Medical Mistrust Scale Research Articles

Measuring research mistrust in adolescents and adults: Validity and reliability of an adapted version of the Group-Based Medical Mistrust Scale.

Mistrust of health care providers among persons of color is a significant barrier to engaging them in research studies. Underrepresentation of persons of color is particularly problematic when the health problem under study disproportionately affects minoritized communities. The purpose of this study was to test the validity and reliability of an abbreviated and adapted version of the Group Based Medical Mistrust Scale. The GBMMS is a 12-item scale with three subscales that assess suspicion, experiences of discrimination, and lack of support in the health care setting. To adapt for use in the research setting, we shortened the scale to six items, and replaced “health care workers” and “health care” with “medical researchers” and “medical research,” respectively. Using panelists from a market research firm, we recruited and enrolled a racially and ethnically diverse sample of American adults (N = 365) and adolescents aged 14–17 (N = 250). We administered the adapted scale in a web-based survey. We used Cronbach’s alpha to evaluate measure internal reliability of the scale and external factor analysis to evaluate the relationships between the revised scale items. Five of the six items loaded onto a single factor, with (α = 0.917) for adolescents and (α = 0.912) for adults. Mean scores for each item ranged from 2.5–2.9, and the mean summary score (range 6–25) was 13.3 for adults and 13.1 for adolescents. Among adults, Black respondents had significantly higher mean summary scores compared to whites and those in other racia/ethnic groups (p<0.001). There was a trend toward significance for Black adolescents as compared to white respondents and those in other racial/ethnic groups (p = 0.09). This five-item modified version of the GBMMS is reliable and valid for measuring research mistrust with American adults and adolescents of diverse racial and ethnic identities.

Determination of the relationship between physician trust, medical mistrust, and self-confidence in the health services provided in Turkey

Objectives: A sense of trust is of great importance for professional professions. Failure to establish trust, especially in an industry where information asymmetry is too high, such as the health sector, also poses important problems for both employees and society. In this study, we aimed to identify variables that affect the distrust of the health system and trust in the physician.&#x0D; Material and Method: This study was carried out in the descriptive design. The study group consisted of 561 people living in different cities of Turkey and whose ages ranged from 18-70 years. “Personal data form”, “ Medical mistrust scale”, “Physician trust scale” and “generalized trust inventory infrastructure scale” were used as data collection tools prepared by the researcher. As a data collection method, the test method performed in a computer environment was used. One-way analysis of variance from parametric test statistics and Pearson correlation analysis test statistics were used to compare data. P&lt;0.050 and p&lt;0.001 were determined for the significance level.&#x0D; Results: In our study, medical mistrust decreased as trust in the physician increased. As a person's level of self-trust increases, medical mistrust increases, and confidence in the physician also decrease. Dissatisfaction with the health service increases medical mistrust, while also reducing trust in the physician. Based on the preferred type of hospital, the level of medical mistrust of patients going to private hospitals is greater than the level of medical mistrust of patients going to public hospitals.&#x0D; Conclusion: This study reveals the importance of trust in the health sector and the factors that affect it. More detailed studies on practices that will increase confidence in the importance of this issue and measures that will reduce distrust will make a great contribution to this issue.

Abstract B107: Cervical cancer screening behaviors and perceptions of medical mistrust among rural Black and White women

Abstract Background: This study examined the relationship of medical mistrust, using the Group-based Medical Mistrust Scale (GBMMS), and Papanicolaou (Pap) testing behaviors among rural Black and White women. Methods: Utilizing a convenience sample, a cross-sectional study was performed. Inclusion criteria included self-identification as a non-Hispanic Black or White female, at least 21 years of age and a resident of one of the predetermined counties in the region. Analyses conducted were two-sample t-tests, Fisher's exact tests, Pearson's r and logistical regression. Results: Among 338 women, four GBMMS items had statistically significant outcomes using multiple significance tests and remained when adjusting for demographic variables. Analyses indicated that Whites were dissatisfied with the health care system to a greater extent than Blacks. In addition, among White respondents, as the level of medical mistrust increases, an individual's likelihood of ever having had a Pap test performed decreases. Moreover, among the White subgroup, women who have formed a habit of adhering to the recommendation were more likely to maintain annual commitment. Conclusions: The impact of medical mistrust on health care-seeking behaviors should be explored beyond merely members of racial/ethnic minority groups. The findings will be used to create a community-informed, multilevel cervical cancer screening intervention to foster healthful behaviors among racially diverse rural populations. This approach has the potential to reduce prevalent disparities among rural residents when compared to urban areas of the state. Citation Format: Marla B. Hall, Paul Vos, Jukelia Bess, Kelly Reburn, Gavin Locklear, Jamila McAlister, Ronny Bell. Cervical cancer screening behaviors and perceptions of medical mistrust among rural Black and White women [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B107.

