Medical Mistrust Research Articles

Addressing tobacco screening and treatment among racially and ethnically minoritized parents in pediatric clinics: barriers and facilitators.

Household secondhand smoke (SHS) exposure remains a significant health issue for racially and ethnically minoritized children in the United States. Delivering parental tobacco treatment during pediatric primary care visits can reduce children's SHS exposure. This study examined current tobacco screening practices and health system stakeholder perceptions of facilitators and barriers to addressing tobacco use during pediatric visits among racially and ethnically minoritized parents. We conducted 25 semi-structured interviews with clinicians, staff, and health system leaders from 5 pediatric primary care clinics in Minneapolis-St. Paul, Minnesota. The study was informed by the Health Equity Implementation Framework. Interviews were analyzed using both directed content and thematic analysis. Participants identified multilevel facilitators and barriers to addressing parental tobacco use in minoritized families. Within the clinical encounter, barriers included linguistic and cultural barriers, health system navigational challenges, medical mistrust, low levels of clinician and staff knowledge, skills, and confidence, time constraints, and lack of alignment with external metrics. Facilitators centered on leveraging interpreters' cultural knowledge and the presence of culturally-congruent clinicians and staff to reduce medical mistrust and stigma, developing linguistically and culturally relevant resources, and integrating prompts and resources into the electronic health record. Participants described how lessons from previous system change mechanisms would facilitate this work. Addressing health system, training and resources, and linguistic and cultural barriers among clinicians and staff is essential to strengthen their capacity to address household SHS exposure among racially and ethnically minoritized populations as a component of pediatric preventive care. Clinicians and health system staff perceive unique barriers to identifying and addressing parental tobacco use among racially and ethnically minoritized parents during pediatric primary care visits. Solutions to expand tobacco treatment access to minoritized parents in pediatric settings must attend to clinician training needs on tobacco treatment, embedding clinical encounter resources and reminders that match the linguistic and cultural needs and preferences of their patient populations, and increasing access to high quality interpreting services and culturally-congruent staff.

Medical mistrust and vaccine-hesitant attitudes explain SARS-CoV-2 vaccination disparities in a mixed-serostatus cohort.

To understand the extent of racial disparities in SARS-CoV-2 vaccination among PWH and those vulnerable to HIV infection and to estimate the contributions of medical mistrust and vaccine-hesitant attitudes to these disparities. Quantitative data analyses in a racially and gender diverse, mixed-serostatus prospective cohort, the MACS/WIHS Combined Cohort Study. Interviewer-assisted questionnaires assessed SARS-CoV-2 vaccination, medical mistrust, and vaccine-hesitant attitudes from March 2021-September 2022 (n=3948). Longitudinal analyses assessed effects of sociodemographics on medical mistrust and vaccine-hesitant attitudes. A hierarchical multivariable logistic regression assessed effects of these co-factors on SARS-CoV-2 vaccination. Causal mediation models assessed whether a) medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, and b) vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 non-vaccination. Participants' mean age was 56.7; 55.3% were Black, 52.6% cisgender female, 62.6% PWH. 10.1% reported never receiving SARS-CoV-2 vaccinations (13.4% of Black and 4.5% of white participants). Black-identified participants had higher odds of non-vaccination than white participants (aOR = 1.72; 95% CI: 1.08, 2.72). Medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, accounting for 46.0% of the effect (p < 0.0001). Vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 non-vaccination to the extent that 57.7% (95% CI: 25.3%, 90.1%) of the disparity would be eliminated if vaccine-hesitant attitudes among Black respondents were reduced to levels reported among other racial groups. Findings indicate a profound need to build trustworthy healthcare environments to combat medical mistrust and vaccine-hesitant attitudes in Black communities in the U.S, including those affected by HIV.

Key contextual factors involved with participation in medical and genomic screening and research for African American and White Americans: a qualitative inquiry.

