The risks of multimedia methods: Effects of actor's race and gender on preferences for health states

Objective: While the use of multimedia methods in medical education and dec ision support can facilitate learning, it also has certain hazards. One pot ential hazard is the inadvertent triggering of racial and gender bias by th e appearance of actors or patients in presentations. The authors hypothesiz ed that race and gender affect preferences. To explore this issue they stud ied the effects of actors' race and gender on preference ratings for health states that include symptoms of schizophrenia. Design: A convenience sample of patients with schizophrenia, family members of patients, and health professionals was used. Participants were randomly assigned to rate two health states, one portrayed by either a man of mixed race (Hispanic-black) or a white man and the second portrayed by either a white woman or a white man. Measurements: Visual analog scale (VAS) and standard gamble ratings of heal th state preferences for health states that include symptoms of mild and mo derate schizophrenia. Results: Studies of the effects of the race of the actor (n = 114) revealed that racial mismatch between the actor and the participant affected the pa rticipant's preferences for health states. Ratings were lower when racial g roups differed (mean difference, 0.098 for visual analog scale ratings and 0.053 lower in standard gamble, P = 0.006 for interactions between the race of the subject and the actor). In studies of the effects of a female actre ss on ratings (n = 117), we found no evidence of a corresponding interactio n between the gender of the actor and the study participant. Rather, an int eraction between actor's gender and method of assessment was observed. Stan dard gamble ratings (difference between means, 0.151), but not visual analo g scale ratings (difference, 0.005), were markedly higher when the state wa s portrayed by the actress (P = 0.003 for interactions between actor's gend er and method of preference assessment). Differential effects on standard g amble ratings suggest that an actor's gender may influence the willingness of viewers to gamble to gain health benefits (or risk attitude). Conclusions: Educators and researchers considering the use of multimedia me thods for decision support need to be aware of the potential for the race a nd gender of patients or actors to influence preferences for health states and thus, potentially, medical decisions.