Journal of General Internal Medicine

, Volume 29, Issue 2, pp 364–387 | Cite as

A Systematic Review of the Extent and Measurement of Healthcare Provider Racism

Review Article

ABSTRACT

BACKGROUND

Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism.

OBJECTIVES

This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism.

METHODS

The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study.

RESULTS

The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed.

CONCLUSION

Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

KEY WORDS

healthcare racism bias measurement, systematic review 

REFERENCES

  1. 1.
    Bhopal R. Chronic diseases in Europe’s migrant and ethnic minorities: challenges, solutions and a vision. Eur J of Public Health. 2009;19(2):140–143.CrossRefGoogle Scholar
  2. 2.
    Frohlich KL, Ross N, Richmond C. Health disparities in Canada today: some evidence and a theoretical framework. Health Policy. 2006;79:132–143.PubMedCrossRefGoogle Scholar
  3. 3.
    Nazroo JY, Karlsen S. Ethnic inequalities in health: social class, racism and identity. In Research Findings from the Health Variations Program. 2001 September.Google Scholar
  4. 4.
    Takeuchi DT, WIlliams DR. Past insights, future promises: race and health in the twenty-first century. Du Bois Rev. 2011;8(1):1–3.CrossRefGoogle Scholar
  5. 5.
    Larson PA. Nurse perceptions of patient characteristics. Nurs Res. 1977;26(6):416–421.PubMedCrossRefGoogle Scholar
  6. 6.
    Smedley BD, Stith AY, Nelson AR. Unequal treatment: Confronting racial and ethnic disparities in health care. Report of the Committee on Understanding Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.Google Scholar
  7. 7.
    Klonoff EA. Disparities in the provision of medical care: an outcome in search of an explanation. J Behav Med. 2009;32(1):48–63.PubMedCrossRefGoogle Scholar
  8. 8.
    Kressin NR, Raymond KL, Manze M. Perceptions of race/ethnicity-based discrimination: a review of measures and evaluation of their usefulness for the health care setting. J Health Poor U. 2008;19(3):697–730.CrossRefGoogle Scholar
  9. 9.
    Shavers VL, Fagan P, Jones D, al. E. The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. 2012;102(5):953–66.Google Scholar
  10. 10.
    Berman G, Paradies Y. Racism, disadvantage and multiculturalism: towards effective anti-racist praxis. Ethn Racial Stud. 2010;33(2):214–232.CrossRefGoogle Scholar
  11. 11.
    Blank RM, Dabady M, Citro CF. Measuring racial discrimination. Washington, DC: The National Academies Press; 2004.Google Scholar
  12. 12.
    Van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(1):140–150.Google Scholar
  13. 13.
    Van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003;93(2):248–255.PubMedCrossRefGoogle Scholar
  14. 14.
    Gee GC, Ford CL. Structural racism and health inequities, old issues, new directions. Du Bois Rev. 2011;8(1):115–132.CrossRefGoogle Scholar
  15. 15.
    Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006;35(4):888–901.PubMedCrossRefGoogle Scholar
  16. 16.
    Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32(1):20–47.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Monrouxe LV. Identity, identification and medical education: why should we care? Med Educ. 2010;44:40–49.PubMedCrossRefGoogle Scholar
  18. 18.
    Kavanagh J, Oliver S, Lorenc T. Reflections on developing and using PROGRESS-PLUS. Equity Update. 2008:1–3.Google Scholar
  19. 19.
    Cardiff University. Health Evidence Bulletins Wales: Critical appraisal checklists. Cardiff University, Cardiff, Wales. 2008. http://hebw.cf.ac.uk/projectmethod/appendix5.htm#top. 2011. Last accessed 14 June 2013.
  20. 20.
