Implicit Association Test Scores Research Articles

Awareness and Calibration: The Role of Descriptive Norms and Social Desirability in Accurate IAT Score Predictions of Food Items vs. Social Groups.

Extending research that people are able to predict the patterns of their social group biases on Implicit Association Tests (IATs), we let participants predict and complete IATs toward five different food item pairs and compared the results with the social-groups domain. Participants predicted the patterns of their IAT scores with similar accuracy in both domains, suggesting similar internal awareness (evidenced by comparable within-subjects correlations), even though food evaluations followed less descriptively-normative patterns. At the same time, participants were better-calibrated in communicating their evaluations in the domain of food than social groups (evidenced by higher between-subjects correlations). This discrepancy may partly stem from participants' tendency to refrain from using harsh labels when predicting social group biases, despite their demonstrated awareness of them: IAT scores predicted as "moderate" or "strong" for food preferences tended to be labeled "mild" for social groups. Discussion centers on the importance of distinguishing between awareness and calibration.

Improved implicit self-esteem is associated with extended antidepressant effects following a novel synergistic intervention.

In a previously published randomized controlled trial, automated self-association training (ASAT), a novel digital intervention, was found to extend the rapid antidepressant effect of a single infusion of ketamine for at least 30 days. In this secondary analysis, we aimed to understand the potential role of implicit self-esteem in the combined antidepressant effect of ketamine and ASAT training, by investigating the novel synergistic treatment's effects on implicit self-associations and their relation to symptom improvement. A total of 154 adults (ages 18-60) with treatment-resistant unipolar depression and lower-than-normative explicit self-esteem were randomized in a double-blind, parallel-arm design to receive one of three treatment allocations: an active/active treatment combination consisting of one infusion of ketamine (0.5 mg/kg) followed by four days of ASAT ( ~ 30-40 min/day), or one of two control arms that lacked either the active drug or the active behavioral component. The Implicit Association Test (IAT) was used to behaviorally assess the strength of association between self-related stimuli and negative concepts. Linear regression models were used to test the relationship between group assignment, IAT scores acquired immediately post-treatment, and both acute and extended clinical outcomes (% change in Montgomery-Asberg Depression Rating Scale scores, relative to pre-treatment baseline) in the trial. The group assigned to ketamine + ASAT intervention, compared to the other groups, had a pattern of IAT scores indicating more positive self-associations immediately after treatment relative to the control arms (F(1, 131) = 3.979; p = 0.048). In regression models, IAT scores tracked with concurrent (acute post-treatment) % change in MADRS scores across all treatment arms (p = 0.001), and mediated more extended (Day 30) depression improvements specifically for the ketamine+ASAT arm (group * IAT interaction term: β = -0.201; p = 0.049). Our findings suggest that changing implicit self-worth during a post-ketamine 'plasticity window' is one key mechanism whereby the novel ketamine+ASAT treatment combination exerts its antidepressant benefit, confirming the intended treatment target at the level of implicit cognition. Future studies should seek to further enhance the reliability of the biobehavioral intervention's impact on implicit cognition, as this mechanism appears linked to the intervention's enduring clinical benefits.

The Implicit Association Test and its difficulty(ies): Introducing the test difficulty concept to increase the true-score variance and, consequently, the predictive power of implicit association tests.

