# Unveiling the role of physician implicit bias and communication behaviors in dissatisfaction, mistrust, and nonadherence in Black patients with Type 2 diabetes

> **NIH NIH R01** · VIRGINIA COMMONWEALTH UNIVERSITY · 2020 · $391,440

## Abstract

Patient-physician racial discordance is strongly associated with patient dissatisfaction and mistrust in
physicians, which is further associated with poor treatment adherence and suboptimal healthcare utilization.
This poses serious public health challenges because approximately 80-90% of Black patients see physicians
from different racial groups. Patient dissatisfaction and mistrust have been recently found to be particularly
magnified when physicians hold high levels of automatic, implicit bias toward Black Americans, suggesting that
physicians’ implicit racial bias impacts physician communication behaviors during medical interactions and
ultimately Black patient outcomes. The overall goal of this research is to identify physicians’
communication behaviors during medical interactions that are associated with physicians’ implicit
racial bias and Black patients’ immediate (satisfaction, trust) as well as clinically important longer-term
outcomes (adherence, healthcare utilization). To achieve this goal, we target medical interactions involving
Black patients with Type 2 diabetes mellitus (T2DM) because nonadherence in Black patients with T2DM is
particularly prevalent. Additionally, the patient-physician communication quality has been found to predict
patient adherence to T2DM treatment regimens. We will use a mixed-methods design that integrates the
strengths of inductive reasoning to explore which physicians’ communication behaviors during medical
interactions matter from Black patients’ perspectives and deductive reasoning to identify theoretically and
clinically important behaviors. Our aims are: Aim 1) to explore which physician communication behaviors
during medical interactions are perceived negatively or positively by Black patients and why; Aim 2) to identify
which physician communication behaviors identified in Aim 1 are associated with physicians’ implicit racial
bias; and Aim 3) to examine how physicians’ implicit racial bias impacts Black patients’ satisfaction, trust,
adherence, and healthcare utilization through physicians’ communication behaviors. We will use an innovative
integration of multiple methods (interviews, video-recorded medical interactions, surveys, medical record
reviews). Findings from this research will enable researchers to identify physician communication behaviors
during medical interactions that are problematic and beneficial to the immediate and longer-term outcomes
among Black patients with T2DM. Such an ability is needed to develop personally-tailored, targeted
communication skills training and other interventions targeting patient-provider interactions to overcome racial
disparities in diabetes treatment adherence, outcomes, and beyond. Additionally, upon completion of this
project, we will have a Medical Interaction involving Black Patients Coding System (MIBPCS) that differs from
prior patient-physician communication coding systems in that it: (1) will focus on physicians’ communication
behaviors during m...

## Key facts

- **NIH application ID:** 9978059
- **Project number:** 5R01DK112009-04
- **Recipient organization:** VIRGINIA COMMONWEALTH UNIVERSITY
- **Principal Investigator:** Nao Hagiwara
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $391,440
- **Award type:** 5
- **Project period:** 2017-07-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9978059

## Citation

> US National Institutes of Health, RePORTER application 9978059, Unveiling the role of physician implicit bias and communication behaviors in dissatisfaction, mistrust, and nonadherence in Black patients with Type 2 diabetes (5R01DK112009-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9978059. Licensed CC0.

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