Intervention to Reduce Implicit Bias in Pharmacies

NCT06487351 | Not Yet Recruiting

• 1 other identifier: 2024P001326
• Study Type: interventional
• Target: 70
• Locations: 1 country
• Sites: 1

Brief Summary

This study will follow the ADAPT-ITT model to apply the Prejudice Habit Breaking Intervention (PHBI) to pharmacists who have experience with or are willing to prescribe PrEP. We will first collect qualitative data through focus group discussions guided by the Health Equity Implementation Framework (HEIF) on determinants related to the intervention itself, pharmacists, and the community pharmacy context that may impact implementation of the PHBI. Then, we will use this information to adapt the PHBI in an iterative process involving topic experts, pharmacists, and PrEP users. We will then determine the feasibility, acceptability, and preliminary impact of the adapted PHBI to reduce implicit racial bias.

Conditions

Bias, Implicit; HIV; Pre-exposure Prophylaxis

Outcome Measures

Primary Outcomes (5)

• Acceptability of the adapted intervention- Questionnaire

  Acceptability will be assessed in all participants by the Acceptability of Intervention Measure (AIM)

  8 weeks

• Feasibility of the adapted intervention- Questionnaire

  Feasibility will be assessed in all participants by the Feasibility of Intervention Measure (FIM)

  8 weeks

• Feasibility of the adapted intervention- Observed length of recruitment time

  As a measure of feasibility, we will evaluate how many weeks are needed to recruit our desired study sample

  8 weeks

• Feasibility of the adapted intervention- Self-reported video completion

  As a measure of feasibility, we will measure the number strategy videos completed

  8 weeks

• Feasibility of the adapted intervention-Observed retention rate

  As a measure of feasibility, we will measure how many participants complete their final follow-up visit

  8 weeks

Secondary Outcomes (2)

• Reduction of implicit racial bias

  8 weeks

• Concern about discrimination

  8 weeks

Study Arms (2)

The adapted PHBI

EXPERIMENTAL

Participants will complete an online lecture on PrEP care (with a knowledge test), followed by the Medical Cooperativeness IAT and a self-efficacy assessment for mitigating implicit bias. They will then watch a neuroscience-based lecture on implicit bias (30 min, in 5-min modules with comprehension checks). A mindfulness activity and three short videos on anti-bias strategies will follow, with brainstorming exercises. One week later, a 3-hour workshop will include prebriefing, reflection on test scores, mindfulness, rewatching videos, debriefing, role-playing, and a post-intervention self-efficacy assessment. Participants will practice bias-reduction strategies, record their applications in a diary, and provide feedback on usage, effectiveness, and experiences.

Behavioral: The adapted PHBI

NIH Implicit Bias course

ACTIVE COMPARATOR

Control group 1. Participants watch online lecture fundamentals of providing PrEP care (followed by knowledge test) 2. Participants take the medical cooperativeness IAT and self-efficacy for mitigating IB. 3. Participants watch online recorded lecture on implicit bias as described above.

Behavioral: The NIH Implicit Bias course

Interventions

The adapted PHBI BEHAVIORAL

The adapted intervention is expected to be an online 60-minute video with an educational part about implicit racial bias, its consequences in healthcare inequalities, how to mitigate it, and seven case scenarios (5 minutes each) to train pharmacy interns on aspects related to cultural competency and how and when to use IBMS to reduce the impact of bias on prescribing PrEP for people of color.

The adapted PHBI

The NIH Implicit Bias course BEHAVIORAL

The NIH Implicit Bias course consists of three modules designed to teach users what bias is, how to recognize it, and how to minimize its impact

NIH Implicit Bias course

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Three types of participants will be included
• Pharmacy interns:
• Pharmacy intern (non-licensed individual undergoing training and preparations for licensure examination).
• Currently registered as a regular student in the School of Pharmacy, Bouvé College of Health Sciences at Northeastern University, Boston, MA.
• Doing the internship in pharmacies located in cities with the highest average annual rate of HIV infection diagnosis in Suffolk County, MA.
• Experience with PrEP (counsel PrEP candidates, complete PrEP continuing education activity, or awareness with current CDC guidelines on PrEP use) OR willingness to prescribe PrEP in the future (will be measured with one Yes/No question: "Are you willing to prescribe PrEP in the future?)
• Moderate to high preference for White people as measured by the Implicit Association Test.
• Pharmacy managers
• Defined as an individual designated by a pharmacy owner to manage a pharmacy.
• Pharmacy managers of pharmacies located in the same areas described above.
• Pharmacy policymaker defined as official employee of the Boards of Registration in Pharmacy whose role is directly related to community pharmacy practice (e.g., director of pharmacy compliance).

You may not qualify if:

• Inability to provide consent (e.g., intoxication), unwillingness to provide consent

Sponsors & Collaborators

• Massachusetts General Hospital: lead

Study Sites (1)

Massachusetts General Hospital

Boston, Massachusetts, 02114, United States

Location

Related Publications (15)

• Devine PG, Forscher PS, Austin AJ, Cox WT. Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. J Exp Soc Psychol. 2012 Nov;48(6):1267-1278. doi: 10.1016/j.jesp.2012.06.003.