We introduce the test difficulty concept from classical test theory to tackle the issue of low predictive power of implicit association tests (IATs). Following classical test theory, we argue that IATs of moderate difficulty (defined as mean IAT scores of zero) have more predictive power than IATs of extreme difficulties (defined as mean IAT scores deviating strongly from zero). Furthermore, we assume this relationship to be mediated by the true-score variance in IAT scores, with moderate difficulty resulting in more true-score variance. To test our hypotheses, we used nonexperimental (Studies 1 and 2) and experimental designs (Study 3). In Studies 1 and 2, we compared IATs of different test difficulties with regard to their ability to predict direct attitude measures, drawing on the Attitudes, Identities, and Individual Differences study. In Study 1, a subset of 95 attitude IATs (n = 127,259) was analyzed using multilevel structural equation models. As expected, IAT test difficulty strongly moderated the predictive power of IATs, and this effect was mediated by IAT true-score variance. In Study 2, we replicated the results with the same analyses but a different subset of 95 identity IATs (n = 43,745). In Study 3, we experimentally manipulated the IAT test difficulty. In total, three IATs (n = 480) were analyzed using multigroup structural equation models. Again, the IAT closer to moderate difficulty had more true-score variance and predictive power than the IATs of extreme difficulty. Accordingly, for correlational research, we recommend developing moderately difficult IATs to maximize IAT true-score variance and provide suggestions on how to achieve that. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Racial Implicit Bias and Communication Among Physicians in a Simulated Environment

Racial implicit bias can contribute to health disparities through its negative influence on physician communication with Black patients. Interventions for physicians to address racial implicit bias in their clinical encounters are limited by a lack of high-fidelity (realistic) simulations to provide opportunities for skill development and practice. To describe the development and initial evaluation of a high-fidelity simulation of conditions under which physicians might be influenced by implicit racial bias. This cross-sectional study, performed on an online platform from March 1 to September 30, 2022, recruited a convenience sample of physician volunteers to pilot an educational simulation. In the simulation exercise, physicians saw a 52-year-old male standardized patient (SP) (presenting as Black or White) seeking urgent care for epigastric pain, nausea, and vomiting. The case included cognitive stressors common to clinical environments, including clinical ambiguity, stress, time constraints, and interruptions. Physicians explained their diagnosis and treatment plan to the SP, wrote an assessment and management plan, completed surveys, and took the Race Implicit Association Test (IAT) and Race Medical Cooperativeness IAT. The SPs, blinded to the purpose of the study, assessed each physician's communication using skills checklists and global rating scales. Association between physicians' IAT scores and SP race with SP ratings of communication skills. In 60 physicians (23 [38.3%] Asian, 4 [6.7%] Black, 23 [38.3%] White, and 10 [16.7%] other, including Latina/o/x, Middle Eastern, and multiracial; 31 [51.7%] female, 27 [45.0%] male, and 2 [3.3%] other), the interaction of physicians' Race IAT score and SP race was significant for overall communication (mean [SD] β = -1.29 [0.41]), all subdomains of communication (mean [SD] β = -1.17 [0.52] to -1.43 [0.59]), and overall global ratings (mean [SD] β = -1.09 [0.39]). Black SPs rated physicians lower on communication skills for a given pro-White Race IAT score than White SPs; White SP ratings increased as physicians' pro-White bias increased. In this cross-sectional study, a high-fidelity simulation calibrated with cognitive stressors common to clinical environments elicited the expected influence of racial implicit bias on physicians' communication skills. The outlined process and preliminary results can inform the development and evaluation of interventions that seek to address racial implicit bias in clinical encounters and improve physician communication with Black patients.

Estimating implicit and explicit racial and ethnic bias among community pharmacists in Canada

