implicit vs. explicit - attitudes, biases, and stereotypes

7/30/2019 Implicit vs. Explicit - Attitudes, Biases, And Stereotypes

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Implicit vs. ExplicitAttitudes, Biases, and

Stereotypes

The Science of Research on

Discrimination and HealthFebruary 2-4, 2011J. DovidioYale University


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Presidential Vote

58 61 64 67 70 73 76 79 82 85 88 91 94 96

100

80

60

40

20

0

Percent


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Disparities in Health Care:

Outcomes (Beyond Access; Penner et al., 2010) Coronary heart disease: See specialist,

prescribed medications, surgical procedures(Vaccarino et al., 2005)

Prostate cancer: Screening and activetreatment (Etzioni et al., 2002; Shavers et al., 2004;Underwood et al, 2004)

Esophageal cancer: See surgeon, surgicalprocedures (Steyerberg et al., 2005)

Greater for high discretion than for lowdiscretion procedures (Geiger, 2003)


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Factors Contributing to Bias

Cognitive- social categorization

Motivational- social dominance

Sociocultural- cultural stereotypes


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Expressed

Behavior

UnclearClear

WhitePerson

Neg

ative

Positive

BlackPerson


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Personnel Decisions

Recommen

dations

876

54321

Strong ModerateQualifications Strong ModerateQualifications

1989 1999

Strong ModerateQualifications

2005

Black Candidate

White Candidate


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Interaction, Subtle Bias, and Intergroup

Relations: The Role of Explicit andImplicit Attitudes

Explicit Attitudes

Conscious Deliberative Social and Personal Values Self-Report

Implicit Attitudes Unconscious Spontaneous Habit from Direct & Vicarious Experience Response Latency (IAT: https://harvard.implicit.edu)


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Explicit & Implicit AttitudesSabin, Nosek. Greenwald, & Rivara (2009; see also https://implicit.harvard.edu; n = 344,469)

Bias:

CohensD

Explicit(Self-Report)

Implicit(IAT)

1.00.90.80.70.60.50.40.30.20.10.00

large

moderate

sm

all .33

.81


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DissociationStudy Implicit Prejudice Measure Explicit Prejudice

Measure Statistic(df, n, direction) Effectsize (r)Dasgupta et al.

(1999) IAT using names andpictures Overall effectFeelings thermometerSemantic differential

Modern RacismDiversity scale

Discrimination scale

r(73)=.145{75}{+}r(73)=.22r(73)=.31

r(73)=-.055r(73)=.06r(73)=.045

0.15

Dovidio et al.(1997, study 1) Evaluative race priming(Black vs. White faces;

positive vs. negative

adjectives)Overall effect

Attitudes Toward BlacksModern racism Scale

r(22)=.215{24}{+}r(22)=.28r(22)=.15

0.22

Dovidio et al.

(1997, study 3) Evaluative race priming(Black vs. White faces;positive vs. negative

adjectives)

Overall effectModern Racism ScaleOld Fashioned Racism

r(31)=-.03{33}{-}

r(31)=.01r(31)=-.07

-0.03

Fazio et al.

(1995, study 1)Evaluative race priming

(Black vs. White faces;positive vs. negative

adjectives)

Modern Racism Scale r(51)=.15(53}{-}

-0.15

Fazio et al.(1995, study 2) Evaluative race priming(Black vs. White faces;

positive vs. negative

adjectives)

Modern Racism Scale r(47)=.28{49}{-} -0.28


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Influence of Implicit and Explicit

Attitudes Behavior

Attitudes

Explicit

Implicit

Deliberative Spontaneous

ReflectiveMonitorableControllableOvert

Reflexive

UnawareUncontrollableSubtle


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Implicit Bias and Hiring

(Son Hing et al., 2008)

Hiring

Recommen

dations

7

6

5

4

3

2

1

Strong Moderate(No Excuse) (Excuse)

Qualifications

Beta = -.04p = .82 Beta = -.60

p = .003

Asian White Asian White


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White Actor Black Observer

How friendly did

I behave?How friendly did

The White person behave?

Conscious attitude -.14Verbal behavior -.17

Implicit Attitude .40*

Nonverbal Behavior .34*

Conscious attitude .33*Verbal behavior .36*

Implicit Attitude .09

Nonverbal Behavior -.07


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Implications for Health Disparities

Physicians AttitudesPhysicians DecisionsPhysician-Patient Interaction


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Physicians Explicit & Implicit AttitudesSabin, Nosek. Greenwald, & Rivara (2009), Sabin, Rivara, &

Greenwald (2008)

Bias:

Cohens

D

Explicit Implicit

1.00.90.80

.70.60

.50

.40

.30

.20

.10.00

large

moderate

small .33

.81

All AllMD(General)

MD(General)

MD(Practice)

MD(Practice)

.40

.89

.60

Preferred care in my practice

88% say Blacks > Whites;0% say Whites > Blacks


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Subtle Bias and Health Care: Decision

Making(Green et al., 2007, JGIM)

Vignette study of physicians treatment(thrombolysis) of Black and White patientswith symptoms of acute coronary syndrome.

Assessed physicians explicit and implicitattitudes and stereotypes (patient

cooperativeness) and treatment(thrombolysis)


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Green et al. (2007,JGIM)

Explicit Biases(Not Significant)

Implicit Biases(Significant)

Treatment Bias

NotSignificant

Significant


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Disparities in Health Care:

Interaction (Beyond Access) Race-discordant visits are shorter, involve less

positive affect, and are less participatory (Albrecht et al.,2003; Cooper et al., 2003)

57% of Blacks say that discrimination occurs oftenor very often in interactions with Whitephysicians (Malat & Hamilton, 2006)

Blacks show lower levels of trust of their physician,and more aftervisit (Gordon et al., 2006; Halbert et al., 2006)

Participation and trust related to patient satisfaction,seeking treatment, and adherence (Roter et al., 1997;Stewart, 2000)


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Physician-Patient Interaction(Penner, Dovidio, et al., 2010)

From the Doctors Perspective: How much did I try toinvolve the patient in decision making?

From the Patients Perspective: How warm and friendlywas the doctor?

Doctors explicit but not implicit bias

Doctors implicit but not explicit bias


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Physician-Patient Interaction(Penner, Dovidio, et al., 2010)

60

5550

45

40Satisfaction

High Exp/

High Imp

High Exp/

Low Imp

Low Exp/

High Imp

Low Exp/

Low Imp


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Challenge: Eliminating Disparities

Acknowledge the Role of Provider BiasUnderstand the Influence of

Unconscious BiasReduce Contextual Factors the Reduce

Control (fatigue, cognitive demand, unfamiliarity)

Help Good Intentions Translate intoPositive Action


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Thank You

implicit vs. explicit - attitudes, biases, and stereotypes

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