Tremendous progress has been made promoting diversity in recruitment for genomic research, yet challenges remain for several racial demographics. Research has cited intertwined fears of racial discrimination and medical mistrust as contributing factors. This study aimed to identify key factors to establishing trust in medical and genomic screening and research among African Americans and White Americans. Participants completed online focus groups and resulting transcripts were analyzed using a qualitative descriptive approach, with content analysis methods based on recommendations by Schreier. Fifteen African Americans and twenty-three White Americans participated in the study, 63% of which were female. The mean age of participants was 38.5 (SD = 16.6). The Overarching Theme of Trust is Context Dependent was identified, along with the following five themes describing elements influencing trustworthiness for our participants: (1) Professional Experience, Education, and Training Bolster Trust; (2) Trust Depends on Relationships; (3) Cross-checking Provided Information is Influential in Establishing Trust; (4) Trust is Undermined by Lack of Objectivity and Bias; and (5) Racism is an Embedded Concern and a Medical Trust Limiting Component for African Americans. To effectively address mistrust and promote recruitment of diverse participants, genomic research initiatives must be communicated in a manner that resonates with the specific diverse communities targeted. Our results suggest key factors influencing trust that should be attended to if we are to promote equity appropriately and respectfully by engaging diverse populations in genomic research.

Context dependent preferences in prestige bias learning about vaccination in rural Namibian pastoralists

Extensive work in the social sciences suggests that vaccination decisions are subject to incentives, biases, and social learning processes, including prestige bias transmission. High status figures, like doctors and public health officials, can be effective messengers for vaccination information and uptake under certain conditions. In communities where there is significant medical mistrust and less interaction with markets and formal medical systems, prestige bias social learning may operate through different channels. Here, we examine the role of prestige bias on vaccine decisions in two ethnic groups (Himba and Herero) with varying levels of market integration and experiences with formal healthcare systems. Participants completed a ranking task, comparing the influence of four prestigious individuals on vaccine decisions and a survey on medical mistrust. Using Plackett-Luce models, we compare the influence of location, ethnic affiliation, and other covariates on rankings. A multi-level model compared the influence of those within and outside one's ethnic group, as well as specialist (doctor/healer) and generalist (chief/governor) prestige figures. Results indicate changes in the rank of prestigious individuals across the rural-urban gradient. Our results demonstrate significant variability in prestige-biased social learning about vaccine decision making. Medical mistrust did not impact rankings. Contrary to previous work, we find that whether a prestigious individual is locally prominent is more important than their expertise in the relevant domain (health and healing). These findings emphasize the need for more context-specific studies of prestige bias, which can improve our understanding of healthcare decision-making and guide public health messaging across diverse contexts.

African American Men and Mental Health

African American men face challenges that include internalized negative social identities, marginalization, oppression, systemic racism, invisibility syndrome, targets of violence, murder, and erasure. Social workers may place the population at further risk of harm by using methods influenced solely by Eurocentric values. There is a paucity of peer-reviewed journal articles in the social work literature regarding the mental health of African American men. The literature fails to support social workers in acquiring the clinical skills required to provide services to African American men. This article will provide guidance to improve assessment, diagnosis, and clinician engagement with adult African American male clients. Barriers to the care of this population include the stigma of receiving mental health services, avoidance of vulnerability, medical distrust, clinician bias, no knowledge culturally expressed symptomology of mental illness, and an absence of culturally responsive care. Theories that inform the work with African American men in this article are the social determinants of health theory, intersectional theory, and narrative theory.

Quantifiable Cross-cultural Research on Medical Mistrust is Necessary for Effective and Equitable Vaccination in Low- and Middle-income Countries.

Perceptions of healthcare personnel and institutions substantially impact healthcare behaviors. In the US, minority experiences with racist events like the Tuskegee study, alongside everyday experiences of marginalization and discrimination, drive medical mistrust in populations that are already burdened with health inequalities. However, the concept of medical mistrust is rarely applied outside of industrialized contexts. Histories of colonialism, underfunded healthcare institutions, and the enormous cultural and ethnolinguistic diversity present in low- and middle-income countries (LMICs) make medical mistrust a likely contributor to health behavior in these contexts. In the era of COVID-19 and emergent malaria vaccines, there is an urgent need to mitigate factors leading to medical mistrust, which impedes interest in novel vaccines. Doing so requires substantial investment in research that examines the causes of medical mistrust across diverse communities, develops methodological tools that can effectively measure medical mistrust across diverse cultural and ethno-linguistic contexts, and applies this data to policy and public health messaging. This commentary highlights the role of medical mistrust in vaccination and argues for its utility in addressing vaccine decision-making in LMICs.

