5 Tips to Improve Implicit Biases for Nutrition Professionals

by Annabelle Shaffer, BS, Master’s candidate in the Division of Nutritional Sciences at the University of Illinois Urbana-Champaign.

What is Implicit Bias?

A review by The Ohio State University defines implicit biases as unconscious positive or negative attitudes or stereotypes we associate with individuals based on skin color, sexuality, gender, age, and other features.¹ Research shows that implicit biases are subconscious behaviors.² In one experiment, interviewers were provided identical resumes with a feminine or masculine name, and they were more likely to hire the candidate with a masculine name, despite believing they don’t have a preference for male employees.² Learning and improving upon our own implicit biases increases our cultural competence, or the maintenance of attitudes, behaviors, and perspectives that promote positive and effective connections with diverse cultures.²

Do implicit biases exist within the healthcare system?

Implicit biases are prevalent among healthcare practitioners. A systematic review of 15 articles found that 14 studies reported healthcare professionals possessing low to moderate levels of implicit bias towards people of color.³ Thirteen of these articles also identified low to moderate levels of negative associations with Black Americans, indicating implicit negative biases among healthcare professionals. Dietitians and other nutrition professionals are not immune to implicit biases and may be biased by body shape or weight in addition to race and ethnicity.⁴

How can I start to improve Implicit Biases as a Nutrition Professional?

1. First acknowledge that implicit biases do exist and recognize that they can negatively impact the nutrition care provided.
2. Identify your own implicit biases. This is a critical step in improving upon them.
   You can start by self-reflecting on the following:^{4, 5}
   • Does a patient’s skin color, body shape or size, literacy level, gender, sexuality, or income change how I interact with them? Do they in any way impact the quality of care I provide?
   • Do I feel less comfortable with patients who look different than me?
   • Has a patient or co-worker ever provided feedback about biases impacting my treatments?
3. For a deeper dive into your implicit biases, visit the Harvard Project Implicit study for assessments on weight, skin color, religion, ability status, and more. Reflect on how these biases influence your caregiving and continually reassess yourself.
4. Once aware of your biases, educate yourself about these cultures. Pertinent aspects to dietetics may include researching common ingredients used in their culture, dietary restrictions, and cooking and eating practices.⁶
5. Attend seminars and earn continuing education credits to reduce implicit biases and improve cultural competence.
   • US Health and Human Service’s “A Physician’s Practical Guide to Culturally Competent Care” is a free, online, 3-course program to improve treatment for diverse populations.
   • The Academy of Nutrition and Dietetics offers an eBook titled “Cultural Competency for Nutrition Professionals”.
   • Georgetown University’s National Center for Cultural Competence offers a free online module for addressing conscious and unconscious biases in healthcare.

It can be uncomfortable to confront our personal biases. However, we must identify them to improve upon them through education and self-reflection. By doing so, we can provide better healthcare to all patients.

References:

1. Understanding Implicit Biases. (2015). The Ohio State University: Kirwan Institute for the Study of Race and Ethnicity. Retrieved 10 June 2020, from http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/.
2. Handelsman, J., & Sakraney, N. Implicit Bias. Retrieved 8 June 2020, from https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/bias_9-14-15_final.pdf
3. Cultural Competence. (2018). Retrieved 8 June 2020, from https://www.hhs.gov/ash/oah/resources-and-training/tpp-and-paf-resources/cultural-competence/index.html
4. Hall, W., Chapman, M., Lee, K., Merino, Y., Thomas, T., & Payne, B. et al. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal Of Public Health, 105(12), e60-e76. doi: 10.2105/ajph.2015.302903
5. Brown-Riggs, C. (2019). Confronting Implicit Bias — The Key to Equitable Diabetes Care and Outcomes – Today’s Dietitian Magazine. Retrieved 8 June 2020, from https://www.todaysdietitian.com/newarchives/0719p35.shtml
6. NCCC: Bias. Retrieved 8 June 2020, from https://nccc.georgetown.edu/bias/
7. Amidor, T. (2018). Ask the Expert: Counseling Clients From Diverse Cultures – Today’s Dietitian Magazine. Retrieved 8 June 2020, from https://www.todaysdietitian.com/newarchives/0918p10.shtml

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