Conscious and Unconscious Biases in Health Care


  1. Tucker C M, Herman KC, Pedersen TR, Higley B., Montrichard M, Ivery P. Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients. Med Care. July 2003;41(7):859-870.
  2. Cooper LA, Roter DL. Patient-provider communication: the effect of race and ethnicity on process and outcomes of healthcare. In: Smedley, BD Stith AY, Nelson A.R. eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care Washington, DC: Institute of Medicine, National Academies Press; 2003:552-593.
  3. Johnson, RL, Somnath, S, Arbelaez, JJ, Beach, MC, Cooper, LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. February 2004;19(2):101-110.
  4. Reference Removed.
  5. Goode T, Jackson V, Bronheim S, Harris-Haywood S. Cultural competence: essential knowledge and skills for health professionals to address diabetes. In Jack L, ed. Diabetes in Black America. Clinical and Public Health Solutions to a National Crisis. 2nd ed. Munster, Ind: Hilton Publishing; 2012:221-238.
  6. Henry J. Kaiser Family Foundation. National Survey of Physicians. Part I: Doctors on Disparities in Medical Care. March 2002. Accessed February 4, 2012.
  7. Sequist TD, Ayanian JZ, Marshall R, Fitzmaurice GM, Safran DG. Primary-care clinician perceptions of racial disparities in diabetes care. J Gen Intern Med. May 2008;23(5):678-684.
  8. Baig AA, Heisler M. The influence of patient race and socioeconomic status and resident physician gender and specialty on preventive screening. Semin Med Pract. January 1, 2008;11:27-35.
  9. Clark-Hitt R, Malat J, Burgess D, Friedemann-Sanchez G. Doctors’ and nurses’ explanations for racial disparities in medical treatment. J Health Care Poor Underserved. 2010;21(1):386-400.
  10. Schulman K, Berlin J, Harless W, et al. The effect of race and sex on physicians’ recommendation for cardiac catheterization. N Engl J Med. 1999;340(8):618-626.
  11. Ferrante JM, Piasecki AK, Ohman-Strickland PA, Crabtree BF. Family physicians’ practices and attitudes regarding care of extremely obese patients. Obes. 2009;17(9):1710-1716.
  12. Pascoe EA, Smart RL. Perceived discrimination and health: a meta-analytic review. Psychol Bull. July 2009;135(4):531-554.
  13. Monteith MJ, Mark AY, Ashburn-Nardo L. The self-regulation of prejudice: toward understanding its lived character. Group Processes Intergroup Relations. 2010;13(2):183-200.
  14. Fehr J, Sassenberg K. Willing and able: how internal motivation and failure help to overcome prejudice. Group Processes Intergroup Relations. 2010;13(2):167-181.
  15. Keeton MT, Sheckley BG, Griggs JK. Efficiency and Effectiveness in Higher Education. Dubuque, IA: Kendall Hunt Publishing Company; 2002.
  16. Kolb AY, Kolb DA. Learning styles and learning spaces: enhancing experiential learning in higher education. Acad Management Learning Educ. 2005;4(2):194.
  17. Goode T, Harris H, Bronheim S, Smith K, Murphy L. The role of self-assessment in achieving cultural and linguistic competence and addressing health care disparities. In: Louden D, Kinsey P, eds. Health, Ethnicity, and Well-Being. Lincoln University, Pa: Lincoln University Press. In press.
  18. Harris-Haywood S, Goode TD, Gao Y, et al. Psychometric evaluation of a cultural competency assessment instrument for health professionals [abstract]. Med Care. March 20, 2012. Accessed May 25, 2012.
  19. Boutin-Foster C, Foster JC, Konopasek L. Physician, know thyself: the professional culture of medicine as a framework for teaching cultural competence. Acad Med. 2008;83(1):106-111.
  20. Assemi M, Cullander C, Hudmon SK. Psychometric analysis of a scale assessing self-efficacy for cultural competence in patient counseling. Ann Pharmacother. December 2006;40:2130-2135.
  21. National Quality Forum. Comprehensive framework and preferred practices for measuring and reporting cultural competency: a consensus report. April 2009.
  22. Lavizzo-Mourey R, Mackenzie E. Cultural competence: essential measurements of quality for managed care organizations. Ann Intern Med. May 1996;124(10):919-921.
  23. Polacek G, MR. Assessing cultural competence at a local hospital system in the United States. Health Care Manag. 2009;28(2):98-110.
  24. IAT Corp. FAQs [Project implicit® Web site]. Accessed August 7, 2012.
  25. Blair IV. The malleability of automatic stereotypes and prejudice. Pers Soc Psychol Rev. 2002;6(3):242-261.
  26. Bishop SR, Lau M, Shapiro S, et al. Mindfulness: a proposed operational definition. Clin Psychol: Sci Pract. 2004;11(3):230-241.
  27. Teal C, Shada R, Gill A, et al. When best intentions aren’t enough: helping medical students develop strategies for managing bias about patients. J Gen Intern Med. 2010;25(suppl 2):115-118.
  28. Ard J, Rosati R, Oddone E. Culturally-sensitive weight loss program produces significant reduction in weight, blood pressure, and cholesterol in eight weeks. J Natl Med Assoc. 2000;92(11):515-523.
  29. Bird JA, McPhee SJ, Le B, et al. Opening pathways to cancer screening for Vietnamese-American women: lay health workers hold a key. Prev Med. 1998;27(6):821-829.
  30. Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care. February 1, 2002;25(2):259-268.
  31. Brown SA, Hanis CL. Culturally competent diabetes education for Mexican Americans: the Starr County study. Diabetes Educ. 1999;25(2):226-236.
