Table 3.

Strategies for Creating “Identity-Safe” Clinical Environments and Reducing Stereotype Threat, Translated from Findings in Nonmedical Domains (adapted from Burgess et al., 2010)

Recommendation	Examples
Actively and intentionally communicate an inclusive, respectful and welcoming environment.	Place cues in the physical environment, such as décor that includes: Positive images of ethnic minorities in valued roles. Images of highly valued ethnic minority role models. Artwork that reflects the achievements of the community. Mission statements that state commitment to diversity. Implement training, monitoring systems, and rewards that reflect a high value on positive and respectful communication among all staff. Recruit and retain underrepresented minority providers.
Elicit the patient’s values and strengths in any way that results in patient self-affirmation.	When recommending significant health behavior change, clinician asks the patient about a time in her life in which she has dealt with a significant challenge, and encourages her to discuss the qualities within herself that helped her overcome it.
Invoke high standards and communicate confidence in the patient’s ability to meet those standards.	Clinician emphasizes that she is setting “a high bar” for the patient because she is confident that he will be able to be successful (e.g., at behavior change, at achieving health-related goals).
Provide external attributions for the patient’s anxiety and difficulties (to prevent anxiety from affecting patient’s sense of competence).	Check in with a patient who seems anxious and distracted, reassuring him that such feelings are something many if not most patients feel at times.