Exploring the Presence of Implicit Bias Amongst Healthcare Professionals Who Refer Individuals Living with COPD to Pulmonary Rehabilitation with a Specific Focus Upon Smoking and Exercise

Abstract

Background

We are developing a shared decision-making intervention for individuals with COPD who are deciding between Pulmonary Rehabilitation (PR) programme options. Previously, we identified Healthcare Professional (HCP) beliefs about the characteristics of COPD individuals as a barrier to PR conversations. Beliefs can lead to implicit biases which influence behaviour. To inform our shared decision-making intervention, we aimed to measure the presence of implicit bias amongst HCPs who refer individuals with COPD to PR.

Methods

We utilised the Implicit Association Test to measure HCPs response times when categorising words related to smoking or exercise (eg stub, run) to matching concepts or evaluations of concepts (eg “smoking, unpleasant” or “exercise, pleasant”) and unmatching concepts or evaluations of concepts (eg “smoking, pleasant” or “exercise, unpleasant”). We approached HCPs across the UK. Following consent, we collected demographic data and then administered the test. The primary outcome was the standardised mean difference in response times from the matching and unmatching categorisations (D₄-score), measured using a one-sample Wilcoxon Signed Rank Test. We explored the relationship between HCP demographics and their D₄-scores using Spearman Rho correlation analysis and logistic regression.

Results

Of 124 HCPs screened, 104 (83.9%) consented. Demographic data were available for 88 (84.6%). About 68.2% were female and most (28.4%) were in the 45–54 years age category. Test data were available for 69 (66.3%) participants. D₄-scores ranged from 0.99 to 2.64 indicating implicit favouring of matching categorisation (MD-score = 1.69, SDD-score = 0.38, 95% CID-score 1.60–1.78, p < 0.05). This was significantly different from zero, z = −7.20, p < 0.05, with a large effect size (r = 0.61, (28)). No demographic predictors of implicit bias were identifiable.

Conclusion

HCPs demonstrated negative bias towards smoking and positive bias towards exercising. Since implicit bias impacts behaviour, we plan to develop intervention components (eg decision coaching training) to enable HCPs to fully and impartially support shared decision-making for a menu of PR options.

Keywords:

• implicit bias
• COPD
• healthcare professionals
• pulmonary rehabilitation

Data Sharing Statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Disclosure

Professor Sally J Singh reports grants from NIHR, grants from Wellcome, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This study contributes to ACB’s PhD. It is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC: East Midlands) and the Centre for Exercise and Rehabilitation Science (CERS) at the University Hospitals of Leicester NHS Trust. SJS is ACB’s senior PhD supervisor and a Senior Investigator for the NIHR. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.