Abstract

The health status for Black-Americans is worse than other ethnic groups due to less seeking of medical care. Many Black-Americans refuse to seek medical care due to a distrust of the medical establishment. Cultural-distrust, which perpetuates medical-mistrust, was used as the theoretical framework for this study. It has been established that medical-mistrust by the Black-American population correlates with to the underutilization of healthcare services, resulting in inferior outcomes and increased healthcare cost and burden to society. The study aimed to determine if age (age group or age-stratification) and medical-mistrust adversely affect healthcare utilization in Black-Americans when controlling for gender, income, insurance status, and education level, using the Medical Mistrust Index and Group-Based Medical Mistrust Scale as data collection tools.
Results from 148 surveys collected from Black men (n = 57) and women (n = 91) in Orlando, Florida, USA revealed a negative significant relationship between medical-mistrust and healthcare utilization (r = -.023) when controlling for gender, income, insurance status, and education level. Further, it was found that a non-significant bivariate relationship exists between age (r = .032) and healthcare utilization among Black-Americans. The results indicated that Black-Americans of all age groups harbor mistrust of healthcare on a near-equal basis per age-stratification.
This research adds to the knowledge-base that medical-mistrust discourages healthcare-seeking behaviors and decreases healthcare utilization by the Black-American population. These findings bring to the forefront the fundamental social, policy, and attitude changes needed to assist Black-Americans to overcome their mistrust in medicine and increase utilization of healthcare services, which decreases the financial burden to society and avoids the emotional fallout due to unnecessary illness and premature death.
A disproportionate number of Black-American men and women are affected by obesity and diabetes. Black-Americans have a high risk for type 2 diabetes and a high rate of diabetic complications due to poor glycemic control and racial disparities in the United States’ healthcare system.
Thus, in the prevention, management, and treatment of type 2 diabetes, physicians and healthcare providers should be sensitive to the persistent medical-mistrust embedded in the psyche of the Black-American population—and be aware that, even though younger Black-Americans are living in a more inclusive society, they might still harbor mistrust of the healthcare system on par with their older counterparts. All medical practitioners in every medical specialty should be aware of this mistrust (and how it discourages positive healthcare-seeking behaviors) and respond accordingly.

Keywords: Black-American; Biopsychosocial; Cultural Mistrust; Diabetes; Racism

References

1. Pruitt KD and Kerna NA. “400 Years of Reasons: Medical Mistrust in the Black-American Population (and Its Adverse Effects on Healthcare Outcomes and Increased Cost to Society)”. EC Emergency Medicine and Critical Care.
2. Pruitt KD and Kerna NA. “Medical Mistrust in the Black-American Population: Significance in Pediatrics and the Whole of Medicine”. EC Paediatrics.
3. Thompson HS., et al. “The group-based medical mistrust scale: Psychometric properties and association with breast cancer screening”. Journal of Preventive Medicine 38 (2004): 209-218. https://pubmed.ncbi.nlm.nih.gov/14715214/
4. Shelton RC., et al. “Validation of the group-based medical mistrust scale among urban Black men”. Journal of General Internal Medicine6 (2010): 549-555. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869405/
5. Hughes-Halbert C., et al. “Racial differences in medical mistrust among men diagnosed with prostate cancer”. Cancer 115 (2009): 2553-2561. https://pubmed.ncbi.nlm.nih.gov/19296516/
6. LaVeist TA., et al. “Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients”. Medical Care Research and Review 57 (2000): 146-161. https://pubmed.ncbi.nlm.nih.gov/11092161/
7. Egede LE and Michel Y. “Medical mistrust, diabetes self-management, glycemic control in an indigent population with type 2 diabetes”. Diabetes Care 1 (2006): 131-132. https://pubmed.ncbi.nlm.nih.gov/16373908/
8. Lillie-Blanton M., et al. “Race, ethnicity, and the health care system: Public perceptions and experiences”. Medical Care Research and Review 57 (2000): 218-235. https://pubmed.ncbi.nlm.nih.gov/11092164/
9. Hammond WP. “Psychosocial correlates of medical mistrust among African American men”. American Journal of Community Psychology 45 (2010): 87-106. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910212/
10. Frankfort-Nachmias C and Nachmias D. “Research methods in the social sciences (7th edition.). New York, NY: Worth (2008). https://courses.lumenlearning.com/suny-hccc-research-methods/
11. Creswell J. “Research design: Qualitative, quantitative, and mixed methods approaches. Thousands Oaks, CA: SAGE (2009). https://us.sagepub.com/en-us/nam/research-design/book255675
12. Patton MQ. “Qualitative research and evaluation methods (3 edition.). Thousand Oaks, California: Sage Publications (2002). https://us.sagepub.com/en-us/nam/qualitative-research-evaluation-methods/book232962
