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Gagneur A, Gutnick D, Berthiaume P, Diana A, Rollnick S, Saha P. From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Hum Vaccin Immunother 2024; 20:2391625. [PMID: 39187772 DOI: 10.1080/21645515.2024.2391625] [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: 05/07/2024] [Revised: 07/30/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024] Open
Abstract
The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world's population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual's autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are 'the heart' of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person's own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual's decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.
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Affiliation(s)
- Arnaud Gagneur
- Department of Pediatrics, Université de Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Quebec, Canada
| | - Damara Gutnick
- Department of Epidemiology & Population Health, The Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Alessandro Diana
- IUMFE - Institute of Primary care Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Paediatric Center, Grangettes Hirslanden Clinic, Geneva, Switzerland
| | | | - Prantik Saha
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
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Slatore CG, Scott JY, Hooker ER, Disher N, Golden S, Govier D, Hynes DM. Motivators, Barriers, and Facilitators to Choosing Care in VA Facilities Versus VA-Purchased Care. Med Care Res Rev 2024; 81:395-407. [PMID: 39075797 DOI: 10.1177/10775587241264594] [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: 07/31/2024]
Abstract
Many Veterans receive Department of Veterans Affairs (VA)-purchased care from non-VA facilities but little is known about factors that Veterans consider for this choice. Between May 2020 and August 2021, we surveyed VA-purchased care-eligible VA patients about barriers and facilitators to choosing where to receive care. We examined the association between travel time to their VA facility and their choice of VA-purchased care (VA-paid health care received in non-VA settings) versus VA facility and whether this association was modified by distrust. We received 1,662 responses and 692 (42%) chose a VA facility. Eighty percent reported quality care was in their top three factors that influenced their decision. Respondents with the highest distrust and who lived >1 hr from the nearest VA facility had the lowest predicted probability (PP) of choosing VA (PP 15%; 95% confidence interval: 10%-20%). Veterans value quality of care. VA and other health care systems should consider patient-centered ways to improve and publicize quality and reduce distrust.
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Affiliation(s)
- Christopher G Slatore
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Division of Pulmonary, Allergy and Critical Care, Oregon Health & Science University, Portland, OR, USA
- Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Natalie Disher
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Sara Golden
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Division of Pulmonary, Allergy and Critical Care, Oregon Health & Science University, Portland, OR, USA
| | - Diana Govier
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Department of Health Systems Management & Policy, Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Health Management and Policy Program, College of Health and Center for Quantitative Life Sciences, Oregon State University; Corvallis, OR, USA
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Brown L, Cambron C, Post WS, Brandt EJ. The Role of Social Determinants of Health in Atherosclerotic Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:451-461. [PMID: 38980573 DOI: 10.1007/s11883-024-01226-2] [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: 06/24/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE OF REVIEW This review seeks to provide important information on each of the major domains of social determinants of health (SDOH) in the context of atherosclerotic cardiovascular disease. RECENT FINDINGS SDOH can be classified into five domains: social and community context, health care access and quality, neighborhood and built environment, economic stability, and education access and quality. SDOH are major drivers for cardiovascular health outcomes that exceed the impact from traditional risk factors, and explain inequities in health outcomes observed across different groups of individuals. SDOH profoundly impacts healthcare's receipt, delivery, and outcomes. Many patients fall within various disenfranchised groups (e.g., identify with minority race, low socioeconomic status, low educational attainment, LGBTQ+), which impact overall health status and care. Learning to understand, recognize, and address SDOH as the driving force of disparities are critical for achieving health equity in the prevention and adequate treatment of ASCVD.
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Affiliation(s)
- Logan Brown
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
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Northam K, Hinds M, Bodepudi S, Stanford FC. The Patient's Journey in Obesity within the United States: An Exercise of Resilience against Disease. Life (Basel) 2024; 14:1073. [PMID: 39337858 PMCID: PMC11433301 DOI: 10.3390/life14091073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/26/2024] [Accepted: 08/21/2024] [Indexed: 09/30/2024] Open
Abstract
Obesity is often viewed as a result of patient failure to adhere to healthy dietary intake and physical activity; however, this belief undermines the complexity of obesity as a disease. Rates of obesity have doubled for adults and quadrupled for adolescents since the 1990s. Without effective interventions to help combat this disease, patients with obesity are at increased risk for developing type 2 diabetes, heart attack, stroke, liver disease, obstructive sleep apnea, and more. Patients often go through several barriers before they are offered pharmacotherapy or bariatric surgery, even though evidence supports the use of these interventions earlier. This partially stems from the cultural barriers associated with using these therapies, but it is also related to healthcare provider bias and limited knowledge of these therapies. Finally, even when patients are offered treatment for obesity, they often run into insurance barriers that keep them from treatment. There needs to be a cultural shift to accept obesity as a disease and improve access to effective treatments sooner to help decrease the risk of health complications associated with obesity.
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Affiliation(s)
- Kayla Northam
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Dartmouth College, Lebanon, NH 03756, USA
- Department of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | | | - Sreevidya Bodepudi
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
| | - Fatima Cody Stanford
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
- Nutrition Obesity Research Center, Harvard Medical School, Boston, MA 02114, USA
- Department of Medicine-Neuroendocrine Unit and Department of Pediatrics-Endocrinology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Phillips G, Xu J, Cortez A, Curtis MG, Curry C, Ruprecht MM, Davoudpour S. Influence of Medical Mistrust on Prevention Behavior and Decision-Making Among Minoritized Youth and Young Adults During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02118-6. [PMID: 39093377 DOI: 10.1007/s40615-024-02118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/16/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Medical mistrust (MM) is seen as a barrier to assessing healthcare needs and addressing health disparities; however, limited literature has focused on assessing MM for vulnerable populations, especially racial/ethnic minority and sexual/gender minority youth and young adults (YYA). METHODS Between February 2021 and March 2022, we conducted the Youth and Young Adults COVID-19 Study, a prospective cohort of minoritized YYA aged 14 to 24 years (n = 1027), within the United States and its territories. Participants were recruited through a combination of paid social media ads, outreach with organizations serving marginalized youth, and an existing registry, targeting racial and ethnic minority and LGBTQ + youth for a study on COVID-19 health behaviors. Multiple multinomial logistic regression models were developed to examine associations between demographics and three dimensions of MM including healthcare experience, government information, and scientific information. RESULTS Most participants were between the ages of 18 and 21 years (48.3%), identified as Hispanic (33.3%) or white (22.5%), and bisexual or pansexual (34.3%). Queer YYA had higher odds of reporting worse personal healthcare experiences than their straight peers. The odds of gay/lesbian YYA that reported somewhat or extreme trust in doctor's sources were two times higher than their straight peers. Except for those who identified as Asian, racial/ethnic minority YYA were less likely to report somewhat or extreme trust in the CDC's general information or its COVID-19 data than white YYA. Transgender and gender diverse YYA were more than twice as likely to report being very or extremely influenced by statistics of the dangers of COVID-19 than cisgender YYA. CONCLUSIONS Our study indicated the importance of incorporating marginalized identities into the assessment of medical mistrust to better understand YYA's health prevention and treatment behaviors and to develop public health prevention and treatment strategies, especially for minoritized communities.
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Affiliation(s)
- Gregory Phillips
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA.
| | - Jiayi Xu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Alfred Cortez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Michael G Curtis
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Caleb Curry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Megan M Ruprecht
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Shahin Davoudpour
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA
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Avorgbedor F, Gondwe KW, Aljarrah A, Bankole AO. COVID-19 Vaccine Decision-Making Among Black Pregnant and Postpartum Women. J Racial Ethn Health Disparities 2024; 11:2073-2082. [PMID: 37335424 DOI: 10.1007/s40615-023-01675-6] [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] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The history of biomedical research is marred by racially discriminatory and abusive practices that impacted Black/African Americans. Medical racism impacts the trust and utilization of new medical interventions, such as the COVID-19 vaccine. This study aimed to understand Black pregnant and postpartum women's perspectives and decision-making about the COVID-19 vaccine. METHODS We used a qualitative descriptive design and recruited 23 pregnant and postpartum Black women aged 18 years and above. Data was collected using a semi-structured interview guide. Data were analyzed using content analysis. FINDINGS The participants described factors influencing their decision to receive or not receive the COVID-19 vaccines. These factors included individual, cultural, ethnicity, religious, and family-related factors (individual-personal beliefs influenced decisions about the vaccine; ethnicity, culture, and religion influenced vaccine decision-making; group-family and friends played a role in decision-making), vaccine or vaccination-related issues (concerns about vaccination and pregnancy outcomes and mistrust in the vaccine information), and contextual influence (sources of vaccine information influenced decision-making and healthcare providers influenced decision-making). CONCLUSION Understanding the vaccine decision-making process of underserved populations likely to decline vaccination due to pregnancy, postpartum, and breastfeeding status will help design tailored interventions to improve vaccine acceptance in minority communities, especially for pregnant and postpartum women.
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Affiliation(s)
- Forgive Avorgbedor
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA.
| | | | - Ahmad Aljarrah
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
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Wenzler S, Keeley J. The initiation or continuation of mental health services in the transition to college. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1768-1777. [PMID: 35728259 DOI: 10.1080/07448481.2022.2089851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Objective: To examine what factors impact college students in the United States who are deciding to initiate or continue mental health services. Participants: Spring 2021 undergraduate students (N = 453) at a large urban university. Methods: Online, cross-sectional survey with mental health service experience as the independent variable and social support, accessibility, attitudes toward mental health, mental health literacy, and trust of mental health professionals as the dependent variables, as well as thematic analysis of reasons to discontinue services. Results: Individuals with lower levels of social support and higher levels of mental health literacy were more likely to have received therapy. Participants tended to discontinue services because of negative experiences, accessibility problems, negative attitudes toward services, or they felt better. Conclusions: Mental health literacy, social support, and accessibility are significant predictors of college student service use and should be taken into consideration by university administration.
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Affiliation(s)
- Shea Wenzler
- Virginia Commonwealth University Honors College, Richmond, Virginia, USA
| | - Jared Keeley
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
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Goddard-Eckrich D, Stringer KL, Richer A, Dasgupta A, Brooks D, Cervantes M, Downey DL, Kelleher P, Bell SL, Hunt T, Wu E, Johnson KA, Hall J, Guy-Cupid GAN, Thomas BV, Edwards K, Ramesh V, Gilbert L. 'Yeah, they suck. It's like they don't care about our health.' Medical mistrust among Black women under community supervision in New York city. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38915232 DOI: 10.1080/13691058.2024.2358084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 05/17/2024] [Indexed: 06/26/2024]
Abstract
Black women in the USA experience some of the poorest health outcomes and this is especially true for those involved in the carceral system who are at elevated risks for HIV/STIs, reproductive health, and chronic diseases. This study aimed to investigate Black women's experience accessing healthcare services. We conducted semi-structured interviews with 43 women from Project EWORTH under community supervision in New York City. We analysed responses focusing on barriers to healthcare engagement. All interviews were recorded, and data analysis was conducted using NVivo. Themes influencing Black women's ability to engage with healthcare providers and systems included: 1) disclosed provider mistrust/judgement; 2) feeling disrespected by providers and the medical system; 3) mistrust of medical providers/system/hospital/government; 4) lack of health communication; 5) low health literacy; 6) provider gender preference. Findings highlight the need to improve trust and collaboration between healthcare providers and Black women. This study addresses the critical gap in understanding perceptions of discrimination, stigma, and barriers to attaining health care. Funders and accreditation agencies must hold providers and organisations accountable for acquiring and making available diversity, equity and inclusion training for providers, demonstrating increasingly equitable medical relationships through responsiveness to patient feedback, and increasing the number of Black providers.