"First, Trust Needs to Develop": Hematologists' Perspectives on Factors Influencing Black Persons' Participation in Clinical Trials.

Cancer clinical trials are crucial for treatment standards and innovation but lack racial-ethnic diversity. Understanding physician perspectives on recruiting participants is critical due to their role in decision-making about trial candidacy and enrollment. From August 2021 to January 2022 we recruited 13 Academic hematologists experienced with treating blood cancers and enrolling clinical trial participants. Each hematologist participated in a 60-75-minute semistructured interview and completed a sociodemographic survey. Using the National Institute on Minority Health and Health Disparities multilevel model as a framework, we characterized hematologists' perceived barriers to clinical trial participation among Black persons. ATLAS.ti v9 and later v 23.2.1 was used for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk Inc). All hematologists were White, with 70% being male. Three factors influenced their perspectives on enrolling Black individuals in clinical trials: individual attitudes and beliefs, such as perceptions that Black or socioeconomically disadvantaged persons will be less willing or less compliant with the requirements for trial participation and follow-up. The need to build trusting relationships between themselves and patients prior to discussing clinical trials and the prevailing legacy of medical mistrust among the Black community. Trust was found to be the underlying factor in determining communication between hematologists and Black persons about clinical trials across all three levels. This study highlights how hematologists' attitudes, beliefs, biases, and views on trust in patient relationships influence their communication with Black individuals about clinical trials. It emphasizes the need for further research to develop interventions that address the lack of racial and ethnic diversity in trials.

A Pilot Randomized Control Trial of the Motivational Interviewing to Increase PrEP Uptake Intervention Among Black Women in the United States.

Despite the disproportional impact of HIV, Black individuals are benefiting the least from pre-exposure prophylaxis (PrEP). Motivational interviewing (MI) for PrEP uptake (MI-PrEP) is a two-session culturally tailored intervention incorporating MI strategies to improve PrEP motivation and uptake among cisgender Black women. A pilot randomized control trial was conducted in the Southeastern United States, and 41 women were randomized to MI-PrEP (session 1 with PrEP psychoeducation and MI and session 2 with MI and light case management) or enhanced treatment as usual (ETAU; two sessions of PrEP psychoeducation [videos explaining PrEP]). Women completed one follow-up assessment (1 month after visit 2). Measures captured primary (motivation [via contemplation and readiness ruler] and PrEP uptake via medical records) and secondary outcomes (e.g., PrEP knowledge, barriers to PrEP, and speaking to a provider about PrEP). Difference-in-differences analyses comparing MI-PrEP with ETAU as well as t-tests for within-group changes over time were conducted. Women who completed MI-PrEP (90.5% retained) compared with ETAU (100% retained) had a significantly higher likelihood of speaking to a provider about PrEP (OR = 4.42e7, CI [8.55e6, 2.29e8], DiD = 17.60, se = 0.84, p < 0.001). Within the MI-PrEP group, women had significant increases in PrEP prescription, knowledge, and motivation/contemplation, and significant decreases in financial resources as a PrEP barrier and medical mistrust (MMT). ETAU had within-group increases in PrEP prescription and speaking to a provider, no changes in motivation and MMT, and increases in specific barriers to care (e.g., transportation). MI-PrEP shows promise, and a large-scale study may be beneficial to further assess efficacy and examine implementation.

Experiences of Racism in Health Care and Medical Mistrust Shape Cancer Prevention and Control Behaviors Among Black Residents of Black Hawk County, Iowa: A Qualitative Study.

