How Subjective and Objective Factors in Research and Practice May Perpetuate Health Disparities amongst Patients with Traumatic Brain Injury.

Research shows disparities exist in traumatic brain injury (TBI)-related outcomes and are associated with objective and subjective factors. We define objective factors (e.g., age, sex, race/ethnicity, health insurance status, and socioeconomic status) as variables that are frequently measured, not easily modifiable, and not easily influenced by individual perceptions, opinions, or experiences. Conversely, we define subjective factors (e.g., personal health literacy, cultural competence, patient/family-clinician communication, implicit bias, and trust) as variables that may be less frequently measured, more easily modifiable, and more easily influenced by individual perceptions, opinions, or experiences. The purpose of this analysis and perspective is to provide recommendations for further examination of subjective factors within TBI research and practice, with the overarching goal of reducing TBI-related disparities. We recommend establishing reliable and valid measures of subjective factors to allow for further examination of the influence of both objective factors and subjective factors in the TBI population. Providers and researchers must also engage in education and training to recognize their biases and how bias influences decision-making. The influence of subjective factors in practice and research must also be considered to ensure we generate knowledge needed to advance health equity and reduce disparities in outcomes for patients with TBI.