Table 3.
Interventions included in scoping review of implicit bias interventions across multiple professional disciplines related to the social determinants of health categorized by self-reported and objective assessments detailing outcome(s) measured, results, and timing of assessment (2000–2020).
| Study Number* | Outcome Assessed** | Results of Assessment | Timing of Assessment |
|---|---|---|---|
| Assessment: Self-Report | |||
| 1 | Attitudes through written reflections | Qualitatively analyzed in aggregate, unable to quantify change | Immediate |
| 6 | Awareness of bias and its influence in medical school admissions decisions | Increased awareness | 16+ weeks |
| 7 | Knowledge and commitment to change | Increased across all measures | 16+ weeks |
| 8 | Empathy- Ethnocultural empathy scale and Jefferson Empathy Scale, Patient-Practitioner Orientation Scale (Patient Centeredness) internal consistency for the three ranged from 0.82 to 0.87 | Intervention group had significantly higher (better) scores on the three scales as compared to the comparison group. | Immediate |
| 9 | Confidence | Increased | Immediate |
| 10 | Frabroni scale of aging (explicit bias)- Internal consistency was 0.72–0.82; Facts on aging quiz- Internal consistency at 0.38–0.40; Relating to older people alpha = 0.57–0.67) | No change in willingness to work with older adults. Did not report the changes in explicit bias but rather looked at the correlations of explicit bias with the other variables. | 1–16 weeks |
| 12 | Skills in mentoring, communication, fostering independence, and addressing diversity in the mentoring relationship | Increased across all constructs | 1–16 weeks |
| 13 | Awareness of bias and the importance of managing it for clinical care, identification of strategies | Increased awareness and recognition of managing bias in nursing care would be helpful. Strategies were analyzed qualitatively in aggregate, unable to quantify change. | Immediate |
| 14 | Knowledge and attitudes | 53% reported no change in self-reported attitudes on post-session follow up | 16+ weeks |
| 15 | Attitudes on racism and prejudice | Increase in acceptance of racial prejudice in self and general population, no change in concern about having implicit bias | Immediate |
| 16 | Skills and attitude around trainee mistreatment | Improved attitudes, increased self-efficacy in recognizing and addressing mistreatment | Immediate |
| 18 | Attitudes | Differences noted between “deniers” and “accepters” of implicit bias potentially influencing some clinical decisions and behaviors | Immediate |
| 22 | Attitudes through written reflections | Qualitatively analyzed in aggregate, unable to quantify change | Immediate |
| 25 | Racial Attributes in Clinical Evaluation survey (internal consistency α=0.885) | Self-reported increased consideration of race in clinical care as compared to pre/post. | 16+ weeks |
| 26 | Knowledge, confidence, and attitudes | Increased across all constructs | Immediate |
| 28 | Knowledge and comfort | Increased across all constructs | Unspecified |
| 29 | Knowledge, competence, and performance | Increased across all constructs | 16+ weeks |
| 30 | Attitudes through written reflections | Qualitatively analyzed in aggregate, unable to quantify change | Immediate |
| 32 | Attitudes through written reflections | Qualitatively analyzed in aggregate, unable to quantify change | Immediate |
| 33 | Self-efficacy | Increase in 13 of 17 self-efficacy measures | Immediate |
| 36 | Skills in recognizing and addressing bias and in teaching trainees about bias | Increased across all constructs | Immediate |
| 37 | Knowledge | No numerical values provided | Immediate |
| 40 | Attitudes and strategies | Decrease in skepticism of IAT results, strategies reflected awareness and acceptance of bias within oneself | Immediate |
| 44 | Mental illness clinician attitudes scale (good face validity, internal consistency α=0.72, moderate convergent validity to similar scales r=0.32–0.49), brief mental illness attitudes scale (internal consistency α > 0.8 and consistent two factor solution), self-reported attitudes through qualitative interviews (conducted months after intervention) | Improvements in explicit attitudes regarding mental illness, but only in the pediatric clinical contexts, not adult emergency contexts; any improvements were not sustained six months later; qualitative interviews did not quantify change | Immediate |
| 45 | Strategies | Change in strategies from pre-post with less internal feedback and humanism strategies and more reflection and debriefing strategies. | Immediate |
| 49 | Knowledge and confidence | Increased across all measures | Immediate |
| 50 | Attitudes | Improved attitudes regarding awareness of implicit bias and its potential influence on clinical care pre/post | Immediate |
| 51 | Knowledge and confidence | Increase in knowledge and confidence to address own biases | Immediate |
| Assessment: Objective | |||
| 11 | Knowledge (true and false questions- with internal consistency of α=0.74) and the Scale of Ethnocultural Empathy (adapted a previously validated scale for their purposes) | Increased across all constructs | Immediate |
| 17 | Knowledge, and self-reported attitudes and confidence | Increased across all constructs | 1–16 weeks |
| 19 | Knowledge, and self-reported attitudes and confidence | Increased across all constructs | Immediate |
| 21 | Shooter Bias Task and a Five Facet Mindfulness Questionnaire- short form (internal consistency for subscales used ranged from alpha 0.70 to 0.86) | Improved control for Black targets pre/post, no change for the Five Facets Mindfulness Questionnaire | 1–16 weeks |
| 23 | Skills assessed through trained observer ratings of participants in standardized patient interactions, self-reported attitudes using Everyday Multicultural Competencies/Revised Scale of Ethnocultural Empath- the Acting as an Ally subscale (internal consistency α>0.70 at both time points), feelings thermometers about various ethnic/racial groups (explicit attitudes- internal consistency α > 0.94 at both time points), Working Alliance Inventory (internal consistency α > 0.85), interaction closeness mean composite score (internal consistency α > 0.67). | Improved emotional rapport building, fewer microaggressions, improved self-reported explicit attitudes and increased self-reported working alliance and interaction closeness with Black standardized patient. | 2 days |
| 27 | Common Ground instrument (Inter-rater reliability = 0.85 for the overall global ratings and 0.92 for the overall checklist assessment) and health literacy skills checklist | Increased across all constructs | 1–16 weeks |
| 38 | Outcomes related to intended ultimate beneficiaries (parents and children in contact with the foster care system) | Increased parental placement of children (as opposed to foster care placement) | Unspecified |
| 39 | Knowledge, self-reported awareness and self-efficacy | No change in knowledge or self-reported awareness, reduction of perceived challenges to addressing microaggressions | Immediate |
| 42 | Knowledge (internal consistency of measures α= 0.87–0.91) | Increased scores for learners in intervention versus control condition | Immediate |
*
Study numbers refer to numerical order listed in Table 1. References 2, 3, 4, 5, 20, 24, 31, 34, 35, 41, 43, 46, 47, 48 did not report any assessments of learners.
**
If an intervention included objective and self-reported assessments, it is listed within the objective assessments portion of the table.