    De Houwer J, Moors A. Implicit measures: Similarities and differences. In: Gawronski B, Payne BK, eds. Handbook of implicit social cognition: measurement, theory, and applications. New York: The Guilford Press; 2010.Google Scholar
  21. 21.
    Strack F, Deutsch R. Reflective and impulsive determinants of social behavior. Pers Soc Psychol Rev. 2004;8(3):220–247.PubMedCrossRefGoogle Scholar
  22. 22.
    Ranganath KA, Smith CT, Nosek BA. Distinguising automatic and controlled components of attitudes from direct and indirect measurement methods. J Exp Soc Psychol. 2008;44(2):386–396.PubMedCentralPubMedCrossRefGoogle Scholar
  23. *23.
    Van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50(6):813–828.PubMedCrossRefGoogle Scholar
  24. *24.
    Penner LA, Dovidio J, et al. Aversive racism and medical interactions with Black patients: a field study. J Exp Soc Psychol. 2010;46:436–440.PubMedCentralPubMedCrossRefGoogle Scholar
  25. *25.
    Michaelsen J, Krasnik A, Nielsen A, Norredam M, Torres AM. Health professionals’ knowledge, attitudes, and experiences in relation to immigrant patients: a questionnaire study at a Danish hospital. Scand J Public Health. 2004;32(4):287–295.PubMedCrossRefGoogle Scholar
  26. *26.
    Middleton RA, Stadler HA, Simpson C, et al. Mental health practitioners: the relationship between white racial identity attitudes and self-reported multicultural counseling competencies. J Couns Dev. 2005;83:444–456.CrossRefGoogle Scholar
  27. *27.
    Constantine MG, Juby HL, Liang JJ. Examining multicultural counseling competence and race-related attitudes among white marital and family therapists. J MaritalFam Ther. 2001;27(3):353–388.CrossRefGoogle Scholar
  28. *28.
    Paez KA, Allen JK, Carson KA, Cooper LA. Provider and clinic cultural competence in a primary care setting. Soc Sci Med. 2008;66(5):1204–1216.PubMedCentralPubMedCrossRefGoogle Scholar
  29. *29.
    Mitchell AA, Sedlacek WE. Ethnically sensitive messengers: an exploration of racial attitudes of health-care workers and organ procurement officers. J Natl Med Assoc. 1996;88(6):349–352.PubMedGoogle Scholar
  30. *30.
    Noble A, Engelhardt K, Newsome-Wicks M, Woloski-Wruble AC. Cultural competence and ethnic attitudes of midwives concerning jewish couples. J Obstet Gynecol Neonatal Nurs. 2009;38(5):544–555.Google Scholar
  31. *31.
    Joseph HJ. Attitudes of army nurses toward African American and Hispanic patients. Mil Med. 1997;162(2):96–100.PubMedGoogle Scholar
  32. *32.
    Green RG, Kiernan-Stern M, Baskind FR. White social workers’ attitudes about people of color. J Ethn Cultural Divers Soc Work. 2005;14(1–2):47–68.CrossRefGoogle Scholar
  33. *33.
    Pagotto L, Voci A, Maculan V. The effectiveness of intergroup contact at work: mediators and moderators of hospital workers’ prejudice towards immigrants. J Community Soc Psychol. 2010;20:317–330.CrossRefGoogle Scholar
  34. *34.
    Moskowitz D, Thom DH, Guzman D, Penko J, Miaskowski C, Kushel M. Is primary care providers’ trust in socially marginalized patients affected by race? J Genl Intern Med. 2011;26(8):846–851.CrossRefGoogle Scholar
  35. *35.
    Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and steretypes about race and quality of medical care. Med Care. 2008;46(7):678–685.PubMedCrossRefGoogle Scholar
  36. *36.
    Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–1238.PubMedCentralPubMedCrossRefGoogle Scholar
  37. *37.
    Sabin JA, Nosek BA, Greenwald AG, Rivara FP. Physicians’ implicit and explicit attitudes about race by md race, ethnicity, and gender. J Health Poor U. 2009;20:896–913.CrossRefGoogle Scholar
  38. 38.
    Ponterotto JG, Potere JC, Johansen SA. The quick discrimination index: normative data and user guidelines for counseling researchers. J Multicultural Couns D. 2002;30:192–207.CrossRefGoogle Scholar