BackgroundBias, whether implicit (unconscious) or explicit (conscious), can lead to preferential treatment of specific social groups and antipathy towards others. When healthcare professionals (HCPs), including pharmacists, act on these biases, patient care and health outcomes can be adversely affected. This study aims to estimate implicit and explicit racial/ethnic bias towards Black and Arab people among community pharmacists in Ontario, Canada. MethodsCommunity pharmacists participated in a secure, web-based survey using a cross-sectional design that included Harvard’s Race and Arab Implicit Association Tests (IATs) to examine bias towards Black and Arab people. Explicit (stated) preferences were measured by self-report. Data were analyzed using descriptive and inferential statistics. ResultsThe study surveyed 407 community pharmacists, 56.1 % of whom were women with an average age of 46.9. Implicit Association Test (IAT) results showed a statistically significant moderate preference for white people over both Black (mean IAT = 0.41) and Arab people (mean IAT = 0.35). However, most pharmacists explicitly stated that they had no racial/ethnic preference, with 75.7 % expressing a neutral preference between Black and white and 66.6 % neutral between Arab and white. However, a slight preference for white individuals was observed. Demographic factors such as age, place of birth, race/ethnicity, and experience significantly impacted IAT scores. For example, older, Canadian-born, white pharmacists with more experience displayed higher implicit bias scores. A mild correlation was found between implicit and explicit bias, indicating as implicit bias increases, explicit bias tends to become more negative. ConclusionsThis study is the first to explore the issue of pharmacist bias in Canada and concentrate on anti-Arab bias. Our findings reveal that Ontario community pharmacists tend to have an unconscious inclination towards white people, which calls for further understanding of this matter. Additionally, we discovered a moderate degree of anti-Arab bias, indicating that studies on other HCPs should consider bias against this social group. Educational interventions are needed to address the implicit biases among community pharmacists in Ontario, Canada. These findings should aim to raise self-awareness of biases, educate about the potential implications of these biases on patient care, and provide strategies to reduce bias.

The Implicit Association Test

Abstract Among the general public and behavioral scientists alike, the Implicit Association Test (IAT) is the best known and most widely used tool for demonstrating implicit bias: the unintentional impact of social group information on behavior. More than forty million IATs have been completed at the Project Implicit research website. These public datasets are the most comprehensive documentation of IAT and self-reported bias scores in existence. In this essay, we describe the IAT procedure, summarize key findings using the IAT to document the pervasiveness and correlates of implicit bias, and discuss various ways to interpret IAT scores. We also highlight the most common uses of the IAT. Finally, we discuss unanswered questions and future directions for the IAT specifically, and implicit bias research more generally.

Obesity bias awareness decreases nursing students' bias toward patients with obesity.

To determine if obesity bias scores among nursing students changed after education was delivered and to what degree body mass index (BMI) was associated with a personal experience of bias during a student's healthcare history. A quantitative, quasi-experimental design was used to analyze sociodemographic information and Implicit Association Test scores of junior, senior, and full-time accelerated coursework track nursing students. Generally, obesity bias declined among the group. However, bias increased regarding increasing BMI. Obesity bias awareness and obesity education can decrease obesity bias among nursing students.

A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender?

