Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans
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 posi...
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| Format: | Article |
| Language: | English |
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BMC
2025-07-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-025-02900-3 |
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| author | Kelly W. Gagnon Katherine Quinn Jennifer L. Walsh Yuri A. Amirkhanian Jeffrey A. Kelly |
| author_facet | Kelly W. Gagnon Katherine Quinn Jennifer L. Walsh Yuri A. Amirkhanian Jeffrey A. Kelly |
| author_sort | Kelly W. Gagnon |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0fb1c1e02f1a43b5ad1da68afee32329 |
| institution | Kabale University |
| issn | 2731-4553 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj-art-0fb1c1e02f1a43b5ad1da68afee323292025-08-20T03:45:34ZengBMCBMC Primary Care2731-45532025-07-0126111110.1186/s12875-025-02900-3Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African AmericansKelly W. Gagnon0Katherine Quinn1Jennifer L. Walsh2Yuri A. Amirkhanian3Jeffrey A. Kelly4Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of WisconsinCenter for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of WisconsinCenter for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of WisconsinCenter for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of WisconsinCenter for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of WisconsinAbstract 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.https://doi.org/10.1186/s12875-025-02900-3MistrustPrimary careBlack and African AmericansHealthcare systems |
| spellingShingle | Kelly W. Gagnon Katherine Quinn Jennifer L. Walsh Yuri A. Amirkhanian Jeffrey A. Kelly Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans BMC Primary Care Mistrust Primary care Black and African Americans Healthcare systems |
| title | Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans |
| title_full | Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans |
| title_fullStr | Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans |
| title_full_unstemmed | Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans |
| title_short | Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among black and African Americans |
| title_sort | characteristics of healthcare providers healthcare systems and patient strategies related to medical mistrust among black and african americans |
| topic | Mistrust Primary care Black and African Americans Healthcare systems |
| url | https://doi.org/10.1186/s12875-025-02900-3 |
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