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Affiliation(s)
- Dawn Goddard-Eckrich
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Kristi L Stringer
- Department of Health and Human Performance, Public Health. Middle Tennessee State University, Murfreesboro, TN, USA
| | - Ariel Richer
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Anindita Dasgupta
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Deidra Brooks
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Melissa Cervantes
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Dget L Downey
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Phoebe Kelleher
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Sydney L Bell
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Timothy Hunt
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Elwin Wu
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Karen A Johnson
- School of Social Work, University of AL, Tuscaloosa, AL, USA
| | - Jennifer Hall
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Gail-Ann N Guy-Cupid
- College of Liberal Arts & Social Sciences, Social Work Program, University of The Virgin Islands, Saint. Thomas/Saint Croix, UVI, USA
| | - Brittany V Thomas
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Kevonyah Edwards
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Vineha Ramesh
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Louisa Gilbert
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
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Yu YL. Disparities by Race/Ethnicity and Immigration Status in Perceived Importance of and Access to Culturally Competent Health Care in the United States. J Racial Ethn Health Disparities 2024; 11:1829-1841. [PMID: 37314687 DOI: 10.1007/s40615-023-01655-w] [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: 03/08/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Abstract
While cultural competence has been proposed as an important framework for enhancing health care equity, how members of different racial/ethnic groups consider the importance of cultural competence and their access to culturally competent health care are insufficiently understood. Despite continuously increasing immigrants into the US, it is unclear how immigration status intersects with race/ethnicity to shape individuals' perception of and access to culturally competent care in the US health care system. To fill this research gap, this study examined how the intersection of race/ethnicity and immigration status is associated with people's perception of and access to culturally competent health care and among immigrants, whether their length of stay matters, using data from the 2017 National Health Interview Survey. The results show that while racial and ethnic minority members reported greater importance of culturally competent care than non-Hispanic whites, Asian, black and other-race immigrants reported even greater importance than their US-born counterparts. Additionally, although racial/ethnic minorities reported greater limited access to culturally competent care than their white peers, this gap in access was observed primarily among US-born racial/ethnic minorities. Shorter length of residence (fewer than 15 years) was associated with greater perceived importance than residence of at least 15 years among immigrants, but access to culturally competent care did not differ by length of residence. The findings speak to racial/ethnic minorities' greater desire for culturally competent care and their unmet needs.
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Affiliation(s)
- Yan-Liang Yu
- Department of Sociology and Criminology, Howard University, 2419 6th St. NW Bldg. 23, Washington, DC, 20059, USA.
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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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Madu CT, Lee TF, Sohn A, Hu J, Matayev R, Paranjpe V, Fam J, Wronka A, Kim ET, Zambrano R, Wollstein G, Schuman JS. Disparities in Visual Field Testing Frequency Among Subjects With Glaucoma. Transl Vis Sci Technol 2024; 13:2. [PMID: 38564202 PMCID: PMC10996970 DOI: 10.1167/tvst.13.4.2] [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] [Accepted: 01/23/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Prior evidence suggests racial disparities in the utilization of visual field testing (VFT) for the diagnosis and monitoring of glaucoma. In this study, we considered the effect of baseline glaucoma severity and socioeconomic disadvantage along with other potential confounders such as test reliability, ancillary tests, and glaucoma surgeries on racial disparity in the frequency of VFT. Methods The records of all subjects with a diagnosis of glaucoma who received VFT at an academic, tertiary care facility from January 2018 to December 2021 were accessed. Analysis was performed to compare VFT frequency, the total number of office visits (DoS), and the ratio of VFT frequency to DoS (VFT/DoS) across self-reported races while controlling for sex, age, socioeconomic disadvantage (Area Deprivation Index), VF reliability indicators and baseline mean deviation, optical coherence tomography frequency, and glaucoma surgeries. Results Among the 2654 subjects (1515 White, 782 Black, and 357 Asian) included in this study, Black subjects had the worst socioeconomic status and disease severity at baseline. They also experienced a 3% lower VFT/DoS ratio compared to White subjects (P = 0.031). Asian subjects had a 5% lower VFT/DoS ratio compared to White subjects (P = 0.015). Discussion We identified racial disparity in performing VFT in subjects with glaucoma even when multiple confounders were considered. Further investigation is necessary to identify other race-associated factors to work toward reducing racial disparities in VFT. Translational Relevance Black and Asian subjects with glaucoma receive fewer VFT per visit compared to White subjects even when considering socioeconomic disadvantage and disease severity.
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Affiliation(s)
- Chisom T Madu
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Ting-Fang Lee
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Ashley Sohn
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Jiyuan Hu
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Rachel Matayev
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Vikram Paranjpe
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Jonathan Fam
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Andrew Wronka
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Eleanore T Kim
- Department of Ophthalmology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | | | - Gadi Wollstein
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Joel S Schuman
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
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Aruma JF, Hearn M, Bernacchi V, Moss JL. Examining the roles of travel distance, medical mistrust, and cancer fatalism in the uptake of clinical cancer prevention among women in rural and urban US communities: A secondary data analysis. Prev Med Rep 2024; 38:102611. [PMID: 38375162 PMCID: PMC10874844 DOI: 10.1016/j.pmedr.2024.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Rural adults are less likely to receive cancer screening than urban adults, likely due to systematic differences in community- and individual-level factors. The purpose of this study was to analyze the relative contributions of rurality, travel time, medical mistrust, and cancer fatalism in explaining uptake of clinical cancer prevention services. Methods We conducted a secondary data analysis of 2019-2020 survey data from women, ages 45-65, in rural and urban counties in central Pennsylvania, examining rurality, travel time to a primary care provider, medical mistrust, and cancer fatalism, as well as uptake of guideline-recommended colorectal cancer screening, cervical cancer screening, and preventive check-up. Final models used multivariable logistic regression to assess the relationships among study variables, controlling for participant demographics. Results Among 474 participants, 48.9 % resided in rural counties. Most participants had received clinical cancer prevention services (colorectal cancer screening: 55.4 %; cervical cancer screening: 82.8 %; preventive check-up in the last year: 75.4 %). Uptake of services was less common among participants with higher medical mistrust (colorectal cancer screening: adjusted odds ratio [aOR] = 0.87, 95 % confidence interval [CI] = 0.76-1.00; cervical cancer screening: aOR = 0.79, 95 % CI = 0.63-1.00; last-year check-up: aOR = 0.74, 95 % CI = 0.63-0.88). Conclusions Patient attitudes, particularly medical mistrust, may contribute to rural/urban disparities in clinical cancer prevention among women. Community- and individual-level interventions are needed to improve cancer outcomes in rural areas.
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Affiliation(s)
- Jane-Frances Aruma
- Penn State College of Medicine, The Pennsylvania State University, State College, PA, USA
| | - Madison Hearn
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Veronica Bernacchi
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Jennifer L. Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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13
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Sarbazi E, Sadeghi-Bazargani H, Farahbakhsh M, Ala A, Soleimanpour H. Psychometric properties of trust in trauma care in an emergency department tool. Eur J Trauma Emerg Surg 2023; 49:2615-2622. [PMID: 37603053 DOI: 10.1007/s00068-023-02348-z] [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: 02/11/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND In emergency cases, lack of other treatment alternatives may affect a person's decision, but it does not render that decision involuntary. Being able to make choices is a crucial (but not necessary) element of trust. We aimed to develop a tool to evaluate the Trust in Trauma Care in an Emergency Department (TTC-ED) among traumatic patients. METHODS This psychometric study was carried out on 498 trauma patients who referred to the Imam Reza hospital in Tabriz, Iran, 2022. Patient-focused interviews, expert/key informants' opinions, and literature reviews were used to generate the items. Several statistical techniques were used to evaluate the TTC-ED trust tool's content validity, reliability, and construct validity, including the modified Kappa (k*), the Intra-Class Correlation (ICC) coefficient, and Exploratory Factor Analysis (EFA). Data were analyzed using SPSS version 26.0 and STATA 14 statistical software packages. RESULTS A tool with 22 items was developed. As a measure of content validity assessment, the k* coefficient was 0.97. Regarding the evaluation of reliability, a good level of internal consistency was noted with a Cronbach's α 0.93, and the scale's test-retest reliability (as measured by ICC) was 0.96. The results of exploratory factor analysis indicated that the TTC-ED had a two-component tool fitted the data. Factor 1 includes 13 items covered 43.0% of the variance (eigenvalue = 9.47) and factor 2 consisted of nine items which accounted for 5.64% of the variance (eigenvalue: 1.24). CONCLUSION The Trust in TTC-ED has been shown to be a valid and reliable test for assessing patients' trust in emergency room settings delivering trauma care. Future research may examine the validity in other contexts and create a TTC-ED instrument with a shorter version.
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Affiliation(s)
- Ehsan Sarbazi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mostafa Farahbakhsh
- Research Centre of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ala
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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14
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El-Krab R, Brousseau N, Kalichman SC. Medical mistrust as a barrier to HIV prevention and care. J Behav Med 2023; 46:897-911. [PMID: 37698802 DOI: 10.1007/s10865-023-00417-7] [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] [Received: 10/22/2022] [Accepted: 05/03/2023] [Indexed: 09/13/2023]
Abstract
Medical mistrust is fueled by conspiracy theories and histories of healthcare systems abuse and is a known determinant of health outcomes in minority populations. Plagued by multiple and pervasive conspiracy theories, HIV/AIDS has proven to be particularly hampered by medical mistrust. The current paper systematically reviews the literature on medical mistrust among people at risk for or living with HIV infection. The bulk of evidence from 17 studies supports medical mistrust as a barrier to HIV testing, engagement in prevention and care services, treatment uptake and adherence, and clinical outcomes. While findings mostly indicate that medical mistrust is a barrier to HIV prevention and care, some studies report null results and others suggest that medical mistrust may actually improve some HIV-related outcomes. Additionally, most of the reviewed literature was cross-sectional. Thus longitudinal, theory-driven research is needed to reconcile inconsistent findings and determine long term outcomes of medical mistrust. Interventions may then be developed to reduce the negative consequences associated with medical mistrust.