Cultural Barriers to Breast Cancer Screening and Medical Mistrust Among Arab American Women

Breast cancer is a common cancer among women in the US and cultural barriers and medical mistrust have been associated with breast cancer screening (BCS) rates among minority populations. A heterogeneous sample of Arab women (N = 196) were recruited from across the Detroit metropolitan area and administered a questionnaire. Multiple regression analyses revealed an association between Arab Cultural Specific Barriers (ACSB) to BCS and Group-Based Medical Mistrust Scale. The environmental ACSB to BCS was associated with the medical mistrust-suspicion of HC providers (β = 0.363, p = 0.01), lack of HC provider support (β = 0.396, p = 0.001), and Arab inequities (β = 0.250, p = 0.05). Findings suggest that ACSB to BCS are predictive of medical mistrust for Arab American women. This study illuminates the need to emphasize strategies that will target the medical care system and the cultural barriers to BCS that Arab American women face in the health care system.

HIV-Related Mistrust(or HIV Conspiracy Theories) and Willingness to Use PrEP Among Black Women in the United States.

Uptake of pre-exposure prophylaxis (PrEP) among Black women living in the US is suboptimal. We sought to determine the association between HIV-related medical mistrust (or belief in HIV conspiracy theories)and willingness to use PrEP among Black women. We analyzed data from the 2016 National Survey on HIV in the Black Community (NSHBC), a nationally representative cross-sectional survey. Among NSHBC participants, 522 were women and 347 (69.0%) reported HIV risk factors. Only 14.1% were aware that PrEP exists; 30.8% reported willingness to use PrEP. HIV-related medical mistrust was reported by 60.4% of women. In multivariable analysis, controlling for income, education, marital status and health care engagement, belief in conspiracy theories was significantly associated with higher willingness to use PrEP. The HIV-Related Medical Mistrust Scale item: "there is a cure for HIV, but the government is withholding it from the poor" was independently associated with higherPrEP willingness. This finding speaks to the need for an improved understanding of the role of HIV-related medical mistrust among Black women to improve uptake of biomedical HIV prevention.

Examining the association between religiosity and medical mistrust among churchgoing Latinos in Long Beach, CA.

Medical mistrust among racial/ethnic minorities has been associated with decreases in health care utilization, whereas religiosity has been separately linked with increases in this behavior. However, very few studies have examined the relationship between religiosity and medical mistrust among Latinos, a group with strong religious connections and potentially high mistrust. In-person, self-administered surveys were collected among 767 adult Latinos attending three Latino churches (one Catholic and two Pentecostal) in Long Beach, CA. Measures included a previously validated 12-item medical mistrust scale, religiosity (religious denomination, length and frequency of attendance, and number of groups or ministries involved in), health care access, and sociodemographic factors. Medical mistrust score was 2.47 (standard deviation [SD] = 0.77; range 1-5). Almost two-thirds of participants (62%) attended religious services frequently (once a week or more), and the majority attended a Catholic church (80%). About half of the participants had attended their church for ≥5 years (50%) and participated in one to two church groups or ministries (53%). Multivariable analyses show that Pentecostal church congregation and those identifying as Mexican/Chicano were negatively associated with medical mistrust. On the contrary, participating in church groups or ministries and having an immigrant parent were positively associated with medical mistrust. Our findings suggest that church-based health initiatives should consider church denomination, length of attendance, participation in groups or ministries, and ethnic differences to address medical mistrust issues among Latino congregants.

Perception of Physician Empathy Varies With Educational Level and Gender of Patients Undergoing Low-Yield Computerized Tomographic Imaging.

