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Projeto de investigação
The Intergroup Time Bias and Its Psychological Mechanisms in the Medical Context
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The Intergroup Time Bias effect and Its psychological mechanisms in the medical context
Publication . Do Bú, Emerson Araújo; Pereira, Cícero Roberto; Vala, Jorge
The Intergroup Time Bias (ITB) effect is a discriminatory behavior characterized by individuals’ motivation to invest more time in members of their own social group as compared to those from different social groups. This phenomenon can profoundly impact various facets of social life, especially within the context of healthcare provision. In the healthcare domain, time is a crucial factor that notably influences both medical decision-making and the ultimate satisfaction of patients with their care outcomes. However, what if the allocation of time in this context is not distributed equally among patients from different social groups, revealing an unobtrusive and often overlooked form of intergroup discrimination? What are the implications of the ITB effect on healthcare outcomes for patients? In the medical context, is the ITB effect associated with well-known racial attitudes, such as aversive racism? This dissertation presents a comprehensive research program that provides evidence that the ITB represents one of the primary insidious discriminatory behaviors exhibited by aversive racists, which ultimately impacts the quality of medical care provided to patients. Our research program was conducted within the clinical assessment and medical decision-making processes to investigate whether White medical trainees exhibit a bias in their investment of time that favors White (vs. Black) patients. Additionally, we investigated whether the ITB effect contributes to healthcare disparities, impacting patient care quality. Critically, the research examines the relationship between ITB and aversive racism in two distinct ways. First, we propose that the ITB is most prevalent among individuals who claim to uphold egalitarian beliefs, consider themselves non-racist, but hold nonconscious negative attitudes and beliefs about Black individuals (i.e., aversive racists). Second, we suggest that avoidance behavior, specifically physical examination avoidance of patients, may serve as an underlying mechanism through which patients’ skin color influences the time invested, particularly among individuals exhibiting an aversive racist profile. In addition to discussing the significance of time in psychological literature and discrimination in healthcare provision within asymmetric intergroup relationships (Chapter 1), this research program includes eight studies and eight pre-tests of paradigms and materials organized in three empirical chapters. These chapters examine whether White medical trainees invest more time in White than Black patients across various healthcare aspects. Specifically, Chapter 2 reveals that White trainees display ITB in forming first impressions, indicating diagnostic hypotheses, assessing pain, and prescribing opioids, with the effect being stronger in those with an aversive racist profile. Chapter 3 replicates the ITB effect in the diagnostic and clinical action recommendation realms and demonstrates that this time bias mediates the effect of patients’ skin color on diagnostic accuracy and recommendation quality. Chapter 4 extends the ITB investigation to the communication domain, exploring whether physical examination avoidance underlies the ITB effect in medical context among individuals who express an aversive racist profile. The synthesis of this research program provides the first experimental evidence that bias in time investment, favoring White over Black patients, is associated with aversive racism and impacts healthcare outcomes. These findings contribute to understanding the socio-psychological implications of time investment in healthcare, offering a new theoretical explanation for an understudied, insidious form of discrimination underlying racial healthcare disparities.
Healthcare providers’ psychological investment in clinical recommendations: investigating the role of implicit racial attitudes
Publication . Duffy, Conor M.C.; Do Bú, Emerson Araújo; Pereira, Cicero Roberto; Madeira, Filipa; Hagiwara, Nao
Racial disparities in clinical recommendations can result in racial disparities in health. While healthcare providers’ implicit racial attitudes (affective component of bias) are theorized to be one major factor contributing to racial disparities in clinical recommendations, empirical evidence to support the link is lacking. This study aimed to bridge this gap by moving beyond the standard approach of operationalizing the quality of clinical recommendations as a guideline-consistent vs. -inconsistent dichotomy. The present secondary study examined the role of provider implicit racial attitudes in the quality of clinical recommendations, operationalized as behaviors reflecting providers’ psychological investment in patient care (i.e., number of words used to describe clinical
recommendations, and number of treatment options recommended). Two-hundred-and-ten White medical trainees reviewed a clinical vignette of either a White or Black male patient and provided clinical recommendations. Their implicit racial attitudes were evaluated using the Implicit Association Test. Participants with more biased implicit racial attitudes (i.e., stronger implicit preference for White vs. Black individuals) used fewer words to describe their clinical recommendations and provided fewer clinical recommendations for the Black (vs. White) patient, while there were no significant differences between Black and White patients among participants with less biased implicit racial attitudes. These results illustrate the insidious impact of implicit racial attitudes in healthcare provision and underscore the need for researchers to consider the complex, nuanced ways in which provider implicit racial attitudes might manifest in clinical decision-making.
Neuroticism, stress, and rumination in anxiety and depression of people with Vitiligo: An explanatory model
Publication . Bú, Emerson Araújo Do; Santos, Vitória Medeiros Dos; Lima, Kaline Silva; Pereira, Cicero Roberto; Alexandre, Maria Edna Silva De; Bezerra, Viviane Alves dos Santos
Psychological impacts of Vitiligo have been demonstrated, and associations of the skin disease with anxiety and
depression disorders have already been shown. However, it is still unclear the role of individuals’ personality
factors, such as neuroticism, stress, and rumination, as well as sociodemographic characteristics of people with
Vitiligo in such disorders. We conducted a study in a community sample of individuals with Vitiligo (N = 324)
aiming to test the hypothesis that neuroticism, stress, and rumination are subjacent to these individuals’ anxiety
and depression symptomatology. We also explored whether individuals’ gender might favor the onset or wors-
ening of the psychological consequences of such disorders. Results showed that the relationship between
neuroticism, anxiety and depression was mediated by stress and rumination (brooding), being this effect
moderated by the participants’ gender. Specifically, women’s reflection and stress seemed to be important
mechanisms to predict their anxiety and depression symptoms, whereas brooding predicts such disorders’
symptomatology in men with Vitiligo. These findings may guide future research and clinical interventions for
this population, for which it is necessary to consider the psychological consequences of the disease and not just
its physiological aspects.
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Fundação para a Ciência e a Tecnologia
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2020.05290.BD