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research-article2014

TCNXXX10.1177/1043659614523471Journal of Transcultural NursingSteed

Education Department

The Effects of an Instructional Intervention on Racial Attitude Formation in Occupational Therapy Students

Journal of Transcultural Nursing 2014, Vol. 25(4) 403­–409 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043659614523471 tcn.sagepub.com

Robin Steed, PhD, LOTR1

Abstract The purpose of this pilot study was to examine the effect of a 9-week instructional intervention designed to increase 24 Caucasian American occupational therapy students’ awareness of personal racial attitudes toward African Americans. The learning content focused on specific cognitive-perceptual biases thought to play a role in the formation of racial attitudes. A pre- to posttest implicit measure of racial bias indicated an increase in bias in some students following the intervention and a decrease of bias in others. Students’ perception of the instruction and subsequent stereotype activation are discussed as possible moderators of the intervention’s effectiveness. Several implications for future instruction and research are suggested to address factors that may limit antibias instruction. Keywords racial attitude, higher education, implicit bias, African American

While blatant discrimination against Blacks in the United States has decreased in the past few decades, more subtle forms of racism have not. Recent evidence suggests that even people who deny negative racial attitudes may demonstrate racist behavior unintentionally (Burgess, van Ryn, Dovidio, & Saha, 2007). Racial bias, whether conscious or unconscious, is unlikely to respond to traditional explicit instructional approaches, such as education on cultural differences and cross-cultural communication. A number of studies suggest that unconscious bias and stereotype activation are amenable to interventions that focus on metacognition and self-awareness (Beach et al., 2005; Dasgupta, 2009; Dovidio et al., 2008; Kawakami, Dovidio, Moll, Hermsen, & Russin, 2000). A recent study conducted at a southern health science center with students enrolled in allied health programs (Steed, in press) demonstrated that, overall, the allied health students had significantly more negative attitudes toward Blacks than the general population on a measure of implicit bias. While research evidence indicates that interventions targeted toward unconscious bias are effective (Kawakami et al., 2000), currently no studies of this type have been conducted with occupational therapy students. Research demonstrating the effectiveness of insight-based interventions is needed to devise the most efficient method of remediating negative racial attitudes in this subpopulation of students.

Review of Literature One approach to understanding the development of ethnic bias is the examination of the psychological and cognitive processes that support the persistence of negative attitudes toward different cultures (Dasgupta, 2009). Sherman et al. (2009) suggest that stereotype formation may be influenced by the brain’s natural tendency to perceive two rare events (such as membership in an ethnic minority group and a physical disability) as being related to each other (thinking people of that ethnicity are more likely to have physical disabilities) even if they are not. This error, illusory correlation, is typically unconscious. Another perceptual error that contributes to stereotype formation, out-group homogeneity, is based on one’s tendency to attend to differences between social groups and similarities within each group in order to distinguish between groups easily. This leads individuals, particularly in the majority group, to believe that members of minority cultures are more similar than they are in reality. As a result, health care providers may treat patients from a certain race or 1

Louisiana State University Health Science Center, Shreveport, LA, USA

Corresponding Author: Robin Steed, Master of Occupational Therapy Program, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71130, USA. Email: [email protected]

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culture according to a stereotype rather than as an individual with specific needs (Dovidio et al., 2008). A legitimizing worldview, a form of cognitive misperception that strengthens racial bias, is the personal view of society that validates the legitimacy of the status quo. This set of beliefs implies that one’s place in society is earned and is the result of personal merit or effort. “Examples of system-justifying beliefs in the United States include the beliefs that hard work pays off and that anyone can get ahead regardless of their group membership” (O’Brien & Major, 2005, p. 1718). Belief that rewards are based on merit may lead to the idea that those of low socioeconomic status are less deserving of rewards because they have not worked hard enough. Recent research demonstrates the malleability of these largely unconscious cognitive perceptual processes (Dasgupta, 2009); however, instruction aimed at reducing racial bias does not always yield the desired results. Reluctant students may perceive antibias instruction as an attempt to control their behavior, resulting in an even stronger identification with biased attitudes (Kawakami, Dovidio, & van Kamp, 2005). The primary purpose of this study was to examine students’ perception of an instructional intervention designed to reduce racial bias and to evaluate the effect of the intervention on students’ attitudes by using an implicit measure of bias. A secondary goal of the study was to determine the extent to which occupational therapy students’ scores on measures of specific cognitive-perceptual biases (out-group homogeneity, illusory correlation, and status legitimizing worldview) would predict scores on a measure of implicit bias.

