonstrate construct validity and reliability. In phase 3, instrument evaluation, we confirmed the factor structure and compared the means of implicit bias training-exposed and -unexposed participants to further demonstrate construct validity with a representative state sample of 2096 maternal healthcare professionals (physicians, midwives, and nurses).
Based on phase 2 results, we retained 23 items for the Bias in Maternal Health Care scale, which showed high internal consistency (Cronbach's alpha, 0.86). We identified 3 subscales, namely a 9-item Bias Awareness subscale (Cronbach's alpha, 0.86), a 7-item Bias Mitigation Practice subscale (Cronbach's alpha, 0.82), and a 7-item Bias Mitigation Self-Efficacy subscale (Cronbach's alpha, 0.81). Validation of the Bias Awareness and Bias Mitigation Practice subscales in phase 3 demonstrated the instrument's high reliability (Cronbach's alpha 0.86 and 0.83, respectively) and discriminating performance among maternal healthcare professionals.
We developed a reliable and valid instrument for measuring awareness and mitigation of bias among maternal healthcare professionals. It can be used to evaluate implicit bias training and other bias mitigation interventions in maternal healthcare settings.
产妇医护专业人员的隐性偏见导致了不尊重的护理以及患者结局的种族和民族差异，越来越多的人认为隐性偏见培训是生育公平倡议的关键组成部分。对医护专业人员进行隐性偏见培训的要求已经变得更加广泛，但培训的效果在很大程度上是未知的，部分原因是缺乏经过验证的工具。因此，迫切需要一种用于评估隐性偏见培训的心理测量有效的工具。
本研究旨在开发一种有效的、可靠的工具，以评估产妇护理专业人员的隐性偏见意识和缓解实践，并可用于评估旨在缓解临床实践中此类偏见的干预措施。
我们分三个阶段进行了工具开发和验证研究。在第 1 阶段，即项目开发阶段，我们从文献和咨询中生成了一个包含 43 个项目的项目库，并通过主题专家确立了内容有效性。在第 2 阶段，即工具开发阶段，我们对 307 名护士进行了一套修订后的 33 个项目的评估，并进行了探索性因素分析，以展示构建有效性和可靠性。在第 3 阶段，即工具评估阶段，我们确认了因素结构，并比较了隐性偏见培训暴露组和未暴露组的平均值，以进一步通过代表 2096 名产妇医护专业人员（医生、助产士和护士）的州样本展示构建有效性。
基于第 2 阶段的结果，我们保留了 23 个项目用于《产妇保健中的偏见量表》，该量表显示出较高的内部一致性（Cronbach's alpha，0.86）。我们确定了 3 个子量表，即 9 个项目的偏见意识子量表（Cronbach's alpha，0.86）、7 个项目的偏见缓解实践子量表（Cronbach's alpha，0.82）和 7 个项目的偏见缓解自我效能子量表（Cronbach's alpha，0.81）。第 3 阶段对偏见意识和偏见缓解实践子量表的验证表明，该工具具有较高的可靠性（Cronbach's alpha 分别为 0.86 和 0.83）和在产妇医护专业人员中的区分性能。
我们开发了一种用于测量产妇医护专业人员的偏见意识和缓解能力的可靠有效的工具。它可用于评估产妇保健环境中的隐性偏见培训和其他偏见缓解干预措施。
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