Combating Medical Mistrust in the Black Community

Medical mistrust causes barriers to health promotion and prevention, eventually leading to greater health disparities in minority communities. This has long-lasting effects and hampers the growth of clinician-patient relationships, according to a poster presentation at DNPs of Color annual meeting held in Washington, DC, October 19-22, 2023.

This pilot study aimed to increase awareness that medical mistrust is widespread in the Black community. Medical mistrust is not a phenomenon but a “true medical issue,” said Clydie Coward-Murrell, MSN-Ed, BSN, RN. “This clinical issue is not as prevalent in other minority communities simply because of the atrocities in health care that African Americans had to suffer for hundreds of years.”

To study this issue, Dr. Coward-Murrell surveyed Black adults with mistrust in the health care system about how they perceive medical information and looked at their receptiveness to health information during a 30-minute patient encounter.

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The study utilized the Group Based Medical Mistrust Scale (GBMMS), the SHARE approach tool, and ASK ME 3 to assess medical mistrust before and during patient encounters, with a study cohort of 25 Black adults aged 18 to 64 years at an outpatient community in Southeastern North Carolina.

Data collected indicated that if providers take the time to address medical mistrust, this could initiate closing the gap. After participants completed the GBMMS, it was determined that 92% were glad that their health care provider took the time to address their medical mistrust, while 84% wished that all their health care providers would take the time to address their medical mistrust. In addition, 64% agreed that they felt more comfortable with the health information provided by the clinician.

The study indicated that there is still a high level of medical mistrust in the Black community, and though providers are working to tackle medical mistrust by utilizing open communication and providers assessing and addressing their own biases, it remains present. The GBMMS questions that demonstrated the highest degree of medical mistrust included:

• Doctors have the best interests of people of my ethnic group in mind.
• People of my ethnic group should be suspicious of modern medicine.
• I have personally been treated poorly or unfairly by doctors or healthcare workers because of my ethnicity.

What can providers do? “Providers can first Assess, to inquire if there is the presence of Medical Mistrust; then address the issues and have a conversation with your patient. Ask your patients of color: ‘What can I do? Make it a mutual decision-making, shared approach,” said Dr Coward-Murrell. “You have to go in and earn the trust [of the patient]. Then incorporate the SHARE approach intervention.”

Organizations should take the initiative to combat medical mistrust by acknowledging disparities in addition to providing health care providers with education on diversity, equity, inclusion, implicit bias, and a historical perspective on why medical mistrust remains a clinical issue.

Study limitations include the small sample size and the exclusion of other marginalized groups. To further expand this study, next steps include offering an intervention in hospitals for transformational change, educating staff nurses on how to address their own biases, and providing tools for faculty to incorporate in both academic and clinical settings, said Dr Coward-Murrell.

Visit Clinical Advisor’s meeting section for more coverage of DNPs of Color 2023.

Source

Coward-Murrell C. Assessing medical mistrust. Poster presented at: DNPs of Color 2023. October 19 to 22, 2023; Washington, DC.