Non-Hispanic Black Iowans have substantially higher incidence of and mortality from cancer than their non-Hispanic White (NHW) counterparts in all but the oldest age groups; rates are particularly high in Black Hawk County, which contains the city of Waterloo, a highly segregated city with a documented history of redlining and distinct racial differences in the social drivers of health. To gather perspectives on race, racism, healthcare, and engagement with cancer prevention and control behaviors, among Black individuals living in Black Hawk County, Iowa. We conducted semi-structured interviews with 20 individuals (10 male, 10 female), questions included experiences in healthcare and feelings towards the healthcare system, trust of the healthcare system, experiences of racism or other perceived biases within healthcare, and how experiences of racism/bias and/or feelings towards the healthcare system impact desire or ability to participate in cancer prevention and control activities. Almost all interviewees reported both positive and negative experiences in healthcare. Nine themes emerged from analysis of the interviews: everyday racism and racism in healthcare, medical mistrust, need for more Black healthcare professionals, communication with healthcare professionals, need to break down cultural stigma around cancer, need and desire for community education around health and cancer, ability to choose, self-advocacy, and social support. There are substantial barriers for Black individuals engaging with cancer prevention and control behaviors in Iowa. Multi-level interventions are needed to address structural, healthcare facility, and individual-level barriers to care; interventions may build on existing resiliencies within the community.

A Survey of Patient Utilization and Trust of Emergency Medical Services

Little is known about patients’ decisions to come to the Emergency Department (ED) via emergency medical services (EMS) versus privately owned vehicle (POV); this is problematic as trust in EMS systems impacts patient care decisions. Furthermore, no studies exist that evaluate patients’ trust of the EMS system as it relates to a patient’s race. Patients completed a multi-method survey during their ED stay. Quantitative data included: patient demographics (age, gender, race) income, insurance status, previous medical training, highest level of education, self-reported medical and social history, number of ED visits in the past three months, and two scales assessing trust and empathy: the Group-Based Medical Mistrust Scale and the Jefferson Scale. Characteristics of patients who came to the ED via EMS versus POV were shown. A Wilcoxon signed rank test described differences in EMS trust scales by race. Logistic regression showed which factors contribute to the decision of EMS or POV. Qualitative comments described patients’ rationale for EMS versus POV. 23/72 (31.94%) patients utilized EMS transport and 49/72 (68.06%) utilized POV. 59.09% of patients self-identified as Black and 40.91% self-identified as White. The Group-Based Medical Mistrust Scale found Black patients had less trust in the EMS system (p=0.0001), while the Jefferson Scale of Patient Perception of Physician Empathy showed no significant difference in patient perceptions of EMS provider empathy (p=0.608). Logistic regression indicated that age predicted the use of EMS over POV (p&lt;0.001). Lack of access to POV, physical limitations, cost, speed, perception of emergency, and fear were identified as reasons that supportg patients’ decision to use EMS or POV. Many factors can influence patients’ transportation decisions and this study highlights trust, age, and other social and economic factors. These findings could inform policy decisions and ensure emergency care systems that are accessible for all patients.

Latine Immigrant Perspectives on Trust of Clinical Research.

Introduction: Medical mistrust impedes minority group participation in research, but there are few studies assessing determinants of Latine immigrants' trust in the clinical research enterprise. This qualitative study explored Latine immigrants' perspectives of clinical research. Methods: We conducted telephonic interviews with 20 Latine immigrants receiving care at a Federally Qualified Health Center in Los Angeles, California. Interviews were conducted between December 2021 and April 2022, and resultant data were coded using thematic analysis. Results: Six main themes emerged across two domains. First, trust was influenced by perceptions of the investigators' intentions. These perceptions were primarily based on (1) adequacy of information provided about the research, (2) perceived intent of investigators to respect their humanity, and (3) opportunities to share personal experiences. Second, trust was influenced by perceptions of the study's potential impact, including (4) risk of adverse outcomes, including health risks and risk of immigration status exposure, (5) perceived personal benefits, and (6) perceived community-level benefits. Conclusion: Researchers can build trust and promote participation among Latine immigrants by effectively communicating study objectives, risk mitigation efforts, and personal and community benefits. Enhancing the trustworthiness of clinical research can increase the relevance of scientific findings, representing one pathway to achieving health equity.

"We want that personal touch”: Dilemma of digitalization of healthcare based on community health worker experiences of depersonalization in healthcare.