Objective:Lack of empathic communication between providers and patients may contribute to low value diagnostic testing in emergency care. Accordingly, we measured the perception of physician empathy and trust in patients undergoing low-value computed tomography (CT) in the emergency department (ED).Methods:Multicenter study of ED patients undergoing CT scanning, acknowledged by ordering physicians as unlikely to show an emergent condition. Near the end of their visit, patients completed the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE), Trust in Physicians Survey (TIPS), and the Group Based Medical Mistrust Scale (GBMMS). We stratified results by patient demographics including gender, race, and education.Results:We enrolled 305 participants across 9 sites with diverse geographic, racial, and ethnic representation. The median scores (interquartile ranges) for the JSPPPE, TIPS, and GBMMS for all patients were 29 (24-33.5), 55 (47-62), and 18 (12-29). Compared with white patients, nonwhite patients had similar JSPPPE and TIPS scores but had higher (worse) GBMMS scores. Females had significantly lower JSPPPE and TIPS scores than males, and scores were lower (worse) in females with college degrees. Patients in the lowest tier of educational status had the highest (better) JSPPPE and TIPS scores. Scores were invariant with physician characteristics.Conclusion:Among patients undergoing low-value CT scanning in the ED, the degree of patient perception of physician empathy and trust varied based on the patients’ level of education and gender. Given this variation, an intervention to increase patient perception of physician empathy should contain individualized strategies to address these subgroups, rather than a one-size-fits-all approach.

The Association of Cultural and Structural Factors with Perceived Medical Mistrust Among Young Adult Latinos in Rural Oregon

Although previous studies have examined the impact of medical mistrust on the health and health care seeking behaviors of diverse populations, including Latinos, limited research has explored cultural and structural factors that contribute to medical mistrust. The aim of the present study was to examine the associations between cultural and structural factors and perceived medical mistrust among a sample of young adult Latinos living in rural Oregon. We conducted in-person interviews with 499 young adult Latinos (ages 18–25). Medical mistrust was assessed using a modified version of the Group-Based Medical Mistrust Scale, which has been used with Latino populations. We included three cultural (acculturation, machismo, and familismo) and one structural (perceived everyday discrimination) variables, all measured using previously validated scales. Socio-demographic variables (eg, age, gender, income, educational level, employment) were also included in multivariable linear regression models. We found that everyday discrimination and traditional machismo values were associated with medical mistrust, the latter primarily among Latino women. It is possible that Latinos living in relatively new minority/immigrant settlement areas (such as rural Oregon) may be more vulnerable to experiencing discrimination, which in turn, may erode trust in health care providers. On the other hand, a strong ethnic identity, including the endorsement of machismo values, may serve as a protective mechanism for Latinos confronted by racial/ethnic discrimination. Culturally responsive, socio-cultural, and societal interventions are warranted to tackle the pervasive and ripple effects that racial/ethnic discrimination has on the health of Latinos and other minority populations.

Cervical Cancer Screening Behaviors and Perceptions of Medical Mistrust among Rural Black and White Women.

This study examined the relationship of medical mistrust using the Group-based Medical Mistrust Scale (GBMMS), and Papanicolaou testing behaviors among rural Black and White women. Utilizing a convenience sample, a cross-sectional study was performed. Inclusion criteria included self-identification as a non-Hispanic Black or White woman, at least 21 years of age, and a resident of one of the selected counties in the region. Analyses conducted were two-sample t-tests, Fisher's exact tests, Spearman's rho, and logistical regression. Among 338 women, four GBMMS items had statistically significant outcomes using multiple significance tests; significance remained when adjusting for demographic variables. Analyses indicated that Whites were dissatisfied with the health care system to a greater extent than Blacks. The impact of medical mistrust should be explored beyond individuals of a racial/ethnic minority group. Future directions include the development of a community-informed screening intervention to foster adherence among diverse rural populations.

Inadequate Cancer Screening: Lack of Provider Continuity is a Greater Obstacle than Medical Mistrust.

Racial minorities and low-income individuals are generally less likely to have adequate cancer screening than Whites or higher-income individuals. To examine the roles of medical mistrust and lack of provider continuity in cancer screening in a low-income minority population. A total of 144 urban federally qualified health center patients completed a cross-sectional survey that included the Group Based Medical Mistrust Scale and questions on provider continuity and cancer-screening-history. Breast cancer screening was associated with continuity of care but not mistrust (respectively p = .002, p > .05); colon cancer screening was not significantly associated with either factor (p > .05). Findings suggest that among low-income minority adults continuity of care is more strongly associated with screening than medical mistrust. Shifting focus from medical mistrust-a patient-level issue-to establishing health care homes-a system-level issue-may be a more effective strategy for reducing racial and socioeconomic disparities in cancer screening.

