Faculty Collaboration Database

Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans. BMC Prim Care 2025 Jul 02;26(1):203

Date

07/03/2025

Pubmed ID

40604500

Pubmed Central ID

PMC12218944

DOI

10.1186/s12875-025-02900-3

Scopus ID

2-s2.0-105010119146 (requires institutional sign-in at Scopus site)   4 Citations

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.

Author List

Gagnon KW, Quinn K, Walsh JL, Amirkhanian YA, Kelly JA

Authors

Yuri A. Amirkhanian PhD Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Kelly W. Gagnon PhD Assistant Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Jeffrey A. Kelly PhD Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Katherine Quinn PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Jennifer L. Walsh PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Decision Making
Delivery of Health Care
Female
Health Personnel
Humans
Male
Middle Aged
Patient Acceptance of Health Care
Physician-Patient Relations
Qualitative Research
Racism
Trust