Molly Higgins and Rachel Keiko Stark April 18, 2018 Working on Ourselves: Mitigating Unconscious Bias in Literature Searching Molly Higgins and Rachel Keiko Stark April 18, 2018

Disclaimers I am not here representing the Congressional Research Service, and the views expressed herein are my own and are not presented as those of the Congressional Research Service or the Library of Congress. - Molly Higgins The information presented here represents my personal views and does not reflect the views of the California State University, nor the views of the California State University, Sacramento – Rachel Keiko Stark

Speaking of Bias… As medical librarians, we have bias and tend to incorporate a lot of jargon into our everyday lives (and presentations) If something is too health science-y, please do let us know in the chat box! We developed this workshop drawing on our backgrounds as Health Sciences Librarians, but we want this information to be accessible to all kinds of librarians. If you have any questions, please don’t hesitate to ask them in the chat box.   And finally, we'd like to make it clear that we're talking about unconscious bias as it relates to race, ethnicity, and the health sciences today. We absolutely recognize that this is an important topic for other areas of librarianship, as well as other people who experience health disparities, the LGBTQ community for example, but we've got forty minutes, so our focus is relatively narrow today.

What is unconscious bias? Rachel: Let's take a minute to define a few terms. Molly, what is racism?   Molly: Racism is a huge force that relies not just on personal prejudice but also on the power of institutions like the law to create structural inequalities. Health disparities are one way that racism operates. Racism can also be a pretty charged thing to discuss. No one likes being called a racist right? It’s a good way to make someone defensive, whether or not they’re acting in a way that’s racist...Rachel, what are microaggressions? Rachel: Microagressions are a way of talking about problematic behavior, without straight up calling someone a racist. These are generally small, everyday occurrences that people may do without any malicious or intent, but still have negative consequences, like asking an Asian American what country they’re really from. But what does that have to do with implicit bias? Molly: Right, because today, we’re talking about implicit or unconscious bias. Even if none of us think of ourselves as racist, we take in all kinds of messages from everywhere-- books, music, TV, and other people. Implicit bias are all the attitudes and stereotypes that we absorb, positive and negative, and then act on involuntarily. The goal of today’s webinar is to talk about how to recognize these biases, so that we can control the ways that we act on them. What is unconscious bias?

Activity: reflecting on interpersonal bias MOLLY: We're going to do a quick activity. Grab something to write on, and write down any assumptions people make about you, or bias you’ve experienced. For instance, I look very young. So young that people often assume that I'm not qualified to do my job. I've had patrons ask if I'm really qualified to help them, or told me, to my face, that they would prefer to wait for a "real librarian to help them". Take a minute, write down anything that comes to you, and if you feel comfortable, you can share it in the chat box. Now let's flip from thinking about our own experiences to thinking about other people's experiences. Let's spend some time reflecting on how aware we are of our surroundings and whether we are ready to support coworkers and patrons. Take a minute to think about if you’ve seen coworkers or patrons experience the bias that people shared in the chat box.   Activity: reflecting on interpersonal bias 

LIS Microagressions Zine Volume 1. Issue 2. You can also take a minute to see other peoples' experiences with microaggressions in libraries in this zine: https://www.dropbox.com/s/1u2mf18p6kfi7ne/LISMicroaggressions%20-%20Volume%201%2C%20Issue%202.pdf?dl=0   Feel free to share your experiences and questions in the chat box.

Exploring Bias Recommended Reading: Take the test: https://implicit.harvard.edu/implicit/takeatest.html Recommended Reading: Blindspot: Hidden Biases of Good People http://www.worldcat.org/oclc/907922915 In our live workshops, which are usually longer than 40 minutes, we often ask participants to use their phones or computers to take the implicit bias test. We’re not going to do that today. But we are going to give you the link (https://implicit.harvard.edu/implicit/takeatest.html) if you’d like to take it on your own later.   If you’ve never heard of the test, the idea is that through a series of rapid matching tasks, you can test your positive and negative associations of certain populations. If you really want to dig deep into how the test works and why, the test’s creators have written a book on it (https://www.amazon.com/Blindspot-Hidden-Biases-Good-People/dp/1491528869), a Worldcat link to this book

How Does unconscious bias affect libraries? MOLLY : Thinking about bias and interpersonal interactions is one way to approach the issue. We also want to take some time addressing where bias exists in library systems. In our work as medical librarians, we've come across a lot of literature on the way that bias operates in medical research. How Does unconscious bias affect libraries?

