Medical Mistrust High Among Minority Women

April 8, 2009
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A recent Michigan State University study revealed a high level of mistrust among minority women in regard to health care and hospital systems. Nearly 70 percent of minority women polled said they believe that health-care organizations sometimes deceive or mislead patients.

MSU researchers say that lack of trust could lead minority women to skip regular preventive screenings, thus impacting the quality of their health care.

The study of 341 Arab-American, African-American and Latina women focused on breast cancer screenings. It was designed to examine levels of medical mistrust and assess the effect that mistrust has on a woman’s willingness to follow through with recommended breast cancer screenings, according to Karen Patricia Williams, lead author and an assistant professor of obstetrics, gynecology and reproductive biology in MSU’s College of Human Medicine.

The women in the study answered questions as part of a seven-item Medical Mistrust Index. The study also collected data on breast cancer screenings and socio-demographics. It was funded by Susan G. Komen for the Cure in Dallas.

Williams said the study measured medical mistrust at the systems level rather than the individual level. A patient might trust their personal physician, for instance, but mistrust the hospital or medical system.

The study revealed an important association between medical mistrust and appropriately timed breast cancer screening among many minority women, Williams said. She noted that medical mistrust is not a particularly new phenominon, but it is understudied. Williams has also studied African-American women in chemotherapy prevention trials. Thomas A. LaVeist, Ph.D., professor of Health Policy and Management and director of the Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health, was a consultant on the project. He pioneered the work on medical mistrust.

“We found high levels of mistrust, regardless of the racial-ethnic group,” Williams said. “People are less likely to engage in preventive screening practices, thereby making them more likely to suffer from conditions such as breast cancer that, if caught early, could be better treated.”

The findings also show many minority women only will use the health-care system when they are very sick, which taxes the health-care system, she said.

Among other findings:

  • 39 percent of African-American women “strongly agreed” that health-care organizations don’t keep information private, compared to 15 percent for Latina women and 9 percent for Arab-American women.

  • 44 percent of women who had never received a clinical breast exam agreed that health-care organizations have sometimes done harmful experiments on patients without their knowledge.

  • 64 percent of women who had not received a breast exam in the past 12 months indicated that they sometimes wonder if health-care organizations really know what they are doing.

Results of the study indicated to Williams that hospital systems and medical systems need to work on being more than just culturally competent; they need to work on how they relate to people of color — and that goes for everyone in the system, from the receptionist to the screener to the nurse and physician. If a person in the system treats a patient in a manner that the patient percieves as disrespectful, then that perception becomes a reality, Williams said.

Williams said mistrust can come from a variety of sources, most often from personal and family experiences. A patient could develop medical mistrust, for instance, if they observed that a relative or family member was treated differently from other patients during a hospital stay.

“Everyone involved in the health-care experience needs to focus on respecting the patient and family, regardless of their race, gender, ethnicity, insurance or lack thereof. We need to provide everyone with the same gold standard regardless of any other factors,” Williams said.

She is now exploring whether interventions using community health workers can make a difference in decreasing medical mistrust. If a community health worker explains the process involved in a screening and helps prepare the patient for a procedure, does it lower the level of mistrust? She also has plans to look at the medical mistrust issue at a national level and include all races and nationalities in the research. Williams said the expanded research will likely be done in collaboration between MSU and Johns Hopkins. HQ

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