Method Subjects Prior to recruitment, the investigator obtained approval from a southern health science center’s institutional review board. The entire first year class of 24 occupational therapy graduate students were invited to participate in the data collection portion of this study. The class was composed of 4 males and 20 females; all were enrolled in a foundational course and were required to participate in the instructional activities as part of the normal course curriculum. Because the focus of the study was on Caucasian attitudes, students were asked to anonymously decline participation in data collection if they did not self-identify as Caucasian or if they simply did not want to participate regardless of racial identity. Students were instructed to write the code phrase “no data” on assessment items if they did not want the data recorded. All students chose to participate initially; two students withdrew during the final week of data collection.

Materials In an effort to avoid self-report of only socially acceptable views, an indirect method of assessing racial attitude, the

Racial Argument Scale (RAS), was used as the pretest and posttest. The RAS is based on the concept of biased assimilation, the process by which people interpret information so that it supports their current belief system (Saucier & Miller, 2003). The RAS consists of 13 arguments and corresponding conclusions relating to African Americans. Individuals are asked to rate how well they think the argument supports the related conclusion, but not how much the individuals agree with the argument itself. Munro and Ditto (1997) have shown that study subjects will interpret ambiguous information according to how that information fits the individual’s beliefs and attitudes regarding another group. Scores on the RAS were found to support qualitative data collected regarding Southern occupational therapists’ attitudes toward Blacks, suggesting that the RAS is an appropriate measure to use in a health care setting (Steed, 2010). The psychometric properties of the RAS have been described elsewhere (Saucier & Miller, 2003). The population mean for the RAS as reported by Saucier and Miller (2003) is 33.098; higher scores indicate increased negativity toward Blacks. Three assessments of cognitive-perceptual processes consisted of measures of out-group homogeneity, illusory correlation, and legitimizing worldviews. Although these measures did not predict RAS scores, taking the tests were learning events for the students, and therefore the measures are described in detail here. Measure for Out-Group Homogeneity.  Ackerman et al. (2006) suggest that a facial recognition task may be used as an implicit measure for out-group homogeneity. The purpose of the facial recognition task was to determine if student’s memory for White faces was more accurate than memory for Black faces. The students watched a slide show of 16 slides, with the image of one face per slide and with an equal number of Black and White faces. The photos were taken from Harvard University’s Project Implicit website and are available online at http://www.projectimplicit.net/stimuli.php (Nosek, Banaji, & Greenwald, 2002). Slide transition speed was one slide per second. In order to allow working memory to fade, students then watched a 5-minute film featuring landscapes. Students then watched another slide show (with a 2-second slide transition) containing four of the previously seen Black faces and four of the previously seen White faces, plus four new Black and four new White faces. Students indicated on a checklist which of these faces had been shown during the initial presentation. Scores reflected number of correct identifications. Scores could range from 8 (no mistakes) to −8 (all incorrect answers). The final score was the accuracy for White faces minus the accuracy for Black faces (Ackerman et al., 2006). In accordance with Ackerman et al.’s suggestion, students were not told this was a test of memory beforehand, in order not to bias the responses. Measure of Illusory Correlation.  Sherman et al. (2009) demonstrated that illusory correlation may be measured using a

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Steed categorizing task in which a large group is compared with a smaller group. For the current study, students were shown 54 stimulus slides. Each slide contained a short text description of either a friendly or a dishonest behavior, along with a group designation. For example, “A member of Group A hits a parked car and then takes off.” Group A had 24 slides describing friendly behaviors and 12 with dishonest behaviors; Group B had 12 slides with friendly behaviors and 6 slides with dishonest behaviors. Behavior descriptions were drawn from Chadwick, Bromgard, Bromgard, and Trafimow (2006). The last two slides required a response from students. The first response slide stated, “This person stole an idea from someone and lied to a professor about a quiz grade.” Students were asked to guess if the person was from Group A or B. The second response slide stated, “This person encourages quieter team mates to speak up and smiles at neighbors.” Again, students were asked to guess the person’s group membership. Two independent chi squares were used to determine if group A or B was thought to be more honest or friendly compared with what would be expected by chance. Measure of Legitimizing World Beliefs.  Twenty statements indicative of legitimizing world beliefs were taken from Levin, Sidanius, Rabinowitz, and Federico (1998) to create a scale to measure the students’ worldviews. Items were rated on a Likert-type scale from 1 (strongly disagree) to 7 (strongly agree). Nine items were reverse-scored to avoid testing bias. Cronbach alpha calculated for internal consistency was .893. Qualitative data were collected from essays completed by students in the last week of the study. Students were asked to write a one-page essay on the effect, negative or positive, that the interventions throughout the semester had on their racial attitudes.

