Envisioning Health: Outcome Findings from a Visual Intervention Trial Targeting Implicit Attitudes and Empathy of Healthcare Providers Toward Latino Adolescents

Background and Purpose: Inequities persist for Latino/a Americans and other people of color in access to healthcare, quality of care, and health outcomes.  Across all racial/ethnic groups, Latino/a adolescents are the most likely to not have health insurance coverage.  And, Latino/a youth report high rates of alcohol use, anxiety disorders, asthma, depression, overweight/obesity, poor dental health, teenage pregnancy, and suicidal ideation.  Health disparities among youth are particularly troubling because adolescence is a vulnerable and formative period of development.  A number of factors contribute to health disparities, including the attitudes and behaviors of healthcare providers.  Over half of primary care providers demonstrated biased attitudes toward Latino/a individuals, and research on the connection between biased attitudes and discriminatory treatment by healthcare providers toward Latino/a Americans and other people of color is growing.  Negative attitudes toward certain social groups often exist at the margins of awareness and are not easily accessible to individuals, yet still often influence behavior.  Implicit attitudes often exist outside of conscious awareness and are difficult to consciously acknowledge and control; thus, they require unique interventions.  This study evaluated an intervention with pediatric residents aimed at influencing their empathy, attitudes, and patient-centeredness regarding immigrant Latino/a adolescents. 

Methods: This study used a sequential cohort trial to compare intervention (n = 28) and control (n = 41) groups on the outcomes, which were assessed at post-test.  An innovative, visually-based, multicomponent intervention was delivered to pediatric residents, which used images captured by a photojournalist and Latino/a adolescents in the local community via PhotoVoice.  Outcomes and measures included implicit attitudes toward Latinos/as (Affect Misattribution Procedure), ethnocultural empathy (Scale of Ethnocultural Empathy), empathic healthcare orientation (Jefferson Scale of Physician Empathy), and patient-centeredness (Patient-Practitioner Orientation Scale). 

Results: Among White pediatric residents, there was a marginally significant effect on the dimension of pleasant/unpleasant when participants were primed with images of White and Latino/a people, F(1, 46) = 3.11, p = .09.  Thus, compared to participants in the control group, those who received the intervention associated pleasantness with both White and Latino/a images at a more equal level.  In addition, analysis of scale measures showed that compared to the control group, participants in the intervention group had significantly higher scores on ethnocultural empathy, t(67) = -4.98, p < .001; empathic healthcare orientation, t(67) = -5.80, p < .001; and patient-centeredness, t(67) = -4.59, p < .001.

Conclusions and Implications: A visually-based intervention may influence the implicit attitudes, ethnocultural empathy, empathic healthcare orientation, and patient-centeredness of healthcare providers regarding Latino/a youth and their families.  Implicit racial/ethnic bias is prevalent yet difficult to change because it often exists outside of individuals’ awareness.  Further research is needed to evaluate this intervention using a larger sample and better matched intervention and control groups; however, the current findings suggest that this is a promising intervention approach.