Passage 6
With an increasing array of innovations and research emerging from low-income
countries there is a growing recognition that even high-income countries could
learn from these contexts. It is well known that the source of a product influences
perception of that product, but little research has examined whether this applies
also in evidence-based medicine and decision-making. In order to examine
likely barriers to learning from low-income countries, this study uses established
methods in cognitive psychology to explore whether healthcare professionals and
researchers implicitly associate good research with rich countries more so than
with poor countries.
[A] Computer-based Implicit Association Test (IAT) [was] distributed to healthcare
professionals and researchers. Stimuli representing Rich Countries were chosen
from OECD members in the top ten (>$36,000 per capita) World Bank rankings and
Poor Countries were chosen from the bottom thirty (<$1000 per capita) countries
by GDP per capita, in both cases giving attention to regional representation. Stimuli
representing Research were descriptors of the motivation (objective/biased), value
(useful/worthless), clarity (precise/vague), process (transparent/dishonest), and
trustworthiness (credible/unreliable) of research.
Three hundred twenty one tests were completed in a four-week period between
March and April 2015. The mean Implicit Association Test result…for the sample
was 0.57 (95% CI 0.52 to 0.61) indicating that on average our sample exhibited
moderately strong implicit associations between Rich Countries and Good
Research. People over 40 years of age were less likely to exhibit pro-poor implicit
associations, and being a peer reviewer contributes to a more pro-poor association.
The majority of our participants associate Good Research with Rich Countries,
compared to Poor Countries. Implicit associations such as these might disfavor
research from poor countries in research evaluation, evidence-based medicine and
diffusion of innovations.
Measuring the bias against low-income country research: an Implicit Association
Test. Adapted from Harris et al. (2017).
Which of the following forms of status was least likely to be important when it
comes to shaping the IAT results of study participants?
A) Achieved status based on occupation
B) Achieved status based on gender
C) Ascribed status based on gross household income
D) Ascribed status based on national origin or affiliation
Correct answer is C
According to the passage, the purpose of this study is identifying biases against
research from low-income countries. Specifically, the study hypothesizes that
people from high-income countries would be less likely to accept research from
low-income countries, or otherwise believe it to be sub-standard, of low quality,
unclear, etc. Study participants are described as “healthcare professionals and
researchers” who performed a computer-based Implicit Association Test (IAT).
Because the purpose of the study is to assess the biases of those from highincome countries, it is reasonable to assume that the healthcare professionals and
researchers surveyed were from high-income countries.
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