Gagnon Kelly W, Quinn Katherine, Walsh Jennifer L, Amirkhanian Yuri A, Kelly Jeffrey A
Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2153 N. Dr. Martin Luther King, Jr. Drive, Milwaukee, WI, 53212, USA.
BMC Prim Care. 2025 Jul 2;26(1):203. doi: 10.1186/s12875-025-02900-3.
Black and African Americans experience an undue burden of disease and reduced life expectancy because of systemic racism. As a result, Black and African Americans report higher levels of mistrust of medical services, providers, and systems. The Model for Health Care Distrust posits that patient characteristics, including prior experiences, when combined with characteristics of providers and healthcare systems can result in distrust of healthcare. Mistrust is associated with lower utilization of preventive care services and poor health outcomes. This study aimed to identify characteristics of healthcare providers and systems related to mistrust and strategies Black patients use to mitigate mistrust.
This study was a sub-analysis of qualitative data collected on factors influencing decision-making around COVID-19 vaccination among Black and African American adults. Eighty-six participants (54% female, average age: 49) were recruited in Milwaukee, WI to participate in in-depth interviews. After an initial thematic analysis was complete, data coded to themes related to primary care, experiences with healthcare, and mistrust were thematically coded to the domains in the Model for Health Care Distrust.
Most participants (67.4%) explicitly stated that they trust their primary care provider. 20% described only trusting some providers or trusting their provider half of the time. Patient characteristics related to mistrust included experiences of discrimination in healthcare and preferring natural medicine and wanting to discuss it as an option with their primary care provider. Healthcare provider characteristics including dismissiveness and treatment insistence were drivers for mistrust, while mutual respect and open communication and feeling like "more than just a number" supported patients' trust. Characteristics of healthcare systems related to mistrust included healthcare capitalism and perceived hidden agendas and experimentation. As strategies to mitigate mistrust, patients described seeking doctors of the same race or gender, doctor shopping when mistrust arises, and empowering themselves to speak up via education and intuition.
Our findings align with the principles of anti-racist patient-centered care and shared decision making and support the application of this approach in primary care. This study lays the groundwork for primary care interventions focused on addressing medical mistrust among Black and African American patients.
Not applicable.
由于系统性种族主义，黑人和非裔美国人承受着过重的疾病负担，预期寿命缩短。因此，黑人和非裔美国人对医疗服务、提供者和系统的不信任程度更高。医疗不信任模型认为，患者特征（包括既往经历）与提供者及医疗系统的特征相结合，可能导致对医疗保健的不信任。不信任与预防性保健服务利用率较低和健康结果较差有关。本研究旨在确定与不信任相关的医疗保健提供者和系统的特征，以及黑人患者用于减轻不信任的策略。
本研究是对收集的关于影响黑人和非裔美国成年人围绕新冠疫苗接种决策的因素的定性数据进行的子分析。在威斯康星州密尔沃基市招募了86名参与者（54%为女性，平均年龄49岁）参与深入访谈。在初步主题分析完成后，将编码为与初级保健、医疗保健经历和不信任相关主题的数据，按照医疗不信任模型中的领域进行主题编码。
大多数参与者（67.4%）明确表示信任他们的初级保健提供者。20%的参与者表示只信任一些提供者，或者只有一半时间信任他们的提供者。与不信任相关的患者特征包括在医疗保健中遭受歧视的经历、更喜欢天然药物并希望与初级保健提供者讨论这一选择。医疗保健提供者的特征，包括轻视和坚持治疗，是不信任的驱动因素，而相互尊重、开放沟通以及感觉“不仅仅是一个数字”则有助于患者产生信任。与不信任相关的医疗系统特征包括医疗资本主义以及察觉到隐藏的议程和试验。作为减轻不信任的策略，患者描述了寻找同一种族或性别的医生、在出现不信任时更换医生，以及通过教育和直觉增强自己发声的能力。
我们的研究结果符合以患者为中心的反种族主义护理和共同决策的原则，并支持这种方法在初级保健中的应用。本研究为专注于解决黑人和非裔美国患者医疗不信任问题的初级保健干预措施奠定了基础。
不适用。