Procedures In the first week of the 2011 fall semester, the primary investigator (PI), who also served as instructor for the course, met with students during a regularly scheduled class time. Students were informed of anonymity, confidentially, and the freedom to not participate. To preserve anonymity, students were given random identification numbers, which were the only identifiers on all data. The RAS was administered prior to the three tasks (face recognition, categorization, and the Levin et al. survey) to prevent biased responses. The pretest RAS and the three cognitive-perceptual tasks were completed during the first 2 weeks of the study. The posttest RAS and essays were completed during the ninth week. The instructional interventions (see the appendix) took place during Weeks 3 through 9 of the study.

Data Analysis The hypothesis “Occupational therapy students who participate in an instructional intervention aimed at increasing

student awareness of cognitive-perceptual biases will have a decrease in RAS scores, pretest to posttest” was analyzed with a dependent t test. The question “To what degree do scores on specific cognitive-perceptual tasks (out-group homogeneity, illusory correlation, and status legitimizing worldview) predict scores on the Racial Argument Scale?” was addressed through a multiple regression analysis with the cognitive perceptual tasks as the predictor and the criterion variable as the initial RAS. The essays completed in the ninth week were analyzed for themes independently by the author and another occupational therapy faculty member. Theme analyses were then compared for commonalities to increase accuracy.

Results Analysis of the pre- to posttest RAS scores indicates that approximately 25% of the students’ scores actually increased (indicating increased bias toward Blacks) whereas 25% of the scores decreased (indicating decreased bias toward Blacks). The scores in the interquartile range remained relatively stable pretest to posttest. Overall, the difference between the pretest mean (38.32) and posttest mean (37.09) was not significant. The means of both RAS measures were greater than two standard deviations above the population mean of 33.098. The three cognitive perceptual variables, out-group homogeneity, legitimizing worldviews, and illusory correlation, did not predict RAS scores (either pre- or posttest). The answers to the legitimizing world view survey are summarized in Table 1. In order to explore reasons why some students responded positively to the intervention (as measured by lowered RAS scores) and others more negatively (as measured by increased RAS scores), the change scores (pretest score – posttest score) were roughly divided into quartiles. The first quartile represents the five students whose scores most dramatically decreased and the third quartile represents the five students whose scores increased the most. The essays for both groups of students were examined separately for themes by the primary investigator and another professor uninvolved in the intervention. The two analyses independently yielded similar themes. Students who were less biased after the intervention, the first quartile, repeatedly mentioned the phrase “eye opening” to describe their reaction to the learning content. The film True Colors was most often credited for raising the students’ awareness of ongoing racism in American society, possibly because of the obvious examples of discrimination portrayed (Pearce & Ross, 1991). As one student stated, “The film about the White man and Black man—how the Black [man] was treated was outrageous and I hope that if I ever saw someone being treated that way I’d be able to do something about it.” Other students in this group also expressed doubts about their ability to bring about change: “I feel frustrated because the only factor I can control in the situation is myself. I know my responses and reactions can influence others, but I don’t feel

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Table 1.  Results of Legitimizing World View Scale. 1 = Strongly disagree; 7 = Strongly agree America is a just society where differences in status between ethnic groups reflect actual group differences Differences in status between ethnic groups are fair America is an open society where individuals of any ethnicity can achieve higher status Advancement in American society is possible for individuals of all ethnic groups Individual members of a low-status ethnic group have difficulty achieving higher status If people work hard they almost always get what they want Most people who don’t get ahead should not blame the system; they really have only themselves to blame All ethnic groups are given the same treatment as other ethnic groups in the criminal justice system American society treats all ethnic groups equally Although there was discrimination in the past, today members of all ethnic groups have equal opportunity African Americans are less intellectually able than other groups African Americans are lazier than other groups