Orthopaedic surgery continues to be one of the least diverse medical specialties. Recently, increasing emphasis has been placed on improving diversity in the medical field, which includes the need to better understand existing biases. Despite this, only about 6% of orthopaedic surgeons are women and 0.3% are Black. Addressing diversity, in part, requires a better understanding of existing biases. Most universities and residency programs have statements and policies against discrimination that seek to eliminate explicit biases. However, unconscious biases might negatively impact the selection, training, and career advancement of women and minorities who are underrepresented in orthopaedic surgery. Although this is difficult to measure, the Implicit Association Test (IAT) by Project Implicit might be useful to identify and measure levels of unconscious bias among orthopaedic surgeons, providing opportunities for additional interventions to improve diversity in this field. (1) Do orthopaedic surgeons demonstrate implicit biases related to race and gender roles? (2) Are certain demographic characteristics (age, gender, race or ethnicity, or geographic location) or program characteristics (geographic location or size of program) associated with the presence of implicit biases? (3) Do the implicit biases of orthopaedic surgeons differ from those of other healthcare providers or the general population? A cross-sectional study of implicit bias among orthopaedic surgeons was performed using the IAT from Project Implicit. The IAT is a computerized test that measures the time required to associate words or pictures with attributes, with faster or slower response times suggesting the ease or difficulty of associating the items. Although concerns have been raised recently about the validity and utility of the IAT, we believed it was the right study instrument to help identify the slight hesitation that can imply differences between inclusion and exclusion of a person. We used two IATs, one for Black and White race and one for gender, career, and family roles. We invited a consortium of researchers from United States and Canadian orthopaedic residency programs. Researchers at 34 programs agreed to distribute the invitation via email to their faculty, residents, and fellows for a total of 1484 invitees. Twenty-eight percent (419) of orthopaedic surgeons and trainees completed the survey. The respondents were 45% (186) residents, 55% (228) faculty, and one fellow. To evaluate response biases, the respondent population was compared with that of the American Academy of Orthopaedic Surgeons census. Responses were reported as D-scores based on response times for associations. D-scores were categorized as showing strong (≥ 0.65), moderate (≥ 0.35 to < 0.65), or slight (≥ 0.15 to < 0.35) associations. For a frame of reference, orthopaedic surgeons' mean IAT scores were compared with historical scores of other self-identified healthcare providers and that of the general population. Mean D-scores were analyzed with the Kruskal-Wallis test to determine whether demographic characteristics were associated with differences in D-scores. Bonferroni correction was applied, and p values less than 0.0056 were considered statistically significant. Overall, the mean IAT D-scores of orthopaedic surgeons indicated a slight preference for White people (0.29 ± 0.4) and a slight association of men with career (0.24 ± 0.3), with a normal distribution. Hence, most respondents' scores indicated slight preferences, but strong preferences for White race were noted in 27% (112 of 419) of respondents. There was a strong association of women with family and home and an association of men with work or career in 14% (60 of 419). These preferences generally did not correlate with the demographic, geographic, and program variables that were analyzed, except for a stronger association of women with family and home among women respondents. There were no differences in race IAT D-scores between orthopaedic surgeons and other healthcare providers and the general population. Gender-career IAT D-scores associating women with family and home were slightly lower among orthopaedic surgeons (0.24 ± 0.3) than among the general population (0.32 ± 0.4; p < 0.001) and other healthcare professionals (0.34 ± 0.4; p < 0.001). All of these values are in the slight preference range. Orthopaedic surgeons demonstrated slight preferences for White people, and there was a tendency to associate women with career and family on IATs, regardless of demographic and program characteristics, similar to others in healthcare and the general population. Given the similarity of scores with those in other, more diverse areas of medicine, unconscious biases alone do not explain the relative lack of diversity in orthopaedic surgery. Implicit biases only explain a small portion of the lack of progress in improving diversity, equity, inclusion, and belonging in our workforce and resolving healthcare disparities. Other causes including explicit biases, an unwelcoming culture, and perceptions of our specialty should be examined. Remedies including engagement of students and mentorship throughout training and early career should be sought.

Initial evidence of reliability and validity of an implicit association test assessing attitudes toward individuals who use substances

ABSTRACT Background: Substance use disorders (SUDs) are stigmatized conditions, with individual biases driving poor health outcomes. There are surprisingly few validated measures of bias or stigma toward individuals who use substances. Bias can be classified as explicit (self-report) or implicit (behaviorally based). Objectives: The goal of the present study was to establish preliminary indices of reliability and validity of an implicit association test (IAT) designed to measure implicit bias toward individuals who use substances. Methods: A large United States-based, crowd-sourced sample (n = 394, 51.5% male, 45.4% female, 2.5% nonbinary) completed the IAT and a small battery of survey instruments that assessed social distance to mental illness (including heroin use), attitude toward and perceived controllability of injection drug use, perception of public stigma, and social desirability. Results: Nearly all (92%; n = 363) scores on the IAT indicated greater negative than positive attitudes toward those who use substances. Spearman-Brown corrected split-half reliability on the IAT scores was excellent, r = .953. Controlling for social desirability, IAT scores positively correlated with all included measures pertaining to substance use as well as social distance for heroin and schizophrenia (but not diabetes). A principal component analysis resulted in two interpretable components representing disapproval (perceived controllability and negative attitudes) and perceived stigma (social stigma and social distance). Scores on the IAT positively correlated to scores on both components, again, controlling for social desirability. Conclusion: These results provide compelling preliminary evidence of validity of an IAT designed to measure bias toward individuals who use substances.

