Examining the Psychometric Properties of the Group-Based Medical Mistrust Scale in Black and Latino Men with Criminal Justice Backgrounds

Background.Culture provides a milieu through which worldviews are explored and may influence how people perceive their health and health problems, especially how they seek out healthcare services, and how they react to recommendations to modify certain lifestyle behaviors, follow through with healthcare interventions, or adhere to medical treatment. Having said that, it is not a stretch to suggest that culture may also impact medical mistrust. Medical mistrust is defined as the inclination to distrust medical systems and healthcare personnel that are believed to represent the dominant culture. Extensive research has explored the relationship between race and ethnicity and trust (or lack thereof) of the healthcare system among Blacks and Latinos living in the U.S. However, the concept of medical mistrust has not been explored in formerly incarcerated Black and Latino men. Thus, the purpose of this study was to validate and assess the psychometric properties of the Group-Based Medical Mistrust Scale (GBMMS) for use among formerly incarcerated Black and Latino men.

Methods. This study employed a cross-sectional research design and used a purposive sample consisting of newly released (defined as released within three years or less) Black and Latino men ages 35 and over in the New York City area. Univariate statistics were used to describe all study variables. Several bivariate statistics were employed: Pearson’s r, a one way ANOVA, and independent t-test. Pearson’s rwas used to calculate correlations between the various subscales of the GBMM. The main analyses used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to replicate and validate the GBMMS scale for use with formerly incarcerated men. For the EFA, Principal Components Analysis was used to extract the factors; a non-orthogonal Oblimin procedure was used to rotate the factors. The CFA was conducted on the measurement model proposed by Shelton and colleagues (2010). The construct validity of the GBMMS scores was calculated by determining the mean of the participant’s responses across the individual items. Model fit was assessed via the chi-square and several fit indices: CFI (a goodness-of-fit index), the RMSEA, and the SRMR (both badness-of-fit indices). The internal consistency reliability was assessed using Cronbach’s.  

Results.The findings of the exploratory and confirmatory factor analyses suggest that a two factor structure fit the data best. Two dimensions emerged as important subscales: discrimination and suspicion. The current findings suggest the two-factor GBMMS is a valid and reliable assessment tool to discern medical mistrust levels among formerly incarcerated Black and Latino men

Implications. The current findings demonstrate that the GBMMS can be a reliable tool to discern trust levels among formerly incarcerated Black and Latino men. Healthcare providers who interface with criminal justice populations should recognize this as a strength in which a positive relationship can be built because former inmates may be more likely to adhere to recommended preventive services; and consider provider input in the decision-making process about medical treatment. Eliminating medical mistrust as a barrier may be an important step toward eliminating health disparities experienced by formerly incarcerated Black and Latino men.