  39. 39.
    Sedlacek W, Brooks G Jr. Measuring racial attitudes in a situational context. Psychol Rep. 1970;27:971–980.PubMedCrossRefGoogle Scholar
  40. 40.
    Bonaparte B. Ego defensiveness, open-closed mindedness, and nurses’ attitudes toward culturally different patients. Nurs Res. 1979;28(3):166–172.PubMedGoogle Scholar
  41. 41.
    Rooda LA. Knowledge an attitudes of nurses towards culturally diverse patients. [Dissertation]. West Layfayette: Purdue University; 1990.Google Scholar
  42. 42.
    Jacobson CK. Resistance to affirmative action: self-interest or racism? J Confl Resolut. 1985;29(2):306–329.CrossRefGoogle Scholar
  43. 43.
    Ponterotto JG, Gretchen D, Utsey SO, Rieger BP, Austin R. A revision of the Multicultural Counseling Awareness Scale. J Multicult Couns D. 2002;30:153–180.Google Scholar
  44. 44.
    Jetten PJ, Ellemers N. Minority hostility and resistance: The interplay between majority rejection and minority goals. The University of Queensland 2010–2012.Google Scholar
  45. 45.
    Hornsey MJ, Wohl MJ. Promoting intergroup forgiveness: The benefits and pitfalls of apologies and invocations of shared humanity. The University of Queensland 2010–2012.Google Scholar
  46. 46.
    Brigham J. College students’ racial attitudes. J App Psychol. 1993;23:1933–1967.CrossRefGoogle Scholar
  47. 47.
    McConahay AR. Modern racism, ambivalence, and the modern racism scale. In: Dovidio JF, Gaertner SL, eds. Prejudice, discrimination, and racism. Orlando: Academic Press; 1986:91–125.Google Scholar
  48. *48.
    Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med. 2000;35(1):11–16.PubMedCrossRefGoogle Scholar
  49. *49.
    Hirsh AT, Jensen MP, Robinson ME. Evaluation of nurses’ self-insight into their pain assessment treatment decisions. J Pain. 2010;11(5):454–461.PubMedCentralPubMedCrossRefGoogle Scholar
  50. *50.
    Kales HC, Neighbors HW, Valenstein M, et al. Effect of race and sex on primary care physicians’ diagnosis and treatment of late-life depression. J Am Geriar Soc. 2005;53(5):777–784.CrossRefGoogle Scholar
  51. *51.
    Kales HC, Neighbors HW, Blow FC, et al. Race, gender, and psychiatrists’ diagnosis and treatment of major depression among elderly patients. Psychiatr Serv. 2005;56(6):721–728.PubMedCrossRefGoogle Scholar
  52. *52.
    McKinlay JB, Burns RB, Durante R, et al. Patient, physician and presentational influences on clinical decision making for breast cancer: results from a factorial experiment. J Eval Clin Pract. 1997;3(1):23–57.PubMedCrossRefGoogle Scholar
  53. *53.
    Stepanikova I. Inequality in quality: toward a better understanding of micro-mechanisms underlying racial/ethnic dispartiies in American health care [Dissertation]. Standford University 2006.Google Scholar
  54. *54.
    Burgess DJ, Crowley-Matoka M, Phelan S, et al. Patient race and physicians’ decisions to prescribe opioids for chronic lower back pain. Soc Sci Med. 2008;67:1852–1860.PubMedCrossRefGoogle Scholar
  55. *55.
    Weisse CS, Sorum PC, Sanders KN, Syat BL. Do gender and race affect decisions about pain management? J Gen Intern Med. 2001;16:211–217.PubMedCentralPubMedCrossRefGoogle Scholar
  56. *56.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catherization. New Engl J Med. 1999;340(8):618–626.PubMedCrossRefGoogle Scholar
  57. *57.
    Thamer M, Hwang W, Fink NE, et al. U.S. Nephrologists’ attitudes towards renal transplantation: results from a national survey. Transplantation. 2001;71(2):281–288.PubMedCrossRefGoogle Scholar
  58. *58.
    Di Caccavo A, Fazal-Short N, Moss TP. Primary care decision making in response to psychological complaints: The influence of patient race. J Community Appl Psychol. 2000;10(1):63–67.CrossRefGoogle Scholar
