Distrust Of Health Care Providers Research Articles

Exploring the Barriers to Clinic-based Screening for Sexually Transmitted Infections (STIs) among Men in Ghana: A Qualitative Study

The burden of sexually transmitted infections (STIs) continues to increase with over one million curable STIs occurring daily worldwide. Sex disparity in the rates of testing for STIs can compromise the efforts to reduce the incidence of STIs. The study aimed to explore the barriers to facility-based screening for STIs among men in Ghana. A qualitative exploratory design was employed in this study. Using a semi-structured interview guide, individual in-depth interviews were conducted among purposively sampled men from November 2019 to January 2020. Data saturation was achieved at the ninth participant. Audio-recorded interviews were transcribed verbatim and analysed thematically through Braun and Clarke’s approach. Four themes emerged from the analyses: (1) lack of privacy from healthcare providers, (2) mistrust of healthcare providers, (3) the burden of handling thoughts of positive status, and (4) fear of stigmatisation. These barriers deterred men from seeking clinic-based screening for STIs. The barriers were multi-factorial and a major hindrance to ensuring that people are aware of their STI status through screening and diagnosis. It is imperative to consider these barriers when designing STI screening interventions and policies to help promote facility-based screening for STIs among men in Ghana.

Barriers and mediators for routine dental care visits from the experiences of immigrant parents of autistic children living in the United States.

Immigrants are reluctant to attend routine dental care visits. Moreover, children with autism have a higher chance of developing periodontal disease. In this study, we describe the experiences of immigrant parents with autistic children and the barriers and mediators to routine dental care visits for their children in the United States. We conducted semistructured interviews with 19 immigrants who have children with autism. We found that lack of transportation, support system, and insurance;prioritization of basic needs; and a mistrust of healthcare providers are the main barriers to attending routine dental care visits for autistic children of immigrant parents. Moreover, staff who consider the needs of children with autism, spend ample time with children with autism, and help with navigating the health system can improve access to routine dental care visits for autistic children with immigrant parents. This study found that despite their immigration status, all parents want to see improvements in the oral health of their children with special needs. This study aimed to unpack the structural barriers and mediators to routine dental care visits for autistic children of immigrant parents. We found that removing structural barriers to care and utilizing mediators will enhance the outcome of routine dental care, resulting in healthier oral hygiene.

Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners.

People capable of pregnancy are disproportionately affected by HIV. Family planning needs and services are often unmet in this population, and clinical care guidelines regarding contraceptive options and abortion care are not well elucidated. Individuals living with HIV often face unique barriers in accessing contraception and abortion services due to internalized stigma, medically complex care (eg, drug-drug interactions, adverse effects of antiretroviral therapy), and distrust of health care providers. There is also a lack of clarity among reproductive health, primary, and infectious disease care providers on best-practice contraceptive counseling and contraceptive care for individuals living with HIV, given limited opportunities to enhance expertise in reproductive infectious disease. In this review, we summarize existing and updated evidence and clinical considerations regarding contraceptive counseling and abortion care in this population.

Occupational Health Providers' Perceptions of Employee Vaccine Hesitancy.

This study examined the perspectives of occupational health providers (OHPs) on the most frequently encountered clinically relevant reasons for employee vaccine hesitancy. We conducted an anonymous, online, cross-sectional survey of US OHPs ( N = 217). The survey asked OHPs about the major reasons that employees cite for being unwilling to receive the following three categories of vaccines: COVID-19, annual influenza, and others relevant to the workplace. Concern about adverse effects was the most frequently reported reason for employee vaccine hesitancy for each vaccine category. Mistrust was reported more frequently for COVID-19 than for the influenza vaccine or other vaccines (χ 2P < 0.05). Targets of employee mistrust included government and researchers or scientists, but mistrust of healthcare providers was uncommon. These results can be used to inform interventions to address vaccine hesitancy in the occupational health setting.

Upward bound students' experience with bias in healthcare: An application of critical race theory.

To explore how students participating in Trio Upward Bound, a federally funded program for low-income and future first-time college students, experience bias when seeking healthcare. Qualitative group discussion. Twenty-six Trio Upward Bound students participated in a group discussion about their experiences in healthcare. Questions for the discussion were developed using Critical Race Theory. Student comments were analysed and coded using Interpretive Phenomenological Analysis (IPA). Results were reported using Standards for Reporting Qualitative Research. Students reported experiencing bias in the healthcare setting because of age, race, native language, traditional dress and/or ability to advocate for their rights. Three themes emerged: communication, invisibility and healthcare rights. Through these themes students expressed how their experiences with healthcare lead to further cultural mistrust and mistrust of healthcare providers. The comments provided by students included examples of the five tenets of Critical Race Theory: the permanence of racism, colorblindness, interest convergence, Whiteness as property, and the critique of liberalism. Among this group of adolescents, early negative experiences in healthcare have led some to avoid seeking treatment. As this continues into adulthood it may further health disparities in these groups. Critical Race Theory is a valuable tool in understanding how race, class and age intersect to create disparities in healthcare.

