Basch Molly C, Lupini Francesca, Janicke David M
Department of Adolescent and Young Adult Medicine, Children's National Hospital, 111 Michigan Ave NW, District of Columbia, Washington, 20010, USA.
Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, District of Columbia, Washington, USA.
J Clin Psychol Med Settings. 2025 Jun;32(2):286-296. doi: 10.1007/s10880-024-10044-2. Epub 2024 Sep 6.
Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants' explanation of why they perceived lower adherence for dyads with obesity-obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers' less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.
医疗保健中的肥胖偏见是有害的。我们探究了医学生的信念，这些信念构成了他们认为肥胖的儿童-母亲二元组不太可能坚持治疗这一认知的基础。参与者观看了一个12岁女性虚拟人在母亲陪同下因背痛去看医生的场景。在不同场景中对患者和母亲的体重线索进行了操控。在120名参与者中，35名参与者认为与健康体重的二元组相比，肥胖的二元组不太会坚持假设的与疼痛相关的治疗建议。我们告知了这些参与者并询问原因。对他们的回答进行了主题分析。52条回答揭示了与参与者解释为何认为肥胖的二元组坚持性较低相关的三个编码——肥胖与以下因素有关：1）不遵守一般健康建议，2）内在特质/因素（即母亲健康意识较低、心理承受力较差），3）外部因素（即健康素养较低、社会经济地位较低）。肥胖与较低坚持性之间的关联是一种可能存在于医学生中的偏见，它源于对先前健康依从性和母亲特质的假设，其中一些本质上带有贬低意味。这种偏见有可能导致医疗保健方面的差异。研究结果凸显了定性方法在理解驱动认知的信念以及根据受训者需求设计减少偏见干预措施方面的效用。