  59. *59.
    Bogart LM, Catz SL, Kelly JA, Benotsch EG. Factors influencing physicians’ judgments of adherence and treatment decisions for patients with HIV disease. Med Decis Mak. 2001;21:28–36.CrossRefGoogle Scholar
  60. *60.
    Al-Khatib SM, Sanders GD, O’Brien SM, et al. Do physicians’ attitudes toward implantable cardioverter defibrillator therapy vary by patient age, gender, or race? Ann Noninvasive Electrocardiol. 2011;16(1):77–84.PubMedCrossRefGoogle Scholar
  61. *61.
    Cabral ED, Caldas AF Jr, Cabral HAM. Influence of the patient’s race on the dentist’s decision to extract or retain a decayed tooth. Community Dent Oral Epidemiol. 2005;33:461–466.PubMedCrossRefGoogle Scholar
  62. *62.
    Barnhart JM, Wassertheil-Smoller S. The effect of race/ethnicity, sex, and social circumstances on coronary revascularization preferences. A vignette comparison. Cardiol Rev. 2006;14(5):215–222.PubMedCrossRefGoogle Scholar
  63. *63.
    Weisse CS, Sorum PC, Dominguez RE. The influence of gender and race on physicians’ pain management decisions. J Pain. 2003;4(9):505–510.PubMedCrossRefGoogle Scholar
  64. *64.
    McKinlay J, Lin T, Freund K, Moskowitz M. The unexpected influence of physician attributes on clinical decisions: results of an experiment. J Health Soc Behav. 2002;43:92–106.PubMedCrossRefGoogle Scholar
  65. *65.
    Drwecki B. An experimental investigation of the causes of and solutions to racial pain treatment bias [dissertation]. University of Wisconsin-Madison; 2011.Google Scholar
  66. 66.
    Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: The Implicit Association Test. J Pers Soc Psychol. 1998;74:1464–1480.PubMedCrossRefGoogle Scholar
  67. 67.
    Gawronski B, Deutsch R, Banse R. Response interference tasks as indirect measures of automatic associations. In: Klauer KC, Voss A, Stahl C, eds. Cognitive methods in social psychology. New York: Guilford Press; 2011.Google Scholar
  68. 68.
    Degner J, Wentura D. Automatic prejudice in childhood and early adolescence. J Pers Soc Psychol. 2010;98(3):356–374.PubMedCrossRefGoogle Scholar
  69. *69.
    Cooper LA, Roter D, Carson K, Beach M, Sabin J, Greenwald AG. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;Online:e1-e9.Google Scholar
  70. *70.
    Moskowitz GB, Stone J, Childs A. Implicit stereotyping and medical decisions: unconscious stereotype activation in practitioners’ thoughts about African Americans. Am J Public Health. 2012;Online:e1-e6.Google Scholar
  71. *71.
    Abreu JM. Conscious and nonconscious African American stereotypes: impact on first impression and diagnostic ratings by therapists. J Consult Clin Psychol. 1999;67(3):387–393.PubMedCrossRefGoogle Scholar
  72. *72.
    Balsa AI, McGuire TG. Testing for statistical discrimination in health care. Health Serv Res. 2005;40(1):227–252.PubMedCrossRefGoogle Scholar
  73. 73.
    Paradies Y, Chandrakumar L, Klocker N, et al. Building on our strengths: a framework to reduce race-based discrimination and support diversity in Victoria. Melbourne: Victorian Health Promotion Foundation; 2009.Google Scholar
  74. 74.
    Halanych JH, Andreae L, Prince CP. The role of ancillary staff in perceived discrimination in medical care. The Science of Research on Discrimination and Health; Washington DC 2011.Google Scholar
  75. 75.
    Blair IV, Hayranek EP, PRice DW, et al. An assessment of biases against Latinos and African Americans among primary care providers and community members. The Science of Research on Discrimination and Health; Washington DC 2011Google Scholar
  76. 76.
