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  • Clinical Research Article
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A mixed methods study of perceptions of bias among neonatal intensive care unit staff

Pediatric Research volume 93, pages 1672–1678 (2023)Cite this article

Abstract

Background

Inequity in neonatology may be potentiated within neonatal intensive care units (NICUs) by the effects of bias. Addressing bias can lead to improved, more equitable care. Understanding perceptions of bias can inform targeted interventions to reduce the impact of bias. We conducted a mixed methods study to characterize the perceptions of bias among NICU staff.

Methods

Surveys were distributed to all staff (N = 245) in a single academic Level IV NICU. Respondents rated the impact of bias on their own and others’ behaviors on 5-point Likert scales and answered one open-ended question. Kruskal–Wallis test (KWT) and Levene’s test were used for quantitative analysis and thematic analysis was used for qualitative analysis.

Results

We received 178 responses. More respondents agreed that bias had a greater impact on others’ vs. their own behaviors (KWT p < 0.05). Respondents agreed that behaviors were influenced more by implicit than explicit biases (KWT p < 0.05). Qualitative analysis resulted in nine unique themes.

Conclusions

Staff perceive a high impact of bias across different domains with increased perceived impact of implicit vs. explicit bias. Staff perceive a greater impact of others’ biases vs. their own. Mixed methods studies can help identify unique, unit-responsive approaches to reduce bias.

Impact

  • Healthcare staff have awareness of bias and its impact on their behaviors with patients, families, and staff.

  • Healthcare staff believe that implicit bias impacts their behaviors more than explicit bias, and that they have less bias than others.

  • Healthcare staff have ideas for strategies and approaches to mitigate the impact of bias.

  • Mixed method studies are effective ways of understanding environment-specific perceptions of bias, and contextual assets and barriers when creating interventions to reduce bias and improve equity.

  • Generating interventions to reduce the impact of bias in healthcare requires a context-specific understanding of perceptions of bias among staff.

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Fig. 1: Perceived bias in the NICU.

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Data availability

The dataset generated and analyzed during the current study is available from the corresponding author on reasonable request.

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Acknowledgements

We thank all the respondents to our survey without whom this work would not be possible. We acknowledge Isabelle Smith for the initial review and editing of survey responses to maintain anonymity.

Funding

Y.S.F. was supported by AHRQ grant number T32HS000063 as part of the Harvard-wide Pediatric Health Services Research Fellowship Program.

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Authors and Affiliations

  1. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Yarden S. Fraiman

  2. Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA

    Yarden S. Fraiman, Diana Morales, Kristen T. Leeman & Anne R. Hansen

  3. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Yarden S. Fraiman, Kristen T. Leeman & Anne R. Hansen

  4. Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA

    Christine C. Cheston

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Contributions

Y.S.F. conceptualized and designed the study, designed the data collection instruments, completed all analyses, drafted the initial manuscript, and reviewed and revised the manuscript. C.C.C. participated in the qualitative analyses, and critically reviewed and revised the manuscript. K.T.L., and A.R.H., and D.M. designed the data collection instruments, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yarden S. Fraiman.

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Competing interests

The authors declare no competing interests.

Consent to participate

Individuals provided implied written consent by returning the completed optional surveys. No additional consent was required by the Institutional Review Board at Boston Children’s Hospital.

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Fraiman, Y.S., Cheston, C.C., Morales, D. et al. A mixed methods study of perceptions of bias among neonatal intensive care unit staff. Pediatr Res 93, 1672–1678 (2023). https://doi.org/10.1038/s41390-022-02217-2

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