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Patient Educ Couns. 2019 Apr 19. pii: S0738-3991(19)30142-9. doi: 10.1016/j.pec.2019.04.023. [Epub ahead of print]

Detecting implicit racial bias in provider communication behaviors to reduce disparities in healthcare: Challenges, solutions, and future directions for provider communication training.

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Department of Psychology, Virginia Commonwealth University, Richmond, USA. Electronic address:
Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, Chapel Hill, USA.
Department of Epidemiology, University of Michigan, Ann Arbor, USA.
Department of Psychology, Virginia Commonwealth University, Richmond, USA.
Department of Family Medicine, University of Michigan, Ann Arbor, USA.


Since publication of Unequal Treatment by the Institute of Medicine in 2003, there has been a growing recognition of the role of provider implicit racial bias in patient care. Provider implicit racial bias has been consistently negatively associated with both care satisfaction and provider trust among racial/ethnic minority patients. This suggests provider implicit racial bias likely manifests through their communication behaviors, which in turn may offer a means of addressing racial disparities in healthcare and ultimately in health. However, identifying provider communication behaviors that mediate the links between provider implicit racial bias and patient outcomes is challenging. In this paper, we argue that identifying these provider communication behaviors requires (1) taking into account findings from social psychology research of implicit racial bias and (2) incorporating the perspectives of racial/ethnic minority patients into patient-provider communication research. We discuss the utility of mixed methods research designs as a framework for resolving this complex scientific question. Research that draws on social psychology research of implicit racial bias and incorporates the racial/ethnic minority patient perspectives can inform the development of communication skills training programs for students and residents in various healthcare fields. Such programs are one element of a broader effort to reduce racial/ethnic disparities in healthcare.


Implicit racial bias; Mixed methods research designs; Patient satisfaction; Patient trust; Patient-provider communication


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