13. Field A. “Discovering statistics using SPSS (3rd Ed.). Thousand Oaks, CA: SAGE (2009).
14. Green S and Salkind N. “Using spss for windows and macintosh: Analyzing and understanding data (6 ed.). Upper Saddle River, NJ: Pearson (2011).
15. Bell TJ and Tracey TG. “The relation of cultural mistrust and psychological health”. Journal of Multicultural Counseling and Development 34 (2006): 2-14. https://www.researchgate.net/publication/264471298_The_Relation_of_Cultural_Mistrust_and_Psychological_Health
16. Montgomery DC., et al. “Introduction to linear regression analysis (3^rd edition)”. New York, NY: Wiley and Sons (2001).
17. S. Census Bureau, Statistical Abstract of the United States (2011).
18. Faul F., et al. “Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses”. Behavior Research Methods4 (2009): 1149-1160. https://link.springer.com/article/10.3758/BRM.41.4.1149
19. Urbaniak GC and Plous S. “Research Randomizer” (2011).
20. Brandon DT., et al. “The Legacy of Tuskegee and trusts and medical care: Is Tuskegee responsible for race differences in mistrust of medical care?” Journal of the National Medical Association7 (2005): 951-956. https://pubmed.ncbi.nlm.nih.gov/16080664/
21. LaVeist TA., et al. “Mistrust of health care organizations is associated with underutilization of health services”. Health Services Research6 (2009): 2093-2105. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796316/
22. Rudestam KE and Newton RR. “Surviving your dissertation: A comprehensive guide to content and process (3rd ed.). Thousand Oaks, CA: Sage (2007). https://us.sagepub.com/en-us/nam/surviving-your-dissertation/book239510
23. Bynum SA., et al. “Unwillingness to participate in colorectal cancer screening: Examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older”. American Journal of Health Promotion 5 (2012): 295-300. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807238/
24. Jupka KA., et al. “African American adults’ experiences with the health care system: In their own words”. Journal of Health Disparities Research and Practice3 (2008): 17-32. https://digitalscholarship.unlv.edu/jhdrp/vol2/iss3/2/
25. Hewins-Maroney B., et al. “Health seeking behaviors of African-Americans: Implementation for health administration”. Journal of Health and Human Services Administration (2005): 68-95. https://pubmed.ncbi.nlm.nih.gov/16521616/
26. Phelps RE., et al. “Cultural mistrust, ethnic identity, racial identity, and self-esteem among ethnically diverse Black university student”. Journal of Counseling and Development2 (2001): 209-216. https://www.researchgate.net/publication/263454680_Cultural_Mistrust_Ethnic_Identity_Racial_Identity_and_Self-Esteem_Among_Ethnically_Diverse_Black_University_Students
27. Kawachi I., et al. “Health disparities by race and class: Why both matter”. Health Affairs2 (2005): 343-352. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.24.2.343
28. Collins TC., et al. “Racial differences in how patients perceive physician communication regarding cardiac testing”. Medical Care1 (2002): I-27-I-34. https://pubmed.ncbi.nlm.nih.gov/11789628/
29. Saha S., et al. “Trust in physicians and racial disparities in HIV care”. AIDS Patient Care and STD’s7 (2010): 415-420. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472674/
30. Soto JA., et al. “The relationship between perceived discrimination and generalized anxiety disorder among African-Americans, Afro-Caribbeans, and non-Hispanic Whites”. Journal of Anxiety Disorders 25 (2011): 258-265. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3053120/
31. Braveman PA., et al. “Health disparities in health equity: The issue is justice”. American Journal of Public Health1 (2011): S149-S155. https://pubmed.ncbi.nlm.nih.gov/21551385/
32. Langford AT., et al. “Ethnic identity predicts loss-to-follow-up in a health promotion trial”. Contemporary Clinical Trials 31 (2010): 414-418. https://pubmed.ncbi.nlm.nih.gov/20601162/
33. Braunstein JB., et al. “Race, medical researcher distrust, perceived harm, and the willingness to participate in cardiovascular prevention trials”. Medicine 1 (2008): 1-9. https://pubmed.ncbi.nlm.nih.gov/18204365/
34. Byrd WM and Clayton LA. “An American health dilemma: Race, medicine, and health care in the United States 1900-2000”. New York, NY: Routledge (2002).