261 Background: Advancements in digital technology is increasingly shaping healthcare delivery with a potential to address disparities by improving access to, enhancing communication with, and streamlining of healthcare management. Increased digitalization could also contribute to depersonalization from healthcare systems, particularly in individuals with low digital health literacy. We examined Community Health Advisors (CHAs) perceptions on community level experiences with technology in cancer care. Methods: University of Alabama at Birmingham and the University of South Alabama CHAs participated in semi-structured interviews exploring their experiences and perspectives on health and technology literacy challenges. Interviews were audio-recorded, transcribed, and inductively analyzed using NVivo and a constant comparative method leading to key representative themes and exemplary quotes. Results: Thirty-two CHAs, predominantly women (94%) and Black or African American (94%), participated in interviews. CHAs underscored multifaceted interactions of technology and healthcare. CHAs discussed the theme of navigating digital health interfaces alongside patient-provider relationships could result in depersonalization. They illuminated on barriers to and mitigation of depersonalization in healthcare engagement in the community. CHAs also discussed the theme of addressing health literacy as an underlying facet of mitigating depersonalization and low digital health literacy. They situated the feelings of depersonalization in relation to patient views on discomfort with digital services, medical mistrust, and provider cultural illiteracy impacting comprehension and engagement with health information and services. CHAs recommended acknowledging the community level discomforts with technology and healthcare, prioritizing human interaction alongside technology, and tailoring of healthcare services to diverse community needs, and linking to existing community infrastructure. Conclusions: Guided efforts focused on existing community infrastructure and integration of humanistic elements could aid in reducing depersonalization and improving digital health literacy.

Medical Mistrust Predicts Lower Likelihood of Wait-Listing in Kidney Transplant Candidates

Medical Mistrust Predicts Lower Likelihood of Wait-Listing in Kidney Transplant Candidates

Exploring Racial Disparities in Awareness and Perceptions of Oncology Clinical Trials: Cross-Sectional Analysis of Baseline Data From the mychoice Study.

Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity. This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process. As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non-Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups. Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non-Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non-Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables. Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients.

Abstract B029: Communication barriers: The role of medical mistrust in patient-centered communication in cancer care among Black and White older patients with cancer receiving treatment

Abstract Introduction: Medical mistrust, characterized by distrust in healthcare providers, institutions, and systems, can hinder effective Patient-Centered Communication (PCC) — a method of healthcare interaction that ensures patients (pts) voices, needs, and values guide clinical decisions and care planning. Medical mistrust can impede effective healthcare delivery, particularly to those from historically marginalized backgrounds. We aimed to explore the effect of race on the association of mistrust with PCC among older Black and White pts with cancer. Methods: Pts were aged 65+, 50% Black, receiving any cancer treatment and were recruited from July 2022 to August 2023. Pts perception of providers’ PCC was assessed using the Patient-Centered Communication in Cancer Care-36 (range: 1-5; higher score=better PCC), and medical mistrust using the Group Based Medical Mistrust Scale (range 12-60; higher score=greater mistrust) which includes subdomains of discrimination, suspicion, and low support. Multivariable linear regression models examined the association of mistrust with PCC separately among Black and White pts controlling for education, income, depression, and anxiety. The interaction of race on the association of mistrust with PCC was also explored. Beta (β) coefficients, 95% Confidence Intervals (CI), and p-values are reported. Results: Forty-three (21 Black) pts, mean age=73.6 years (range 65-86) completed the study. Sociodemographic and psychosocial characteristics was similar, except income &amp;lt;$50,000 was more common among Black than White pts (48% vs 27%; p=0.005) as was unmarried status (57% vs 27%; p=0.020). Between Black and White pts there were no significant differences in the median levels of mistrust (22.5 vs 20.0; p=0.34) and PCC (4.6 vs 4.5; p=0.82). Among Black pts increased overall mistrust and all mistrust subdomains were associated with decreased PCC [Overall Score: (β=-0.06; 95% CI=-0.09 to - 0.02; p=0.003), discrimination (β=-0.20; 95% CI=-0.30 to -0.11, p&amp;lt;0.001); suspicion (β=-0.14; 95%CI=-0.25 to -0.02; p=0.022) and low support (β=-0.15; 95% CI=-0.27 to -0.03; p=0.017)]. Among White pts, only the mistrust domain of low support was negatively associated with PCC (β=-1.21; 95%CI=-0.25 to -0.02; p=0.028). Exploration of racial differences in the association of mistrust and its subdomains and PCC revealed that the association of the discrimination subdomain and PCC varied between Black and White pts at the 9.5% significance level; p=0.095. Conclusion: Black pts with diminished trust in healthcare providers, institutions, and systems, may be less inclined to actively participate in open and collaborative communication with healthcare providers, which could adversely affect their clinical outcomes. Furthermore, considering the trending difference in mistrust domain of discrimination between Black and White pts, developing communication strategies tailored to address discrimination might be key to mitigating mistrust, cultivating strong patient-provider bonds, and advancing health equity among older Black pts with cancer. Citation Format: Nikesha Gilmore, Nikesha Jean, Nikesha Loh, Nikesha Strawderman, Rev Patrina Freeman, Elizabeth Diaz Fontanez, Marquita Thames-Lewis, Lee Kehoe, Marie Flannery, Ronald Epstein, Supriya Mohile, Charles Kamen. Communication barriers: The role of medical mistrust in patient-centered communication in cancer care among Black and White older patients with cancer receiving treatment [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B029.