Prevalence of influenza-specific vaccination hesitancy among adults in the United States, 2018

BackgroundThe role of vaccine hesitancy on influenza vaccination is not clearly understood. Low influenza vaccination coverage in U.S. adults suggests that a multitude of factors may be responsible for under-vaccination or non-vaccination including vaccine hesitancy. Understanding the role of influenza vaccination hesitancy is important for targeted messaging and intervention to increase influenza vaccine confidence and uptake. The objective of this study was to quantify the prevalence of adult influenza vaccination hesitancy (IVH) and examine association of IVH beliefs with sociodemographic factors and early-season influenza vaccination. MethodsA four-question validated IVH module was included in the 2018 National Internet Flu Survey. Weighted proportions and multivariable logistic regression models were used to identify correlates of IVH beliefs. ResultsOverall, 36.9% of adults were hesitant to receive an influenza vaccination; 18.6% expressed concerns about vaccination side effects; 14.8% personally knew someone with serious side effects; and 35.6% reported that their healthcare provider was not the most trusted source of information about influenza vaccinations. Influenza vaccination ranged from 15.3 to 45.2 percentage points lower among adults self-reporting any of the four IVH beliefs. Being female, age 18–49 years, non-Hispanic Black, having high school or lower education, being employed, and not having primary care medical home were associated with hesitancy. ConclusionsAmong the four IVH beliefs studied, being hesitant to receiving influenza vaccination followed by mistrust of healthcare providers were identified as the most influential hesitancy beliefs. Two in five adults in the United States were hesitant to receive an influenza vaccination, and hesitancy was negatively associated with vaccination. This information may assist with targeted interventions, personalized to the individual, to reduce hesitancy and thus improve influenza vaccination acceptance.

A Qualitative Inquiry of Older Afghan Refugee Women's Individual and Sociocultural Factors of Health and Health Care Experiences in the United States.

Approximately 132,000 Afghans have resettled in the United States since the 1980s and are now aging. As older adults, sociocultural factors influence health and health-related behaviors. This study aimed to explore older Afghan refugee women's perceptions of individual and sociocultural factors of health and health care experiences. A focused ethnography methodology was conducted with 27 semi-structured interviews with older Afghan refugee women, family members, and community key informants in Southern California. Recorded interviews were transcribed and analyzed using inductive thematic analysis. Five themes were identified as key to health promotion in the post-migration setting: (a) health promotion through Islam, (b) the centrality of family, (c) ongoing stressors that impact health, (d) needing support in navigating health services, and (e) miscommunication leading to mistrust of health care providers. Health interventions should consider social and cultural contexts and faith-based and family-centered approaches when addressing older Afghan refugee women's long-term health and well-being.

Effects of Experienced Discrimination in Pediatric Sickle Cell Disease: Caregiver and Provider Perspectives.

For Black children with sicklecell disease (SCD) and their families, high disease stigmatization and pervasive racism increase susceptibility to discrimination in healthcare settings. Childhood experiences of discrimination can result in medical nonadherence, mistrust of healthcare providers, and poorer health outcomes across the lifespan. Caregivers and medical providers are essential to childhood SCD management and are therefore well-positioned to provide insight into discrimination in the context of pediatric SCD. This mixed-methods study sought caregivers' and providers' perspectives on processes underlying discrimination and potential solutions to mitigate the negative effects of perceived discrimination among children with SCD. Caregivers (N = 27) of children with SCD (≤ 12years old) and providers from their hematology clinics (N = 11) participated in individual semi-structured interviews exploring experiences of discrimination and daily SCD management and completed a quantitative measure of discrimination. Qualitative data were collected until themes reached saturation and subsequently transcribed verbatim, coded, and analyzed using applied thematic analysis. Quantitative and qualitative data converged to suggest the pervasiveness of discrimination in healthcare settings. Three qualitative themes emerged: (1) healthcare system factors underlie discrimination, (2) families' challenging interactions with providers lead to perceptions of discrimination, and (3) experiences of discrimination impact caregiver-provider interactions. Both caregivers and providers highlighted building trusting patient-provider relationships and encouraging patients' self-advocacy as means to reduce experiences and impacts of discrimination. These findings offer potential approaches to tangibly mitigate occurrences of discrimination in pediatric healthcare settings by trust building, accountability keeping, and fostering rapport to improve quality of care and pediatric SCD health outcomes.

