Module 5: Respectful Dialogue & Structure of a Conversation

5.2 Understanding Bias

BiasThe Conversations Approach is highly individualized to address the knowledge, beliefs and circumstances of each family. Because it is not a scripted training or a set group of messages in printed materials, it is important to be sure that biases do not affect how families are approached. Sometimes our biases influence how we interact with families.

Everyone has biases. Having biases does not make us bad people. A bias is simply a preference for one thing, person or group over another. For example, thinking one’s own children are cuter, smarter, or more talented than others or believing that one’s spouse’s cooking is the best in the neighborhood are biases. Our biases are typically preferences for things, people, and groups that are familiar and are like us.  Bias becomes a concern when it becomes a prejudice against certain people or groups in ways that are unfair and lead to stereotyping and discrimination.

We may not be aware of our biases. Unconscious or implicit bias is the unintentional activation of prejudicial attitudes towards a group based on stereotypes that have receded from consciousness overtime and have become invisible to the holder. These attitudes represent “overlearned association with a strong affective basis that are difficult to completely overwrite with recent experiences or acquired values.” Such biases result in an automatic and unconscious reaction and/or behavior. In other words, we don’t mean to have these prejudices, and in fact, aren’t really aware of them most of the time—they automatically affect how we view others and how we treat them. 

It may seem strange that people who want to help others may, without realizing it, treat families differently based on their own biases, however there is significant evidence: (1) Health care providers hold stereotypes based on patient race, class, sex, and other characteristics; and (2) These stereotypes influence their interpretations of behaviors and decisions about how to offer treatments and services.

Without realizing it, unconscious bias can lead to assumptions that affect how we approach conversations with diverse groups based on characteristics such as:

  • Age (teen mothers)
  • Race or ethnicity
  • Level of education
  • Ability to speak English
  • Income

It is important to develop an awareness of how biases can potentially affect an individualized approach to families.

Self-Reflection Activity

Since many of these biases are implicit—automatic and not in our awareness—how can we deal with them? Everyone has some biases, so how do we work to assure that all families get the full range of information and support they need. While there are a number of approaches, self-reflection is again a key tool. Consider the following questions:  

Do my biases:

  • Impact the amount of time I spend with patients?
  • Influence how I communicate with patients and their families?
  • Hamper my capacity to feel and express empathy toward my patients?
  • Affect the types of information and recommendations I offer?
  • Affect my expectations about whether families can succeed in carrying out their plans for feeding and sleeping their babies?

Each time you meet a new family, check in with yourself—are you making any assumptions about how the conversation will go? about how likely the family is to accept or implement the recommendations you will share? about how much they will understand of the information you plan to share? See the Handout in the left navigation bar for a checklist for biases in conversations.