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Affiliation(s)
- Renee El-Krab
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States.
| | - Natalie Brousseau
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, Storrs, CT, United States
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, Storrs, CT, United States
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15
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Thomas M, Flaherty J, Wang J, Henderson M, Ho V, Cuban M, Cram P. Comparison of Hospital Online Price and Telephone Price for Shoppable Services. JAMA Intern Med 2023; 183:1214-1220. [PMID: 37721765 PMCID: PMC10507593 DOI: 10.1001/jamainternmed.2023.4753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/27/2023] [Indexed: 09/19/2023]
Abstract
Importance US hospitals are required to publicly post their prices for specified shoppable services online. However, the extent to which a hospital's prices posted online correlate with the prices they give to a telephone caller is unknown. Objective To compare hospitals' online cash prices for vaginal childbirth and brain magnetic resonance imaging (MRI) with prices offered to secret shopper callers requesting price estimates by telephone. Design, Setting, and Participants This cross-sectional study included cash online prices from each hospital's website for vaginal childbirth and brain MRI collected from representative US hospitals between August and October 2022. Thereafter, again between August and October 2022, simulated secret shopper patients called each hospital requesting their lowest cash price for these procedures. Main Outcomes and Measures We calculated the difference between each hospital's online and phone prices for vaginal childbirth and brain MRI, and the Pearson correlation coefficient (r) between the online and phone prices for each procedure, among hospitals able to provide both prices. Results A total of 60 representative US hospitals (20 top-ranked, 20 safety-net, and 20 non-top-ranked, non-safety-net hospitals) were included in the analysis. For vaginal childbirth, 63% (12 of 19) of top-ranked hospitals, 30% (6 of 20) of safety-net hospitals, and 21% (4 of 19) of non-top-ranked, non-safety-net hospitals provided both online and telephone prices. For brain MRI, 85% (17 of 20) of top-ranked hospitals, 50% (10 of 20) of safety-net hospitals, and 100% (20 of 20) of non-top-ranked, non-safety-net hospitals provided prices both online and via telephone. Online prices and telephone prices for both procedures varied widely. For example, online prices for vaginal childbirth posted by top-ranked hospitals ranged from $0 to $55 221 (mean, $23 040), from $4361 to $14 377 (mean $10 925) for safety-net hospitals, and from $1183 to $30 299 (mean $15 861) for non-top-ranked, non-safety-net hospitals. Among the 22 hospitals providing prices both online and by telephone for vaginal childbirth, prices were within 25% of each other for 45% (10) of hospitals, while 41% (9) of hospitals had differences of 50% or more (Pearson r = 0.118). Among the 47 hospitals providing both online and phone prices for brain MRI, prices were within 25% of each other for 66% (31) of hospitals), while 26% (n = 12) had differences of 50% or more (Pearson r = -0.169). Among hospitals that provided prices both online and via telephone, there was a complete match between the online and telephone prices for vaginal childbirth in 14% (3 of 22) of hospitals and for brain MRI in 19% (9 of 47) of hospitals. Conclusions and Relevance Findings of this cross-sectional study suggest that there was poor correlation between hospitals' self-posted online prices and prices they offered by telephone to secret shoppers. These results demonstrate hospitals' continued problems in knowing and communicating their prices for specific services. The findings also highlight the continued challenges for uninsured patients and others who attempt to comparison shop for health care.
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Affiliation(s)
- Merina Thomas
- The University of Texas Medical Branch John Sealy School of Medicine, Galveston
| | - James Flaherty
- The University of Texas Medical Branch John Sealy School of Medicine, Galveston
| | - Jiefei Wang
- Department of Biostatistics and Data Science, School of Public and Population Health, The University of Texas Medical Branch at Galveston, Galveston
| | - Morgan Henderson
- The Hilltop Institute, University of Maryland Baltimore County, Baltimore
| | - Vivian Ho
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Baker Institute, Rice University, Houston, Texas
| | | | - Peter Cram
- Department of Medicine, The University of Texas Medical Branch John Sealy School of Medicine, Galveston
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Kuzma LH, Miller AM, Harvey E, McDonald MF. Association of Provider Recommendation and Receipt of Influenza Vaccine Among Pregnant Women by Race and Ethnicity. J Womens Health (Larchmt) 2023; 32:1052-1061. [PMID: 37582216 PMCID: PMC10623458 DOI: 10.1089/jwh.2023.0012] [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: 08/17/2023] Open
Abstract
Background: All pregnant women and those who may become pregnant are recommended by the Advisory Committee on Immunization Practices to receive the flu vaccine to prevent severe illness in the woman and infant. Despite the increased risk for complications in this population, flu vaccine uptake in pregnant women was 68.1% in the 2020-2021 flu season, with disparities by race and ethnicity. We sought to describe associations between provider recommendation with flu vaccine uptake by race and ethnicity in Tennessee women with a recent live birth. Materials and Methods: Weighted analysis used data from the 2016 to 2020 Tennessee Pregnancy Risk Assessment Monitoring System complex survey analysis procedures. Uptake was measured as receipt of flu vaccine in the 12 months before the most recent live birth, and positive recall of receiving provider advice to get the shot was the independent variable; for both we estimated 5-year averages stratified by race/ethnicity. Differences were assessed using chi-square tests. We modeled receipt of flu vaccine and estimated marginal predicted prevalence ratios (PRs); stratified models by race/ethnicity were constructed to estimate unadjusted and adjusted PRs. Results: The 5-year average for vaccine uptake before or during pregnancy was 56.7% but varied by race and ethnicity. Stratified bivariate analyses yielded different magnitudes of association by race/ethnicity between provider recommendation and flu vaccine receipt. After adjustment for payment source at delivery, marital status, age group, urbanicity, and maternal education, receiving a provider recommendation was strongly associated with flu vaccine uptake for all stratified models of pregnant women included in the study. The effect size was of a larger magnitude among non-Hispanic Black women, a population with a lower vaccine uptake. Conclusions: Given the association between provider recommendation and vaccine uptake in all groups, attention should be focused on increasing rates of provider recommendation.
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Affiliation(s)
- Lauren H. Kuzma
- Divisions of Population Health Assessment, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Angela. M. Miller
- Divisions of Population Health Assessment, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Elizabeth Harvey
- Divisions of Population Health Assessment, Tennessee Department of Health, Nashville, Tennessee, USA
- Divisions of Family Health and Wellness, Tennessee Department of Health, Nashville, Tennessee, USA
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Morgan F. McDonald
- Divisions of Population Health Assessment, Tennessee Department of Health, Nashville, Tennessee, USA
- Divisions of Family Health and Wellness, Tennessee Department of Health, Nashville, Tennessee, USA
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17
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Siegal R, Nance A, Johnson A, Case A. "Just because I have a medical degree does not mean I have the answers": Using CBPR to enhance patient-centered care within a primary care setting. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:217-229. [PMID: 37086213 DOI: 10.1002/ajcp.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
Patient-centered care (PCC) is a health care delivery model that is considered a means to reduce inequities in the healthcare system, specifically through its prioritization of patient voice and preference in treatment planning. Yet, there are documented challenges to its implementation. Community-based participatory research (CBPR) is seemingly well-positioned to address such challenges, but there has been limited discussion of utilizing CBPR in this way. This article begins to address this gap. In it, we present three diverse stakeholders' perspectives on a CBPR project to enhance PCC within a primary care clinic serving low-income patients. These perspectives provide insights into benefits, challenges, and lessons learned in using CBPR to implement PCC. Key benefits of using CBPR to implement PCC include increasing the acceptability and feasibility of data collection tools and process, and the generating of high-quality actionable feedback. Important CBPR facilitators of PCC implementation include intentional power-sharing between patients and providers and having invested stakeholders who "champion" CBPR within an organization with empowering practices.
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Affiliation(s)
- Rachel Siegal
- Health Psychology Doctoral Program, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Andrew Nance
- Atrium Health Primary Care Cabarrus Family Medicine, Kannapolis, North Carolina, USA
- Community Free Clinic, Concord, North Carolina, USA
| | | | - Andrew Case
- Health Psychology Doctoral Program, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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18
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Somohano VC, Smith CL, Saha S, McPherson S, Morasco BJ, Ono SS, Zaccari B, Lovejoy J, Lovejoy T. Patient-Provider Shared Decision-Making, Trust, and Opioid Misuse Among US Veterans Prescribed Long-Term Opioid Therapy for Chronic Pain. J Gen Intern Med 2023; 38:2755-2760. [PMID: 37118560 PMCID: PMC10506962 DOI: 10.1007/s11606-023-08212-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Patient-provider shared decision-making is associated with better treatment adherence and pain outcomes in opioid-specific pain management. One possible mechanism through which shared decision-making may impact pain management outcomes is trust in one's prescribing provider. Elucidating relationships between factors that enhance the patient-provider relationship, such as shared decision-making and trust, may reduce risks associated with opioid treatment, such as opioid misuse. OBJECTIVE The purpose of this study was to investigate the mediating effect of trust in one's prescribing provider on the relationship between shared decision-making and current opioid misuse. DESIGN A secondary analysis of data from a prospective cohort study of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. PARTICIPANTS Eligibility criteria included being prescribed LTOT, ability to speak and read English, and access to a telephone. Veterans were excluded if they had a cancer diagnosis, received opioid agonist therapy for opioid use disorder, or evidence of pending discontinuation of LTOT. Stratified random sampling was employed to oversample racial and ethnic minorities and women veterans. MAIN MEASURES Physician Participatory Decision-Making assessed level of patient involvement in medical decision-making, the Trust in Provider Scale assessed interpersonal trust in patient-provider relationships, and the Current Opioid Misuse Measure assessed opioid misuse. KEY RESULTS Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator (c = - 0.243, p < 0.001), such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant (c' = - 0.147, p = 0.007). CONCLUSIONS Shared decision-making is associated with less prescription opioid misuse through the trust that is fostered between patients and providers.
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Affiliation(s)
- Vanessa C Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Crystal L Smith
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Belle Zaccari
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Jennette Lovejoy
- Department of Communication Studies, University of Portland, Portland, OR, USA
| | - Travis Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
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Kinser PA, Bodnar-Deren S, Amstadter AB, Lapato DM, Thacker LR, Johnson JA, Aubry C, Johnson A, Gault C, Hill-Thomas A, Russell S, Lanni S, Freeman A. Study protocol for the Mindful Moms Study: A randomized controlled trial evaluating a mindful movement intervention for marginalized pregnant people experiencing depression. Contemp Clin Trials 2023; 132:107302. [PMID: 37500008 PMCID: PMC10529983 DOI: 10.1016/j.cct.2023.107302] [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] [Received: 03/31/2023] [Revised: 06/22/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
More than 1 in 5 pregnant people in the United States experience depressive symptoms. Although treatments exist, many people remain under- or un-treated due to concerns about stigma, side effects, and costs of medications or psychotherapy, particularly those who are marginalized (defined as those who are minoritized, low-income, or with low-educational attainment). Further, the standard depression treatments do not address social connectedness, which is a potentially modifiable factor involved in depressive symptom etiology. This protocol presents the rationale, design, and status of the two-arm longitudinal parallel group randomized controlled trial - the Mindful Moms Study - which aims to evaluate the effects and mechanisms of a group-based mindful physical activity (yoga) intervention in marginalized pregnant people with depressive symptoms (n = 200) compared to a prenatal education control group. The primary aim is to evaluate effects of group assignment on depressive symptom severity, anxiety, and perceived stress over time from baseline to six weeks postpartum. Secondary aims include understanding the role of social connectedness as a moderator of the effects and to identify genome-wide DNA methylation patterns associated with depressive symptoms and perceived social connectedness at postpartum. A focus on adequate symptom management through non-pharmacologic, accessible therapies that address social connectedness during pregnancy in marginalized women is an urgent clinical and research priority. The successful completion of this study will provide important insights into social connectedness as a mechanism to decrease depressive symptoms in a largely understudied population. Trial registration: NCT04886856.
