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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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From background to solutions: Eliminating sex gaps in clinical electrophysiology practice
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“Several strategies to reduce bias have been described and empirically verified in the social psychology literature (Table 3), but there is only limited research testing the validity of such strategies in the clinical setting.(39) To address the knowledge gaps that limit the effectiveness of implicit bias training in t…”
BackgroundSoffer, M., Cohen, M. W., & Azaiza, F. (2021) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-021-01008-5 · Cited by 2
Prevalence and determinants of unconscious stereotyping among primary care physicians
Alqahtani, N. M., Shehata, S. F., & Mostafa, O. A. (2020) · Saudi Medical Journal · doi:10.15537/smj.2020.8.25186 · Cited by 2
Shelton, K. H., Haddock, G., & Ottaway, H. (2018) · Children and Youth Services Review · doi:10.1016/j.childyouth.2018.02.009 · Cited by 2
Does Race Play a Role in Invasive Procedure Treatments? An Initial Analysis
Hammarlund, N., & Natarajan, S. (2017) · IEEE/ACM International Conference on Connected Health: Applications, Systems and Engineering Technologies · doi:10.1109/chase.2017.84 · Cited by 1
“Here, well-meaning doctors may rely on generalizing and stereotypes in attempts to combat the increased uncertainty which may bias the decision [5] [6].”
BackgroundThe Road to Tolerance and Understanding
Szilagyi, P. G., Dreyer, B. P., Fuentes‐Afflick, E., Coyne-Beasley, T. D., & First, L. (2017) · Academic Pediatrics · doi:10.1016/j.acap.2017.03.008 · Cited by 1
How group processes influence, maintain, and overcome health disparities
Stone, J., & Kwan, V. S. Y. (2016) · Group Processes & Intergroup Relations · doi:10.1177/1368430216642612 · Cited by 1
“The paper by Zestcott, Blair, and Stone (2016) reviews the overall evidence that provider implicit bias contributes to health disparities, and examines the available data on whether training in implicit bias can effectively reduce the biases that providers exhibit.”
BackgroundSelf-citationSafa, A. S., & Farkas, E. R. (2024) · Asian Journal of Ethics in Health and Medicine · doi:10.51847/7t31yxi8ju · Cited by 6
LGBTQ Cultural Humility for the Urology Healthcare Provider
Kuzma, E. K., & Lehmann, B. C. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-45267-4_24 · Cited by 1
Pförtner, T., Hennemann, T., Gube, M., & Elgar, F. J. (2026) · Archives of Public Health · doi:10.1186/s13690-026-02111-x
Maasz, J. J., Bezuidenhout, C., Graham, M. A., & van der Linde, J. (2026) · International Journal of Language & Communication Disorders · doi:10.1111/1460-6984.70345
“Understanding how HCPs perceive the populations they serve is therefore essential, as their perceptions are often shaped by implicit biases and stigma (Chapman et al. 2013 ; Zestcott et al. 2016 ).”
Mitigating bias in chest X-ray disease diagnosis via de-biased disentangled representation learning
Lai, X., Li, J., Gao, X., Jiao, Z., & Zhong, Z. (2026) · Artificial Intelligence in Medicine · doi:10.1016/j.artmed.2026.103446
Toker, O., & Dikmen, M. (2026) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-026-01980-2
Cantle, F., Reid, C., Williams, S., Jina, R., Spooner, C., Corbett, C., Harrington, R., Hardwick, S., Oriolo, V., Tampsett, R., et al. (2026) · Emergency Medicine Journal · doi:10.1136/emermed-2025-215003
Implicit Bias in Health Professionals: A Scoping Review
Chacón-Acevedo, K., Castillo, A. M. D., Castro-Muñoz, J. A., Rojas, Y. F., Bermudez-Rodriguez, A., & Rojas-Gómez, A. M. (2026) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph23070840
“In healthcare settings, implicit bias has been associated with differences in communication, clinical judgment, and treatment decisions, with potential downstream effects on patient experiences and outcomes [19–23].”
A Policy Analysis of Mandatory Implicit Bias Training for Perinatal Nurses.
