The Prevalence of Implicit Bias in Practicing Physical Therapists
Keywords:implicit bias, unconscious bias, race, disability
AbstractBackground: Implicit biases (IB) are unconscious or automatic attitudes and stereotypes that all people hold towards individuals or groups based on social group membership, categories, or traits. While implicit biases are unconscious or automatic, one is by definition more aware and conscious of their explicit biases. In the healthcare setting, implicit biases can and do impact perceptions, interactions, and clinical decision-making involving patients. Most research regarding the prevalence of implicit bias in healthcare, to date, focuses on physicians and nurses, but no evidence exists regarding implicit bias prevalence in physical therapists (PTs). Our objectives were to determine the difference, if any, between levels of race- and disability-related implicit biases using Implicit Association Test (IAT) score comparisons between PTs practicing in orthopedic and pediatric settings. Methods: A total of 59 licensed orthopedic and pediatric PTs completed the IAT race and disability subtests, self-reported levels of explicit racial and disability biases, and demographic characteristics. Results: On average, participants reported slight levels of IB favoring White over Black people despite reports of neutral explicit bias (EB). Similarly, participants reported moderate levels of IB favoring individuals without disabilities over those with disabilities despite reports of only neutral to slight EB on average. PTs practicing in pediatric settings reported significantly higher levels of race-related IB than those practicing in orthopedic settings (Wilcoxon S=623.5, p=0.014), but there was no significant difference between the levels of disability-related IB based on practices setting (Wilcoxon S= 850, p=0.245). Conclusions: This sample of PTs demonstrated rates of IB on the basis of race or disability status similar to other healthcare providers and the general population. Furthermore, participants generally rated their EBs towards racial minorities and individuals with disabilities more favorably than IAT test results indicated. The disconnect between IBs and EBs was confirmed in our study and highlights the continued need for IB awareness and subsequent bias reduction interventions for healthcare providers given the negative consequences.
Greenwald AG, Krieger LH. Implicit Bias: Scientific Foundations. California Law Review. 2006;94:945-967. doi: 10.2307/20439056
Staats, C, Capatosto, K, Wright, R., and Jackson, V.W. State of the science: Implicit bias review. Kirwan Institute for the Study of Race and Ethnicity. 2016. http://kirwaninstitute.osu.edu/wp-content/uploads/2016/07/implicit-bias-2016.pdf
Hall W, Chapman M, Lee K, et al. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. AM J Public Health. 2015;105:E60-E76.
FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18 doi: 10.1186/s12910-017-0179-8
Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Soc Sci Med. 2018;199:219-229. doi:10.1016/j.socscimed.2017.05.009.
American Physical Therapy Association. About physical therapists (PTs) and physical therapist assistants (PTAs). Accessed September 5, 2020. https://www.choosept.com/aboutptsptas/default.aspx
Pennington S. Rural center expands its classification of North Carolina counties. North Carolina Department of Commerce. 2015. https://www.nccommerce.com/blog/2015/07/09/rural-center-expands-its-classification-north-carolina-coeunties
Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464-1480. doi:10.1037/0022-35184.108.40.2064.
Greenwald AG, Banaji MR, Nosek BA. Statistically small effects of the Implicit Association Test can have societally large effects. J Pers Soc Psychol. 2015;108(4):553-561. doi:10.1037/pspa0000016
Nosek BA, Smyth FL, Hansen JJ, et al. Pervasiveness and correlates of implicit Attitudes and stereotypes. Eur Rev Soc Psych. 2007;18: 36–88.
Project Implicit. http://implicit.harvard.edu/implicit/takeatest.html. Accessed December 2, 2021.
Valla LG, Boss F, Calì R, Fox V, Ali SI, Rivolta, D. Not Only Whites: Racial Priming Effect for Black Faces in Black People. Basic and Applied Social Psychology. 2018; 40(4), 195-200.
Shutts K, Pemberton CK, Spelke ES. Children’s use of social categories in thinking about people and social relationships. J Cogn Dev. 2013;14(1):35-62. doi:10.1080/15248372.2011.638686
Jacoby-Senghor DS, Sinclair S, Smith CT. When bias binds: Effect of implicit outgroup bias on ingroup affiliation. J Pers Soc Psychol. 2015;109(3):415-433. doi:10.1037/a0039513
VanPuymbrouck L, Friedman C, Feldner H. Explicit and implicit disability attitudes of healthcare providers. Rehabil Psychol. 2020;65(2):101-112. doi:10.1037/rep0000317
Wilson MC, Scior K. Attitudes towards individuals with disabilities as measured by the Implicit Association Test: A literature review. Res Dev Disabil. 2014;35(2): 294-321.doi: 10.1016/j.ridd.2013.11.003
Dionne CD, Gainforth HL, O’Malley DA, Latimer-Cheung AE. Examining implicit attitudes towards exercisers with a physical disability. ScientificWorldJournal. 2013;2013:621596. doi:10.1155/2013/621596
Robey KL, Beckley L, Kirschner M. Implicit infantilizing attitudes about disability. J Dev Phys Disabil. 2006;18(4):441-453. doi:10.1007/s10882-006-9027-3
Keith JM, Bennetto L, Rogge RD. The relationship between contact and attitudes: Reducing prejudice toward individuals with intellectual and developmental disabilities. Res Dev Disabil. 2015;47:14-26. doi:10.1016/j.ridd.2015.07.032
Johnson TJ, Winger DG, Hickey RW, et al. Comparison of physician implicit racial bias toward adults versus children. Acad Pediatr. 2017;17(2):120-126. doi:10.1016/j.acap.2016.08.010
Sabin JA, Greenwald AG. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health. 2012;102(5):988-995. doi:10.2105/AJPH.2011.300621
Lane WG, Rubin DM, Monteith R, Christian CW. Racial differences in the evaluation of pediatric fractures for physical abuse. JAMA. 2002;288(13):1603-1609. doi:10.1001/jama.288.13.1603
McFarland SG. Crouch, Z. A cognitive skill confound on the Implicit Association Test. Soc Cogn. 2002;20: 483–510.9.
Greenwald AG, Nosek BA, Banaji MR. Understanding and using the Implicit Association Test: I. An improved scoring algorithm. J Pers Soc Psychol. 2003;85: 197–216.doi:10.1037/0022-35220.127.116.11
McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267-277. doi:10.1016/j.jclinepi.2013.08.015
Data USA. Physical Therapists. Accessed June 9, 2020. https://datausa.io/profile/soc/physical-therapists.
US Census Bureau QuickFacts: United States. Accessed September 5, 2020. https://www.census.gov/quickfacts/fact/table/US/PST045219.
Hall JM, Fields B. Continuing the conversation in nursing on race and racism. Nurs Outlook. 2013;61:164-173. doi:10.1016/j.outlook.2012.11.006.
How to Cite
Copyright (c) 2022 Bria Dunn, Jennell Mcintosh, Laurie Ray, Dana McCarty
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.