Sexual and gender minority health in the Middle East and North Africa Region: A scoping review.

Researchers in studies from multiple countries suggest that sexual and gender minority people experience high rates of violence, stigma, and discrimination, as well as mistrust of health care providers and systems. Despite growing evidence related to sexual and gender minority health in North America and Europe, we know little about the health of this population in the Middle East and North Africa. We aimed to comprehensively examine the literature related to the health of sexual and gender minority people in the Middle East and North Africa and to identify research gaps and priorities. We conducted a scoping review informed by the framework recommended by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. We searched the following databases: PubMed (using Medline All on the Ovid platform), PsycINFO (Ovid), CINAHL (Ebsco), and Embase (Ovid). The search strategy combined terms for the geographic region of interest (Middle East and North Africa) and the population of interest (sexual and gender minority). Each was operationalized using multiple search terms and, where available, controlled vocabulary terms. Research articles were identified and assessed for inclusion using an explicit strategy. Relevant information was extracted and synthesized to present a descriptive summary of existing evidence. Research designs of the 98 articles we reviewed included quantitative (n=73), qualitative (n=20), and mixed methods (n=5). Most studies were conducted in Lebanon (n=33), Pakistan (n=32), and Iran (n=23) and focused mainly on gender minority individuals (n=46) and men who have sex with men (n=32). Five themes emerged from the review: sexual health (52; 53%); mental health (20; 20%); gender identity (17; 17%); violence and discrimination (7; 7%); and experiences with the healthcare system (2; 2%). Although researchers focused on multiple health outcomes in some studies, we included them under the theme most closely aligned with the main objective of the study. Although our study is limited to few countries in the Middle East and North Africa region, we found that sexual and gender minority individuals face multiple adverse sexual and mental health outcomes and experience high rates of stigma, discrimination, and violence. More research is needed from countries outside of Lebanon, Pakistan, and Iran, including community-based participatory approaches and multi-level intervention development. Nurses and other healthcare providers in the region need training in providing inclusive care for this population.

Attitudes toward harm reduction and low-threshold healthcare during the COVID-19 pandemic: qualitative interviews with people who use drugs in rural southern Illinois

BackgroundChronic health conditions associated with long-term drug use may pose additional risks to people who use drugs (PWUD) when coupled with COVID-19 infection. Despite this, PWUD, especially those living in rural areas, may be less likely to seek out health services. Previous research has highlighted the increased disease burden of COVID-19 among PWUD. Our manuscript supplements this literature by exploring unique attitudes of PWUD living in rural areas toward the pandemic, COVID-19 vaccination, and the role of harm reduction (HR) organizations in raising health awareness among PWUD.MethodsSemi-structured interviews were conducted with 20 PWUD living in rural southern Illinois. Audio recordings were professionally transcribed. A preliminary codebook was created based on interview domains. Two trained coders conducted iterative coding of the transcripts, and new codes were added through line-by-line coding and thematic grouping.ResultsTwenty participants (45% female, mean age of 38) completed interviews between June and November 2021. Participants reported negative impacts of the pandemic on mental health, financial wellbeing, and drug quality. However, the health impacts of COVID-19 were often described as less concerning than its impacts on these other aspects of life. Many expressed doubt in the severity of COVID-19 infection. Among the 16 unvaccinated participants who reported receiving most of their information from the internet or word of mouth, uncertainty about vaccine contents and distrust of healthcare and government institutions engendered wariness of the vaccination. Distrust of healthcare providers was related to past stigmatization and judgement, but did not extend to the local HR organization, which was unanimously endorsed as a positive institution. Among participants who did not access services directly from the HR organization, secondary distribution of HR supplies by other PWUD was a universally cited form of health maintenance. Participants expressed interest in low-threshold healthcare, including COVID-19 vaccination, should it be offered in the local HR organization’s office and mobile units.ConclusionCOVID-19 and related public health measures have affected this community in numerous ways. Integrating healthcare services into harm reduction infrastructures and mobilizing secondary distributors of supplies may promote greater engagement with vaccination programs and other healthcare services.Trial numberNCT04427202.

