Understanding Healthcare Students' Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings.

Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.

Disparate healthcare experiences of people living with overweight or obesity in England.

BACKGROUND: Ensuring that patients have high quality, equitable experiences in healthcare is a high priority in the UK. As such, identifying and addressing areas where patient experiences are unsatisfactory and inequitable is of high priority, and has been included as part of the National Health Service (NHS) England equity objectives. METHODS: The healthcare experiences of people who identified as living with overweight or obesity were gathered from freely available websites using the Patient Experience Platform (PEP). PEP was used to gather and analyse all comments from NHS UK, Google, Facebook and Twitter that related to care experiences of people who identified as living with overweight or obesity across all NHS Acute and Specialist Trusts and all general practitioners (GPs) in England from 01/01/2018 to 31/12/2020. These healthcare experiences were analysed to provide care quality metrics, a comparison of care across regions of England, and to explore associations between behavioural clusters of personality attributes, values and sentiment with care quality metrics. FINDINGS: Perceptions of the quality of care were significantly lower for people who identified as living with overweight or obesity compared to people who didn't identify as living with overweight or obesity across all regions for 'Effective Treatment' and 'Emotional Support'. The perceived quality of care metrics can be predicted by the behavioral clusters, where for instance, the experiences of people who identified as living with overweight or obesity in the negative behavioral cluster have a lower overall perceived quality of care score. Themes arising from the data also highlighted that barriers quality care experienced by people who identified as living with obesity include the speed of access, effective treatment, and emotional support, with stigmatising healthcare experiences are reported. INTERPRETATION: The findings of this study provide insights into the experiences reported via freely available websites, of people who self-identified as living with overweight or obesity in healthcare in England. These insights demonstrate that the perceived quality of care was lower for people who identified as living with overweight or obesity compared to the general population, and that there is regional variation in care quality. The study has also shown that patient experiences differ based on personality attributes, values and sentiment, highlighting the need for patient-centred care and personalised approaches. These findings hold important considerations for healthcare and policy makers aiming to address healthcare inequity.

A mixed-method analysis of the #SugarTax debate on Twitter.

OBJECTIVE: To explore the #SugarTax debate on Twitter to assess actors involved, their connections and the topics being discussed during the implementation and first anniversary of the UK Soft Drink Industry Levy. DESIGN: The structure of the #SugarTax debate on Twitter was assessed using social network analysis. The actors involved, their connections and the topics of discussion taking place were also explored using content, sentiment and thematic analyses. SETTING: Twitter between 2017 and 2019. PARTICIPANTS: Twitter users engaging in discussions relating to the hashtag 'SugarTax'. RESULTS: Tweets (n 5366) posted between 5 August 2017 and 7 May 2019 containing #SugarTax were downloaded from Twitter using Network Overview for Discovery and Exploration in Excel. The network included 1883 users, with 686 unique edges and 4679 edges with duplicates. The majority of tweets were negative in sentiment, when assessed by both automatic (64 %, n 141) and manual sentiment analysis (52 %, n 115) methods. Nine key themes were identified and grouped into two groups according to 'support for a sugar or SSB tax' or 'opposition for a sugar or SSB tax'. CONCLUSIONS: Twitter was used as a platform for debating the benefits and limitations of sugar-sweetened beverage taxes. The findings indicate that numerous actors are involved in the debates on Twitter, with advocates and lobbyists using the platform to raise support for their campaigns and reshape public perceptions. The findings and the methods used may be of interest to policymakers as well as to academics and members of the public looking to explore and engage in policy debates.

Cross-sectional analysis to explore the awareness, attitudes and actions of UK adults at high risk of severe illness from COVID-19.

OBJECTIVES: This study explored the impact of COVID-19 on people identified as at high risk of severe illness by UK government, and in particular, the impact of lockdown on access to healthcare, medications and use of technological platforms. DESIGN: Online survey methodology. SETTING: UK. PARTICIPANTS: 1038 UK adults were recruited who were either identified by UK government as at high risk of severe illness from COVID-19 or self-identified as at high risk with acute or other chronic health conditions not included in the UK government list. Participants were recruited through social media advertisements, health charities and patient organisations. MAIN OUTCOMES MEASURES: The awareness, attitudes and actions survey which explores the impact of COVID-19, on including access to healthcare, use of technology for health condition management, mental health, depression, well-being and lifestyle behaviours. RESULTS: Nearly half of the sample (44.5%) reported that their mental health had worsened during the COVID-19 lockdown. Management of health conditions changed including access to medications (28.5%) and delayed surgery (11.9%), with nearly half of the sample using telephone care (45.5%). Artificial Intelligence identified that participants in the negative cluster had higher neuroticism, insecurity and negative sentiment. Participants in this cluster reported more negative impacts on lifestyle behaviours, higher depression and lower well-being, alongside lower satisfaction with platforms to deliver healthcare. CONCLUSIONS: This study provides novel evidence of the impact of COVID-19 on people identified as at high risk of severe illness. These findings should be considered by policy-makers and healthcare professionals to avoid unintended consequences of continued restrictions and future pandemic responses.

An exploration of the portrayal of the UK soft drinks industry levy in UK national newspapers.

OBJECTIVE: News media play a role in politics through the portrayal of policies, influencing public and policymaker perceptions of appropriate solutions. This study explored the portrayal of sugar and sugar-sweetened beverage (SSB) taxes in UK national newspapers. Findings aid understanding of the role newspapers play in shaping understanding and acceptance of policies such as the UK Soft Drink Industry Levy (SDIL). DESIGN: Articles discussing sugar or SSB taxes published in six UK national newspapers between 1 April 2016 and 1 May 2019 were retrieved from the LexisNexis database. Articles were thematically analysed to reveal policy portrayal. SETTING/PARTICIPANTS: Analysis of UK newspaper articles. RESULTS: Two hundred and eighty-six articles were assessed. Sugar and SSB taxes were discussed across the sample period but publication peaked at SDIL announcement and introduction. Themes were split according to support for or opposition to taxation. Supportive messaging consistently highlighted the negative impacts of sugar on health and the need for complex actions to reduce sugar consumption. Opposing messages emphasised individual responsibility for health and the unfairness of taxation both for organisations and the public. CONCLUSIONS: Sugar and SSB taxes received considerable media attention between 2016 and 2019. All newspapers covered arguments in support of and opposition to taxation. Health impacts of excess sugar and the role of the soft drink industry in reducing sugar consumption were prevalent themes, suggesting a joined-up health advocacy approach. Industry arguments were more varied, suggesting a less collaborative argument. Further research should investigate how other media channels portray taxes such as the SDIL.

Seven-year itch: the UK Government's difficult relationship with the food and drink industry since Healthy Lives, Healthy People: A Call to Action on Obesity in England (2011).

OBJECTIVE: Unhealthy food and drink consumption is associated with a range of physical and mental health concerns. In response, public health policies have been developed targeting a reduction in obesity in particular. In the present commentary we argue that government-industry partnerships have reduced the effectiveness of resultant policies and explore why. DESIGN: Perspectives of authors. SETTING: UK.ParticipantsPopulations in the UK; UK Government. RESULTS: Industry involvement has presented three interrelated challenges for the UK Government: (i) balancing collaboration while maintaining appropriate distance from industry stakeholders; (ii) resultant production of 'watertight' and effective legislation or intervention; and (iii) actual or perceived limited sanctioning or bargaining power. CONCLUSIONS: Industry involvement in public health policy making has led to weak action. Support with policy implementation (rather than development) and genuine 'buy-in' from industry could accelerate the pace of public health improvement.