Challenges and Opportunities for Clinician Implicit Bias Training: Insights from Perinatal Care Stakeholders

Sarah B Garrett; Linda Jones; Alexandra Montague; Haleemat Fa-Yusuf; Julie Harris-Taylor; Breezy Powell; Erica Chan; Stephen Zamarripa; Sarah Hooper; Brittany D Chambers Butcher

doi:10.1089/heq.2023.0126

Challenges and Opportunities for Clinician Implicit Bias Training: Insights from Perinatal Care Stakeholders

Health Equity. 2023 Sep 13;7(1):506-519. doi: 10.1089/heq.2023.0126. eCollection 2023.

Affiliations

¹ Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA.
² California Preterm Birth Initiative, University of California, San Francisco, California, USA.
³ UCSF-UC Law Consortium on Law, Science & Health Policy, University of California College of the Law, San Francisco, California, USA.
⁴ Independent Researcher and Community Advisor, San Francisco, California, USA.
⁵ University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁶ Department of Human Ecology, University of California, Davis, California, USA.

Abstract

Introduction: In an attempt to address health inequities, many U.S. states have considered or enacted legislation requiring antibias or implicit bias training (IBT) for health care providers. California's "Dignity in Pregnancy and Childbirth Act" requires that hospitals and alternative birthing centers provide IBT to perinatal clinicians with the goal of improving clinical outcomes for Black women and birthing people. However, there is as yet insufficient evidence to identify what IBT approaches, if any, achieve this goal. Engaging the experiences and insights of IBT stakeholders is a foundational step in informing nascent IBT policy, curricula, and implementation.

Methods: We conducted a multimethod community-based participatory research study with key stakeholders of California's IBT policy to identify key challenges and recommendations for effective clinician IBT. We used focus groups, in-depth interviews, combined inductive/deductive thematic analysis, and multiple techniques to promote rigor and validity. Participants were San Francisco Bay Area-based individuals who identified as Black or African American women with a recent hospital birth (n=20), and hospital-based perinatal clinicians (n=20).

Results: We identified numerous actionable challenges and recommendations regarding aspects of (1) state law; (2) IBT content and format; (3) health care facility IBT implementation; (4) health care facility environment; and (5) provider commitment and behaviors. Patient and clinician insights overlapped substantially. Many respondents felt IBT would improve outcomes only in combination with other antiracism interventions.

Health equity implications: These stakeholder insights offer policy-makers, health system leaders, and curriculum developers crucial guidance for the future development and implementation of clinician antibias interventions.

Keywords: community-based participatory research; health equity intervention; implicit bias training; maternal health; qualitative research; stakeholder engagement.