Prall Sean, Scelza Brooke, Davis Helen Elizabeth
Department of Anthropology, University of California, Los Angeles, CA, USA.
School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA.
J Racial Ethn Health Disparities. 2025 Apr 21. doi: 10.1007/s40615-025-02442-5.
Substantial inequalities in access to healthcare are common in rural and marginalized populations in the Global South, and these inequalities can drive health disparities. Historical mistrust of healthcare institutions can further impact healthcare behaviors, including vaccination. Here, we apply the concept of medical mistrust, which has been widely applied to healthcare decisions in industrialized countries, across a rural-urban spectrum of communities in Namibia, and assess its utility in understanding vaccination decisions.
Otjiherero-speaking indigenous communities of Kunene, Namibia, were surveyed to assess medical mistrust. Participants also answered questions about COVID-19 vaccination status, vaccine safety, and interest in a hypothetical malaria vaccine. Bayesian multilevel models were used to compare medical mistrust across communities and its influence on vaccination and vaccine perceptions.
The level of medical mistrust varied across contexts, with the highest level of mistrust in peri-urban communities. Medical mistrust predicted beliefs about vaccine safety and interest in the malaria vaccine, but not COVID-19 vaccine status, which was largely driven by access to the vaccine. For rural and peri-urban Himba, participants also expressed disinterest in the COVID-19 vaccine and worries about its safety.
Addressing global health disparities requires understanding how locally contextualized social and ecological experiences shape healthcare and vaccination decisions. Results of this study show fundamental differences in medical mistrust by community, which may be contributing to beliefs about vaccines. Understanding how medical mistrust varies across these contexts, and how it impacts perceptions about vaccination, can inform health communication and public policy in underserved communities.
在全球南方的农村和边缘化人群中，获得医疗保健的机会存在严重不平等现象，这些不平等会加剧健康差距。对医疗机构由来已久的不信任会进一步影响医疗行为，包括疫苗接种。在此，我们将医疗不信任这一概念应用于纳米比亚城乡不同社区，该概念已在工业化国家的医疗决策中广泛应用，并评估其在理解疫苗接种决策方面的效用。
对纳米比亚库内内地区讲奥齐赫雷罗语的土著社区进行调查，以评估医疗不信任情况。参与者还回答了关于新冠疫苗接种状况、疫苗安全性以及对一种假设的疟疾疫苗的兴趣等问题。采用贝叶斯多层次模型比较不同社区的医疗不信任情况及其对疫苗接种和疫苗认知的影响。
医疗不信任程度因环境而异，城郊社区的不信任程度最高。医疗不信任预示了对疫苗安全性的看法以及对疟疾疫苗的兴趣，但对新冠疫苗接种状况没有影响，新冠疫苗接种状况主要取决于疫苗的可及性。对于农村和城郊的欣巴人，参与者也表示对新冠疫苗不感兴趣并担心其安全性。
解决全球健康差距问题需要了解当地背景下的社会和生态体验如何影响医疗保健和疫苗接种决策。本研究结果显示不同社区在医疗不信任方面存在根本差异，这可能影响了对疫苗的看法。了解医疗不信任在这些背景下如何变化，以及它如何影响对疫苗接种的认知，可为服务不足社区的健康宣传和公共政策提供参考。
