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Richmond J, Anderson A, Cunningham-Erves J, Ozawa S, Wilkins CH. Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness. Annu Rev Public Health 2024; 45:465-484. [PMID: 38100649 PMCID: PMC11156570 DOI: 10.1146/annurev-publhealth-061022-044737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.
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Affiliation(s)
- Jennifer Richmond
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew Anderson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Consuelo H Wilkins
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
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Lizarraga KJ, Gyang T, Benson RT, Birbeck GL, Johnston KC, Royal W, Sacco RL, Segal B, Vickrey BG, Griggs RC, Holloway RG. Seven Strategies to Integrate Equity within Translational Research in Neurology. Ann Neurol 2024; 95:432-441. [PMID: 38270253 PMCID: PMC10922988 DOI: 10.1002/ana.26873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
The rapidly accelerating translation of biomedical advances is leading to revolutionary therapies that are often inaccessible to historically marginalized populations. We identified and synthesized recent guidelines and statements to propose 7 strategies to integrate equity within translational research in neurology: (1) learn history; (2) learn about upstream forces; (3) diversify and liberate; (4) change narratives and adopt best communication practices; (5) study social drivers of health and lived experiences; (6) leverage health technologies; and (7) build, sustain, and lead culturally humble teams. We propose that equity should be a major goal of translational research, equally important as safety and efficacy. ANN NEUROL 2024;95:432-441.
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Affiliation(s)
| | - Tirisham Gyang
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Richard T. Benson
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Karen C. Johnston
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Walter Royal
- Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Ralph L. Sacco
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Benjamin Segal
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Barbara G. Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert C. Griggs
- Department of Neurology, University of Rochester, Rochester, NY, USA
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Melikam ES, Magwood GS, Ford M, Salley J, Abraham-Hilaire L, Nelson J, McCrary-Quarles A, Berry C, Cartmell KB. Community Trust, Attitudes and Preferences Related to Participation in Cancer Research in South Carolina. J Community Health 2024; 49:100-107. [PMID: 37531048 DOI: 10.1007/s10900-023-01251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/03/2023]
Abstract
African American adults have the highest mortality rate for most cancers in the United States, and meaningful, community-driven research is needed to inform optimal strategies for addressing these disparities. Unfortunately, research mistrust, often driven by historical inequities, is well-documented among African Americans.This study explored trust, attitudes, and preferences regarding participation in cancer research activities among primarily African American and other medically underserved communities in South Carolina from August 2020 to December 2021. Trust was measured using the Trust in Medical Researchers Scale (TMRS).The mean TMRS score for all study participants (N = 179) was 26.54 (SD 7.57) out of 48 (maximum possible score). Significant differences in mean values of the TMRS scores were only observed for gender (p = 0.0056) and race (p < 0.0001), with White participants and males reporting higher levels of trust in medical researchers. Overall, 52.5% of participants were somewhat likely or likely to volunteer to participate in a cancer research opportunity, with White participants (73.81%) being more likely to participate in cancer research compared to African American participants (45.74%) (p = 0.0054). Furthermore, participants were most willing to provide saliva (80.85%) and urine samples (80.85%), new blood samples (60.64%), stool samples (54.26%), medical records or laboratory results (52.13%) and least willing to allow left-over blood, tissue, or other fluids from medical procedures to be used for research (50%).These results provide evidence of the need for concerted programmatic efforts to build trust in cancer researchers, particularly among females and African American adults.
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Affiliation(s)
- Ezinne Sylvia Melikam
- Department of Public Health Sciences, Clemson University, 513 Edwards Hall, Clemson, SC, 29634, U.S.A
| | - Gayenell S Magwood
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene St, Columbia, SC, 29208, U.S.A
| | - Marvella Ford
- Cancer Disparities, Hollings Cancer Center, Department of Public Health Sciences, Medical University of South Carolina (MUSC), 86 Jonathan Lucas Street, Charleston, SC, 29425, U.S.A
| | - Judith Salley
- Department of Biological & Physical Sciences, South Carolina State University, 300 College Street, Orangeburg, SC, 29117, U.S.A
| | - Latecia Abraham-Hilaire
- Academic Affairs Faculty, MUSC Library-PICO, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, 29425, U.S.A
| | - Joni Nelson
- Division of Population Oral Health, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue BSB 127, Charleston, SC, 29425, U.S.A
| | - Audrey McCrary-Quarles
- Department of Health Sciences & Physical Education, South Carolina State University, 300 College Street, Orangeburg, SC, 29117, U.S.A
| | - Cammie Berry
- Office of Institutional Research, South Carolina State University, 300 College Ave, Orangeburg, SC, 29117, U.S.A
| | - Kathleen B Cartmell
- Department of Public Health Sciences, Clemson University, 513 Edwards Hall, Clemson, SC, 29634, U.S.A..