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Affiliation(s)
- Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.
| | - Susan Bodnar-Deren
- Department of Sociology, Virginia Commonwealth University, Richmond, VA, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA; Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Dana M Lapato
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA; Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Leroy R Thacker
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer A Johnson
- Department of Sociology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Christine Aubry
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Anisa Johnson
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Candice Gault
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Ariel Hill-Thomas
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Sally Russell
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan Lanni
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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20
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Cox AB, Jaiswal J, LoSchiavo C, Witte T, Wind S, Griffin M, Halkitis PN. Medical Mistrust Among a Racially and Ethnically Diverse Sample of Sexual Minority Men. LGBT Health 2023; 10:471-479. [PMID: 37418567 PMCID: PMC10623470 DOI: 10.1089/lgbt.2022.0252] [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: 07/09/2023] Open
Abstract
Purpose: Medical mistrust is a barrier to health care utilization and is associated with suboptimal health outcomes. Research on mistrust among sexual minority men (SMM) is limited and largely focuses on Black SMM and HIV, with few studies assessing mistrust among SMM of other race/ethnicities. The purpose of this study was to examine differences in medical mistrust among SMM by race. Methods: From February 2018 to February 2019, a mixed-methods study examined the health-related beliefs and experiences of young SMM in New York City. The Group-Based Medical Mistrust Scale (GBMMS) was used to measure medical mistrust related to race, and a modified version of the scale assessed mistrust related to one's "sexual/gender minority" status (Group-Based Medical Mistrust Scale-Sexual/Gender Minority [GBMMS-SGM]). With an analytic sample of 183 cisgender SMM, a one-way multivariate analysis of variance was used to examine differences in GBMMS and GBMMS-SGM scores by race/ethnicity [Black, Latinx, White, "Another Racial Group(s)"]. Results: There were significantly different GBMMS scores by race, with participants of color reporting higher levels of race-based medical mistrust than White participants. This finding is supported by effect sizes ranging from moderate to large. Differences in GBMMS-SGM scores by race were borderline; however, the effect size for Black and White participants' GBMMS-SGM scores was moderate, indicating that higher GBMMS-SGM scores among Black participants is meaningful. Conclusion: Multilevel strategies should be used to earn the trust of minoritized populations, such as addressing both historical and ongoing discrimination, moving beyond implicit bias trainings, and strengthening the recruitment and retention of minoritized health care professionals.
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Affiliation(s)
- Amanda B. Cox
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
| | - Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Tricia Witte
- Department of Human Development and Family Studies, University of Alabama, Tuscaloosa, Alabama, USA
| | - Stefanie Wind
- Department of Educational Studies in Psychology, Research Methodology and Counseling, University of Alabama, Tuscaloosa, Alabama, USA
| | - Marybec Griffin
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Perry N. Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Rutgers University, Newark, New Jersey, USA
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Kerrison EMT, Hyatt JM. COVID-19 Vaccine Refusal and Medical Distrust Held by Correctional Officers. Vaccines (Basel) 2023; 11:1237. [PMID: 37515052 PMCID: PMC10384026 DOI: 10.3390/vaccines11071237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
This study explores COVID-19 vaccine acceptance among prison security staff and the extent to which they trust varied sources of information about the vaccines. Cross-sectional survey data were obtained from a state-wide sample of corrections officers (COs, hereafter; n = 1208) in February 2021. Group differences, disaggregated by demographic characteristics, were examined using F-tests and t-tests. Despite the comparatively limited risk of contracting the virus, non-security staff reported they would accept a COVID-19 vaccine at no cost (74%), compared to their more vulnerable CO counterparts (49%). We observed vaccine refusal correlations between COs' reported gender, age, and length of time working as a CO, but none with their self-reported race. Vaccine refusal was more prevalent among womxn officers, younger officers, and those who had spent less time working as prison security staff. Our findings also suggest that the only trusted source of information about vaccines were family members and only for officers who would refuse the vaccine; the quality of trust placed in those sources, however, was not substantially positive and did not vary greatly across CO racial groups. By highlighting characteristics of the observed gaps in COVID-19 vaccine acceptance between COs and their non-security staff coworkers, as well as between corrections officers of varied demographic backgrounds, these findings can inform the development of responsive and accepted occupational health policies for communities both inside and intrinsically linked to prisons.
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Affiliation(s)
| | - Jordan M. Hyatt
- College of Arts and Sciences, Drexel University, Philadelphia, PA 19104, USA
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22
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Lee WJ, Shah Y, Patel N, Ku A, Rodriguez A, Salvador M. The Consequences of COVID-19 on Breast Cancer Screenings in an Underserved Urban Population and the Screening Access of Value for Essex Program's Efforts to Control the Damage. Cureus 2023; 15:e42338. [PMID: 37614270 PMCID: PMC10444536 DOI: 10.7759/cureus.42338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE This study aims to examine the impact of the COVID-19 pandemic on breast cancer screening in an underserved population, identify patient barriers, and discuss strategies to promote the importance of screening. Methods/operations: The Rutgers New Jersey Medical School Screening Access of Value for Essex (SAVE) program delivers cancer prevention services to the most vulnerable population in Essex County, New Jersey. The SAVE program was shut down from March 2020 to June 2020 due to COVID-19. The number of mammograms performed 18 months before the pandemic (September 2018 to March 2020) and 18 months after the shutdown of the program (July 2020 to December 2021) were recorded. A calling project was created in response to the pandemic to educate patients about COVID-19 precautions and provide healthcare and social services resources. RESULTS There was a 15.4% reduction in screening mammograms during the post-shutdown period (1,459 pre-COVID-19 versus 1,234 post-shutdown). The number of diagnostic mammograms increased from 264 to 272. The calling project spoke with 1,548 patients and identified the following concerns: exposure to COVID-19, language barriers, and lack of health insurance. CONCLUSION Although COVID-19 had a profound impact on most patients, especially in the realm of breast cancer screening, the implementation of the SAVE program's strategies such as transitioning to an appointment-only system has helped minimize the negative impacts. Reaching out to the patients, partnering with community organizations, and promoting SAVE services have played a vital role in encouraging more patients to have screening done.
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Affiliation(s)
- William J Lee
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
| | - Yash Shah
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
| | - Nidhi Patel
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
| | - Albert Ku
- Radiology, Drexel University College of Medicine, Philadelphia, USA
| | - Anibian Rodriguez
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
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Thomas MK, Amstutz C, Orr-Roderick D, Horter J, Holben DH. Medical Mistrust Among Food Insecure Individuals in Appalachia. FAMILY & COMMUNITY HEALTH 2023; 46:192-202. [PMID: 37079541 PMCID: PMC10179979 DOI: 10.1097/fch.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study focused on the relationship between food insecurity and medical mistrust within Appalachia. Food insecurity has negative consequences on health, while medical mistrust can lead to a decrease in health care use, creating additive consequences to already vulnerable populations. Medical mistrust has been defined in various ways, with measures addressing health care organizations and individual health care providers. To determine whether food insecurity has an additive impact on medical mistrust, a cross-sectional survey was completed by 248 residents in Appalachia Ohio while attending community or mobile clinics, food banks, or the county health department. More than one-quarter of the respondents had high levels of mistrust toward health care organizations. Those with high food insecurity levels were more likely to have higher levels of medical mistrust than those with lower levels of food insecurity. Individuals with higher self-identified health issues and older participants had higher medical mistrust scores. Screening for food insecurity in primary care can reduce the impact of mistrust on patient adherence and health care access by increasing patient-centered communication. These findings present a unique perspective on how to identify and mitigate medical mistrust within Appalachia and call attention to the need for further research on the root causes among food insecure residents.
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Affiliation(s)
- Melissa K. Thomas
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Ciara Amstutz
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Debra Orr-Roderick
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Julia Horter
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - David H. Holben
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
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24
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Cho A, Mendenhall E, Griffith DM. Power, place, and access: Why history is at the center of black D.C. residents of wards 7 and 8 decisions to receive the COVID-19 vaccine. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100270. [PMID: 37073370 PMCID: PMC10101486 DOI: 10.1016/j.ssmqr.2023.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/26/2023] [Accepted: 04/08/2023] [Indexed: 04/20/2023]
Abstract
Vaccines have played an essential role in curbing case and mortality rates due to SARS-CoV-2 in the United Sates. Still, many communities display high rates of unwillingness or inability to get a COVID-19 vaccine, limiting overall vaccination efforts and contributing to viral spread. Black Americans have expressed skepticism towards vaccines because of limited access to the technology, mistrust in its safety and efficacy, and a lack of confidence in the healthcare authorities that distribute it. This article investigates how Black residents of Wards 7 and 8 in Washington, D.C. thought about COVID-19 vaccination and why or why not they decided to vaccinate. These Wards' vaccination rates were markedly lower than those from Wards 1-6, which have substantially higher populations of White residents, affluence, access, and resources. This study involved 31 interviews with Ward 7 and 8 residents recruited through snowball sampling. We found that residents navigated the dual perceived risks of coronavirus infection and vaccination through three key frames: their relationship to their place or location, their desires to maintain autonomy over their health, and their abilities to access COVID-19 vaccines. This case study advances knowledge of vaccine utilization among marginalized communities, and how this phenomenon varies depending on local social, cultural, and political dynamics. Moreover, this research has implications for vaccine rollout efforts and the D.C. health system, as it reveals gaps in confidence and care that undermine health outcomes for Black residents.
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Affiliation(s)
- Allison Cho
- Edmund A Walsh School of Foreign Service, Georgetown University, 3700 O St. NW, Washington, DC, 20057, USA
| | - Emily Mendenhall
- Edmund A Walsh School of Foreign Service, Georgetown University, 3700 O St. NW, Washington, DC, 20057, USA
| | - Derek M Griffith
- Racial Justice Institute and School of Health, Georgetown University, 3700 O St. NW, Washington, DC, 20057, USA
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25
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Cafferty LA, Williamson LD, Anderson LN, Jones SR, Moore JX, Benson RD, Whisenant EB, Clinton C, Lawson NL, Ledford CJW. How Attributes of Place Threaten Community Trust in the American South: Opportunities for Improving Pandemic-Related Communication. JOURNAL OF HEALTH COMMUNICATION 2023; 28:67-75. [PMID: 36896640 DOI: 10.1080/10810730.2023.2187484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Trust and mistrust influence the utilization of health services, the quality of overall healthcare, and the prevalence of health disparities. Trust has significant bearing on how communities, and the individuals within them, perceive health information and recommendations. The People and Places Framework is utilized to answer what attributes of place threaten community trust in public health and medical recommendations.Augusta-Richmond County is ranked among the least healthy counties in Georgia despite being home to the best healthcare-to-residence ratios and a vast array of healthcare services. Semi-structured interviews were conducted with 31 neighborhood residents. Data were analyzed using the Sort & Sift, Think & Shift method. Threats to community trust were identified within four local-level attributes of place: availability of products and services, social structures, physical structures, and cultural and media messages. We found a broader web of services, policies, and institutions, beyond interactions with health care, that influence the trust placed in health officials and institutions. Participants spoke to both a potential lack of trust (e.g. needs not being met, as through lack of access to services) and mistrust (e.g. negative motives, such as profit seeking or experimentation). Across the four attributes of place, residents expressed opportunities to build trust. Our findings highlight the importance of examining trust at the community level, providing insight into an array of factors that impact trust at a local level, and extend the work on trust and its related constructs (e.g. mistrust). Implications for improving pandemic-related communication through community relationship building are presented.
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Affiliation(s)
- Lauren A Cafferty
- Department of Prevention and Community Health Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Lillie D Williamson
- Department of Communication Arts, University of Wisconsin-Madison, Madison, WI, USA
| | - LaKesha N Anderson
- Department of Medicine Uniformed Services University of the Health Sciences,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Samantha R Jones
- Department of Family Medicine Medical College of Georgia, Augusta University
| | - Justin X Moore
- Cancer Prevention, Control, & Population Health, Department of Medicine, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Reginald D Benson
- Department of Family Medicine Medical College of Georgia, Augusta University
| | - Ebony B Whisenant
- Department of Family Medicine Medical College of Georgia, Augusta University
| | - Candace Clinton
- Department of Family Medicine Medical College of Georgia, Augusta University
| | | | - Christy J W Ledford
- Department of Family Medicine Medical College of Georgia, Augusta University
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Washington A, Randall J. "We're Not Taken Seriously": Describing the Experiences of Perceived Discrimination in Medical Settings for Black Women. J Racial Ethn Health Disparities 2023; 10:883-891. [PMID: 35239178 PMCID: PMC8893054 DOI: 10.1007/s40615-022-01276-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Cervical cancer disparities persist for Black women despite targeted efforts. Reasons for this vary; one potential factor affecting screening and prevention is perceived discrimination in medical settings. The purpose of this study was to describe experiences of perceived discrimination in medical settings for Black women and to explore the impact on cervical cancer screening and prevention. METHODS This paper presents mixed methods results using the Discrimination in Medical Settings (DMS) scale and qualitative interviews to understand the medical experiences of Black women. We administered the DMS scale to 48 Black women and interviewed five about their experiences engaging in the healthcare system. RESULTS High levels of perceived discrimination were experienced by our sample, with the majority of women having experienced discrimination in the medical setting. Qualitative data contextualized these results, including the impact on the patient-provider relationship and on the development of medical mistrust. Most women reported they had been screened within the last 3 years (75%) and had seen a doctor within the past year (89.6%). CONCLUSIONS Black women are engaging in healthcare while experiencing perceived discrimination in medical settings. Future interventions should address the poor quality of medical encounters that Black women experience.