    Steenkamp J-BEM, de Jong MG, Baumgartner H. Socially desirable response tendencies in survey research. Journal of Marketing Research. 2010;XLVII:199–214.Google Scholar
  77. 77.
    Tausch N, Hewstone M, Kenworthy JB, et al. Secondary transfer effects of intergroup contact: Alternative accounts and underlying processes. J Pers Soc Psychol. 2010;99(2):282–302.PubMedCrossRefGoogle Scholar
  78. 78.
    Duckitt J, Callaghan J, Wagner C. Group identification and outgroup attitudes in four South African Ethnic Groups: A multidimensional approach. Pers Soc Psychol B. 2005;31(5):633–646.CrossRefGoogle Scholar
  79. 79.
    Al Ramiah A, Hewstone M, Dovidio J, Penner LA. The social psychology of discrimination: Theory, measurement and consequences In: Bond L, McGinnity F, Russell H, editors. Making equality count: Irish and international research measuring equality and discrimination. Dublin: Liffey Press; 2010. p. 84–112.Google Scholar
  80. 80.
    Gawronski B, LeBel EP, Peters KR. What do implicit measures tell us? Scrutinizing the validity of three common assumptions. Perspect Psychol Sci. 2007;2(2):181–193.CrossRefGoogle Scholar
  81. 81.
    Rich J. Measuring discrimination: What do field experiments of markets tell us? In: Bond L, McGinnity F, Russell H, eds. Making equality count: Irish and international research measuring equality and discrimination. Dublin: LIffey Press; 2010:48–63.Google Scholar
  82. 82.
    Cuddy AJC, Fiske ST, Glick P. Behaviors from intergroup affect and stereotypes: the BIAS Map. J Pers Soc Psychol. 2007;92(4):631–648.PubMedCrossRefGoogle Scholar
  83. 83.
    Caprariello PA, Cuddy AJC, Fiske ST. Social structure shapes cultural stereotypes and emotions: A causal test of the stereotype content model. Group Process Intergr Relat. 2009;12(2):147–155.CrossRefGoogle Scholar
  84. 84.
    Burgess D, Van Ryn M, Dovidio J, Saha S. Reducing racial bias among health care providers: lessons from social-cognitive psychology. J Gen Intern Med. 2007;22(6):882–887.PubMedCentralPubMedCrossRefGoogle Scholar
  85. 85.
    Kowal E, Franklin H, Paradies Y. Exploring reflexive antiracism as an approach to diversity training. Ethnicities. 2013;13(3):316–336.CrossRefGoogle Scholar
  86. 86.
    Lillis J, Hayes SC. Applying acceptance, mindfulness, and values to the reduction of prejudice. Behavior Modif. 2007;31(4):389–411.CrossRefGoogle Scholar
  87. 87.
    Gawronski B, Brochu PM, Sritharan R, Strack F. Cognitive consistency in prejudice-related belief systems: Integrating old-fashioned, modern, aversive, and implicit forms of prejudice. In: Gawnronski B, Strack F, eds. Cognitive consistency: a fundamental principle in social cognition. New York: Guilford Press; 2012.Google Scholar
  88. 88.
    Ecclesston CP, Kaiser CR, Kraynak LR. Shifts in justice beliefs induced by Hurricane Katrina: The impact of claims of racism. Group Processes Intergr. 2010;13(5):571–584.CrossRefGoogle Scholar
  89. 89.
    Pinterits EJ, Poteat VP, Spanierman LB. The White Privilege Attitudes scale: development and initial validation. J Couns Psychol. 2009;56(3):417–429.CrossRefGoogle Scholar
  90. 90.
    Plaut VC. Diversity science: Why and how difference makes a difference. Psychol Inq. 2010;21:77–99.CrossRefGoogle Scholar
  91. 91.
    Keller J. In genes we trust: The biological component of psychological essentialism and its relationship to mechanisms of motivated social cognition. J Pers Soc Psychol. 2005;88(4):686–703.PubMedCrossRefGoogle Scholar
  92. 92.
    Bastian B, Haslam N. Psychological essentialism and stereotype endorsement. J Exp Soc Psychol. 2009;42:228–235.CrossRefGoogle Scholar
  93. 93.
    Fiske ST, Cuddy AJC, Glick P, Xu J. A model of (often mixed) stereotype content: Stereotype competence and warmth respectively follow from perceived status and competition. J Pers Soc Psych. 2002;82(6):878–902.CrossRefGoogle Scholar
