Stop the Stigma! Eliminating Implicit and Explicit Bias Toward Adult Obese Women Receiving Gynecological Care: A Quality Improvement Project to Cultivate Empathy and Increase Knowledge of Best Practices

Abstract

Background: Increased weight carries significant health risks, yet obese individuals face stigma, implicit and explicit bias by health care providers that affects quality of care and increases health care avoidance. Obese women may delay or avoid gynecological care due to fear of stigma, inadequate equipment and embarrassment about their weight. Review of Literature: In the United States, 70.7% of adults, almost three quarters of the adult population are overweight or obese. Purpose: The purpose of this quality improvement project was to improve the quality of care and empathy toward obese women by health care providers in an OB/GYN practice through education about the experiences of obese women who receive healthcare and provision of resources within OB/GYN practices. Methods: A quality improvement project with an educational design was implemented using a Plan, Do, Check, Act framework. The plan was implemented at an OB/GYN practice in Western Massachusetts using a team approach consisting of the DNP student, providers and staff. The Thin-Fat Implicit Bias Test and Anti-Fat Attitudes test were administered pre-and post-educational program to assess change in provider bias toward obese women. Results: A decrease in explicit bias was shown both immediately and 3 months after the intervention. There was minimal decrease and some increase in implicit bias after the intervention which may be related to confounding factors such as increased familiarity with the testing procedure. At 3 months some participants were avoidant at follow-up suggesting possible shame, embarrassment, or deeper feelings which merit future exploration. Conclusions: Continued education and awareness is needed to sustain and decrease stigma toward obese women in the health care setting