Perceptions of HIV self-testing promotion in black barbershop businesses: implications for equitable engagement of black-owned small businesses for public health programs

BackgroundHIV self-testing (HIVST) offers an innovative and promising approach to increasing HIV testing among Black men in the United States, a population disproportionately affected by HIV. However, engaging Black men in traditional HIV prevention programs has been challenging due to stigma, medical mistrust, and limited access to preventive health services. This formative qualitative study aimed to explore the potential of utilizing barbershops as an example of a nontraditional healthcare venue to promote and distribute HIVST.MethodsFour virtual focus group discussions (FGDs) consisting of 19 participants in North Carolina were conducted with Black men, including barbershop business owners, barbers, and their customers, to assess perceptions of HIVST and the acceptability of partnering with barbershop businesses to promote HIVST. FGDs were digitally recorded, transcribed, and analyzed using a deductive coding approach to thematic analysis.ResultsParticipants reported that the trusting relationship between barbers and their customers, which may not exist between Black men and health care providers, is a facilitator of collaborating with barbershop businesses to reach Black men for HIVST distribution. Participants recommended providing education for barbers on the use of HIVST, as well as how to inform self-testers about linkage to care following HIVST to build the credibility of the barbers in delivering the intervention. Participants also raised the issue of the cost of HIVST to barbershop customers as a potential barrier to implementation, as well as the possibility that the implementation of such interventions could be seen as out of place in a barbershop business venue. Participants also expressed a strong belief that compensation to barbershops and their employees should accompany any intervention.ConclusionThese findings suggest that barbershop business venues may provide an appropriate venue for HIVST promotion and distribution, though factors like cost, training, and incentivization of implementers are necessary to consider in implementation planning. Furthermore, partnerships between public health actors and the business community must be built on equitable engagement to ensure the long-term viability of these critical initiatives.

Hepatitis A vaccination in a racially and sexually diverse population of gay, bisexual, and other men who have sex with men: Findings from the QVax study.

Previous studies found vaccination uptake of vaccine-preventable diseases (VPD) to be associated with race/ethnicity and medical mistrust among key populations, however, few studies examine Hepatitis A vaccination uptake. This cross-sectional study used online survey data collected from NJ and NY residents identifying as lesbian, gay, bisexual, transgender, queer (LGBTQ+) from October 2021 through November 2022. This study used a subsample of 222 gay, bisexual, and other cisgender men, 66.7% White, with mean age 41.22years (SD = 15.23), and 60% fully vaccinated for Hepatitis A. Overall, average group-based medical mistrust scores did not differ among non-vaccinated participants compared to fully or partially vaccinated participants. However, higher group-based medical mistrust scores were associated with non-White identifying participants, and were highest among Hispanic/Latinx (2.68, sd = 0.43) and Black non-Hispanic (2.58, sd = 0.50) participants (p < .001). Vaccination patterns did not differ among fear or vaccine confidence-based items. Our results contribute to the limited knowledge of differences in Hepatitis A vaccination uptake among men who have sex with men, and support the need for targeted intervention programs that acknowledge the diverse population of LGBTQ + identifying individuals and their associated health behaviors.