Restoring trust in research among historically underrepresented communities: A call to action for antiracism research in nursing

Background: Health disparities and inequities among historically underrepresented populations represent a public health crisis. Purpose: This manuscript describes how use of an antiracism framework, an evidence-based approach to addressing systemic barriers, can assist with restoring trust in historically underrepresented communities that have experienced harm by researchers. Methods: We also discuss the necessity of inclusive research teams and provide exemplars of how antiracism research principles and inclusive research teams can be used to mitigate harm and restore trust in historically underrepresented communities. Discussion: Historical trauma and research misconduct have resulted in the mistrust of healthcare providers and health care systems among historically underrepresented individuals and communities. Conclusion: Nurse scientists are positioned to appreciate historical inequities and trauma and to intervene by developing culturally relevant interventions. This work, however, will only happen if communities that have suffered harm trust nurse scientists.

Factors Affecting Hispanics’ Access to Healthcare During the COVID-19 Pandemic: An Integrative Review

Hispanics comprise more than one third of U.S. COVID-19 cases. This higher prevalence is associated with determinants to access that existed long before the pandemic. Using the Preferred Report Items for Systematic Review and Metanalysis (PRISMA) guidelines, this review examined 20 studies that addressed barriers faced specifically by Hispanics in the United States, Sampling methods are described and the synthesized research findings are organized using the Theoretical Framework of Access, which classified barriers as either structural or personal. Results suggested that Hispanics had lower COVID-19 knowledge than other groups. The article discussion considers possible causes, such as low health literacy levels, an inability to reach or pay for services, a mistrust of healthcare providers, or a lack of access to information. To increase U.S. Hispanics’ COVID-19 knowledge and encourage safer behaviors, culturally sensitive and linguistically appropriate information is needed.

The 2021 Joseph St Geme, Jr, Leadership Award Address: The Role of Structural Racism in Injuries to Children and Adolescents.

The 2021 Joseph St Geme, Jr, Leadership Award Address: The Role of Structural Racism in Injuries to Children and Adolescents.

Association among trust in health care providers, friends, and family, and vaccine hesitancy

A health care provider’s vaccination recommendation is one of the most important factors influencing parents’ decisions about whether to vaccinate their children. Unfortunately, vaccine hesitancy is associated with mistrust of health care providers and the medical system. We conducted a survey of 2440 adults through the RAND American Life Panel in 2019. Respondents were asked to rate their trust in pediatricians, OB/GYNs, doulas, midwives, lactation consultants, friends and family for information about childhood vaccines. Respondents were also asked about willingness to vaccinate a hypothetical child as a measure of vaccine hesitancy. We used principal component analysis to characterize variance in responses on trust items and logistic regression to model the relationship between trust and vaccine hesitancy. Vaccine hesitancy was associated with: (1) lower overall trust; (2) reduced trust in OB/GYNs and pediatricians and greater trust in doulas, midwives, and lactation consultants; and (3) greater trust in friends and family.

Characterizing the role of facial hair in gender identity and expression among transgender men

Characterizing the role of facial hair in gender identity and expression among transgender men

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.

1062. HCV GET-UP: A Group Evaluation and Treatment Uptake Intervention Improves HCV Linkage to Care for PWID

BackgroundThough PWID represent the overwhelming majority of those living with HCV in the United States, most have not been treated. PWID often have reduced access to specialty care, as well as limited HCV knowledge, low perceived vulnerability to poor HCV-related health outcomes, poor self-efficacy, high levels of perceived stigma, and mistrust of healthcare providers. We therefore evaluated an primary care based HCV Group Evaluation and Treatment UPtake (HCV GET-UP) intervention to improve HCV medical evaluation and treatment uptake for HCV+ PWIDs.Figure 1 MethodsWe enrolled 84 HCV+ PWID and randomize them 1:1 to a 4-week group evaluation intervention followed by individual treatment (intervention) versus onsite treatment alone (control). The group consisted of 4 weekly 1-hour sessions focused on HCV education, peer motivation, and health behavior change skills, along with an HCV medical evaluation. Both arms received HCV treatment according to national guidelines. Baseline questionnaires were performed via Audio Computer-Assisted Self-Interview (ACASI) technology. Clinical Data was extracted from the medical chart. Our primary outcomes were HCV linkage to care (HCV evaluation) and treatment uptake. Bivariate analyses were performed to evaluate HCV treatment outcomes between arms using chi square tests.ResultsOf the 76 participants that have currently completed the study (84 enrolled) 35% identified their race as black, 61% identified their ethnicity as Hispanic, 79% were male, and 25% of the participants were homeless. 87% had genotype 1, 28% were HIV+, and 20% had cirrhosis. Baseline urine tocixicologies were positive for cocaine in 38% of participants and 40% for heroin. Of those randomized to the group treatment arm vs individual arm 87% vs 62% were linked to care (p=0.012), 51% vs. 41% initiated treatment (p=.35), 41% vs. 35% completed treatment (p=0.6), and 33% vs. 27% (p=0.6)ConclusionHCV GET-UP, a primary-care based group evaluation and treatment uptake intervention significantly improved linkage to care for HCV+ PWID. Though this is encouraging, we must integrate other interventions to aid PWID as they move through the more proximal steps of the HCV cascade, for HCV cure still remains elusive for the majority of PWID enrolled.Disclosures Chinazo O. Cunningham, MD, MPH, General Electric Health (Other Financial or Material Support, My husband is currently employed by General Electric Health and receives stock and stock options.)Quest Diagnostics (Other Financial or Material Support, My husband was previously employed by Quest Diagnostics and received stocks and stock options.) Alain H. Litwin, MD, MPH, MS, Gilead (Advisor or Review Panel member)Merck (Advisor or Review Panel member)