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27
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Grimes T, Marcilly R, Bonnici West L, Cordina M. Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care. PHARMACY 2023; 11:pharmacy11020060. [PMID: 36961038 PMCID: PMC10037618 DOI: 10.3390/pharmacy11020060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023] Open
Abstract
Marginalised people experience diminished access to pharmaceutical care and worse medication-related outcomes than the general population. Health equity is a global priority. This article explores the key evidence of health inequity and medication use, structures the causes and contributory factors and suggests opportunities that can be taken to advance the pharmaceutical care agenda so as to achieve health equity. The causes of, and contributors to, this inequity are multi-fold, with patient- and person-related factors being the most commonly reported. Limited evidence is available to identify risk factors related to other aspects of a personal medication use system, such as technology, tasks, tools and the internal and the external environments. Multiple opportunities exist to enhance equity in medication-related outcomes through pharmaceutical care research and practice. To optimise the effects and the sustainable implementation of these opportunities, it is important to (1) ensure the meaningful inclusion and engagement of members of marginalised groups, (2) use a person-centred approach and (3) apply a systems-based approach to address all of the necessary components of a system that interact and form a network as work processes that produce system outcomes.
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Affiliation(s)
- Tamasine Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, D02PN40 Dublin, Ireland
| | - Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
- Inserm, CIC-IT 1403, F-59000 Lille, France
| | - Lorna Bonnici West
- Applied Research and Innovation Centre, Malta College of Arts, Science and Technology, PLA9032 Paola, Malta
| | - Maria Cordina
- Department of Clinical Pharmacology & Therapeutics, WHO Collaborating Centre for Health Professionals Education and Research, Faculty of Medicine and Surgery, University of Malta, 2080 Msida, Malta
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28
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Trust Dynamics of Community Health Workers in Frontier Food Banks and Pantries: a Qualitative Study. J Gen Intern Med 2023; 38:18-24. [PMID: 36864268 PMCID: PMC9980865 DOI: 10.1007/s11606-022-07921-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Medical mistrust has had devastating consequences during the COVID-19 pandemic, particularly in rural communities. Community Health Workers (CHWs) have been shown to build trust, but there is little research on trust-building by CHWs in rural communities. OBJECTIVE This study aims to understand the strategies that CHWs use to build trust with participants of health screenings in frontier Idaho. DESIGN This is a qualitative study based on in-person, semi-structured interviews. PARTICIPANTS We interviewed CHWs (N=6) and coordinators of food distribution sites (FDSs; e.g., food banks and pantries) where CHWs hosted a health screening (N=15). APPROACH Interviews were conducted with CHWs and FDS coordinators during FDS-based health screenings. Interview guides were initially designed to assess facilitators and barriers to health screenings. Trust and mistrust emerged as dominant themes that determined nearly every aspect of the FDS-CHW collaboration, and thus became the focus of interviews. KEY RESULTS CHWs encountered high levels of interpersonal trust, but low institutional and generalized trust, among the coordinators and clients of rural FDSs. When working to reach FDS clients, CHWs anticipated confronting mistrust due to their association with the healthcare system and government, especially if CHWs were perceived as "outsiders." Hosting health screenings at FDSs, which were trusted community organizations, was important for CHWs to begin building trust with FDS clients. CHWs also volunteered at FDS locations to build interpersonal trust before hosting health screenings. Interviewees agreed that trust building was a time- and resource-intensive process. CONCLUSIONS CHWs build interpersonal trust with high-risk rural residents, and should be integral parts of trust building initiatives in rural areas. FDSs are vital partners in reaching low-trust populations, and may provide an especially promising environment to reach some rural community members. It is unclear whether trust in individual CHWs also extends to the broader healthcare system.
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TAYLOR LAURENA, NONG PAIGE, PLATT JODYN. Fifty Years of Trust Research in Health Care: A Synthetic Review. Milbank Q 2023; 101:126-178. [PMID: 36689251 PMCID: PMC10037697 DOI: 10.1111/1468-0009.12598] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 01/24/2023] Open
Abstract
Policy Points First, policymakers can create conditions that will facilitate public trust in health care organizations by making creating and enforcing health policies that make exploitative behavior costly. Second, policymakers can bolster the trustworthiness of health care markets and organizations by using their regulatory authority to address and mitigate harm from conflicts-of-interest and regulatory capture. Third, policymakers and government agencies can further safeguard the public's trust by being transparent and effective about their role in the provision of health services to the public. CONTEXT Trust plays a critical role in facilitating health care delivery and calls for rebuilding trust in health care are increasingly commonplace. This article serves as a primer on the trust literature for health policymakers, organizational leaders, clinicians, and researchers based on the long history of engagement with the topic among health policy and services researchers. METHODS We conducted a synthetic review of the health services and health policy literatures on trust since 1970. We organize our findings by trustor-trustee dyads, highlighting areas of convergence, tensions and contradictions, and methodological considerations. We close by commenting on the challenges facing the study of trust in health care, the potential value in borrowing from other disciplines, and imperatives for the future. FINDINGS We identified 725 articles for review. Most focused on patients' trust in clinicians (n = 499), but others explored clinicians' trust in patients (n = 11), clinicians' trust in clinicians (n = 69), and clinician/patient trust in organizations (n = 19) and systems (n = 127). Across these five subliteratures, there was lack of consensus about definitions, dimensions, and key attributes of trust. Researchers leaned heavily on cross-sectional survey designs, with limited methodological attention to the relational or contextual realities of trust. Trust has most commonly been treated as an independent variable related to attitudinal and behavioral outcomes. We suggest two challenges have limited progress for the field: (1) conceptual murkiness in terms and theories, and (2) limited observability of the phenomena. Insights from philosophy, sociology, economics, and psychology offer insights for how to advance both the theoretical and empirical study of health-related trust. CONCLUSION Conceptual clarity and methodological creativity are critical to advancing health-related trust research. Although rigorous research in this area is challenging, the essential role of trust in population health necessitates continued grappling with the topic.
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Affiliation(s)
| | - PAIGE NONG
- University of Michigan School of Public HealthAnn ArborUSA
| | - JODYN PLATT
- University of Michigan Medical SchoolAnn ArborUSA
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30
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Ni H, Jordan E, Cao J, Kinnamon DD, Gottlieb SS, Hofmeyer M, Jimenez J, Judge DP, Kransdorf E, Morris AA, Owens A, Shah P, Tang WHW, Wang J, Hershberger RE. Knowledge of Genome Sequencing and Trust in Medical Researchers Among Patients of Different Racial and Ethnic Groups With Idiopathic Dilated Cardiomyopathy. JAMA Cardiol 2023; 8:33-42. [PMID: 36383367 PMCID: PMC9669924 DOI: 10.1001/jamacardio.2022.4132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
Importance Cardiovascular disease contributes outsized mortality in patients from underrepresented racial and ethnic groups. Understanding levels of trust in medical researchers and knowledge of genome sequencing may help identify barriers to research participation and develop strategies to educate patients about the role of genetics in cardiovascular disease. Objective To assess racial and ethnic differences in trust in medical researchers and genome-sequencing knowledge among patients with idiopathic dilated cardiomyopathy and determine the association between trust in medical researchers and genome-sequencing knowledge. Design, Setting, and Participants This cross-sectional study conducted by a consortium of 25 US heart failure programs included patients with idiopathic dilated cardiomyopathy defined as left ventricular systolic dysfunction and left ventricular enlargement after excluding usual clinical causes. Enrollment occurred from June 7, 2016, to March 15, 2020. Main Outcomes and Measures Percent distributions, means, and associations of genome-sequencing knowledge scores and research trust scores for Hispanic, non-Hispanic Black (hereafter referred to as Black), and non-Hispanic White participants (hereafter referred to as White). Results Among 1121 participants, mean (SD) age was 51.6 (13.6) years with 41.4% Black, 8.5% Hispanic, and 43.4% female. After accounting for site effects, the level of genome-sequencing knowledge was lower in Hispanic and Black participants compared with White participants (mean score difference, -2.6; 95% CI, -3.9 to -1.2 and mean score difference, -2.9; 95% CI, -3.6 to -2.2, respectively). The level of trust in researchers was lowest in Black participants (mean score, 27.7), followed by Hispanic participants (mean score, 29.4) and White participants (mean score, 33.9). Racial and ethnic differences remained after adjusting for education, age at enrollment, duration of dilated cardiomyopathy, and health status. A higher level of trust was associated with a higher level of genome-sequencing knowledge within different racial and ethnic groups. Conclusions and Relevance In this cross-sectional study, large racial and ethnic differences in levels of genome-sequencing knowledge and trust in medical researchers were observed among patients with dilated cardiomyopathy. Findings from this study can inform future studies that aim to enhance the uptake of genomic knowledge and level of trust in medical researchers.
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Affiliation(s)
- Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | | | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, Florida
| | | | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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Williamson LD. Testing Vicarious Experiences as Antecedents of Medical Mistrust: A Survey of Black and White Americans. Behav Med 2023; 49:40-52. [PMID: 34473612 DOI: 10.1080/08964289.2021.1958740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In response to recent calls to examine medical mistrust antecedents, the present study investigated the influence of negative healthcare (personal, vicarious interpersonal, vicarious media) and racial discrimination (personal, vicarious interpersonal, vicarious media) experiences on medical mistrust, and whether these relationships were mediated by perceived racism and perceived financial corruption in healthcare. Multigroup structural equation modeling was utilized to test the model using a cross-sectional survey of Black and White adults. Personal negative healthcare experiences and vicarious media racial discrimination experiences were directly related to medical mistrust for Black and White participants. Additionally, personal negative healthcare experiences exerted indirect effects through both perceived racism in healthcare and perceived financial corruption in healthcare. Vicarious media racial discrimination experiences exerted indirect effects through perceived financial corruption for both Black and White participants and through perceived racism for Black participants. Finally, both types of vicarious interpersonal experiences and racial discrimination experiences exerted indirect effects through perceived racism for White participants. The findings have implications for medical mistrust scholarship going forward. It is necessary to acknowledge the role vicarious experiences plays in medical mistrust antecedents, which may include recognizing the impact of news depictions of racial discrimination on patients' behaviors. Additionally, there is a need to further investigate the role of perceived financial corruption in healthcare in medical mistrust.