  32. D’Eramo Melkus G, Spollett G, Jefferson V, et al. A culturally competent intervention of education and care for black women with type 2 diabetes. Appl Nurs Res. 2004;17(1):10-20.
  33. Fitzgibbon ML, Gapstur SM, Knight SJ. Results of mujeres felices por ser saludables: a dietary/breast health randomized clinical trial for Latino women. Ann Behav Med. 2004;28(2):95-104.
  34. Gary TL, Batts-Turner M, Yeh H-C, et al. The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. October 26, 2009;169(19):1788-1794.
  35. Gilmer TP, Philis-Tsimikas A, Walker C. Outcomes of Project Dulce: a culturally specific diabetes management program. Ann Pharmacother. May 2005;39(5):817-822.
  36. Lasser KE, Murillo J, Lisboa S, et al. Colorectal cancer screening among ethnically diverse, low-income patients: a randomized controlled trial. Arch Intern Med. 2011;171(10):906-912.
  37. Lieu TA, Finkelstein JA, Lozano P, et al. Cultural competence policies and other predictors of asthma care quality for Medicaid-insured children. Pediatr. July 2004;114(1):e102-e110.
  38. Goode T, Dunne C, Bronheim S. The Evidence Base for Cultural and Linguistic Competence in Health Care. New York, NY: The Commonwealth Fund; 2006.
  39. McElmurry BJ, McCreary LL, Park CG, et al. Implementation, outcomes, and lessons learned from a collaborative primary health care program to improve diabetes care among urban Latino populations. Health Promot Pract. 2009;10:293-302.
  40. Philis-Tsimikas A, Fortmann A, Lleva-Ocana L, Walker C, Gallo LC. Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial. Diabetes Care. 2011;34:1926-1931.
  41. Goode T, Wells N, Rhee K. Family-centered, culturally and linguistically competent care: essential components of the medical home. In: Turchi R, Antonelli R, eds. Pediatric Annals Special Supplement on the Medical Home. Thoroughfare, NJ: SLACK Incorporated; 2009.
  42. Like RC , Goode TD. Promoting cultural and linguistic competence in the American health system: Levers of change. In: Ingle D, Chiarenza A, Kotsioni I, Devillé W, eds. Inequalities in Health Care for Migrants and Ethnic Minorities. COST Series on Health and Diversity Volume II, Antwerp: Garant; 2012.
  43. National Center for Cultural Competence. Cultural competence: definition and conceptual framework. Accessed September 16, 2012.
  44. Dovidio, JF, Fiske ST. Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities. May 2012. Available at:
  45. Richeson JA, Trawalter S. Why do interracial interactions impair executive function? A resource depletion account. J Pers Soc Psychol. 2005;88:934-947.
  46. Richeson JA, Trawalter S, Shelton JN. African Americans’ racial attitudes and the depletion of executive function after interracial interactions. Soc Cogn. 2005;23:336-352.
  47. Ferguson, WJ, Candib, LM. Culture language, and the doctor-patient relationship. Family Medicine and Community Health Publications and Presentations. Paper 61. 2002. Accessed October 9, 2012.
  48. Hudelson P, Vilpert S. Overcoming language barriers with foreign language speaking patients: a survey to investigate intra-hospital variation in attitudes and practices. BMC Health Serv Res. 2009;9:187.
  49. Valdez CR, Dvorscek MJ, Budge SL, Esmond S. Provider perspectives about Latino Patients: determinants of care and implications for treatment. Couns Psychol. 2011. April 15, 2011;39(4):497-526.
  50. van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813-828.
  51. Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19:60-67.
  52. Johnson RL, Saha S, Arbelaez J, Beach MC, Cooper LA. Racial and ethnic differences in patient perception of bias and cultural competence in health care. J Gen Intern Med. 2004;19:101-110.
  53. US Census Bureau. Language spoken at home: 2010 American community survey 1-year estimates. Accessed September 18, 2012.
  54. National Center for Cultural Competence. Linguistic competence: definition. Accessed September 16, 2012.
  55. Cunningham JW, Many JE, Carver RP, Gunderson L, Mosenthal PB. How will literacy be defined in the new millennium? Reading Res Quarterly. 2000;35(1):64-71.
  56. National Center for Education Statistics. National Assessment of Adult Literacy (NAAL) results. Commissioner’s remarks. Accessed September 27, 2012.
  57. UNESCO. Education for all global monitoring report: literacy for life. chapter 6: understandings of literacy. Paris, France: UNESCO; 2006. Accessed September 27, 2012.
  58. Glossary of Education. Functional literacy [definition]. Accessed September 27, 2012.
  59. Soricone L, Rudd R, Santos M, Capistrant B. Health Literacy in Adult Basic Education: Designing Lessons, Units, and Evaluation Plans for an Integrated Curriculum. National Center for the Study of Adult Learning and Literacy and Health and Adult Literacy and Learning Initiative. Boston, Mass: Harvard University; 2007.
  60. Berkman ND, DeWalt DA, Pignone MP, et al. Literacy and Health Outcomes. Evidence Report/Technology Assessment No. 87. Rockville, Md: Agency for Healthcare Research and Quality. Available at:
  61. National Network of Libraries of Medicine. Definition of health literacy. Healthy People 2010. May 2012. Accessed October 2, 2012.
  62. Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.
  63. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2006.
  64. Rudd R, McCray A, Nutbeam D. Health Literacy and Definition of Terms. In: Begoray D, Gillis D, Rowlands G, eds. Health Literacy in Context: International Perspective. New York. NY: Nova Science Publishers, Inc; 2012.
  65. National Networks of Libraries of Medicine. Heath literacy. Accessed March 19, 2017.
  66. Brault MW. Americans with disabilities: 2010. Household economic studies. Current population reports. US Department of Commerce, Economics and Statistic Administration, US Census Bureau.