Killam, B., Dyck, M. J., Gulley, T., Hammer, D., Houston, D., & Blakeman, J. R. (2026) · Nursing for Women s Health · doi:10.1016/j.nwh.2026.01.005
Cabán, M., Brown-Bradley, C. J., Wetmore, J. B., Ottman, R., & Siegel, K. (2026) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2026.100753
“…current evidence about how provider implicit bias contributes to health disparities and whether training can effectively reduce such biases, Zestcott et al. (2016) suggested developing training models that not only raise awareness of implicit biases but also teach control strategies and…”
Horn, C., & Newnam, K. M. (2026) · Advances in Neonatal Care · doi:10.1097/anc.0000000000001342
Sawyer, K., & Corr, P. G. (2025) · Occupational Therapy In Health Care · doi:10.1080/07380577.2025.2604698
Chui, Z., Welsh, H., Rhead, R. D., Valmaggia, L., Onwumere, J., Ensum, L., & Hatch, S. L. (2025) · medRxiv · doi:10.1101/2025.09.26.25336643
“By foregrounding equity and intersectionality, VR can extend beyond technical skills training into complex domains such as bias, discrimination, and healthcare inequalities [14,15,17].”
Virtual Reality Upstander Training to Disrupt Microaggressions.
Cameron, W., Real, F., Fleck, L., Kelleher, M. E., Weber, D. E., Gilliam, C. A., & Unaka, N. I. (2025) · Academic pediatrics · doi:10.1016/j.acap.2025.103144
Akinsete, A., Hossain, O. B., Agalliu, I., Wahezi, D. M., Silvers, E. J., Blanco, I., Rubinstein, T. B., & González, C. M. (2025) · ACR Open Rheumatology · doi:10.1002/acr2.70082
Treptow, R. L., Browne, J. V., Feder, J. D., Glovinsky, I., & Skotko, B. (2025) · American Journal of Medical Genetics. Part A · doi:10.1002/ajmg.a.64166
“…has been explored, with systematic reviews (Ahadinezhad et al. 2022; Chapman et al. 2013; Dehon et al. 2017; Maina et al. 2018; Van Ryn et al. 2011; Zestcott et al. 2016) concurring that further knowledge of how physician beliefs impact clinical decision-making and create health disparities is…”
Racial and Socioeconomic Disparities in Autism Providers’ ACEs Inquiries
Walker, K. L., Gates, J. A., Boateng, S., Gerber, A. S., Gurba, A. N., Moskowitz, L. J., & Lerner, M. D. (2025) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-025-06948-z
Ehmke, S. D., Ehmke, E. T., & Chauhan, P. (2025) · Nurse Educator · doi:10.1097/nne.0000000000001871
Bonte, L. D., Goubert, L., & Ceuterick, M. (2025) · Qualitative Health Research · doi:10.1177/10497323241303713
“Consequently, the overall health status of an already vulnerable target population is at risk of deteriorating (Zestcott et al., 2016).”
Salmond, S. W., Aktan, N. M., Pitts, S., Repsha, C. L., Manchester, J., Schill, K. O. A. C., & Allread, V. (2025) · Orthopaedic Nursing · doi:10.1097/nor.0000000000001107
How to negotiate a plurality of myths about grief and death: Les Revenants as a case study
Wittman, L. (2025) · Asian Journal of Medical Humanities · doi:10.1515/ajmedh-2025-0032
Evaluating Modern Implicit Bias Training in the Urology Workforce
Myrga, J., Patnaik, S., & Gayed, B. (2025) · Cureus · doi:10.7759/cureus.77677
“Studies have shown that there are disparities in medical outcomes of Black patients compared to Caucasian patients, possibly related to perceived racial bias [5].”
Women’s Perspectives on Black Infant Mortality in the United States
Obeng, C. S., Nolting, T. M., Jackson, F., Obeng-Gyasi, B., Brandenburg, D., Byrd, K. A. D., & Obeng-Gyasi, E. (2024) · Women · doi:10.3390/women4040038
“Research shows that uncon-scious biases can result in unequal treatment and increase health inequities [45,46].”
Provider Perceptions of Outcomes in the Pediatric Cardiac Intensive Care Unit
Boyer, P. J., Schumacher, K. R., Thornsberry, K., Yu, S., Lowery, R., & Sznycer-Taub, N. R. (2024) · Pediatric Cardiology · doi:10.1007/s00246-024-03717-0
“Weighing the risks and benefits of an intervention is impacted by both objective data as well as a provider’s personal perception, experience, and bias [5–8].”
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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