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Allen JD, Fu Q, Shrestha S, Nguyen KH, Stopka TJ, Cuevas A, Corlin L. Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults. SSM Popul Health 2022; 20:101278. [PMID: 36407121 PMCID: PMC9652159 DOI: 10.1016/j.ssmph.2022.101278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccine, although few studies to date have investigated medical mistrust and perceived discrimination together. Method We conducted a cross-sectional online survey between April 23-May 3, 2021, among a national sample of U.S. adults ages 18 years and older. We assessed receipt of and intention to be vaccinated for COVID-19 and associations with the validated Medical Mistrust Index and Everyday Discrimination Scale. Results 1449 individuals responded, of whom 70.2% either had ≥1 dose of COVID-19 vaccine or reported that they were 'very' or 'somewhat' likely to be vaccinated in the future. In bivariate analyses, vaccination status was significantly associated with age, race/ethnicity, education, income, employment, marital status, health insurance, and political party affiliation. In multivariable analyses comparing those who had ≥1 vaccine dose or were likely to get vaccinated in the future with those who had not had any vaccine doses or did not intend to be vaccinated, each additional point in the Medical Mistrust Index was independently associated with a 16% decrease in the odds of vaccination (adjusted odds ratio = 0.84; 95% confidence interval = 0.81, 0.86). Discriminatory experiences were not associated with vaccination behavior or intention in bivariate or multivariable analyses. Conclusions Medical mistrust is significantly associated with vaccination status and intentions. Increasing uptake of COVID-19 vaccines will likely require substantive efforts on the part of public health and healthcare officials to build trust with those who are not yet fully vaccinated. We recommend that these efforts focus on building the 'trustworthiness' of these entities, an approach that will require a paradigm shift away from a focus on correcting individual beliefs and knowledge, to acknowledging and addressing the root causes underlying mistrust.
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Affiliation(s)
- Jennifer D. Allen
- Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Kimberly H. Nguyen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Adolfo Cuevas
- Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA, 02155, USA
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Stallings SC, Cunningham-Erves J, Frazier C, Ichimura JS, Hurd TC, Jurinsky J, Acquaye A, Dalton JS, Wilkins CH. Development and Validation of the Perceptions of Research Trustworthiness Scale to Measure Trust Among Minoritized Racial and Ethnic Groups in Biomedical Research in the US. JAMA Netw Open 2022; 5:e2248812. [PMID: 36580334 PMCID: PMC9856656 DOI: 10.1001/jamanetworkopen.2022.48812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Historically, trust in biomedical research has been lower among minoritized racial and ethnic groups who are underrepresented in and excluded from research, with the same groups experiencing worse health outcomes. Unfortunately, instruments that measure trust may not capture components of trust relevant to minoritized racial and ethnic groups. OBJECTIVE To develop and validate a scale to measure trust in biomedical research among minoritized racial and ethnic groups. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, community-based survey study compared trust and distrust in biomedical research among Black, Latino, and White subgroups in the US using the Perceptions of Research Trustworthiness (PoRT) scale. The scale was developed between March 22, 2016, and September 19, 2018, as part of this study, and its structure, reliability, and validity were examined during pilot (n = 381) and validation (n = 532) phases between February 4, 2019, and July 27, 2021. Convenience samples of adult participants (aged ≥18 years) were recruited locally (Nashville, Tennessee, and San Antonio, Texas) and nationally through the ResearchMatch and Cint online platforms. MAIN OUTCOMES AND MEASURES Overall and individual item Trust and Distrust subscale scores were compared. Overall Trust and Distrust scores were compared by race and ethnicity using a Kruskal-Wallis H test and individual item scores were compared using independent samples t test. RESULTS Of the 532 participants in the scale validation study, 144 (27.1%) were Black, 90 (16.9%) were Latino, and 282 (53.0%) were White. Participants had a median age of 43 years (range, 18-90 years), 352 (66.2%) were women, and 198 (37.2%) had educational attainment levels less than a college degree. Factor analysis of the 18-item PoRT scale revealed a 2-factor structure with two 9-item PoRT subscales (Trust and Distrust), which demonstrated high internal consistency (Cronbach α = 0.72 and 0.87, respectively). Mean (SD) Trust subscale scores were lower among Black (34.33 [2.02]) and Latino (34.55 [1.97]) participants compared with White participants (36.32 [1.81]; P < .001). Mean (SD) Distrust subscale scores were higher among Black (21.0 [2.15]) and Latino (20.53 [2.21]) participants compared with White participants (18.4 [2.03]; P < .001). Individual item results showed that Black and Latino participants were less trusting and more distrusting than White individuals on items related to risks, harms, secrecy, confidentiality, and privacy. CONCLUSIONS AND RELEVANCE These findings suggest that the PoRT scale incorporates trust and trustworthiness concepts relevant among Black and Latino individuals and may allow more precise assessment of trust in research among these groups.
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Affiliation(s)
- Sarah C. Stallings
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Meharry-Vanderbilt Alliance, Nashville, Tennessee
| | | | - Carleigh Frazier
- Public Health Department, University of California, Merced, Visalia
| | | | - Thelma C. Hurd
- Department of Surgery, University of Texas Health Science Center, San Antonio
- Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Jordan Jurinsky
- Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Amber Acquaye
- Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee
| | | | - Consuelo H. Wilkins
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Meharry-Vanderbilt Alliance, Nashville, Tennessee
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Williamson LD, Tarfa A. Examining the relationships between trust in providers and information, mistrust, and COVID-19 vaccine concerns, necessity, and intentions. BMC Public Health 2022; 22:2033. [PMCID: PMC9639262 DOI: 10.1186/s12889-022-14399-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
To facilitate maximum uptake of the COVID-19 vaccine, the roles of medical trust and mistrust of healthcare professionals must be examined. Previous work suggests that trust and mistrust may have differential impacts on vaccination intention via vaccine necessity and concerns. Multigroup structural equation modeling was utilized to test whether vaccine necessity and concerns mediated the associations between trust in providers and health information, mistrust of providers, and willingness to get the COVID-19 vaccine. The model was found to be invariant across Black and White respondents. Trust in providers and trust in healthcare information exerted indirect effects on intentions through vaccine necessity, while mistrust of providers exerted indirect effects through vaccine concerns. Unlike previous work, the forms of trust did not influence vaccine concerns. The findings have implications for future communication efforts from healthcare professionals and health messengers.
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Affiliation(s)
- Lillie D. Williamson
- grid.14003.360000 0001 2167 3675Department of Communication Arts, University of Wisconsin-Madison, 6050 Vilas Hall, 821 University Ave, Madison, WI 53706 USA
| | - Adati Tarfa
- grid.14003.360000 0001 2167 3675School of Pharmacy, University of Wisconsin-Madison, Madison, WI USA
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Hines AL, Brody R, Zhou Z, Collins SV, Omenyi C, Miller ER, Cooper LA, Crews DC. Contributions of Structural Racism to the Food Environment: A Photovoice Study of Black Residents With Hypertension in Baltimore, MD. Circ Cardiovasc Qual Outcomes 2022; 15:e009301. [PMID: 36378767 PMCID: PMC9710204 DOI: 10.1161/circoutcomes.122.009301] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Disproportionate exposure to poor food environments and food insecurity among Black Americans may partially explain critical chronic disease disparities by race and ethnicity. A complex set of structural factors and interactions between Black residents and their food environments, including store types, quantity, proximity, and quality of goods and consumer interactions within stores, may affect nutritional behaviors and contribute to higher cardiovascular and kidney disease risk. METHODS We used the Photovoice methodology to explore the food environment in Baltimore, MD, through the perspectives of Black residents with hypertension between August and November 2019. Twenty-four participants were enrolled in the study (mean age: 65.1 years; 67% female). After a brief photography training, participants captured photos of their food environment, which they discussed in small focus groups over the course of 5 weeks. Discussions were audiotaped and analyzed for emergent themes using a line-by-line inductive approach. Themes were, then, organized into a collective narrative. RESULTS Findings describe physical and social features of the food environment as well as participants' perceptions of its origins and holistic and generational health effects. The study illustrates the interrelationships among the broader socio-political environment, the quality and quantity of stores in the food landscape, and the ways in which they engage with the food environment as residents and consumers who have been marginalized due to their race and/or social class. The following meta-themes emerged from the data: (1) social injustice; (2) structural racism and classism; (3) interpersonal racism; (4) generational effects; (5) mistrust; (6) social programs; and (7) community asset-based approaches, including advocacy and civic engagement. CONCLUSIONS Understanding residents' perceptions of the foundations and effects of the food environment on their health may help stakeholders to cocreate multilevel interventions alongside residents to improve access to healthy food and health outcomes among disparities affected populations.
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Affiliation(s)
- Anika L. Hines
- Virginia Commonwealth University School of Medicine, Richmond, VA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca Brody
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zehui Zhou
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah V. Collins
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Chiazam Omenyi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Edgar R. Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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McClaran N, Rhodes N, Yao SX. Trust and Coping Beliefs Contribute to Racial Disparities in COVID-19 Vaccination Intention. HEALTH COMMUNICATION 2022; 37:1457-1464. [PMID: 35135397 DOI: 10.1080/10410236.2022.2035944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Racial disparities in intention to obtain the COVID-19 vaccination have been noted in academic and popular press reports. The present study sought to identify cognitive and affective factors that contribute to the observed lack of acceptance of COVID-19 vaccination, even before a vaccine was made publicly available, among Black and White Americans through a national survey (N = 487; 50.6% female, 24.8% Black). Our findings are consistent with previous studies that Black respondents had lower intention to obtain the eventual COVID-19 vaccine than White respondents. Protection motivation theory's construct of coping efficacy and an additional COVID-19-relevant variable, trust in vaccination, mediated the effect of race on behavioral intention. Lastly, beliefs were elicited from Black and White Americans to identify communication strategies regarding the issue.
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Affiliation(s)
- Nikki McClaran
- Department of Advertising and Public Relations, Michigan State University
| | - Nancy Rhodes
- Department of Advertising and Public Relations, Michigan State University
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Heydarian N, Hughes AS, Morera OF. An Exploratory Mixed Methods Study of Diabetes self-management in Blind Americans. West J Nurs Res 2022; 44:830-837. [PMID: 34053395 PMCID: PMC10783657 DOI: 10.1177/01939459211019421] [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: 11/16/2022]
Abstract
This study used mixed methods to investigate the experiences of 33 participants who are blind (PWB) and have diabetes in managing their diabetes, support (or lack thereof) from their health care providers, and diabetes distress as PWB. Participants most frequently reported barriers to check blood glucose (55%), maintaining a healthy diet (45%), and distress due to their intersectional status of having blindness and diabetes. Those who mentioned intersectional distress of managing diabetes as a PWB tended to be Braille illiterate and less likely to use mobility tools that are symbolic of blindness (e.g., white cane, guide dog). These results illuminate heterogenous characteristics of PWB with diabetes, an understudied population of public health significance, to be considered when setting priorities for diabetes self-management support and health care coverage policy.
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Affiliation(s)
- Nazanin Heydarian
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | | | - Osvaldo F. Morera
- Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
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Ye M, Chen Y, Liu Y, Li X. Impact of organizational health-oriented strategies on employees' job performance, perceived medical mistrust as a moderator: A COVID-19 perception-based view. Front Public Health 2022; 10:946946. [PMID: 36033813 PMCID: PMC9403412 DOI: 10.3389/fpubh.2022.946946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/21/2022] [Indexed: 01/21/2023] Open
Abstract
After experiencing the COVID-19 pandemic, employees' health and well-being become a priority for firms. Organizational health-oriented strategies assist them in coping with health-related crises. Based on the social exchange theory, the present study attempts to determine the role of organizational health-oriented strategies in promoting employees' job performance. This study hypothesized that the organizations' health-oriented strategies positively correlate with employees' job performance. This study also assessed the mediating role of employees' psychological wellbeing and trust and moderating role of perceived medical mistrust. For the empirical examination, data of the present study was gathered from the textile sector in China. This study analyzed data through partial least square structural equation modeling (PLS-SEM). For this purpose, Smart-PLS software was used. The outcomes revealed that organizational health-oriented strategies positively enhance the employees' psychological wellbeing, trust, and job performance. Moreover, the results revealed that employees' psychological wellbeing and trust positively mediate the proposed relationships. This study found that perceived medical mistrust moderates the relationship between employees' psychological wellbeing and job performance. However, the findings revealed that perceived medical mistrust does not moderate the relationship between employees' trust and job performance. In addition, the present study's findings provide insights to the firms about the importance of health-oriented strategies. Moreover, this study's findings also serve the literature by providing important theoretical and practical implications.