Characteristics and Attitudes of Men Using Anabolic Androgenic Steroids (AAS): A Survey of 2385 Men.

Additional characterization of patients using anabolic androgenic steroids (AAS) is needed to improve harm reduction and cessation resources for patients. Our group sought to expand upon the currently limited data regarding AAS use by performing a web-based survey assessing experiences of males using AAS. Participants included men over the age of 18 with history of AAS use within the past 5 years. Data were collected between August 2019 and April 2020. Primary outcome measures included age when starting AAS, dose of AAS, motivations for use, experiences with health-care professionals, and rate of successful cessation. The survey was accessed 3640 times, resulting in 2385 completed surveys meeting the inclusion criteria (68.93% participation rate).Average participant age was 31.69 ± 10.09 years. Over half of respondents were from the United States (n = 1271, 53.3%). Motives to use AAS included improving appearance (n = 1959, 82.2%), strength gain (n = 1192, 50%), and self-esteem/body image issues (n = 712, 29.87%). Participants rated physicians poorly, regarding knowledge of AAS (4.08 ± 2.23). Most participants did not reveal AAS use to their health-care providers (n = 1338, 56.1%); of those that did, 55.30% (n = 579) reported feeling discriminated against for their use. Of 46.16% (n = 1101) attempting AAS cessation, 60.22% (n = 663) were unsuccessful. Challenges in the management of AAS use include early onset of use, supraphysiologic doses used, and frequently present body image disorders stress. Distrust of health-care providers, poor cessation rates, and lack of physician training further exacerbate this. These findings should serve to reinforce previous calls to action for further research on the treatment of AAS use disorder.

Barriers to palliative care in sexual and gender minority patients with cancer: A scoping review of the literature.

The Institute of Medicine reports lesbian, gay, bisexual and transgender (LGBT) individuals having the highest rates of tobacco, alcohol and drug use leading to elevated cancer risks. Due to fear of discrimination and lack of healthcare practitioner education, LGBT patients may be more likely to present with advanced stages of cancer resulting in suboptimal palliative care. The purpose of this scoping review is to explore what is known from the existing literature about the barriers to providing culturally competent cancer-related palliative care to LGBT patients. This review will use the five-stage framework for conducting a scoping review developed by Arksey and O'Malley. The PubMed, Scopus, PsychINFO and Cochrane electronic databases were searched resulting in 1,442 citations. Eligibility criteria consisted of all peer-reviewed journal articles in the English language between 2007 and 2020 resulting in 10 manuscripts. Barriers to palliative cancer care for the LGBT include discrimination, criminalisation, persecution, fear, distress, social isolation, disenfranchised grief, bereavement, tacit acknowledgment, homophobia and mistrust of healthcare providers. Limited healthcare-specific knowledge by both providers and patients, poor preparation of legal aspects of advanced care planning and end-of-life care were underprovided to LGBT persons. As a result of these barriers, palliative care is likely to be provided for LGBT patients with cancer in a deficient manner, perpetuating marginalisation and healthcare inequities. Minimal research investigates these barriers and healthcare curriculums do not provide practitioners skills for administering culturally sensitive palliative care to LGBT patients.

Healthcare Disparities in the Treatment of Pelvic Floor Disorders

Pelvic floor disorders (PFD) include urinary incontinence, pelvic organ prolapse, fecal incontinence and other storage and emptying abnormalities. These disorders are common among women and are significantly undertreated. Healthcare disparities may partly explain this phenomenon. Disparities in the treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence can be stratified by race, age, and socioeconomic status. Race is often closely intertwined with socioeconomic status, access to care, and mistrust of healthcare providers. Overall, the etiology of disparities in treatment of PFD is multifactorial and complex. Normalization and removing the stigma of pelvic floor disorders, using better metrics for screening, and increasing the diversity in studies that assess pelvic floor disorders may reduce healthcare disparities in treatment, leading to improved care for common and treatable pelvic floor conditions.