3.6 2.9 6.15 6.35 3.2 5 4.6 4.2 2.9 4.8 2.05 2.55

Reverse scored items: 1 = Strongly agree; 7 = Strongly disagree African Americans have poor schools and live in bad neighborhoods African Americans still experience the effects of past discrimination and racism Differences in status between ethnic groups are the result of injustice It is unfair that certain ethnic groups have poorer living conditions than other ethnic groups In America, getting ahead doesn’t always depend on hard work Even if people work hard, they don’t always get ahead African Americans usually don’t get fair treatment (on the labor market, education, politics) People often discriminate against members of certain ethnic groups (e.g., African Americans and Latinos)

4.2 4.2 4.3 4.1 3.1 2.95 5.05 3.5

Note. Adapted from Levin, Sidanius, Rabinowitz, and Federico (1998, pp. 382-383).

like it can change the world’s view on race.” While agreeing that blatant racism is undesirable, the students in this group were still hesitant to accept the effect that racial discrimination might have on socioeconomic status, as this statement indicates: “I did not find that the exploration of [White] advantages activity was very beneficial. I believe that it has more to do with economics and people’s individual motivation and drive to be successful.” All five of these students started the course with RAS scores much higher than the population (>39) and all but one finished the course with an RAS score within one standard deviation of the population. Examination of the students’ essays that had change scores in the third quartile yielded several common themes. Although all the students in this group had RAS scores at the end of the course that were over two standard deviations above the population and sample mean for negative bias toward Blacks, each made a statement denying any bias, for example, “I feel I am not racist although I occasionally joke about racial issues” and “I firmly believe that I operate on a developed level [of cultural competence] when it comes to this topic.” Similar to the students in the first quartile, students in this group also shared the belief that disparities in quality of health care in the south are due to poor socioeconomic status rather than ethnic discrimination by providers. The students in the third quartile were more likely to question the validity of the health care disparity research presented in class that claimed to have controlled for socioeconomic status. Examples of this theme are “Most problems originate from lack of finances and that is a problem that people of every race encounter” and “The film

regarding effect of racism on health . . . was interesting, but I feel that there were too many uncontrolled variables.” The learning content regarding advantages of growing up as a Caucasian in America received negative attention in this group of essays: “The main purpose was to put down White people and make everyone feel sorry for someone because they are Black.” “It is easier for Blacks to ‘play the race card’ if they are not successful, while it is expected of Whites to be successful (as if they are all given some special gift).” Students in this group stated that the intervention had not changed their attitudes, which makes sense given that the group did not see a need to change at any point in the study. Students in this group did not emphasize the need for health care providers to address disparities; on the contrary, statements tended to indicate satisfaction with the current system or resignation to status quo, for example, “I wish there were more things that could be done about changing this, but it seems as though it will always exist,” “My attitudes toward people of other races have not changed and they probably never will, but I am capable of treating my clients the same regardless of who they are,” and “As long as there is differences in cultures (not races) we will all judge others because we are different.”

Study Limitations The results of the regression analysis seem to indicate that illusory correlation and out-group homogeneity do not predict implicit racial bias, at least as measured by the RAS. It must be noted, however, that it is possible that the categorization test

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Steed and facial recognition test were not of sufficient fidelity to measure the cognitive perceptual errors. Also, the small sample size of 22 students reduces the power of the design to detect anything less than a moderate effect size. It may be with more thoroughly tested measures of cognitive perceptual errors with a larger sample size would yield different results. The small sample size also limits external validity and extrapolations to other populations should be avoided. Another threat to internal validity is researcher bias. Since the primary investigator was also the course instructor, the interpretation of the qualitative results may have been influenced by classroom experiences, even though an independent analysis conducted by another faculty member yielded similar themes in the qualitative data.

