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Examining the presence, consequences, and reduction of implicit bias in health care: A narrative review
Open accessAbstract
Recent evidence suggests that one possible cause of disparities in health outcomes for stigmatized groups is the implicit biases held by health care providers. In response, several health care organizations have called for, and developed, new training in implicit bias for their providers. This review examines current evidence on the role that provider implicit bias may play in health disparities, and whether training in implicit bias can effectively reduce the biases that providers exhibit. Directions for future research on the presence and consequences of provider implicit bias, and best practices for training to reduce such bias, will be discussed.
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“The scientific community working in this area agrees that the relationship between levels of implicit bias in healthcare professionals and clinical decision-making is complex and that there is currently a lack of good evidence for a direct negative influence of biases [16, 17].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [16]
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Cited by
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BackgroundInfluentialSelf-citationPatient-provider communication patterns among Asian American immigrant subgroups in New York City
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“are subject to the same social influences that foster gender/ gender-related biases in the general population.(13) Dentists and physicians see many patients with a primary complaint of pain, yet receive relatively little formal training in pain management and rely on simple cues for pain management decisions.”
BackgroundIn the Name of Fairness: Assessing the Bias in Clinical Record De-identification
Xiao, Y., Lim, S., Pollard, T., & Ghassemi, M. (2023) · ACM Conference on Fairness, Accountability, and Transparency (FAccT) · doi:10.1145/3593013.3593982 · Cited by 23
“Bias in healthcare can occur in both systematic and implicit ways based on demographic factors such as race, ethnicity, gender, sexual orientation, or socio-economic status [48, 59, 88, 137].”
BackgroundLGBTQ+ health: tackling potential health-care professionals’ bias
Malta, M. (2023) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00413-2 · Cited by 28
Barrett, N. J., Boehmer, L., Schrag, J., Benson, A. B., Green, S., Hamroun, L., Howson, A., Matin, K., Oyer, R. A., Pierce, L. J., et al. (2023) · JCO Oncology Practice · doi:10.1200/op.22.00378 · Cited by 33
“Implicit bias affects patient-provider interactions, clinical decision making, and treatment recommendations, and is a contributing factor to disparities in clinical trial recruitment.(13,15-20) Studies have found that implicit bias reduces the likelihood of offering clinical trials to racially and ethnically marginal…”
BackgroundHagiwara, N., Duffy, C. M. C., Cyrus, J. W. W., Harika, N., Watson, G. S., & Green, T. (2024) · Science Advances · doi:10.1126/sciadv.ado5957 · Cited by 26
“Two important elements of successful behavioral change are (i) learning specific strategies to replace old behaviors and (ii) the opportunity to practice the strategies repeatedly over time ( 17 ).”
Defeating Unconscious Bias: The Role of a Structured, Reflective, and Interactive Workshop
Ogunyemi, D. A. (2021) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-20-00722.1 · Cited by 33
Cunningham, G. B., & Wigfall, L. T. (2020) · PLoS ONE · doi:10.1371/journal.pone.0242044 · Cited by 29
“Past researchers focusing on racial bias and health outcomes have predominantly done so at the individual level of analysis (for examples, see [21,22]).”
BackgroundChavan, N., Eubanks, A. A., Ollendorff, A. T., Radke, S. M., & White, M. P. (2025) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000005888 · Cited by 24
“Strategies to address identified disparities and ineq-uities include implicit bias training for staff, the implementation of culturally responsive care practices, and focused efforts to engage and support historically marginalized communities in prenatal and perinatal care (33).”
Pain-related stigma as a social determinant of health in diverse pediatric pain populations
Wakefield, E. O., Kissi, A., Mulchan, S. S., Nelson, S., & Martin, S. R. (2022) · Frontiers in Pain Research · doi:10.3389/fpain.2022.1020287 · Cited by 26
Breithaupt, L. E., Trojanowski, P. J., & Fischer, S. F. (2020) · Obesity · doi:10.1002/oby.22909 · Cited by 25
“, purposely interacting with out-group members and finding similarities between them and the self) (17,29,30).”