Nurses’ Implicit Attitudes Regarding Sexual and Gender Minorities

Negative health impacts exist for individuals who identify as lesbian, gay, bisexual, transgender, or something other than heterosexual are critical. Nurses are on the front lines of delivering holistic patient care to everyone, and their potential biases regarding this vulnerable population may negatively affect care. The study used scores from two tests designed to measure implicit bias in individuals towards sexual and gender minorities (SGM). A retrospective design with secondary data from Project Implicit was conducted using the Transgender (2020) and Sexuality (2006 to 2020) Implicit Association Tests (IATs). We compared mean Transgender IAT scores of nurses to other health-related professions (n = 53,586) and investigated differences between nurses’ Transgender IAT scores and self-identified explicit attitudes (n = 1558). A time-series of nurses’ Sexuality IAT scores was also explored (N = 25,791). Our study findings demonstrated that nurses held the strongest implicit preference for cisgender people compared to other occupational groups. No significant difference was found between nurses’ implicit and explicit preferences. Nurses’ implicit attitudes about sexual orientation have trended toward less biased scores. Comprehensive nursing education and implementation of nursing practices that promote health and well-being for sexual and gender minority patients are needed to reduce biases and continue this trend.

Pediatric healthcare professionals' attitudes and beliefs about weight stigma: A descriptive study

PurposeChildren face weight-based stigma from their healthcare providers at a disconcerting rate, and efforts to mitigate this have been scant. This study aimed to quantify pediatric healthcare professionals' attitudes and beliefs about weight stigma and to determine stigma reduction interventions that are most supported by pediatric healthcare providers. Design and methodsParticipants completed two validated instruments which measured implicit and explicit weight bias, respectively. They then completed a researcher-designed questionnaire to assess their attitudes and beliefs about weight stigma, and demographic questions. ANOVA models were used to examine associations between bias measures and participant characteristics, chi-square analyses were used to examine associations between questionnaire responses and participant characteristics, and Spearman's rank was used to determine correlations between weight bias and questionnaire responses. ResultsParticipants exhibited moderate-to-high levels of implicit and explicit weight bias (mean Implicit Association Test score = 0.59, mean Crandall Anti-Fat Attitudes Score = 38.95). Associations were noted between implicit bias and years in practice (p < 0.05), and implicit bias and occupation (p < 0.05). There was a significant correlation between explicit bias and multiple questionnaire items, suggesting that healthcare providers with greater weight bias are aware of those biases and are ready to take action to address them. ConclusionThough pediatric healthcare exhibit weight-based biases, they are invested in taking steps to mitigate these biases and their impact on patients. Practice implicationsThe results of this study can inform the design of future interventions that aim to reduce healthcare-based weight bias, thus improving the quality of pediatric healthcare.

Does Implicit Racial Bias Affect Auditory-Perceptual Evaluations of Dysphonic Voices?

PurposeThe purpose of this study was to understand the role of implicit racial bias in auditory-perceptual evaluations of dysphonic voices by determining if a biasing effect exists for novice listeners in their auditory-perceptual ratings of Black and White speakers. MethodThirty speech-language pathology graduate students at Boston University listened to audio files of 20 Black speakers and 20 White speakers of General American English with voice disorders. Listeners rated the overall severity of dysphonia of each voice heard using a 100-unit visual analog scale and completed the Harvard Implicit Association Test (IAT) to measure their implicit racial bias. ResultsBoth Black and White speakers were rated as less severely dysphonic when their race was labeled as Black. No significant relationship was found between Harvard IAT scores and differences in severity ratings by race-labeling condition. ConclusionsThese findings suggest a minimizing bias in the evaluation of dysphonia for Black patients with voice disorders. These results contribute to the understanding of how a patient’s race may impact their visit with a clinician. Further research is needed to determine the most effective interventions for implicit bias retraining and the additional ways that implicit racial bias impacts comprehensive voice evaluations.

