Differences in the conceptualization of medical mistrust among low SES African American and white women

Background: Low SES African Americans and Whites believe that our health care system fundamentally undermines our constitutional rights of equality, and disregards our moral obligations to care for all persons. Medical mistrust rises from a culture of biased and inferior care, and is a social justice issue because it has been allowed to continue. Little has been done to understand the extent to which mistrust contributes to health disparities. Existing measures of physician trust and satisfaction were derived from studies conducted in the context of managed care, using samples of predominantly white, insured people with a regular source of care, and are, therefore, inappropriate to measure the mistrust construct. Objective: Developing a conceptual framework, and defining a measurement theory for mistrust that is socially and culturally grounded in the experiences of low SES African Americans and whites were the goals of this study. Methods: Concept Mapping is a mixed methods participatory approach that combines qualitative (focus groups, structured sorting and rating exercises) with multivariate methods (multidimensional scaling and cluster analysis). It provides a pictorial representation of a group's thinking, shows how ideas are related to each other and which concepts are most important. Results: While the two groups have experiences of mistrust in common, African Americans portray a “landscape” view of the construct, while Whites' depiction is in “portrait.” Medical mistrust is not the opposite of physician trust. Mistrust is more complicated and negative, and is shaped by various cultural, social and historic contexts.