Healthcare Provider Implicit Bias Training to Improve the Sexual and Reproductive Healthcare of Women with Disability - Abstract Sexual and reproductive health is essential to the overall health of all women. Nevertheless, the nearly six million women, adolescents, and girls with disability must endure environmental and attitudinal barriers, and ill-informed systems of care to receive this crucial healthcare. Healthcare provider disability bias results in a lack of education around sexual and reproductive health topics, denial of contraceptive care, and missed diagnoses leading to poorer and sometimes fatal health outcomes. Moreover, women at the intersection of disability and other underserved populations (race/ethnicity, rurality, sexual orientation and gender identity, immigration status), experience even greater attitudinal barriers and discrimination in healthcare settings. These enduring stigmas, fragmented and incomplete sexual and reproductive health information and care, and a lack of accessible and targeted training for healthcare providers have substantially diminished sexual and reproductive healthcare quality and access for women with disability. However, improving patient-centered and culturally responsive care by bringing awareness to and mitigating implicit bias is critical to reducing health disparities related to disability stigma and inequitable care environments. The proposed project aims to close these gaps in health equity by developing and piloting an implicit bias training that will support and educate clinicians and healthcare providers as they navigate sexual and reproductive healthcare with female patients with disability. The training will be adapted from an existing implicit bias training to be specific to the unique experiences of women with disability and women at the intersection of disability and other underserved populations. In my previous work, focus groups of diverse women with disability identified deficiencies and differences in their care related to disability stigma and bias from providers. The constructs that arose from the data, as well as the conceptual model that was developed, will be used to guide the development of the training. The two-hour implicit bias training will be held in-person and virtually. The virtual trainings will help ensure that providers who serve more diverse patients are able to participate, such as providers in rural settings. Healthcare providers will be recruited through the University of Washington School of Medicine and Department of Rehabilitation Medicine, and through the American Occupational Therapy Association Preferred Provider Program. Program outcomes will be measured prior to engaging in the training and again at the conclusion of the training, and include self-perceived implicit bias, and self-efficacy for providing care to women with disability. Two disability item banks developed in the previous study (sexual health and sexual self-efficacy) will be disseminated to providers during the training. These item banks can help facilitate difficult conversations with patients, and help providers have a better understanding of the unique needs and experiences of their patients with disability. A program evaluation will be conducted through qualitative (focus groups) and quantitative methods to assess effectiveness of training and utility of item banks in practice. The anticipated results of the proposed study are that providers will reduce their self-perceived implicit bias towards patients with disability and intersecting identities, and improve their self-efficacy for providing care for this population. It is also anticipated that participants will provide helpful feedback that can be used to improve future iterations of this implicit bias training. By examining their own implicit bias, understanding the structural biases present in their institutions, and transforming their beliefs and behaviors, clinicians will be able to provide the most equitable care for their patients with disability. It is my hope that the proposed training will change clinical practice, inform