Factorial Invariance and Convergent Validity of the Group-Based Medical Mistrust Scale across Gender and Ethnoracial Identity.

The objective of this study was to assess the factorial invariance and convergent validity of the Group-Based Medical Mistrust Scale (GBMMS) across gender (male and female) and ethnoracial identity (Latino and Black). Minority students (N = 686) attending a southeastern university were surveyed in the fall of 2011. Psychometric analysis of the GBMMS was performed. A three-factor solution fit the data after the omission of two problematic items. This revised version of the GBMMS exhibited sufficient configural, metric, and scalar invariance. Convergence of the GBMMS with conceptually related measures provided further evidence of validity; however, there was variation across ethnoracial identity. The GBMMS has viable psychometric properties across gender and ethnoracial identity in Black and Latino populations.

A Validation of the Group-Based Medical Mistrust Scale in Formerly Incarcerated Black and Latino Men.

While there is a growing body of literature on medical mistrust and its relevance to public health, research on formerly incarcerated Black and Latino men and their perception of mistrust toward medical providers and medical institutions remains scant. Very little is known about whether formerly incarcerated Black and Latino men mistrust medical and clinical providers given their previous experiences with the criminal justice system. It is important to determine whether medical mistrust play a key role in the health and health behaviors of released Black and Latino men. The purpose of this study is to validate and assess the psychometric properties of the Group-Based Medical Mistrust Scale for use among formerly incarcerated Black and Latino men in New York City. The findings of the exploratory and confirmatory factor analyses state that a two-factor structure fit the data best. Two dimensions emerged as important subscales: discrimination and suspicion. The current findings suggest the two-factor Group-Based Medical Mistrust Scale is a valid and reliable assessment tool to discern medical mistrust levels among formerly incarcerated Black and Latino men.

Experiences of diagnosis, care and treatment among Aboriginal people living with hepatitis C

Objective:Aboriginal Australians are disproportionately affected by hepatitis C (HCV). There are a range of barriers to HCV care, often beginning with poor diagnosis experiences. Little research exists on the experiences of Aboriginal Australians living with HCV. This study aimed to describe their patterns of HCV care and treatment with specific emphasis on the impact of their being informed of their diagnosis in a culturally sensitive manner. Methods:A total of 203 Aboriginal people living with HCV were recruited to complete a survey assessing experiences of HCV testing and care, HCV knowledge, lifestyle changes after diagnosis, perceived stigma and discrimination. Results:Of the sample, 58% were male and 96% identified as Aboriginal, with a mean age of 28 years. Correlation analysis revealed that satisfaction with the cultural appropriateness of the diagnosis was associated with: being offered pre‐ and post‐test counselling; satisfaction with HCV care; decreased feelings of HCV‐related stigma; lower scores on the medical mistrust scale; and greater intentions to access HCV treatment. Conclusions:These findings confirm the importance of providing a HCV diagnosis in a culturally appropriate way for Aboriginal people. Implications:Satisfaction with HCV diagnosis appears essential in establishing patterns of greater engagement with HCV care and treatment for this group.

Abstract B104: Medical mistrust and cancer screening in an underserved population