Discussion While the explanation for the variability of response to the intervention is most likely complex and multifaceted, the change scores on the RAS pre- to posttest indicate that the response may have been influenced by stereotype activation, an unconscious triggering of previously learned stereotypes (Devine, 1989). The attention given to racial bias during the 9 weeks may have caused some students to question previously held racial beliefs. If this produced an uncomfortable cognitive dissonance, it is possible that some students unconsciously chose to re-identify with stereotypical attitudes, whereas other students may have elected to inhibit stereotypical beliefs in favor of the new information presented in class. Although stereotype activation is unconscious, it can still result in discriminatory behavior. As Devine (1989) reports, “Even for subjects who honestly report having no negative prejudices against Blacks, activation of stereotypes can have automatic effects that if not consciously monitored, produce effects that resemble prejudiced responses” (p. 12). Stereotypes may be activated simply by discussing racial issues (Dasgupta, 2009), and the design of effective cultural competency curriculum should take this into consideration. Greenwald et al. (2002) propose a theory of association between attitudes, self-esteem, and self-concept. This theory suggests that individuals link perceptions of self and others with positive and negative traits. Individuals with high identification with the in-group (Caucasian American) and low self-esteem tend to associate negative stereotypes with members of an out-group (African American) in order to resolve cognitive dissonance. Conversely, individuals with high selfesteem, regardless of in-group affinity, tend to associate members of the out-group with more positive traits. It may be important for some students to approach new ideas, such as White privilege, very slowly with an empathetic role model. Extra care should be taken to avoid placing blame on any ethnic group. Moskowitz and Li (2011) view stereotype activation as goal-directed cognitive processing. Depending on the individual, a goal to inhibit stereotypical thinking may be subsumed to a higher order goal of cognitive efficiency. As applied to the current study, it may be that students in the third quadrant were overwhelmed with the emotionally laden

learning content and may have unconsciously relegated cognitive energy elsewhere, resulting in uninhibited activation of stereotypical responses on the RAS posttest. For other students, the goal to be egalitarian was congruent with the goal to inhibit stereotype activation, resulting in lower scores on the posttest RAS. It may be that drawing students’ attention toward a positive goal of increasing tolerance, rather than the negative goal of reducing bias, would inhibit stereotype activation. Motivation to inhibit stereotype activation also plays a role in negating prejudiced beliefs. Kawakami et al. (2000) report that students are able to consciously inhibit bias as measured by an implicit association test, but only after extensive practice (480 trials). The authors also suggest that students must be willing to replace old conceptions of race with new egalitarian views, a change that biased students in the current study were resistant to make. The results of this study have several implications for future research. Further research is needed to determine if explicit instruction about cognitive perceptual errors is an effective method to reduce racial bias in this population. It maybe that such a direct approach is perceived by some students as an overt attempt to control their behavior. In addition, it would be helpful to measure the degree to which students recognize metacognitive inconsistencies following instruction since only a small percentage of participants in this study seemed to gain increased self-awareness. Examination of the types of reasoning that students use to refute evidence of racial discrimination in health care settings and the relationship of students’ reasoning to stereotype activation might yield new strategies for instruction. Variables that predict stereotype activation, such as level of cognitive dissonance, motivation, and psychological stress, should be examined as possible targets for remediation. Because of the complexity of racial bias, future research should include larger samples that will allow for more rigorous study designs.

Conclusions Although the results of this study must be viewed with some caution, given the design limitations inherent in small pilot studies, the results suggest that care must be taken in the design of cultural competency curriculum. Instruction in racial attitude formation should take into account the effect of stereotype activation. As Moskowitz and Li (2011) suggest, it is important to emphasize positive egalitarian views rather than focusing solely on factors related to racial bias. Instructors should consider the strength of underlying negative bias in students and encourage nonthreatening examination of personal values rather than presenting health care disparity evidence that may be too overwhelming for some students to process. Further research is needed to identify mediating attitudes and beliefs that contribute to inhibition of racial bias. Self-concept and self-esteem are two factors that may play a significant role in stereotype activation and should be assessed in future studies. Racial prejudice is a complex phenomenon and it cannot be assumed that one instructional approach will work equally well for all students.

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Facial Recognition Practice



Description

Illusory Correlation

Racial Attitude Implicit Association Test Racial Discrimination

True Colors

Students practiced identifying Completed online at Students watched a differences in facial features understandingprejudice. short video of an ABC of people from different org. This test is designed Primetime segment ethnicities. Students were to increase awareness in which two men, instructed to look for of out-group bias just by one White the other differences in faces of completing the exercise Black, receive different African Americans in the (see description, Steed, treatment in public lower portion of the face, 2010). (Pearce & Ross, 1991). and to look for differences in Caucasian faces in the upper portion of the face according to protocol specified by Hugenberg (2010). Followed by class discussion of results.