How executive functioning moderates the relation between implicit alcohol associations and heavy episodic drinking: The roles of planning and working memory.

Heavy episodic drinking (HED) is common among college students and poses risks for negative consequences. Evidence suggests that HED is more frequent among those with stronger implicit alcohol associations, and the impact of these implicit associations on drinking may be moderated by executive functioning. This study examined the role of two executive function components-working memory (WM) and planning-as moderators of implicit alcohol-approach associations and HED among college students who drink alcohol. One hundred forty-one participants completed measures of alcohol use, implicit alcohol-approach associations, WM, and planning. Regression analyses were conducted to examine the respective two-way and three-way interactions between implicit alcohol associations, WM, and planning on HED. Results showed that WM and planning each moderated the relation between alcohol implicit association test (IAT) and HED. IAT scores were positively associated with HED when WM and planning were low (-1 SD) but not high (+1 SD). Although results from the three-way interaction exhibited a nonsignificant trend, the pattern of results showed that the association between IAT and HED was stronger at lower levels of WM, but only when planning was also low, not high. Findings support the view that HED among college students who drink alcohol may be a function of automatic alcohol associations and that these associations may be stronger among those with lower WM and planning abilities. These results replicate and extend our understanding of how executive functioning may moderate the impact of implicit alcohol cognitions on risky drinking and suggests potential intervention targets. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Robust within-session modulations of IAT scores may reveal novel dynamics of rapid change

The Implicit Association Test (IAT) is employed in the domain of social psychology as a measure of implicit evaluation. Participants in this task complete blocks of trials where they are asked to respond to categories and attributes (e.g., types of faces and types of words). Reaction times in different blocks sharing certain response combinations are averaged and then subtracted from blocks with other response combinations and then normalized, the result of which is taken as a measure indicating implicit evaluation toward or away from the given categories. One assumption of this approach is stationarity of response time distributions, or at a minimum, that temporal dynamics in response times are not theoretically relevant. Here we test these assumptions, examine the extent to which response times change within the IAT blocks and, if so, how trajectories of change are meaningful in relation to external measures. Using multiple data sets we demonstrate within-session changes in IAT scores. Further, we demonstrate that dissociable components in the trajectories of IAT performance may be linked to theoretically distinct processes of cognitive biases as well as behaviors. The present work presents evidence that IAT performance changes within the task, while future work is needed to fully assess the implications of these temporal dynamics.

Regional Implicit Racial Bias and Rates of Breast Reconstruction, Complications, and Cost Among US Patients With Breast Cancer

Racial disparities influencing breast reconstruction have been well-researched; however, the role of implicit racial bias remains unknown. An analysis of the disparities in care for patients with breast cancer may serve as a policy target to increase the access and quality of care for underserved populations. To identify whether variations in implicit racial bias by region are associated with the differences in rates of immediate breast reconstruction, complications, and cost for White patients and patients from minoritized racial and ethnic groups. This cohort study used data from the National Inpatient Sample (NIS) from 2009 to 2019. Adult female patients with a diagnosis of or genetic predisposition for breast cancer receiving immediate breast reconstruction at the time of mastectomy were included. Patients receiving both autologous free flap and implant-based reconstruction were included in this analysis. US Census Bureau data were extracted to compare rates of reconstruction proportionately. The Implicit Association Test (IAT) was used to classify whether implicit bias was associated with the primary outcome variables. Data were analyzed from April to November 2022. IAT score by US Census Bureau geographic region. Variables of interest included demographic data, rate of reconstruction, complications (reconstruction-specific and systemic), inpatient cost, and IAT score by region. Spearman correlation was used to determine associations between implicit racial bias and the reconstruction utilization rate for White patients and patients from minoritized racial and ethnic groups. Two-sample t tests were used to analyze differences in utilization, complications, and cost between the 2 groups. A total of 52 115 patients were included in our sample: 38 487 were identified as White (mean [SD] age, 52.0 [0.7] years) and 13 628 were identified as minoritized race and ethnicity (American Indian, Asian, Black, and Hispanic patients and patients with another race or ethnicity; mean [SD] age, 49.7 [10.5] years). Implicit bias was not associated with disparities in breast reconstruction rates, complications, or cost. Nonetheless, the White-to-minoritized race and ethnicity utilization ratio differed among the regions studied. Specifically, the reconstruction ratio for White patients to patients with minoritized race and ethnicity was highest for the East South Central Division, which includes Alabama, Kentucky, Mississippi, and Tennessee (2.17), and lowest for the West South Central Division, which includes Arkansas, Louisiana, Oklahoma, and Texas (0.75). In this cohort study of patients with breast cancer, regional variation of implicit bias was not associated with differences in breast reconstruction utilization, complications, or cost. Regional disparities in utilization among racial and ethnic groups suggest that collaboration from individual institutions and national organizations is needed to develop robust data collection systems. Such systems could provide surgeons with a comparative view of their care. Additionally, collaboration with high-volume breast centers may help patients in low-resource settings receive the desired reconstruction for their breast cancer care, helping improve the utilization rate and quality of care.

