Applying multi-theory model of health behaviour change to address implicit biases in public health
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20173813Keywords:
Implicit bias, Theory, Educational intervention, ChangeAbstract
A person receiving public health services should not receive a lesser standard of service because of his/her race, gender, age, colour, national origin, disability status, occupation or any other extraneous characteristics. However, sometimes our perception based on these hidden linkages (unconscious, irrepressible, or irrational connotations) may influence our judgements resulting in unfairness which are referred as implicit biases. Such biases can result in poorer quality of care. In public health, where the ultimate motive is to ensure social justice, these implicit biases are thus quite deleterious. The purpose of this article was to examine the implicit biases in public health practice and develop recommendations for education, training and research in this discipline using the application of a novel behavioural theory, multi-theory model (MTM) of health behaviour change. A review of literature in the MEDLINE, CINAHL, Google Scholar, and ERIC databases was performed to prepare this article. The constructs of participatory dialogue in which advantages outweigh disadvantages, behavioural confidence, and changes in physical environment were discussed to initiate behaviour change devoid of implicit biases. The constructs of emotional transformation, practice for change and changes in social environment were discussed to sustain behaviour change devoid of implicit biases. Educational interventions based on MTM need to be adopted by Schools of Public Health in education of public health students and training of public health professionals. Such efforts will reduce implicit biases in the discipline of public health and improve quality of care.
Metrics
References
Blair IV, Steiner JF, Havranek EP. Unconscious (implicit) bias and health disparities: where do we go from here? Perm J. 2011;15(2):71-8.
Holroyd J, Sweetman, J. The heterogeneity of implicit bias. In: Brownstein M, Saul J, eds. Implicit Bias and Philosophy: Vol. 1. Metaphysics and Epistemology. Oxford, UK: Oxford University Press; 2016: 80-103.
Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, et al. Clinicians' implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med. 2013;11(1):43-52.
Bobo L. Racial attitudes and relations at the close of the twentieth century. In: Smelser N, Wilson WJ, Mitchell F. eds. America Becoming: Racial Trends and their Consequences. Washington, DC: National Academy Press; 2001: 262-9.
Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR. Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. J Pers Soc Psychol. 2009;97(1):17-41.
Rudberg LA, Feinberg J, Fairchild K. Minority members’ implicit attitudes: automatic ingroup bias as a function of group status. Soc Cogn. 2002;20(4):294-320.
FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1):19.
Martin AK, Tavaglione N, Hurst S. Resolving the conflict: clarifying 'vulnerability' in health care ethics. Kennedy Inst Ethics. 2014;24(1):51-72.
Hernandez RA, Haidet P, Gill AC, Teal CR. Fostering students' reflection about bias in healthcare: cognitive dissonance and the role of personal and normative standards. Med Teach. 2013;35(4):e1082-9.
Boscardin CK. Reducing implicit bias through curricular interventions. J Gen Intern Med. 2015;30(12):1726-8.
Sharma M. Theoretical Foundations of Health Education and Health Promotion. 3rd ed. Burlington, MA: Jones and Bartlett; 2017:250-62.
Devine PG, Forscher PS, Austin AJ, Cox WTL. Long-term reduction in implicit race bias: a prejudice habit-breaking intervention. J Exp Soc Psychol. 2012;48(6):1267-78.
Sharma M. Multi-theory model (MTM) for health behavior change. Webmed Central Behaviour. 2015;6(9):WMC004982.
Nahar VK, Sharma M, Catalano HP, Ickes MJ, Johnson P, Ford MA. Testing multi-theory model (MTM) in predicting initiation and sustenance of physical activity behavior among college students. Health Promot Perspect. 2016;6(2):58-65.
Sharma M, Catalano HP, Nahar VK, Lingam V, Johnson P, Ford MA. Using multi-theory model of health behavior change to predict portion size consumption among college students. Health Promot Perspect. 2016;6(3):137-44.
Sharma M, Catalano HP, Nahar VK, Lingam V, Johnson P, Ford MA. Using multi-theory model (MTM) of health behavior change to predict water consumption instead of sugar sweetened beverages. J Res Health Sci. 2017;17(1):e00370.
Knowlden AP, Sharma M, Nahar VK. Using multi-theory model of health behavior change to predict adequate sleep behavior. Fam Community Health. 2017;40(1):56-61.
Friere P. Pedagogy of the Oppressed. New York: Herder and Herder, 1970:5.
Murray-García JL, Harrell S, García JA, Gizzi E, Simms-Mackey P. Dialogue as skill: training a health professions workforce that can talk about race and racism. Am J Orthopsychiatry. 2014;84(5):590-6.
Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice-Hall; 1986: 39.
Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179-211.
Goleman D. Emotional Intelligence. New York, NY: Bantam; 1995.
Salovey P, Mayer J. Emotional intelligence. Imagin Cogn Pers. 1990;9:185-211.
Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28(11):1504-10.
Sharma M, Petosa RL. Measurement and Evaluation for Health Educators. Burlington, MA: Jones & Bartlett Learning; 2014:126-31.
Faul F, Erdfelder E, Lang AG, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.