Cognitive Perceptual Out-group homogeneity Process

Learning Experience

Instructional Interventions

Appendix

Healthcare Disparities

Student groups summarized one factor and presented to the class (www. unnaturalcauses. org/ interactivities_08. php).

Followed by class discussion (California Newsreel, 2008a, 2008b; Kaiser Permamente, 2008).

Status Legitimizing World Views and Racial Discrimination The website Two short videos addresses eight demonstrating socioeconomic health care factors thought to discrimination contribute to poor and the effect of health outcomes discrimination in minorities and on the health of in people of low minorities. socioeconomic status.

Status Legitimizing World Views

Accumulating Advantage

Completion of onepage essay describing student perception of the instructional interventions presented over the past 6 weeks.

PowerPoint explaining the formation of implicit racial bias. Explicit identification of cognitive perceptual processes that help form racially biased attitudes.

Implicit Racial Bias

Racial Attitude Formation

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Steed Acknowledgment The author would like to express her gratitude to Christine Wright, PhD, LOTR, for her analysis for themes in the qualitative data collected in this study. This article was accepted under the editorship of Marty Douglas, PhD, RN, FAAN.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Greenwald, A., Rudman, L., Nosek, B., Banaji, M., Farnham, S., & Mellott, D. (2002). A unified theory of implicit attitudes, stereotypes, self-esteem, and self-concept. Psychological Review, 109(1), 3-25. Hugenberg, K., Young, S. G., Bernstein, M. J., & Sacco, D. F. (2010). The categorization-individuation model: An integrative account of the other-race recognition deficit. Psychological Review, 117, 1168-1187. Kaiser Permamente. (2008). Bridging the great divide. Video available at http://www.youtube.com/watch?v=lINSIZUtlFE Kawakami, K., Dovidio, J. F., Moll, J., Hermsen, S., & Russin, A. (2000). Just say no (to stereotyping): Effects of training in trait negation on stereotype activation. Journal of Personality and Social Psychology, 78, 871-888. Kawakami, K., Dovidio, J. F., & van Kamp, S. (2005). Kicking the habit: Effects of nonstereotypic association training and correction processes on hiring decisions. Journal of Experimental Social Psychology, 41(1), 68-75. Levin, S., Sidanius, J., Rabinowitz, J. L., & Federico, C. (1998). Ethnic identity, legitimizing ideologies, and social status: A matter of ideological asymmetry. Political Psychology, 19, 373-404. Moskowitz, G. B., & Li, P. (2011) Egalitarian goals trigger stereotype inhibition: A proactive form of stereotype control. Journal of Experimental Social Psychology, 47(1), 103-116. Munro, G., & Ditto, P. (1997). Biased assimilation, attitude polarization, and affect in reactions to stereotype-relevant scientific information. Personality and Social Psychology Bulletin, 23, 636-653. Nosek, B. A., Banaji, M. R., & Greenwald, A. G. (2002). Harvesting implicit group attitudes and beliefs from a demonstration website. Group Dynamics, 6(1), 101-115. O’Brien, L. T., & Major, B. (2005). System-justifying beliefs and psychological well-being: The roles of group status and identity. Personality and Social Psychology Bulletin, 31, 1718-1729. Pearce, K., & Ross, S. (Producers). (1991, September 26). Primetime live: True colors [Television broadcast]. New York, NY: ABC News. Saucier, D., & Miller, C. (2003). The persuasiveness of racial arguments as a subtle measure of racism. Personality and Social Psychology Bulletin, 29, 1303-1315. Sherman, J., Kruschke, J., Sherman, S., Percy, E., Petrocelli, J., & Conrey, F. (2009). Attentional processes in stereotype formation: A common model for category accentuation and illusory correlation. Journal of Personality and Social Psychology, 96, 305-323. Steed, R. (2010). Attitudes and beliefs of occupational therapists’ participation in a cultural competency workshop. Occupational Therapy International, 17, 142-151. Steed, R. (in press). Allied health students’ attitudes towards African Americans: Implications for instruction and research, Journal of Cultural Diversity.

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The effects of an instructional intervention on racial attitude formation in occupational therapy students.

The purpose of this pilot study was to examine the effect of a 9-week instructional intervention designed to increase 24 Caucasian American occupation...
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