Exploring implicit bias among ENT surgeons: an analysis of the implicit association test.

This study aimed to investigate the presence of implicit bias among ENT surgeons and explore the impact of the results of the Implicit Association Test on the surgeons' behaviour towards patients. Seven ENT surgeons who were not black, Asian or minority ethnic were asked to complete the Race Implicit Association Test. The surgeons also completed a survey about their perceptions of their implicit biases and the impact of the Race Implicit Association Test results on their behaviour towards patients. The mean Race Implicit Association Test score for the ENT surgeons suggested a slight bias that favoured white over black people. Furthermore, 42 per cent of the surgeons thought that they had hidden or unconscious racial bias, 42 per cent said they would change their behaviour towards patients after receiving these results and 85 per cent thought that the Race Implicit Association Test was helpful for appraisal purposes. The results suggest that ENT surgeons who are not black, Asian or minority ethnic may have implicit biases towards black patients. These findings highlight the need for interventions to reduce implicit bias among ENT surgeons and improve healthcare outcomes for marginalised populations.

Provider Implicit Bias in Prescribing HIV Pre-exposure Prophylaxis (PrEP) to People Who Inject Drugs

BackgroundMultiple HIV outbreaks among people who inject drugs (PWIDs) have occurred in the USA since 2015, highlighting the need for additional HIV prevention tools. Despite high levels of need, pre-exposure prophylaxis (PrEP) is drastically underutilized among PWIDs. Implicit bias toward PWID held by clinicians may impede PrEP scale-up among these underserved patients. This study examined how primary care providers’ (PCPs) clinical decisions related to PrEP can be impacted by biases when the patient has a history of substance use.MethodsWe conducted an online survey of PCPs (n = 208). The survey included the implicit association test (IAT) to assess unconscious attitudes toward PWIDs, direct questions regarding clinicians’ explicit PWID attitudes, and an embedded experiment in which we systematically varied the risk behavior of a hypothetical patient and asked PCPs to make clinical judgments.ResultsA minority (32%) of PCPs reported explicit PWID bias. The IAT indicated strong implicit PWID bias (meant IAT score = 0.59, p < .0001) among 88% of the sample. Only 9% of PCPs had no implicit or explicit PWID bias. PWID patients were judged as less likely to adhere to a PrEP regimen, less responsible, and less HIV safety conscious than heterosexual or gay male patients. Anticipated lack of adherence mediated PCPs’ intent to prescribe PrEP to PWID.ConclusionsPCPs’ bias may contribute to PrEP being under-prescribed to PWID. Implicit and explicit PWID biases were common in our sample. This study illustrates the need to develop and test tailored interventions to decrease biases against PWID in primary care settings.