Abstract Racial/ethnic minorities and those of lower socioeconomic status suffer disproportionate rates of cancer incidence and mortality. They are also less likely to engage in preventive screening practices. The potential impact for improved screening rates is great. Screening for breast and colon cancer, two of the top five cancer sites, has been shown to reduce mortality. Results are more controversial for the effect on prostate cancer mortality, another of the top five cancer sites in men. Among reported reasons for lower screening practices are mistrust of the healthcare system, fear of the procedures or results, lack of or inadequate insurance coverage, and fatalistic beliefs. Racial/ethnic minorities are typically thought to exhibit higher levels of medical mistrust than their Caucasian counterparts. The purpose of this analysis was to examine associations between medical mistrust and specific cancer screening behaviors – breast, colon, and prostate cancer screening – in a low-income urban and predominately racial minority adult population. As part of a longitudinal survey study to assess colon cancer screening practices, participants were recruited from federally qualified health centers in an urban Midwest city. Eligibility included age ≥40 and being a patient at a federally qualified health center. Interviewer-administered surveys were used to collect baseline data on self-reported cancer screening practices, health history, insurance status, and demographics. Medical mistrust was assessed using the Group Based Medical Mistrust Scale. The study population included 144 individuals and was 61% male, with an average age of 51 years (±6.73 SD). Participants were predominately African American (87.5%), uninsured (52%), and low income, with 42.4% earning a monthly income &amp;lt; $400. Only 15% were married or in a marriage-like relationship, and just under half reported good/excellent overall health. Preliminary results indicate that there were no significant differences in medical mistrust by gender, having a healthcare home (defined as one particular doctor's office individuals visit when sick), or by ever having been screened for colon, breast, or prostate cancer. Bivariate analysis found that having a healthcare home was significantly associated with having had a mammography (p=0.02), CRC screening (p=0.012), and prostate cancer screening (p &amp;lt; 0.001). Mistrust levels did not vary by healthcare home status. Medical mistrust may be a less important determinant in nonadherence of low-income, racial/ethnic minority adults to screening guidelines than previously thought. As medical mistrust levels did not differ by gender or healthcare home status, it may be that focusing efforts on connecting low-income individuals with regular sources of care in which they will experience a greater continuity in care has the potential to increase cancer screening and preventive behaviors. This may provide avenues for interventions focused on eliminating disparities in cancer screening rates among minorities and those of lower socioeconomic status. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B104.

Validation of the group-based medical mistrust scale among urban black men.

Socioculturally relevant measures of medical mistrust are needed to better address health disparities, especially among Black men, a group with lower life expectancy and higher death rates compared to other race/gender groups. The study aim was to investigate the psychometric properties of the Group-Based Medical Mistrust Scale (GBMMS) in a Black male sample. Data were collected as part of a randomized controlled trial testing educational strategies to support Black men's decisions about prostate cancer screening. Participants included 201 Black men ages 40-75 years recruited in New York City during 2006-2007. The primary measures included: race-based medical mistrust, health care participation, avoidance of health care, perceived access to health care, health care satisfaction, racial identity, residential racial segregation, attitudes towards prostate cancer screening, and past prostate cancer screening behavior. An exploratory factor analysis suggested a three-factor structure. Confirmatory factor analysis supported the three-factor model. Internal consistency was high for the total GBMMS and the three sub-scales: Suspicion, Discrimination, and Lack of Support. Construct validity was supported by: significant positive correlations between GBMMS and avoidance of health care and racial identity as well as significant negative correlations with health care access, health care satisfaction, and attitudes about prostate cancer screening. ANOVA showed that the GBMMS was associated with greater residential racial segregation. Higher total GBMMS scores were associated with not visiting a physician in the last year and not having a regular physician. The present findings provide strong additional evidence that the GBMMS is a valid and reliable measure that may be used among urban Black men.

The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening

Background. There is little research on medical mistrust as a barrier to breast cancer screening. This study investigated the psychometric properties of a new scale, the Group-Based Medical Mistrust Scale (GBMMS), and its association with cancer screening attitudes and breast cancer screening practices among African American and Latina women. Methods. Participants were 168 African American and Latina urban women who completed the GBMMS and measures of sociodemographics, cancer screening pros and cons, acculturation, breast cancer screening practices and physician recommendation of such screening. Results. A principal components analysis of GBMMS items revealed three factors that were analyzed as subscales: (1) suspicion, (2) group disparities in health care, and (3) lack of support from health care providers. Convergent validity of the GBMMS was supported by its negative association with perceived benefits of cancer screening and acculturation and positive association with perceived disadvantages of cancer screening. Results further showed that women who reported no previous mammogram or a long-term lapse in mammography participation (>5 years) had significantly higher total GBMMS scores ( P < 0.04) compared to women who were either adherent to mammography guidelines or nonadherent but reported a mammogram within the past 5 years. This analysis controlled for physician recommendation. Conclusions: Results support the validity of the GBMMS and its association with breast cancer screening adherence. The GBMMS may be used to further investigate medical mistrust as a barrier to screening for cancers for which ethnic group disparities have been observed.