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Affiliation(s)
- Mao Ye
- School of Literature and Journalism, Xihua University, Chengdu, China
| | - Yu Chen
- School of Literature and Journalism, Xihua University, Chengdu, China
| | - Yang Liu
- School of Literature and Journalism, Xihua University, Chengdu, China
| | - Xiaohuan Li
- Agricultural and Rural Bureau of Shizhong District, Leshan, China
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Williamson LD. Beyond Personal Experiences: Examining Mediated Vicarious Experiences as an Antecedent of Medical Mistrust. HEALTH COMMUNICATION 2022; 37:1061-1074. [PMID: 33432836 DOI: 10.1080/10410236.2020.1868744] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
African Americans consistently report higher levels of medical mistrust than their White counterparts. As a result, medical mistrust is considered to be a contributor to racial health disparities. Despite calls to address medical mistrust, few studies have explicitly examined it as a phenomenon of interest; those that have, tended to focus on personal experiences while neglecting vicarious experiences. The current study a) explicitly tests the effects of two types of news story content on reported levels of medical mistrust within an African American adult sample and b) examines two widely used medical mistrust measures. Participants (N = 410) were randomly assigned to view a news story based on a 2 (health care, non-health care) x 2 (racial discrimination, nonracial discrimination) experimental design. Results indicated that individually, both health care content and racial discrimination content increased race-based medical mistrust, but had no effect on general medical mistrust. However, when all four conditions were examined, exposure to health-related racial discrimination stories resulted in higher levels of race-based and general medical mistrust than non-health, nonracial discrimination stories. Findings are discussed in terms of the theoretical and practical implications for health communication scholars.
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Govere-Hwenje S, Jarolimova J, Yan J, Khumalo A, Zondi G, Ngcobo M, Wara NJ, Zionts D, Bogart LM, Parker RA, Bassett IV. Willingness to accept COVID-19 vaccination among people living with HIV in a high HIV prevalence community. BMC Public Health 2022; 22:1239. [PMID: 35733209 PMCID: PMC9214683 DOI: 10.1186/s12889-022-13623-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 06/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND People living with HIV (PLWH) may have a poorer prognosis with COVID-19 infection and are an important population for COVID-19 vaccination. We assessed the willingness and reasons for COVID-19 vaccine acceptance or hesitancy among PLWH in South Africa. METHODS We conducted a cross-sectional study consisting of telephone interviews with a randomly selected subset of participants enrolled in a prospective observational cohort study evaluating a decentralized antiretroviral therapy (ART) delivery program in South Africa. Questions assessed willingness to accept a future COVID-19 vaccine, concerns regarding COVID-19 vaccination, and overall vaccine confidence. Interviews were conducted between September 2020 and January 2021. We evaluated participant demographics, sources of COVID-19 information, stigma and medical mistrust, uptake of non-pharmaceutical interventions, and socioeconomic impacts of the COVID-19 pandemic as potential covariates of willingness to accept vaccination. RESULTS We completed interviews with 213 participants; 153 (72%) were female, median age 35y, and 100 (47%) had completed secondary school. Among the participants, 121 (57%) were willing to accept future vaccination, 46 (22%) were unsure, and 45 (21%) stated they did not intend to be vaccinated. Fear of side effects, reported by 42 (20%), was the most common concern about COVID-19 vaccination. Older age was associated with willingness to accept vaccination (aOR 1.75 for every 10-year increase in age, 95% CI 1.10-2.78, p = 0.02), while higher medical mistrust related to COVID-19 (aOR 0.21, 95% CI 0.093-0.45, p < 0.001) and use of social media for COVID-19 information (aOR 0.30, 95% CI 0.11-0.84, p = 0.02) were associated with lower willingness to accept vaccination. CONCLUSIONS In this cohort of PLWH in South Africa, over half were willing to accept COVID-19 vaccination, although a substantial proportion remained unsure or were not willing to be vaccinated. Public health messaging should emphasize the safety and efficacy of COVID-19 vaccination and address misinformation and medical mistrust among PLWH. Ongoing efforts to ensure access to COVID-19 vaccines for vulnerable populations are crucial.
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Affiliation(s)
| | - Jana Jarolimova
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, USA
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, USA
| | - Joyce Yan
- Massachusetts General Hospital, Biostatistics Center, Boston, USA
| | | | | | | | - Nafisa J Wara
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, USA
| | - Dani Zionts
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, USA
| | | | - Robert A Parker
- Massachusetts General Hospital, Biostatistics Center, Boston, USA
- Harvard University, Center for AIDS Research (CFAR), Boston, USA
- Harvard Medical School, Boston, USA
| | - Ingrid V Bassett
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, USA
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, USA
- Harvard University, Center for AIDS Research (CFAR), Boston, USA
- Harvard Medical School, Boston, USA
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Angelo F, Veenstra D, Knerr S, Devine B. Prevalence and prediction of medical distrust in a diverse medical genomic research sample. Genet Med 2022; 24:1459-1467. [PMID: 35384843 DOI: 10.1016/j.gim.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Medical distrust has been identified as a persistent barrier to medical care, affecting preventative screening, treatment uptake, and treatment adherence. Despite this, little research to date has examined medical distrust in a genomic medicine context. The goal of this work was to assess the prevalence of medical distrust in a genomic medicine research study and examine patient-level demographic, access-related, and health-status characteristics that predict medical distrust. METHODS We assessed medical distrust in a research sample of adults (N = 967) receiving genomic sequencing to screen for hereditary risk of cancer syndromes in the United States. We used multiple predictive variable selection models to determine predictors of medical distrust followed by marginal mean analyses to characterize the relationships. RESULTS The prevalence of medical distrust was 32%. The final model indicated that Black and African American race/ethnicity; trans, nonbinary, or nonidentifying gender identity; high education; low income; low access to health care; and poor Short Form 12 mental health composite scores predict medical distrust. CONCLUSION Medical distrust may pose similar challenges to genomic sequencing, as it does in other medical contexts. The pattern of variables that predict distrust suggest that increasing access and accommodation for stigmatized and underserved communities may help overcome the negative effects of medical distrust.
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Affiliation(s)
- Frank Angelo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - David Veenstra
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute and Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
| | - Beth Devine
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute and Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
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Perceived discrimination, adherence to antiretroviral therapy, and HIV care engagement among HIV-positive black adults: the mediating role of medical mistrust. J Behav Med 2022; 45:285-296. [PMID: 35028783 PMCID: PMC8957584 DOI: 10.1007/s10865-021-00277-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023]
Abstract
Perceived discrimination and medical mistrust are contributors to HIV inequities. The current study examined whether medical mistrust mediated the associations between perceived discrimination and adherence to antiretroviral therapy (ART) as well as care engagement in a sample of 304 Black adults living with HIV. Perceived discrimination and medical mistrust were measured using validated scales; ART adherence was electronically monitored for a month; care engagement was determined by medical record data. Results support significant total indirect effects from perceived discrimination (due to HIV-serostatus, race, sexual orientation) to ART adherence through three types of medical mistrust (towards healthcare organizations, one's physician, and HIV-specific mistrust). The total indirect effects were also significant for care engagement and were largely driven by mistrust towards one's own physician. Findings suggest interventions at the provider or healthcare organization levels should address medical mistrust to improve the health and well-being of Black Americans living with HIV.
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Richmond J, Boynton MH, Ozawa S, Muessig KE, Cykert S, Ribisl KM. Development and Validation of the Trust in My Doctor, Trust in Doctors in General, and Trust in the Health Care Team Scales. Soc Sci Med 2022; 298:114827. [PMID: 35255277 PMCID: PMC9014823 DOI: 10.1016/j.socscimed.2022.114827] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
RATIONALE Historic and present-day racism and inequity in the United States (U.S.) have resulted in diminished trust in health care among many populations. A key barrier to improving trust in health care is a dearth of well-validated measures appropriate for diverse populations. Indeed, systematic reviews indicate a need to develop and test updated trust measures that are multidimensional and inclusive of relevant domains (e.g., fairness). OBJECTIVE We developed three trust measures: the Trust in My Doctor (T-MD), Trust in Doctors in General (T-DiG), and Trust in the Health Care Team (T-HCT) scales. METHODS After developing an initial item pool, expert reviewers (n = 6) provided feedback on the face validity of each scale. We conducted cognitive interviews (n = 21) with a convenience sample of adults to ensure items were interpreted as intended. In 2020, we administered an online survey to a convenience sample of U.S. adults recruited through the Qualtrics Panel (n = 801) to assess scale reliability and validity. RESULTS Exploratory and confirmatory factor analyses indicated acceptable model fit for second order latent factor models for each scale (root mean square error of approximation: <0.07, comparative fit index: ≥0.98, and standardized root mean square residual: ≤0.03). The T-MD contained 25 items and six subscales: communication competency, fidelity, systems trust, confidentiality, fairness, and global trust. The T-DiG and T-HCT each contained 29 items and seven subscales (the same subscales in the T-MD plus an additional subscale related to stigma-based discrimination). Each scale was strongly correlated with existing trust measures and perceived racism in health care and was significantly associated with delayed health care seeking and receipt of a routine health exam. CONCLUSIONS The multidimensional T-MD, T-DiG, and T-HCT scales have sound psychometric properties and may be useful for researchers evaluating trust-related interventions or conducting studies where trust is an important construct or main outcome.
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Affiliation(s)
- Jennifer Richmond
- Vanderbilt University Medical Center, Department of Medicine, Division of Genetic Medicine, 2525 West End Ave, 7th Floor Suite, Nashville, TN, 37203, USA; University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA.
| | - Marcella H Boynton
- University of North Carolina School of Medicine, North Carolina Translational & Clinical Sciences Institute (NC TraCS), 160 N. Medical Drive, Chapel Hill, NC, 27599, USA; University of North Carolina School of Medicine, Division of General Medicine and Clinical Epidemiology, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Sachiko Ozawa
- University of North Carolina, Eshelman School of Pharmacy, Division of Practice Advancement and Clinical Education, CB #7574, Beard Hall 115G, Chapel Hill, NC, 27599, USA
| | - Kathryn E Muessig
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA
| | - Samuel Cykert
- University of North Carolina School of Medicine, Division of General Medicine and Clinical Epidemiology, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA
| | - Kurt M Ribisl
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA
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Hall OT, Bhadra-Heintz NM, Teater J, Samiec J, Moreno J, Dixon-Shambley K, Rood KM, Fiellin DA, Jordan A. Group-based medical mistrust and care expectations among black patients seeking addiction treatment. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100026. [PMID: 36845897 PMCID: PMC9949334 DOI: 10.1016/j.dadr.2022.100026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/26/2021] [Accepted: 01/10/2022] [Indexed: 01/19/2023]
Abstract
Background Black patients seeking addiction care experience poorer treatment access, retention, and outcomes when compared to White counterparts. Black patients may have elevated group-based medical mistrust, which has been associated with poorer health outcomes and increased experiences of racism across multiple healthcare contexts. The relationship between group-based medical mistrust and expectations for addiction treatment among Black individuals remains untested. Methods A total of 143 Black participants were recruited from two addiction treatment centers in Columbus, Ohio. Participants completed the Group Based Medical Mistrust Scale (GBMMS) and answered questions related to expectations of addiction treatment. Descriptive analysis and Spearman's rho correlations were performed to assess for relationships between group-based medical mistrust and expectations of care. Results Group-based medical mistrust in Black patients was associated with self-reported delay in accessing addiction treatment, anticipation of racism during addiction treatment, non-adherence and discrimination-precipitated relapse. However, non-adherence to treatment was least strongly correlated with group-based medical mistrust demonstrating an opportunity for engagement. Conclusion Group-based medical mistrust is associated with Black patients' care expectations when seeking addiction treatment. Use of the GBMMS within addiction medicine to address themes of mistrust in patients, and potential biases in providers, may improve treatment access and outcomes.