Gender Stereotypes Selectively Affect the Remembering of Highly Valued Professions

This study includes two experiments designed to assess the effects of occupational gender-related stereotypes on information processing and memory performance. These two experiments were conducted in two separate cohorts of undergraduate students (N = 107 and N = 96, respectively). In each of them, we assessed (and confirmed) the presence of an implicit association preferentially linking high status attributes to men using the Implicit Association Test (IAT). We also assessed the effective incorporation of this association into gender-schemata and its consequences for information processing with a memory task that involved remembering the feminine and masculine forms of high or low status professional occupations. Results indicated that, independently of their gender, participants were more likely to forget and less likely to falsely recall the feminine forms of high status professions, whereas the opposite was true for the masculine forms of high status professions. The magnitude of these memory biases was correlated with the IAT scores. Moreover, in agreement with the predictions of gender-schemata theory, these memory biases (and their correlations with IAT scores) were predominantly observed when participants were not adverted that their recall would be evaluated later on (incidental-encoding memory task; Experiment 1), but less so when participants were explicitly instructed to memorize the same feminine and masculine forms of high or low status professional occupations (intentional encoding memory task; Experiment 2). Taken together, these results call into question the notion that gender stereotypes about professional occupations are declining, and they highlight a “men-high-status” association as a major component of these occupational stereotypes.

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

BackgroundPerson-centered maternity care (PCMC) has become a priority in the global health discourse on quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic status (SES) tend to receive poorer PCMC than women of higher SES. Yet few studies have explored factors underlying these inequities. In this study, we examined provider implicit and explicit biases that could lead to inequitable PCMC based on SES.MethodsData are from a cross-sectional survey with 150 providers recruited from 19 health facilities in the Upper East region of Ghana from October 2020 to January 2021. Explicit SES bias was assessed using situationally-specific vignettes (low SES and high SES characteristics) on providers’ perceptions of women’s expectations, attitudes, and behaviors. Implicit SES bias was assessed using an Implicit Association Test (IAT) that measures associations between women’s SES characteristics and providers’ perceptions of women as ‘difficult’ or ‘good’. Analysis included descriptive statistics, mixed-model ANOVA, and bivariate and multivariate linear regression.ResultsThe average explicit bias score was 18.1 out of 28 (SD = 3.60) for the low SES woman vignette and 16.9 out of 28 (SD = 3.15) for the high SES woman vignette (p < 0.001), suggesting stronger negative explicit bias towards the lower SES woman. These biases manifested in higher agreement to statements such as the low SES woman in the vignette is not likely to expect providers to introduce themselves and is not likely to understand explanations. The average IAT score was 0.71 (SD = 0.43), indicating a significant bias in associating positive characteristics with high SES women and negative characteristics with low SES women. Providers with higher education had significantly lower explicit bias scores on the low SES vignette than those with less education. Providers in private facilities had higher IAT scores than those in government hospitals.ConclusionsThe findings provide evidence of both implicit and explicit SES bias among maternity providers. These biases need to be addressed in interventions to achieve equity in PCMC and to improve PCMC for all women.

Decoupling the Conflicting Evaluative Meanings in Automatically Activated Race-Based Associations.

Implicit measures of attitudes have classically focused on the association between a social group and generalized valence, but debate exists surrounding how these associations arise and what they can tell us about beliefs and attitudes. Here, we suggest that representations of oppression, which relate positively to implicitly measured prejudice but negatively to explicitly measured prejudice, can serve to decrease the predictive validity of implicit measures through statistical suppression. We had participants complete a Black-White implicit association test (IAT) and an IAT measuring representations of oppression, and find that oppression-related representations statistically suppress the relation between IAT scores and explicit attitudes, such that accounting for these representations increases the total amount of variance explained by implicit measures. We discuss the implications of this work both for practical matters around use of the IAT and for theoretical debates on the conceptualization of valence in implicit attitudes.