African Americans, compared to European Americans, have a higher prevalence of hypertension and worse blood pressure control. Hypertension requires interaction with the healthcare system for both diagnosis and treatment, yet racial/ethnic minorities use health services less than the European-American majority. Lower use of health services in minority patients is poorly understood, but it has been attributed to factors such racial bias. Social norms have progressed such that overt discriminatory acts, especially in health care, are unacceptable. However, research reveals that racial biases occur implicitly, without intention or awareness, as well as explicitly. To date, interventions have focused on addressing racial bias in physicians. In our NHLBI- funded work, we found that many behaviors contributing to patients'perceived discrimination come, not from the physician, but from non-physician healthcare staff, such as receptionists, medical assistants, and licensed practical nurses. We are unaware of any interventions that aim to increase cultural competency or address racial bias among non-physician healthcare staff. Addressing racial bias in non-physician healthcare staff may help create an environment that increases the staff's cultural competency, reduces patients'perception of discrimination, and improves visit adherence. The goal of this application is to develop and pilot test an internet- facilitated intervention to addrss racial bias in non-physician healthcare staff that will be rigorously tested using future funding, and that, if found effective, can be disseminated for use in primary care and other medical settings.
The specific aims for this pilot project are: 1) To engage an advisory group of non-physician healthcare staff and use participatory research methods to develop a theory-driven, internet-facilitated intervention to address racial bias;2) To pilot test strategies for recruitin non-physician healthcare staff to participate in a randomized trial;3) To pilot test the intervention in 10 groups of non-physician healthcare staff to assess feasibility and acceptability and to pilot assessments of staff cultural competency, patient-reported perceived discrimination, and clinic-reported visit adherence. Guiding this innovative study is a team particularly suited to the task, whose knowledge in community-based interventions, healthcare disparities, social science, and internet interventions provide the necessary expertise to guide and develop an effective intervention. The primary product from this application will be the internet-facilitated intervention. This pilot study will generate the required feasibility data for a R01-funded, group randomized controlled trial, which will be able to assess the effectiveness of the intervention in improving staff cultural competency, reducing patients'perception of discrimination, and improving visit adherence. If successful, this work has the potential to decrease racial disparitie in health outcomes by reducing racial bias in health care and increasing the use of healthcare services by racial/ethnic minorities.

Public Health Relevance

Racial bias in health care contributes to disparities in health outcomes, especially hypertension. Our recent work demonstrates that the behaviors of non-physician healthcare providers contribute to patient perception of discrimination in the healthcare setting, yet most efforts to address racial bias in health care are directed at physicians. This research project will develop an internet-facilitated intervention to address racial bias in non- physician healthcare staff.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Exploratory/Developmental Grants (R21)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Boyington, Josephine
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University of Alabama Birmingham
Internal Medicine/Medicine
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United States
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