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Key Words
- GBMMS DISP, group, based health disparities subscale
- GBMMS LOS, lack of support from healthcare providers subscale
- GBMMS SUSP, suspicion subscale
- GBMMS, group, based medical mistrust scale
- HIRHW, history of interpersonal racism by healthcare workers
- Healthcare disparities
- Medical mistrust
- OSUWMC, Ohio State Wexner Medical Center
- Racial discrimination
- STEPP, substance use, treatment, education and prevention program
- Social justice
- Substance use treatment
- Substance-related disorders
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Affiliation(s)
- O. Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Talbot Hall 181 Taylor Ave., Columbus, OH 43203, USA
| | - Nia M. Bhadra-Heintz
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Talbot Hall 181 Taylor Ave., Columbus, OH 43203, USA
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Talbot Hall 181 Taylor Ave., Columbus, OH 43203, USA
| | - Jennifer Samiec
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jose Moreno
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Talbot Hall 181 Taylor Ave., Columbus, OH 43203, USA
| | - Kamilah Dixon-Shambley
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kara M. Rood
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David A. Fiellin
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Ayana Jordan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Neil JM, Senecal C, Ballini L, Chang Y, Goshe B, Flores E, Ostroff JS, Park ER. A multi-method evaluation of tobacco treatment trial recruitment messages for current smokers recently diagnosed with cancer: A pilot factorial randomized control trial (Preprint). JMIR Cancer 2022; 8:e37526. [PMID: 36001378 PMCID: PMC9453579 DOI: 10.2196/37526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials offer cessation resources but have low accrual rates. Digital outreach may improve accrual, but knowledge of how best to recruit smokers with recent diagnoses is limited. Objective This study aims to identify the message frames that were most effective in promoting intent to talk to a physician about participating in a tobacco treatment trial for smokers recently diagnosed with cancer. Methods From February to April 2019, current smokers diagnosed within the past 24 months were recruited from a national web-based panel for a multimethod pilot randomized trial (N=99). Participants were randomized to a 2×3 plus control factorial design that tested 3 unique message frames: proximal versus distal threats of smoking, costs of continued smoking versus benefits of quitting, and gains of participating versus losses of not participating in a tobacco treatment trial. The primary outcome was intent to talk to a physician about participating in a tobacco treatment trial. In phase 1, the main effect within each message factor level was examined using ANOVA and compared with the control condition. Other message evaluation and effectiveness measures were collected and explored in a multivariable model predicting intent to talk to a physician. In phase 2, open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare the prevalence of linguistic markers among message factors. Results Of the 99 participants, 76 (77%) completed the intervention. Participants who received the cost of continued smoking frame were significantly more likely to intend to talk to their physician about participating in a tobacco treatment trial than those who received the benefits of the quitting frame (mean costs 5.13, SD 1.70 vs mean benefits 4.23, SD 1.86; P=.04). Participants who received the proximal risks of continued smoking frame were significantly more likely to seek more information about participating (mean distal 4.83, SD 1.61 vs mean proximal 5.55, SD 1.15; P=.04), and those who received the losses of not participating frame reported significantly improved perceptions of smoking cessation research (mean gain 3.98, SD 0.83 vs mean loss 4.38, SD 0.78; P=.01). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their physician. Participants’ perceptions of their smoking habits, as well as their motivation to quit smoking, were prevalent themes in the open-text data. Differences in the percentages of affective words across message frames were identified. Conclusions Multimethod approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future tobacco treatment trials should evaluate the effectiveness of different message frames on smoker enrollment rates. Trial Registration Clinicaltrials.gov NCT05471284; https://clinicaltrials.gov/ct2/show/NCT05471284
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Affiliation(s)
- Jordan M Neil
- Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Christian Senecal
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Lauren Ballini
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Yuchiao Chang
- Division of General Internal Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, MA, United States
| | - Brett Goshe
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, United States
| | - Efren Flores
- Department of Radiology, Harvard Medical School/Massachusetts General Hospital, Boston, MA, United States
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elyse R Park
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, United States
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46
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Ghoshal A, O'Carroll RE, Ferguson E, Shepherd L, Doherty S, Mathew M, Morgan K, Doyle F. Assessing medical mistrust in organ donation across countries using item response theory. J Health Psychol 2021; 27:2806-2819. [PMID: 34963351 DOI: 10.1177/13591053211064985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although medical mistrust (MM) may be an impediment to public health interventions, no MM scale has been validated across countries and the assessment of MM has not been explored using item response theory, which allows generalisation beyond the sampled data. We aimed to determine the dimensionality of a brief MM measure across four countries through Mokken analysis and Graded Response Modelling. Analysis of 1468 participants from UK (n = 1179), Ireland (n = 191), India (n = 49) and Malaysia (n = 49) demonstrated that MM items formed a hierarchical, unidimensional measure, which is very informative about high levels of MM. Possible item reduction and scoring changes were also demonstrated. This study demonstrates that this brief MM measure is suitable for international studies as it is unidimensional across countries, cross cultural, and shows that minor adjustments will not impact on the assessment of MM when using these items.
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Affiliation(s)
- Arunangshu Ghoshal
- Tata Memorial Centre, India.,Homi Bhaba National Institute (HBNI), India
| | | | | | | | | | | | - Karen Morgan
- Perdana University-Royal College of Surgeons in Ireland School of Medicine, Malaysia
| | - Frank Doyle
- Royal College of Surgeons in Ireland, Ireland
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47
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Duthely LM, Sanchez-Covarrubias AP, Prabhakar V, Brown MR, Thomas TES, Montgomerie EK, Potter JE. Medical Mistrust and Adherence to Care Among a Heterogeneous Cohort of Women Living with HIV, Followed in a Large, U.S. Safety Net Clinic. Health Equity 2021; 5:681-687. [PMID: 34909537 PMCID: PMC8665805 DOI: 10.1089/heq.2020.0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: To explore the relationship between medical mistrust, as measured by the Group-Based Medical Mistrust (GBMM) scale, and HIV care adherence among a cohort of minority women receiving care in a U.S. safety net clinic. Methods: English-, Spanish-, and Haitian Creole (Creole)-speaking patients with a recent history of nonadherence to care were surveyed. Results: English speakers endorsed the highest level of mistrust, followed by Spanish speakers and Creole speakers. Creole speakers endorsed lower mistrust, lower suspicion of providers, and lower levels of “perceived health care disparities.” Higher mistrust was associated significantly with lower medication adherence, and lower rates of viral suppression (nonsignificant). Conclusion: Understanding perceptions of medical care and the relationship to HIV care adherence is an important step to addressing negative health outcomes for ethnic minority women with HIV. Clinical Trial Registration Number: NCT03738410.
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Affiliation(s)
- Lunthita M Duthely
- Divisions of Research and Special Projects and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alex P Sanchez-Covarrubias
- Divisions of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Varsha Prabhakar
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan R Brown
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tanya E S Thomas
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Emily K Montgomerie
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - JoNell E Potter
- Divisions of Research and Special Projects and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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Medical Mistrust and Stigma Associated with COVID-19 Among People Living with HIV in South Africa. AIDS Behav 2021; 25:3967-3977. [PMID: 33999300 PMCID: PMC8127851 DOI: 10.1007/s10461-021-03307-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 01/04/2023]
Abstract
We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0-8; possible range 0-24] and 6 (IQR 2-9) for mistrust (possible range 0-28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy.
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Greene J, Samuel-Jakubos H. Building Patient Trust in Hospitals: A Combination of Hospital-Related Factors and Health Care Clinician Behaviors. Jt Comm J Qual Patient Saf 2021; 47:768-774. [PMID: 34654668 DOI: 10.1016/j.jcjq.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients' trust in their regular clinician is relatively high in the United States, but trust in the health care system and in key institutions, such as hospitals, is considerably lower. The purpose of this study was to identify the factors that build patients' trust in hospitals. METHODS In early 2020 the authors conducted 38 semistructured telephone interviews with participants across the United States. Respondents were asked about trust in hospitals generally, as well as what makes them trust and not trust specific hospitals. Interviews were audio recorded, transcribed, and analyzed using a descriptive thematic approach. RESULTS Participants identified three mechanisms through which hospitals build their trust: (1) competence (effectively treating health issues, providing a safe and clean hospital environment, and having clinicians who are knowledgeable and thorough), (2) caring (hospital culture that prioritizes patients' comfort, welcoming physical environment, and clinicians who are compassionate), and (3) communication (hospital culture of listening to patients and explaining clearly, particularly with treatment and discharge plans). The absence of these three factors resulted in loss of trust. Hospital cost also lost patients' trust in hospitals. While the cost of hospital care affected some participants' overall level of trust in hospitals, others separated the trust they had in the medical care received from trust in billing practices. CONCLUSION The findings underscore the importance of perceived quality of care and hospital safety/hygiene, as well as having an organizational culture that emphasizes caring and effective communication, for building patient trust.
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Hsueh L, Layland EK, Kipke MD, Bray BC. Linking racism and homonegativity to healthcare system distrust among young men of color who have sex with men: Evidence from the Healthy Young Men's (HYM) study. Soc Sci Med 2021; 284:114219. [PMID: 34271403 PMCID: PMC8958666 DOI: 10.1016/j.socscimed.2021.114219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experiences with racism predict healthcare system distrust among people of color, but Black and Latino young men who have sex with men (YMSM) also experience overlapping forms of stigma associated with their sexual identities and behaviors (i.e., homonegativity and internalized homonegativity). These forms of minority stress may drive healthcare system distrust among Black and Latino YMSM but have received far less attention. OBJECTIVES To examine the associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust among a community sample of Black and Latino YMSM. METHODS Data came from waves 2-4 (years 2017-2018) of the Healthy Young Men's study, a longitudinal cohort study of Black and Latino YMSM living in Los Angeles County. Data across waves (n = 424, nobs = 1272) were combined and analyzed using a fixed effects approach and adjusting for repeated measures across participants. A series of regression models that added sets of covariates (demographics, syndemic indicators, and health-related factors) were tested to examine associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust. RESULTS Adjusting for demographics and syndemic indicators, racism, but not homonegativity or internalized homonegativity, was associated with healthcare system distrust. Adjustment for health-related factors had little impact on results. CONCLUSIONS Among Black and Latino YMSM, greater exposure to racism is associated with greater healthcare system distrust. Efforts to strengthen healthcare system trust should explicitly target the institutional policies that disproportionately harm people of color.
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Affiliation(s)
- Loretta Hsueh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Eric K Layland
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, 135 College Street, Suite 200, New Haven, CT, 06510, USA
| | - Michele D Kipke
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA; Departments of Pediatrics and Preventive Medicine, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA, 90027, USA
| | - Bethany C Bray
- Center for Dissemination and Implementation Science, University of Illinois at Chicago, 818 South Wolcott Ave., Chicago, IL, 60612, USA
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