Clinical Research Directory

Counter Bias Training Simulation Healthcare

The overall goal of this project was to develop and evaluate Counter Bias Training Simulation (CBTsim) Healthcare - an anti-bias training program that is specific for healthcare professionals. First, a culturally diverse team developed CBTsim Healthcare scenarios based on an extensive review of the literature on healthcare disparities. Then, a randomized control trial was conducted with 91 nurses to test the effectiveness of CBTsim Healthcare. Nurses received approximately 2 hours of baseline testing, then 51 nurses (treatment group) received approximately 3 hours of CBTsim Healthcare training and the other 40 nurses (control group) watched a 90-minute documentary on bias, information which is more typical of current standard practice. Then, all 91 nurses received approximately 2 hours of post-intervention testing. Baseline testing included a demographic questionnaire, a prejudiced belief assessment scale, and three written patient care scenarios in which decisions and communications to the patient were documented. Post-intervention testing included a survey to assess engagement with the training, the same prejudiced belief assessment scale, and three different patient care scenarios. Three months after the intervention participants were surveyed to gather qualitative feedback on beliefs about training effectiveness and how it had impacted patient care. Finally, Press Ganey scores from the hospital (patient satisfaction with nursing care) were analyzed for a 3-month period before the intervention and again after the intervention to try and determine whether the training had a measurable impact on patient care in the hospital.

Effects of Implicit Bias in Clinician Decision-making of Tooth Restorability

This study aims to determine the association between race and clinical decision-making for dental treatment planning. The investigators conducted cross-sectional survey on participants, who are randomized to one of two patient race conditions.

Accountability for Care Through Undoing Racism & Equity for Moms

This project-also known as "Accountability for Care through Undoing Racism \& Equity for Moms" or ACURE4Moms-aims to reduce Black-White maternal health disparities using multi-level interventions designed to decrease bias in prenatal care, improve care coordination, and increase social support. ACURE4Moms is a pragmatic 4-arm cluster randomized controlled trial conducted with 39 prenatal practices across North Carolina. Practices have been randomly assigned to receive either: Arm 1 (Standard Care): North Carolina Medicaid Care management for high-risk pregnancies; Arm 2 (Data Accountability and Transparency): North Carolina Medicaid Care Management + Practice-level Data Accountability interventions; Arm 3 (Community-Based Doula Support): North Carolina Medicaid Care Management + Community-Based Doula support intervention for high-risk patients during pregnancy and postpartum; or Arm 4 (Data Accountability and Transparency + Community-Based Doula Support): North Carolina Medicaid Care Management + Both Arms 2 and 3 interventions. During each practice's 2-year intervention period, the practice will initiate prenatal care for \~750-1,500 patients (up to 60,000 patients total), whose outcomes the investigators will follow and compare between arms until all these patients have reached 1-year post-delivery.

Evaluating Simulation Experiences to Help Navigate Racism and Hidden Bias

This study utilizes a quasi-experimental design to examine the acceptability, usability and impact of the A-CHARM resources including the pre-learning, the SEs and the debrief. Consenting participants will be asked to complete a demographic questionnaire and pre-simulation assessment of cultural humility using the Cultural Humility Scale, and cultural awareness using the Cultural Diversity Awareness Questionnaire. Participants will complete an education intervention that provides definitions of race, racism, and discrimination and provides an overview of the Six-Step Approach, ERASE framework and Microaggression Triangle model. Following the education intervention, they will complete a SE and a post-simulation questionnaire that reassess cultural humility, cultural awareness and the usability and acceptability of the SE.

Virtual Reality to Combat Weight-Based Implicit Bias: BWH Pilot Study

The goal of this pilot implementation study is to evaluate the impact of a virtual reality (VR) intervention on implicit bias for resident physicians. The main question it aims to answer are: Does watching VR experience of two clinical encounters reduce implicit bias association test scores? Is the VR experience an acceptable intervention tool for reducing implicit bias? Researchers will compare weight-based VR experiences consisting of two observed clinical encounters to a neutral education VR encounter to see if our intervention significantly impacts implicit bias association scores. Participants will be asked 1. Complete Implicit Association test for weight-based bias pre-intervention and post-intervention (immediately, at one week, and one month after the intervention) to assess their implicit bias 2. Watch either experimental clinical encounter videos or neutral education video using a VR headset 3. Participants will also complete an abbreviated IAT related to views on compliance

Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT)

Healthcare providers' implicit bias has been identified as a contributor to longstanding health inequities via negative impacts on the patient-clinician relationship and biased delivery of high-quality evidence-based practices (EBP). The implementation of any EBP runs the risk of worsening existing health disparities due to inequitable access, delivery, or benefit of the intervention. Clinician bias can be a critical and unaddressed determinant of implementation for any EBP. Although some implicit bias interventions for healthcare providers are emerging, studies have rarely included mental health professionals. In a previously NIMH funded project, our research team iteratively developed a brief (\~45 minutes), interactive online Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for school mental health clinicians with promising preliminary findings. The current study will test the effectiveness of VIBRANT-an implementation strategy for promoting equitable adoption, penetration, fidelity, and sustainment of EBPs. One highly learnable, efficient, and scalable EBP that is particularly well-suited for the education sector is Measurement-Base Care (MBC)-the systematic collection of patient-reported progress data to inform clinical decision-making. The proposed study aims to (1) evaluate VIBRANT's feasibility to promote equitable adoption, penetration, fidelity, and sustainment of MBC, with a validated, brief, interactive online training for MBC; (2) examine VIBRANT's impact on proximal mechanisms of change including clinicians' implicit bias as well as distal youth mental health outcomes (i.e., symptoms and functioning) with Black and Latinx youth, and (3) assess feasibility of research procedures for a future large-scale efficacy trial.

Measuring Change in Overcoming Implicit Biases in Behavior by Emergency Care Center Providers

Implicit bias is a form of bias in which a person's automatic and unintentional thoughts of another person or group influence either positively or negatively their behavior or the decisions they make. Studies show that healthcare providers have the same amount of bias as any other person and that it can affect patient care. However, in the emergency room, which is fast-paced and there is a high number of patients, implicit bias may be higher. Therefore, this study will look at emergency care center (ECC) providers' willingness to change their implicit bias behaviors. After, it will provide implicit bias education designed for the ECC to the healthcare providers at SMHCS Sarasota campus and assess whether it improved their willingness to change implicit bias behaviors when compared to the providers in the SMHCS Venice campus who did not receive the education.

AI-Augmented Motivational Interviewing Training for Primary Care

This study will examine the impact of training primary care providers (PCPs) in motivational interviewing (MI) using artificial intelligence (AI) to augment the training process. MI is a patient-centered approach to engaging patients in their own care. There will be a control group and two intervention groups, with the intervention groups receiving a different amount of MI training. The hypothesis is that the AI-augmented MI training will result in improved patient outcomes, improved clinician wellbeing, and reduced behavioral manifestation of clinician biases. This mixed-methods project will also collect qualitative data from structured interviews and focus groups with participating PCPs to examine perceived facilitators and barriers to the use of the MI approach in primary care.