Racial Bias Across Practitioner Training Programmes in Aotearoa

Abstract

In Aotearoa New Zealand, socially constructed racial hierarchies privilege New Zealand (NZ) Europeans whilst positioning Māori as the marginalised and oppressed group. Consequently, Māori are subjected to greater racial discrimination and poorer health outcomes than any other ethnic or racial group in New Zealand. Less recognised is how individuals’ implicit racial biases can maintain or potentially exacerbate the health disparities between Māori and NZ Europeans. Internationally, there is growing evidence of implicit racial biases contributing to health care outcomes; however, there is scant research within New Zealand. The primary aim of this study was to explore the level of implicit racial bias towards NZ Europeans and Māori amongst clinical students and healthcare workers in New Zealand. The study also aimed to determine how explicit (i.e., self-reported) racial bias compares with implicit (i.e., unconscious or automatic) racial bias. Furthermore, how implicit and explicit racial bias towards Māori and NZ Europeans varies by clinical programme type, training status and occupation were examined. A web-based survey was conducted to explore implicit and explicit racial bias towards Māori and NZ Europeans. There were three sections to the web-based survey: 1) basic demographic information, 2) explicit racial bias questionnaire and 3) implicit racial bias task. The Go/No-go Association Task (GNAT) was utilised to measure implicit racial preference and implicit racial compliance in relation to NZ Europeans and Māori. The GNAT is a categorisation task measuring automatic associations which indexes implicit biases. New Zealand registered healthcare workers and clinical students from medicine, nursing, psychology, social work or a relevant programme were invited to participate. A total of 143 participants (76 clinical students and 67 healthcare workers) completed the study. Analyses revealed that clinical students and healthcare workers held a more implicit preference for NZ Europeans compared to Māori and an implicit bias for NZ Europeans as compliant and Māori as reluctant. For explicit racial bias, clinical students and healthcare workers both rated Māori and NZ Europeans as equal in preference. Both groups rated Māori as being higher in warmth, liking, sincerity and tolerance. Healthcare workers rated Māori to be more intelligent than NZ Europeans, while clinical students reported both as being equally intelligent. Māori and NZ Europeans were equal for competence, compliance and reliability in both clinical students and healthcare workers. For personal comfort, healthcare workers rated personal comfort higher for NZ Europeans than Māori, but clinical students found personal comfort to be equal. Clinical students rated NZ Europeans to be higher in motivation than Māori, while healthcare workers rated motivation as equal. Both groups rated confidence and personal competence higher for NZ Europeans than Māori. Clinical students and healthcare workers demonstrated a weak correlation between implicit and explicit racial preference variables towards Māori. Clinical students and healthcare workers also demonstrated a weak correlation between implicit and explicit racial preference variables towards NZ Europeans. Regarding the correlation between implicit and explicit racial compliance, both clinical students and healthcare workers demonstrated a weak correlation, which was revealed for bias towards both Māori and NZ Europeans. Medical students revealed a greater implicit bias for Māori as compliant than nursing students, whilst psychology students demonstrated greater implicit bias for Māori as reluctant compared to nursing students. Students' clinical training/placement status showed no significant differences (pretrained vs. training/completed). When compared by occupation, healthcare workers implicitly associated all comparisons of NZ Europeans and Māori with compliance and reluctance attributes more quickly than clinical students, but implicit preference did not vary by occupation. This is the first study in New Zealand to examine the level of implicit racial bias in both clinical students and healthcare workers. The main findings revealed that clinical students and healthcare workers both hold more positive implicit biases towards NZ Europeans than Māori, yet they explicitly report as having equal preference towards NZ Europeans and Māori. Further research is necessary to determine whether having implicit racial biases will translate into real-life behaviour.