  94. 94.
    Burgess DJ, Dovidio J, Phelan S, Van Ryn M. The effect of medical authoritarianism on physicians’ treatment decisions and attitudes regarding chronic pain. J Appl Soc Psychol. 2011;41:1399–1420.CrossRefGoogle Scholar
  95. 95.
    Sidanius J, Pratto F. Social dominance: An intergroup theory of social hierarchy and oppression. New York: Cambridge University Press; 1999.CrossRefGoogle Scholar
  96. 96.
    Roets A, Van Hiel A, Cornelis I. Does materialism predict racism? Materialism as a distinctive social attitude and a predictor of prejudice. Euro J Personality. 2006;20:155–168.CrossRefGoogle Scholar
  97. 97.
    Riek BM, Mania EW, Gaertner SL. Intergroup threat and outgroup attitudes: A meta-analytic review. Pers Soc Psychol B. 2006;10(4):336–353.CrossRefGoogle Scholar
  98. 98.
    Gordon HS, Street RL Jr, Sharf BF, Souchek J. Racial differences in doctors’ information-giving and patients’ participation. Cancer. 2006;107(6):1313–1320.PubMedCrossRefGoogle Scholar
  99. 99.
    Johnson RL, Roter DL, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94(12):2084–2090.PubMedCrossRefGoogle Scholar
  100. 100.
    Hagiwara N, Penner LA, Eggly S, Albrecht TL. Perceived discrimination, implicit bias, and adherence to physician recommendations. The Science of Research on Discriminiation and Health; Washington DC 2010.Google Scholar
  101. 101.
    Burgess DJ, Warren J, Phelan S, Dovidio J, Van Ryn M. Stereotype threat and health disparities: What medical educators and future physicians need to know. J Gen Intern Med. 2010;25(Supp 2):169–177.PubMedCentralCrossRefGoogle Scholar
  102. 102.
    Shelton JN, West TV, Trail TE. Concerns about appearing prejudiced: Implications for anxiety during daily interracial interactions. Group Process Intergr. 2010;13(3):329–344.CrossRefGoogle Scholar
  103. 103.
    Finchilescu G. Intergroup anxiety in interracial interaction: The role of prejudice and meta-stereotypes. J Soc Issues. 2010;66(2):334–351.CrossRefGoogle Scholar
  104. 104.
    Czopp AM. When is a compliment not a compliment? Evaluating expressions of positive stereotypes. J Exp Soc Psychol. 2008;44:413–420.CrossRefGoogle Scholar
  105. 105.
    Lawrence JS, Crocker J, Blanton H. Stigmatized and dominant cultural groups differentially interpret positive feedback. J Cross Cult Psychol. 2011;42(1):165–169.CrossRefGoogle Scholar
  106. 106.
    Persky S. Employing immersive virtual environments for innovative experiments in health care communication. Patient Educ Couns. 2011;82(3):313.PubMedCentralPubMedCrossRefGoogle Scholar
  107. 107.
    Dovidio JF, Brigham JC, Johnson BT, et al. Stereotyping, prejudice, and discrimination: Another look. Stereotypes and stereotyping. New York: Guilford; 1996. p. 276–319.Google Scholar
  108. 108.
    Schutz H, Six B. How strong is the relationship between prejudice and discrimination - a meta-analytic answer. Int J Intercult Rel. 1996;20(3–4):441–462.CrossRefGoogle Scholar
  109. 109.
    Wagner U, Christ O, Pettigrew TF. Prejudice and group-related behavior in Germany. J SocIssues. 2008;64(2):403–416.Google Scholar
  110. *110.
    Sabin JA, Greenwald AG. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: Pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health. 2012;102:988–995.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  1. 1.Centre for Citizenship and Globalisation, Faculty of Arts and EducationDeakin UniversityVictoriaAustralia
  2. 2.McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global HealthUniversity of MelbourneVictoriaAustralia

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