The literature reviewed for this course is based primarily on 75 items published between 1990 and 2011 (except for one that was dated 1987) on unconscious or implicit bias and conscious or explicit bias in health care from both the provider and patient perspectives. This review started with a PubMed search of articles published between 1990 and 2011 in English. Search terms and number of articles resulting were as follows: implicit bias and provider (1); implicit bias and patient (120); explicit bias and provider (2); and explicit bias and patient (180). There was an overlap of the articles listed in these searches, and although the searches with “patient” yielded more results, the bias was not on the part of the patient; it was largely directed toward the patient.
Additional PubMed searches were conducted because no articles surfaced about bias and religion including discrimination, prejudice, or stereotyping. Four specific search terms included: implicit bias and patient and religion; implicit bias and provider and religion; explicit bias and patient and religion; and explicit bias and provider and religion. No items were found. During the process of completing the course, articles published in 2012 were also added. Only studies conducted in the United States were reviewed. In addition, not all articles identified related directly to this review because bias was also used in contexts distinct from this study.
The literature reveals that implicit and explicit biases take place in diverse health and behavioral health care contexts and settings among multiple medical specialties, types of professionals, and students. Health professionals identified in this literature were non-Hispanic White, Asian, African American, and Hispanic/Latino. There were no American Indian/Native Americans or Alaska Native health care practitioners or professionals noted in this literature. Research was conducted in all regions of the United States. The sample sizes varied; however, studies were primarily conducted in urban settings with little mention of rural settings, tribal communities, or U.S. territories.
The great majority of the studies focused on African American patients, followed by Hispanic/Latinos with White patients as a comparison group. It should also be noted that there was little mention of Asians and barely any reference to American Indians/Native Americans. Within-group diversity was rarely considered beyond the socioeconomic status of patients.
The literature also addressed non-ethnic cultural groups such as patient populations who are elderly or obese and those with disabilities without specifying race or ethnicity. Several studies identified women without reference to any other demographic characteristics (i.e., race, ethnicity, age). Several studies combined racial minority identity status and sexual orientation and gender identity.
The population of health care practitioners and other health professionals identified in this literature was non-Hispanic White, Asian, African American, and Hispanic/Latino. There were no American Indian/Native Americans or Alaska Native health care practitioners or professionals noted in this literature.
The literature reviewed can broadly be grouped categorically by studies that: