The Role of Bias by Emergency Department Providers in Care for American Indian Children

Abstract

Background American Indian children have high rates of emergency department (ED) use and face potential discrimination in health care settings. Objective Our goal was to assess both implicit and explicit racial bias and examine their relationship with clinical care. Research Design We performed a cross-sectional survey of care providers at five hospitals in the Upper Midwest. Questions included American Indian stereotypes (explicit attitudes), clinical vignettes and the Implicit Association Test (IAT). Two IATs were created to assess implicit bias toward the child or the parent/caregiver. Differences were assessed using linear and logistic regression models with a random effect for study site. Results A total of 154 care providers completed the survey. Agreement with negative American Indian stereotypes was 22–32%. Overall, 84% of providers had an implicit preference for non-Hispanic white adults or children. Older providers (≥ 50 years) had lower implicit bias than those middle aged (30–49 years), (p = 0.01). American Indian children were seen as increasingly challenging (p = 0.04) and parents/caregivers less compliant (p = 0.002) as the proportion of American Indian children seen in the ED increased. Responses to the vignettes were not related to implicit or explicit bias. Conclusions The majority of ED care providers had an implicit preference for non-Hispanic white children or adults compared to those who were American Indian. Provider agreement with negative American Indian stereotypes differed by practice and respondents’ characteristics. These findings require additional study to determine how these implicit and explicit biases influence healthcare or outcomes disparities.

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Addressing implicit bias in pediatric hematology‐oncology

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