(see Poster Gallery) Predictors of Perceived Health Risk and Medical Care Avoidance Among African American Women: The Role of Racial Pride, Medical Discrimination, and Medical Mistrust

Background and Purpose: The purpose of this study was to understand how experiences of perceived medical discrimination and medical mistrust were associated with odds of worry about health (i.e. perceived health risk) and avoiding medical care among African American women. Additionally, we sought to explore the relationship between these outcomes and cultural beliefs (i.e., racial pride).

Methods: We used cross-sectional data obtained as part of the African American Identity, Socialization, Discrimination and Outcomes Project. Study recruitment took place between January 2020 - February 2020 and participants self-identifying as African American/Black and at least 18 years old completed a Qualtrics administered survey. This analysis focuses on participants who self-identified as female. Our outcome of interest was perceived health risk, measured using the survey question: “How often do you worry about becoming chronically ill?” Responses were dichotomized as never/not often vs. often/very often. Medical discrimination is a sum of three items assessing experiences of discrimination in health settings based on race (a=.71). The medical mistrust scale was six items measuring beliefs that individuals and institutions will act in a manner consistent with patients’ interests (a=.73). Racial pride was calculated using a 5-item racial identity salience scale (a=.93). Bivariate analyses were conducted examining the distribution of perceived health risk and medical avoidance by age, education, marital status, and having a usual source of care. Odds ratios were estimated using logistic regression models.

Results: In our sample (n=603), there was a significant difference in mean racial pride scores by perceived risk (p=.05) and by avoidance of care (p=.001). Higher scores on the experiences of medical discrimination scale was associated with higher odds of often/very often worrying about becoming chronically ill (OR: 1.10, 95% CI: 1.03, 1.18). Higher medical mistrust scores was not significantly associated with perceived health, nor was racial pride associated with perceived risk. In the unadjusted model examining avoidance of medical care, women aged 55 and older (vs. 35 and younger) and those with a usual source of care had lower odds of avoiding care (OR 0.38, 95% CI: .21-.68; OR .56, 95% CI: .33, .94, respectively.). While women who were married or living with a partner had significantly higher odds of avoiding care (OR 1.73, 95% CI: 1.09, 2.76). In the adjusted models, higher medical discrimination was associated with higher odds of avoiding care (OR: 1.46, 95% CI: 1.32, 1.62) and higher medical mistrust scores also had higher odds of avoiding care (Model 2; OR: 1.11, 95% CI: 1.04, 1.19). Higher racial pride was significantly associated with avoiding medical care as well (OR: 1.10, 95% CI: 1.03, 1.16).

Conclusions and Implications: This analysis provides critical insight on factors associated with perceived health risk and avoidance of medical care among African American women. Findings suggest that prior experiences of discrimination in healthcare settings, attitudes of medical mistrust, saliency of racial identity, and marital status play a role in health attitudes for Black women. Health interventions, programming, and policy efforts to improve health outcomes should consider these contextual factors.