Abstract
BACKGROUND: Black and African Americans experience an undue burden of disease and reduced life expectancy because of systemic racism. As a result, Black and African Americans report higher levels of mistrust of medical services, providers, and systems. The Model for Health Care Distrust posits that patient characteristics, including prior experiences, when combined with characteristics of providers and healthcare systems can result in distrust of healthcare. Mistrust is associated with lower utilization of preventive care services and poor health outcomes. This study aimed to identify characteristics of healthcare providers and systems related to mistrust and strategies Black patients use to mitigate mistrust. METHODS: This study was a sub-analysis of qualitative data collected on factors influencing decision-making around COVID-19 vaccination among Black and African American adults. Eighty-six participants (54% female, average age: 49) were recruited in Milwaukee, WI to participate in in-depth interviews. After an initial thematic analysis was complete, data coded to themes related to primary care, experiences with healthcare, and mistrust were thematically coded to the domains in the Model for Health Care Distrust. RESULTS: Most participants (67.4%) explicitly stated that they trust their primary care provider. 20% described only trusting some providers or trusting their provider half of the time. Patient characteristics related to mistrust included experiences of discrimination in healthcare and preferring natural medicine and wanting to discuss it as an option with their primary care provider. Healthcare provider characteristics including dismissiveness and treatment insistence were drivers for mistrust, while mutual respect and open communication and feeling like "more than just a number" supported patients' trust. Characteristics of healthcare systems related to mistrust included healthcare capitalism and perceived hidden agendas and experimentation. As strategies to mitigate mistrust, patients described seeking doctors of the same race or gender, doctor shopping when mistrust arises, and empowering themselves to speak up via education and intuition. CONCLUSIONS: Our findings align with the principles of anti-racist patient-centered care and shared decision making and support the application of this approach in primary care. This study lays the groundwork for primary care interventions focused on addressing medical mistrust among Black and African American patients. CLINICAL TRIAL NUMBER: Not applicable.