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Goodwill JR, Fike KJ. Black in the pandemic: Comparing experiences of mistrust, anxiety, and the COVID-19 vaccine among Black adults in the U.S. Soc Sci Med 2023; 338:116302. [PMID: 37871396 DOI: 10.1016/j.socscimed.2023.116302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
COVID-19 vaccine decisions are shaped by many factors including historical and contemporary patterns of medical mistreatment of marginalized communities. In attending to these concerns, we measured whether fear of COVID-19, general feelings of mistrust, and race-specific mistrust of the government and healthcare providers are indirectly associated with COVID-19 vaccination status via anxiety among Black Americans. We analyzed responses from 996 Black adults who participated in the AmeriSpeak panel - a nationally representative probability-based sample recruited from the National Opinion Research Center from April-June 2022. We used multiple-group structural equation modeling to compare outcomes among those who lost a loved one to COVID-19 to those who did not. Results indicate that fear of COVID-19 was associated with a greater probability of being fully vaccinated for those who lost a family member/friend. Race-specific mistrust was positively associated with anxiety, but was negatively associated with being fully vaccinated for bereaved Black Americans. Targeted efforts are needed to specifically reach those who lost a loved one to COVID-19. More within-group evaluations are needed to identify barriers to COVID-19 vaccination that are specific to Black Americans living with loss and grief.
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Affiliation(s)
- Janelle R Goodwill
- University of Chicago, Crown Family School of Social Work, Policy, and Practice, United States.
| | - Kayla J Fike
- Vanderbilt University, Peabody College of Education and Human Development, United States
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Kost RG, Devine RK, Fernands M, Gottesman R, Kandpal M, MacArthur RB, O’Sullivan B, Romanick M, Ronning A, Schlesinger S, Tobin JN, Vaughan R, Neville-Williams M, Krueger JG, Coller BS. Building an infrastructure to support the development, conduct, and reporting of informative clinical studies: The Rockefeller University experience. J Clin Transl Sci 2023; 7:e104. [PMID: 37250985 PMCID: PMC10225266 DOI: 10.1017/cts.2023.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/30/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Clinical trials are a vital component of translational science, providing crucial information on the efficacy and safety of new interventions and forming the basis for regulatory approval and/or clinical adoption. At the same time, they are complex to design, conduct, monitor, and report successfully. Concerns over the last two decades about the quality of the design and the lack of completion and reporting of clinical trials, characterized as a lack of "informativeness," highlighted by the experience during the COVID-19 pandemic, have led to several initiatives to address the serious shortcomings of the United States clinical research enterprise. Methods and Results Against this background, we detail the policies, procedures, and programs that we have developed in The Rockefeller University Center for Clinical and Translational Science (CCTS), supported by a Clinical and Translational Science Award (CTSA) program grant since 2006, to support the development, conduct, and reporting of informative clinical studies. Conclusions We have focused on building a data-driven infrastructure to both assist individual investigators and bring translational science to each element of the clinical investigation process, with the goal of both generating new knowledge and accelerating the uptake of that knowledge into practice.
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Affiliation(s)
- Rhonda G. Kost
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Rita K. Devine
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Mark Fernands
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Riva Gottesman
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Manoj Kandpal
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Robert B. MacArthur
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Barbara O’Sullivan
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Michelle Romanick
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Andrea Ronning
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Sarah Schlesinger
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Jonathan N. Tobin
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
- Clinical Directors Network, Inc. (CDN), New York, NY, USA
| | - Roger Vaughan
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Maija Neville-Williams
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - James G. Krueger
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
| | - Barry S. Coller
- Center for Clinical and Translational Science, Rockefeller University, New York, NY, USA
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