BackgroundMedical Mistrust, COVID-19 Stress, and Intent to Vaccinate in Racial–Ethnic Minorities
Minaya, C., McKay, D., Benton, H., Blanc, J., & Seixas, A. A. (2022) · Behavioral Sciences · doi:10.3390/bs12060186 · Cited by 28
“Another limitation includes the omission of other psychological factors that might impact vaccine hesitancy such as health literacy, discrimination, and implicit medical biases [36].”
BackgroundMaternal experiences of ethnic discrimination and subsequent birth outcomes in Aotearoa New Zealand
Thayer, Z. M., Bécares, L., & Carr, P. A. (2019) · BMC Public Health · doi:10.1186/s12889-019-7598-z · Cited by 26
Nathan, M., Ormond, K., Dial, C. M., Gamma, A., & Lunn, M. (2019) · Journal of Genetic Counseling · doi:10.1007/s10897-018-0295-8 · Cited by 24
Bilotta, I., Tonidandel, S., Liaw, W. R., King, E. B., Carvajal, D. N., Taylor, A., Thamby, J. M., Xiang, Y., Tao, C., & Hansen, M. A. (2024) · JMIR Medical Informatics · doi:10.2196/50428 · Cited by 19
“Subtle bias by health care clinicians is linked to negative outcomes for racial and ethnic minority patients, particularly Black non-Hispanic and Hispanic or Latino patients [5].”
BackgroundInfluentialGonzález, C. M., Nava, S., List, J., Liguori, A., & Marantz, P. R. (2021) · MedEdPORTAL · doi:10.15766/mep_2374-8265.11162 · Cited by 23
“Through analysis of notes taken during each debriefing, three themes emerged: (1) successes, (2) unanticipated pitfalls, and (3) future opportunities (Table 2).”
BackgroundInfluentialMoving beyond the individual: Community-level prejudice and health
Blair, I. V., & Brondolo, E. N. (2017) · Social Science & Medicine · doi:10.1016/j.socscimed.2017.04.041 · Cited by 27
Self-citationRace and Ethnicity and Clinician Linguistic Expressions of Doubt in Hospital Admission Notes
Lee, C. R., Aysola, J., Chen, X., Addisu, E., Klein, A. Z., Weissenbacher, D., Gonzalez‐Hernandez, G., & Weissman, G. E. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.38550 · Cited by 22
Bascom, E., Casanova-Pérez, R., Tobar, K., Bedmutha, M. S., Ramaswamy, H., Pratt, W., Sabin, J., Wood, B. R., Weibel, N., & Hartzler, A. L. (2024) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642756 · Cited by 12
“Bringing awareness to one’s implicit bias alone can result in dissonance, discomfort, and defensiveness [62, 64, 65, 72], thus, interventions that raise awareness of implicit bias should be paired with strategies that help individuals to understand and reduce its impact on patient care [63, 64].”
BackgroundTjia, J., Pugnaire, M., Calista, J., Eisdorfer, E., Hale, J., Terrien, J., Valdman, O., Potts, S., Garcia, M. M., Yazdani, M., et al. (2023) · Journal of Medical Education and Curricular Development · doi:10.1177/23821205231175033 · Cited by 22
Jindal, M., Mistry, K. B., McRae, A., Unaka, N. I., Johnson, T. J., & Thornton, R. L. J. (2021) · Academic Pediatrics · doi:10.1016/j.acap.2021.12.012 · Cited by 21
Racism against healthcare users in inpatient care: a scoping review
Merz, S., Aksakal, T., Hibtay, A., Yücesoy, H., Fieselmann, J., Annaç, K., Yılmaz-Aslan, Y., Brzoska, P., & Tezcan‐Güntekin, H. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02156-w · Cited by 38
“Discrimination can have detrimental effects on patients’ decision-making capabilities and their trust towards physicians [9, 11].”
BackgroundImplicit Bias Training in Health Professions Education: A Scoping Review
Mavis, S. C., Caruso, C. G., Dyess, N. F., Carr, C. B., Gerberi, D., & Dadiz, R. (2022) · Medical Science Educator · doi:10.1007/s40670-022-01673-z · Cited by 27
Changing the PrEP Narrative: A Call to Action to Increase PrEP Uptake among Women
Cernasev, A., Walker, C. M., Armstrong, D. L., & Golden, J. (2021) · Women · doi:10.3390/women1020011 · Cited by 22
“What is even more concerning about implicit bias is that it can also negatively impact patients’ perceptions and behaviors and create uncomfortable environments [36].”
