Reducing Racial Disparities in Healthcare: Developing Social Connections Through Behavioral Science
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University of Washington
- Enrollment
- 25
- Locations
- 2
- Primary Endpoint
- Change in Emotional Rapport Building from Pre- to Post-Intervention
Study Overview
Brief Summary
Racial bias in medical care is a significant public health issue, with increased focus on microaggressions and the quality of patient-provider interactions. Innovations in training interventions are needed to decrease microaggressions and improve provider communication and rapport with patients of color during medical encounters. This paper presents a pilot randomized trial of an innovative clinical workshop that employed a theoretical model from social and contextual behavioral sciences. The intervention was largely informed by research on the importance of mindfulness and interracial contact involving reciprocal exchanges of vulnerability and responsiveness, to target processes centered on the providers' likelihood of expressing biases and negative stereotypes when interacting with patients of color in racially challenging moments. Twenty-five medical student and recent graduate participants were randomized to a workshop intervention or no intervention. Outcomes were measured via provider self-report and observed changes in targeted provider behaviors. Specifically, two independent, blind teams of coders assessed provider emotional rapport and responsiveness during simulated interracial patient encounters with standardized Black patients who presented specific racial challenges to participants. We observed greater improvements in observed emotional rapport and responsiveness (indexing fewer microaggressions), improved self-reported explicit attitudes toward minoritized groups, and improved self-reported working alliance and closeness with the Black standardized patients were observed and reported by intervention participants. Effects largely were driven by improvements by the White participants.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Supportive Care
- Masking
- Triple (Participant, Care Provider, Outcomes Assessor)
Masking Description
The participants, who are the care providers, are blind to condition in that they are simply told when to show up for patient exams and the workshop (intervention condition). The outcomes assessors who rated microaggressions was blind to condition.
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Medical students or recent graduates of Bastyr University.
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Change in Emotional Rapport Building from Pre- to Post-Intervention
Time Frame: Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4ater after the intervention
We used the Roter Interactional Analysis System (RIAS), a turn-by-turn coding system in which each provider and patient utterance is coded into one of 40 categories of speech, which can be combined to create various summary scores. RIAS codes have demonstrated validity with a variety of samples and medical contexts. For the current study, two trained RIAS coders provided ratings, and both coders coded a subset of tapes (10%) for reliability (r= 0.92). Because standardized patients in our study were following a protocol and not responding naturally, we analyzed only provider codes, specifically the Emotional Rapport Building summary score which is a composite of doctor codes including emotional statements, legitimizing statements, concern statements, partnership statements, self-disclosure statements, and reassurance statements.
Change in responsiveness to racial challenges from Pre- to Post-Intervention
Time Frame: Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4ater after the intervention
We modified observer-based responsiveness coding systems used in previous research that operationalized positive responsiveness in dyads as concrete instances of understanding, validation, and caring on a 0 to 3 scale. We expanded the previous 0 code, which originally combined both no responses (e.g., simply ignoring the challenge) and invalidating responses (e.g., defensive or microaggressive responses), into a negative responsiveness dimension and provided anchors and examples for each score, producing a Likert scale from - 3 to + 3, as shown in Table 3. Four coders were trained to high reliability.
Secondary Outcomes
- Change in offensiveness from Pre- to Post-Intervention(Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4)
- Change in Bias from Pre- to Post-Intervention(Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4)
- Change in Recommendations from Pre- to Post-Intervention(Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4)
- Change in Patient experience from Pre- to Post-Intervention(Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4)
- Change in Ethnocultural empathy from Pre- to Post-Intervention(Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4)
- Change in attitudes toward various ethnic/racial groups from Pre- to Post-Intervention(Pre-test occurred during screening, between 5 days and 4 months prior to Intervention; post-test occurred two days after intervention.)
- Change in Working alliance from Pre- to Post-Intervention(Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4)
- Change in Interaction closeness from Pre- to Post-Intervention(Pre-test occurred on Day 1, the Intervention occurred Day 2, and then post-test occurred Day 4)
Investigators
Jonathan Kanter
Research Associate Professor
University of Washington