Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
Departments of Psychology, Physical Medicine and Rehabilitation, Virginia Commonwealth University, 800 West Franklin St., Room 201, Box 842018, Richmond, VA, 23284-2018, USA.
J Clin Psychol Med Settings. 2021 Mar;28(1):181-190. doi: 10.1007/s10880-020-09702-y.
There has been a growing research focus on social determinants to health disparities in general and medication adherence more specifically in low-income Black populations. The purpose of this study was to examine whether prior experiences of racism among Black patients in safety-net primary care indirectly predicts poor medication adherence through increased mental health symptoms and low healthcare provider trust. Two competing models were run whereby mental health leads to provider trust or provider trust leads to mental health in this multiple mediational chain. A group of 134 Black patients (76 men, average age 45.39 years) in a safety-net primary care clinic completed measures of these constructs. Results revealed that in the first model, mental health mediated the relationship between racism and provider trust, and provider trust mediated the relationship between mental health and medication adherence. All paths within this model were statistically significant, except the path between provider trust and medication adherence which approached significance. In the second model, provider trust and mental health significantly mediated the relationship between racism and medication adherence, and all direct and indirect paths were statistically significant, though the path between provider trust and medication adherence was omitted. These results may serve as catalysts to assess and attempt to mitigate specific minority-based stressors and associated outcomes within safety-net primary care settings.
人们越来越关注社会决定因素对健康差距的影响，特别是对低收入黑人群体的药物依从性的影响。本研究的目的是检验在初级保健安全网中，黑人患者先前经历的种族主义是否通过增加心理健康症状和降低医疗服务提供者信任度，间接地预测药物依从性差。在这个多重中介链中，运行了两个竞争模型，即心理健康导致提供者信任，或提供者信任导致心理健康。在一家初级保健安全网诊所中，一组 134 名黑人患者（76 名男性，平均年龄 45.39 岁）完成了这些结构的测量。结果表明，在第一个模型中，心理健康中介了种族主义与提供者信任之间的关系，而提供者信任中介了心理健康与药物依从性之间的关系。该模型中的所有路径均具有统计学意义，但提供者信任与药物依从性之间的路径接近显著。在第二个模型中，提供者信任和心理健康显著中介了种族主义与药物依从性之间的关系，所有直接和间接路径均具有统计学意义，尽管省略了提供者信任与药物依从性之间的路径。这些结果可能成为评估和尝试减轻初级保健安全网中特定的基于少数群体的压力源和相关结果的催化剂。