  PMID: 23524616 BACKGROUND

• Woodward EN, Matthieu MM, Uchendu US, Rogal S, Kirchner JE. The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment. Implement Sci. 2019 Mar 12;14(1):26. doi: 10.1186/s13012-019-0861-y.

  PMID: 30866982 BACKGROUND

• Wingood GM, DiClemente RJ. The ADAPT-ITT model: a novel method of adapting evidence-based HIV Interventions. J Acquir Immune Defic Syndr. 2008 Mar 1;47 Suppl 1:S40-6. doi: 10.1097/QAI.0b013e3181605df1.

  PMID: 18301133 BACKGROUND

• Wingood GM, Dunkle K, Camp C, Patel S, Painter JE, Rubtsova A, DiClemente RJ. Racial differences and correlates of potential adoption of preexposure prophylaxis: results of a national survey. J Acquir Immune Defic Syndr. 2013 Jun 1;63 Suppl 1(0 1):S95-101. doi: 10.1097/QAI.0b013e3182920126.

  PMID: 23673895 BACKGROUND

• Crawford ND, Myers S, Young H, Klepser D, Tung E. The Role of Pharmacies in the HIV Prevention and Care Continuums: A Systematic Review. AIDS Behav. 2021 Jun;25(6):1819-1828. doi: 10.1007/s10461-020-03111-w. Epub 2021 Jan 2.

  PMID: 33386509 BACKGROUND

• McCree DH, Byrd KK, Johnston M, Gaines M, Weidle PJ. Roles for Pharmacists in the "Ending the HIV Epidemic: A Plan for America" Initiative. Public Health Rep. 2020 Sep/Oct;135(5):547-554. doi: 10.1177/0033354920941184. Epub 2020 Aug 11.

  PMID: 32780671 BACKGROUND

• Tung EL, Thomas A, Eichner A, Shalit P. Implementation of a community pharmacy-based pre-exposure prophylaxis service: a novel model for pre-exposure prophylaxis care. Sex Health. 2018 Nov;15(6):556-561. doi: 10.1071/SH18084.

  PMID: 30401342 BACKGROUND

• Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, Eng E, Day SH, Coyne-Beasley T. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health. 2015 Dec;105(12):e60-76. doi: 10.2105/AJPH.2015.302903. Epub 2015 Oct 15.

  PMID: 26469668 BACKGROUND

• Avant ND, Weed E, Connelly C, Hincapie AL, Penm J. Qualitative Analysis of Student Pharmacists' Reflections of Harvard's Race Implicit Association Test. Curr Pharm Teach Learn. 2018 May;10(5):611-617. doi: 10.1016/j.cptl.2018.02.002. Epub 2018 Mar 13.

  PMID: 29986821 BACKGROUND

• Cox WTL. Developing scientifically validated bias and diversity trainings that work: empowering agents of change to reduce bias, create inclusion, and promote equity. Manag Decis. 2023 Apr 17;61(4):1038-1061. doi: 10.1108/md-06-2021-0839. Epub 2022 Sep 5.

  PMID: 37090785 BACKGROUND

• Forscher PS, Lai CK, Axt JR, Ebersole CR, Herman M, Devine PG, Nosek BA. A meta-analysis of procedures to change implicit measures. J Pers Soc Psychol. 2019 Sep;117(3):522-559. doi: 10.1037/pspa0000160. Epub 2019 Jun 13.

  PMID: 31192631 BACKGROUND

• Lateef F. Simulation-based learning: Just like the real thing. J Emerg Trauma Shock. 2010 Oct;3(4):348-52. doi: 10.4103/0974-2700.70743.

  PMID: 21063557 BACKGROUND

• Zhao A, Dangerfield DT 2nd, Nunn A, Patel R, Farley JE, Ugoji CC, Dean LT. Pharmacy-Based Interventions to Increase Use of HIV Pre-exposure Prophylaxis in the United States: A Scoping Review. AIDS Behav. 2022 May;26(5):1377-1392. doi: 10.1007/s10461-021-03494-4. Epub 2021 Oct 20.

  PMID: 34669062 BACKGROUND

• Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, Boynton MH, Halko H. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017 Aug 29;12(1):108. doi: 10.1186/s13012-017-0635-3.

  PMID: 28851459 BACKGROUND

• Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998 Jun;74(6):1464-80. doi: 10.1037//0022-3514.74.6.1464.

  PMID: 9654756 BACKGROUND

MeSH Terms

Conditions

Bias, Implicit

Condition Hierarchy (Ancestors)

Prejudice; Social Behavior; Behavior

Central Study Contacts

Jessica Haberer

CONTACT

4086053500; jhaberer@mgb.org

Abubaker I Saeed

CONTACT

6177085285; aisaeed@mgh.harvard.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Open label
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Medicine

Model Details: Pharmacy intern participants will be randomized 1:1 using permuted block and stratified by gender and race/ethnicity to the adapted intervention or control group. Participants will be notified after consent.

Study Record Dates

• First Submitted: June 27, 2024
• First Posted: July 5, 2024
• Study Start (Estimated): July 1, 2027
• Primary Completion (Estimated): January 1, 2029
• Study Completion (Estimated): July 1, 2029
• Last Updated: November 12, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)