Members of the Lesbian, Gay, Bisexual, Transgender, Queer, and other (LGBTQ+) community are more prone to experience discrimination than the general population based on their sexual orientation or gender identity. In healthcare, examples include assumptions about heterosexuality, homophobic/transphobic attitudes or comments, or neglecting the specific needs of LGBTQ+ patients. This discrimination results in poor patient- provider communication, delays in care-seeking, care inequities, and health disparities. Often such discrimination is due to implicit biases that are unintentional, and thus ?hidden? in patient-provider communication, yet linked with negative healthcare experiences associated with inadequate care and lack of provider knowledge about LGBTQ+ health care needs. The resulting health disparities are demonstrated by the LGTBQ+ community having greater susceptibility to mental health issues, higher rates of substance use, and poorer diet and exercise behaviors than the general population. As we argue in the parent grant, there is a dire need to address health disparities by understanding and mitigating implicit bias that manifests within the interactions between patients and providers. To expand our parent grant focus on low income, racially diverse patients, this diversity supplement focuses on LGBTQ+ people. Following the same study design as Aim 2 of the parent grant, the proposed project will engage LGBTQ+ patients and primary care providers to design communication feedback that conveys hidden bias. The proposed project will engage LGBTQ+ patients and primary care providers in three aims to (1) assess needs for communication feedback on implicit bias, (2) co-design prototype feedback, and (3) and iteratively refine prototype feedback through usability testing. Project findings will extend the parent grant by providing design evidence from a second critical patient population known to experience implicit healthcare biases that lead to health disparities. In addition to advancing our understanding of implicit bias as a barrier to patient-centered communication for LGBTQ+ people, this evidence will contribute to more robust models and automated tools for assessment and feedback being developed in the parent grant.
Implicit bias contributes to poor communication between primary care providers and patients who identify as Lesbian, Gay, Bisexual, Transgender, Queer and others (LGBTQ+), resulting in health disparities. In an investigation of implicit bias that is hidden in patient-provider communication, this project engages LGBTQ+ patients and primary care providers to design communication feedback that raises awareness of hidden bias in patient-provider interactions. Needs assessment, co-design, and usability studies with LGBTQ+ people will augment our understanding of implicit bias with a broader representation of health disparity groups and inform more robust and inclusive tools for enhancing patient-centered communication.