BackgroundWhat COVID-19 Teaches Us About Implicit Bias in Pediatric Health Care
Mulchan, S. S., Wakefield, E. O., & Santos, M. (2020) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsaa131 · Cited by 24
“Systematic and narrative reviews of studies using the IAT in adult health care have demonstrated that implicit bias not only applies to race and ethnicity, but also to gender, age, and weight (Fitzgerald & Hurst, 2017; Zestcott et al., 2016).”
BackgroundInfluentialTajeu, G., Halanych, J., Juarez, L., Stone, J., Stepanikova, I., Green, A., & Cherrington, A. (2018) · Journal of the National Medical Association · doi:10.1016/j.jnma.2017.12.001 · Cited by 21
Self-citationGonzález, C. M., Onumah, C. M., Walker, S. A., Karp, E., Schwartz, R., & Lypson, M. L. (2022) · Advances in Health Sciences Education · doi:10.1007/s10459-022-10168-w · Cited by 22
Connaghan, K., Wertheim, C., Laures-Gore, J. S., Russell, S., & Patel, R. (2020) · International Journal of Speech-Language Pathology · doi:10.1080/17549507.2020.1768286 · Cited by 20
Wolsiefer, K. J., Mehl, M., Moskowitz, G., Cagno, C. K., Zestcott, C. A., Tejeda-Padron, A., & Stone, J. (2021) · Health Communication · doi:10.1080/10410236.2021.1936756 · Cited by 19
Self-citation‘I'm happy to own my implicit biases’: Public encounters with the implicit association test
Yen, J., Durrheim, K. L., & Tafarodi, R. W. (2018) · British Journal of Social Psychology · doi:10.1111/bjso.12245 · Cited by 25
Aysola, J., Clapp, J. T., Sullivan, P., Brennan, P. J., Higginbotham, E. J., Kearney, M. D., Xu, C., Thomas, R. A., Griggs, S., Abdirisak, M., et al. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-021-07028-5 · Cited by 20
Tolchin, B. D., Latham, S. R., Bruce, L., Ferrante, L. E., Kraschel, K., Jubanyik, K. J., Hull, S. C., Herbst, J. L., Kapo, J. M., MORITZ, E. D., et al. (2020) · The Journal of Clinical Ethics · doi:10.1086/jce2020314303 · Cited by 28
Diversity in Medical Education
Dogra, N., & Carter‐Pokras, O. (2018) · Wiley eBooks · doi:10.1002/9781119373780.ch35 · Cited by 11
Applying Intergroup Relations Research to Understanding LGB Health Disparities
Ryan, W. S., Hunger, J. M., & Major, B. (2017) · Journal of Social Issues · doi:10.1111/josi.12227 · Cited by 17
Disparities in the provision of perinatal care based on patient race in the United States
Byrn, M. A., Buys, E. A., Mujahid, M., & Madsen, K. (2023) · Birth · doi:10.1111/birt.12717 · Cited by 17
Metadata
- Authors
- Zestcott, C. A., Blair, I. V., & Stone, J.
- Affiliations
- University of Arizona (US)
- University of Colorado, USA
- Corresponding author
- Zestcott, Colin A.
- Venue
- Group Processes & Intergroup Relations
- Publisher
- SAGE Publications
- Published
- 2016-05-08
- Volume
- 19
- Issue
- 4
- Pages
- 528-542
- ISSN
- 1368-4302 (ISSN-L)
- 1461-7188
- PMC
- PMC4990077
- OpenAlex
- W2347070413
- Cited by
- 381
- References
- 146
- Citations by year
- 2026: 13 · 2025: 34 · 2024: 49 · 2023: 53 · 2022: 62 · 2021: 49 · 2020: 46 · 2019: 26 · 2018: 24 · 2017: 18 · 2016: 7
- FWCI
- 9.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Group Processes & Intergroup Relations (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Minority Health and Health Disparities (R01MD008940)
- Topics
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Keywords
- implicit bias, healthcare workers, health disparities, implicit bias training, stigmatized groups, health equity
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