Bias and discrimination perceived by antimicrobial stewards: a mixed-methods study

Bias and discrimination influence the experience of many in health care, including antimicrobial stewardship providers. In this mixed-methods study, we explore the perceptions of bias and discrimination among antimicrobial stewards.

We conducted a nationwide survey of stewardship providers including physicians, pharmacists, advanced practice providers, and trainees. Participants were recruited via convenience sampling using X and professional listservs during May and June 2023. We solicited steward and program demographics and responses to statements exploring bias and discrimination through a 67-item electronic survey (Qualtrics). We further explored these experiences through semi-structured interviews.

Of 211 responses, 204 participants were included. Approximately half had been practicing for 5 years or less, 65% identified as female, and 24% identified as nonwhite or multiracial. Half of female stewards (50%) reported experiencing bias or discrimination in their role as an antimicrobial steward compared to 26% of male stewards. When controlling for race and ethnicity, seniority, and credentials, females were 2.8 times more likely (95% CI, 1.5-5.4; P < 0.01) to have experienced bias or discrimination when performing stewardship duties. Themes from our 16 interviews illuminated sources of perceived bias against stewards, the impact they had, and strategies to mitigate the influence of these biases.

Bias and discrimination are felt disproportionately by women and junior antimicrobial stewards and can lead to poor job satisfaction and a lack of perceived effectiveness. Acknowledging these experiences and equipping stewards with strategies to mitigate their effects should be a priority of institutions and professional societies.