Implicit Racial Attitudes and Associations Among Obstetricians in Hawaiʻi: a Pilot Study

Abstract

Introduction Pacific Islanders living in Hawai‘i with ancestral ties to islands in the western Pacific region of Micronesia are common targets of uninhibited forms of prejudice in multiple sectors, including healthcare. Whether the explicit societal-level attitudes toward this group are reflected in implicit attitudes among healthcare providers is unknown; therefore, we designed a pilot study to investigate this question. Our study measures implicit racial bias toward Pacific Islanders from Micronesia among Obstetrician-Gynecologists (OB-GYNs) in Hawai‘i. Methods We developed 4 new implicit association tests (IATs) to measure implicit attitudes and associations (i.e., stereotypes) toward Pacific Islanders from Micronesia in 2 conditions: (1) Micronesians vs. Whites and (2) Micronesians vs. Japanese Americans. Participants were practicing OB-GYNs in Hawai‘i. The study was conducted online and included survey questions on demographic and physician practice characteristics in addition to IATs. The primary outcome was the mean IAT D score. Associations between IAT D scores and demographic and practice characteristics were also analyzed. Results Of the 49 OB-GYNs, 38 (77.6%) were female, mean age was 40 years, 29.5% were Japanese, 22.7% were White, and none were from a Micronesian ethnic group. The mean IAT D score in the Micronesian vs. White condition (N = 29) was 0.181, (SD: 0.465, p < 0.05) for the Attitude IAT and 0.197 (SD: 0.427; p < 0.05) for the Stereotype IAT. Conclusion The findings from this pilot suggest a slight degree of implicit bias favoring Whites over Micronesians within this sample of OB-GYNs and warrant a larger investigation into implicit biases toward this unique and understudied Pacific Islander population.

Implicit racial bias among dental hygienists practicing in the United States

“…This study also found that IAT d-scores increased with increasing age, which may suggest greater levels of implicit bias in older populations. This finding is comparative to previous research suggesting aging may cause practitioners to rely more on stereotypes and neglect mindfulness 19,40,41 as aging decreases suppression of prejudicial thoughts or actions from consciousness, allowing implicit bias to be more easily expressed. 40 However, this finding should be interpreted with caution as the R 2 was 0.02, indicating that only 2% of the variability in d-score could be attributed to age.…”

Real-World Evaluation of an Automated Algorithm to Detect Patients with Potentially Undiagnosed Hypertension in an Ethnically Diverse, Large Health System in Hawaiʻi

“…26,27 Implicit biases on the part of providers may contribute to unequal care and treatment of minority groups. [28][29][30] While there are evident disparities in diagnosed hypertension in Hawaiʻi, it remains unclear whether similar disparities exist for undiagnosed hypertension. In other words, are certain groups more likely to be missed than others?…”

Real‐World Evaluation of an Automated Algorithm to Detect Patients With Potentially Undiagnosed Hypertension Among Patients With Routine Care in Hawaiʻi

“… 32 , 33 Implicit biases on the part of providers may contribute to unequal care and treatment of minority groups. 34 , 35 , 36 Although there are evident disparities of diagnosed hypertension in Hawaiʻi, it remains unclear whether similar disparities exist for undiagnosed hypertension. In other words, are certain groups more likely to be missed than others?…”