Black college women's preventive health behaviors: Applications of a Black Feminist-Womanist research paradigm

ObjectiveThe researchers applied Lindsay-Dennis' Black Feminist-Womanist research paradigm to Andersen's Behavioral Model for Health Service Use to guide initial research about Black American women's preventive health behaviors. MethodsThis article highlights this application, using interpretive phenomenological analysis for qualitative questions assessing how 40 Black college women define health and their experiences in health care. This was part of a larger convergent parallel mixed-methods approach in a 2022 cross-sectional online survey. ResultsParticipants defined health as a concept involving health literacy, physical and mental health, and being free from health conditions or disease. Regarding health-related lived experiences, negative experiences were more frequently reported than positive experiences. However, many participants reported both positive and negative health care related experiences. Predisposing, enabling, and need factors were all present in qualitative responses. ConclusionsThis article highlights the fit of a Black Feminist-Womanist research paradigm to Andersen's model to better understand Black women's health experiences and illustrates ways that medical mistrust, health literacy, and past experiences with health care can influence health service use. Areas for future research on barriers and facilitators to preventive care and implications for reducing health disparities are also discussed.

Group-based medical mistrust in genomic medicine: Associations with patient and provider perceptions of a specialty clinical encounter

PurposeInvestigating associations between group-based medical mistrust (GBMM) and perceptions of patient-provider encounters can identify one mechanism through which GBMM may influence health outcomes and serve as a barrier to equitable health care. This study investigated associations between GBMM reported by caregivers of children with a possible genetic condition and caregivers’ and providers’ perceptions of a specialty care appointment discussing diagnostic plans. MethodsCaregivers (N = 177) completed the GBMM scale and other measures before their child’s initial specialty clinic visit. After the visit, they reported their perceptions of the visit, including patient centeredness and satisfaction with care. Providers (N = 6) reported their perceptions of patient engagement. ResultsMultivariable linear regression showed that higher caregiver GBMM was associated with caregivers’ lower satisfaction with care (P < .01) and more negative perceptions of every domain of patient centeredness (P = .001-.04). Multilevel modeling showed that higher caregiver GBMM was associated with more negative provider perceptions of caregivers’ preparedness to participate in care (P = .03), likely treatment compliance (P = .03), and relevance of questions asked during visit (P = .04). ConclusionOur findings extend evidence for detrimental effects of GBMM on patient satisfaction to caregivers of pediatric patients and offer new evidence for associations with health care providers’ perceptions of caregivers’ engagement with care.

Medical Mistrust Among Black Patients with Serious Illness: A Mixed Methods Study.

Medical mistrust among Black patients has been used to explain the existence of well-documented racial inequities at the end of life that negatively impact this group. However, there are few studies that describe patient perspectives around the impact of racism and discriminatory experiences on mistrust within the context of serious illness. To better characterize experiences of racism and discrimination among patients with serious illness and its association with medical mistrust. Seventy-two Black participants with serious illness hospitalized at an academic county hospital. This is a convergent mixed methods study using data from participant-completed surveys and existing semi-structured interviews eliciting participants' perspectives around their experiences with medical racism, communication, and decision-making. The experience of medical racism and its association with Group-Based Medical Mistrust (GBMM) scale scores, a validated measure of medical mistrust. Of the 72 Black participants, 35% participated in interviews. Participants were mostly men who had significant socioeconomic disadvantage, including low levels of wealth, income, and educational attainment. There were reported high levels of race-based mistrust in the overall GBMM scale score (mean [SD], 36.6 [9.9]), as well as high scores within the suspicion (14.2 [5.0]), group disparities in healthcare (9.9 [2.8]), and lack of support (9.1 [2.7]) subscales. Three qualitative themes aligned with the GBMM subscales. Participants expressed skepticism of healthcare workers (HCWs) and modern medicine, recounted personal experiences of discrimination in the medical setting, and were frustrated with poor communication from HCWs. This study found high levels of mistrust among Black patients with serious illness. Suspicion of HCWs, disparities in healthcare by race, and a lack of support from HCWs were overarching themes that influenced medical mistrust. Critical, race-conscious approaches are needed to create strategies and frameworks to improve the trustworthiness of healthcare institutions and workers.