35. Andretta JR., et al. “Demographic group differences in adolescents’ time attitudes”. Journal of Adolescence 36 (2013): 289-301. https://www.sciencedirect.com/science/article/abs/pii/S0140197112001698
36. Kunjufu J. “Countering the conspiracy to destroy Black boys”. Chicago, IL: Afro-Am Publishing (1984).
37. Burrell T. “Brainwashed: Challenging the myth of Black inferiority”. New York, NY: Smiley Books (2010).
38. Feldstein-Ewing SW., et al. “Two approaches to tailoring treatment for cultural minority adolescents”. Journal of Substance Abuse Treatment 43 (2012): 190-203. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371296/
39. Sewell K., et al. “Perceptions of and barriers to use of generic medications in a rural African American population, Alabama, 2011”. Preventing Chronic Disease (2012): 9. https://pubmed.ncbi.nlm.nih.gov/22935144/
40. Feldstein PJ. “Health policy issues: An economic perspective (4^th edition)”. Chicago, IL: HAP (2007).
41. Gapenski LC. “Healthcare finance (4^th edition)”. Arlington, VA: AUPHA (2008).
42. Hausmann LR., et al. “Racial disparities in the monitoring of patients on chronic opioid therapy”. Pain 1 (2013): 46-52. https://pubmed.ncbi.nlm.nih.gov/23273103/
43. Devi S. “Getting to the root of America’s racial health inequalities”. The Lancet 380 (2012): 1043-1044. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61584-0/fulltext
44. Selden SC and Selden F. “Rethinking diversity in public organizations for the 21st century: Moving towards a multicultural model”. Administration and Society3 (2001): 303-329. https://www.researchgate.net/publication/240689843_Rethinking_Diversity_in_Public_Organizations_for_the_21st_Century_Moving_Toward_a_Multicultural_Model
45. Hughes-Halbert C., et al. “Differences in cultural beliefs and values among African-Americans and European-American man with prostate cancer”. Cancer Control3 (3): 277-284. https://journals.sagepub.com/doi/10.1177/107327480701400311
46. Terrell F and Terrell S. “Race of counselor, client sex, cultural mistrust level, and premature termination from counseling among Black clients”. Journal of Counseling Psychology3 (1984): 371-375. https://psycnet.apa.org/record/1984-29563-001
47. Wasserman J., et al. “Raising in the ivory tower: The production of knowledge and distrusts of medicine among African-Americans”. Journal of Medical Ethics (2006): 177-180. https://pubmed.ncbi.nlm.nih.gov/17329393/
48. Dovidio JF., et al. “Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and health care”. Social Science and Medicine 67 (2008): 478-486. https://pubmed.ncbi.nlm.nih.gov/18508171/
49. Gaskin DJ., et al. “Examining racial and ethnic disparities in site of usual source of care”. Journal of the National Medical Association1 (2007): 22-30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569590/
50. Petrocelli JV. “Hierarchical multiple regression in counseling research: Common problems and possible remedies”. Measurement and Evaluation in Counseling and Development1 (2003): 9-22. https://www.tandfonline.com/doi/abs/10.1080/07481756.2003.12069076
51. Marshall MC Jr. “Diabetes in African Americans”. Postgraduate Medical Journal 962 (2005): 734-740. https://pmj.bmj.com/content/81/962/734
52. Meis SB., et al. “Metabolic syndrome in nondiabetic, obese, first-degree relatives of African American patients with type 2 diabetes: African American triglycerides-HDL-C and insulin resistance paradox”. Ethnicity and Disease Autumn4 (2006): 830-836. https://pubmed.ncbi.nlm.nih.gov/17061734/