Racial Disparities in Medicine Why America’s Black Mothers and Babies are in a Life-or-Death Crisis. Villarosa, 2018 Serena Williams on Motherhood, Marriage, and Making Her Comeback. Haskell, 2018 Disparities in maternal and child death are linked to racism in health systems and living environment, not the behavior of individuals MOLLY: About a week ago, the New York Times Magazine ran a piece on why black mothers and their children die in and around childbirth at rates so much higher than women and children of other races. These disparities cut across education, socioeconomic status, whether a woman takes her prenatal vitamins. These disparities are caused by unequal healthcare and the stresses of living in a racist society. That's our current research's best guess.   We've linked to that article, as well as Serena Williams' story of her own postpartum care. Here's a talented, rich, successful, famous black woman, and she still can't get her doctors to take her pain and postpartum complications seriously. The next slide is full of even more examples of documented medical disparities, linked to the articles themselves. You'll be able to download a copy of our presentation from the NCLA website, so don't worry about trying to capture all of these articles here.

Bias in Medical Research Black patients are less likely to be screened for pain than white patients. Burgess et al., 2013 Hispanics with traumatic brain injuries are less likely to be referred to rehab than white patients. Budnick, Tyroch, and Milan, 2017 Carbamazepine, a common seizure medication, can damage the skin and internal organs of many Asians and Asian Americans. Ferrell and McLeod, 2009 Clopidogrel, a blood thinner commonly sold as Plavix, is ineffective in 75% of Pacific Islanders. Mega et al., 2011 All people of color are underrepresented in clinical trials. Bichell, 2015 MOLLY: So, what does that have to do with us as librarians? We believe that we have the power to help medical professionals and patients find the research they need, and encourage researchers to be more inclusive in their research. And that's why our next activity will be about practicing finding hard to find information to help patients. Rachel: Like Molly mentioned, this next exercise explores bias in research. We’re going to put up a hypothetical request from a hypothetical library patron. Read the scenario, then spend a few minutes writing up your search strategy. Include what databases you would search, what search terms you would use, and if you would suggest the patron consult any specific resources. This is just planning. You don’t need to actually search yet. You have five minutes to read and plan your search strategy. Do your best. Even if you're not a medical librarian, or someone who answers reference questions like these.

Scenario A second year internal medicine resident has a patient who has just been diagnosed with Type 2 diabetes. The resident has asked you to run a search to help them find literature on how to best speak to the patient about behavioral modifications such as making healthier food choices and increasing physical activity. The patient is Vietnamese American female in her 60’s who lives with her husband and eldest daughter.

Possible Strategies Databases? Terms? Other tricks?

Possible Strategies Databases Terms PubMed, CINAHL, Scopus, Web of Science Terms Asian American/Southeast Asian AND American/Vietnamese American Diabetes/Type II diabetes Diet/food/meal planning/lifestyle intervention/management Patient education

Culturally diverse health information Ethnomed https://ethnomed.org/ SPIRAL: http://spiral.tufts.edu/ Medline Plus: https://medlineplus.gov/  NNLM: https://nnlm.gov/mar/guides/multicultural https://nnlm.gov/sea/guides/tn/specpops https://nnlm.gov/class/omhrc2017 https://americanindianhealth.nlm.nih.gov/subtopic/5/Research-Data/63/Resources

Ethnomed.org

Spiral.Tufts.edu

Questions? Molly Higgins mhiggins@crs.loc.gov Rachel Keiko Stark, MS, AHIP stark@csus.edu Questions?

Further Reading Library Sciences Is Your Librarian Racist? Misra, 2018 Missed Connections: What Search Engines Say About Women. Noble, 2012 Soliciting Performance, Hiding Bias: Whiteness and Librarianship. Galvan, 2015 “This Actually Happened”: An Analysis of Librarians’ Responses to a Survey About Racial Microagressions. Alabi, 2015 Trippin' Over the Color Line: The Invisibility of Race in Library and Information Studies. Honma, 2005 White Librarianship in Black Face: Diversity Initiatives in LIS. Hathcock, 2015

Further Reading Health Sciences Exploring Unconscious Bias in Disparities Research and Medical education. van Ryan and Saha, 2011 Structural Racism and Supporting Black Lives - The Role of Health Professionals. Hardeman, Medina, and Kozhimannil, 2016 Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here? Blair, Steiner, and Havranek, 2011 A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making. Dehon, Weiss, Jones, Faulconer, Hinton, and Sterling, 2017 Other Sciences Consciously combating unconscious bias. Kuo, 2017