Examining the Impact of Knowledge, Belief, and Accessibility on Black Women's Healthcare Utilization

Background/Purpose: Research has shown that the maternal health crisis in the United States disproportionately affects Black women more compared to women of other racial backgrounds. Studies highlight social determinants and systemic factors contributing to this disparity, such as socioeconomic status and biases within the healthcare system. In light of current knowledge and this ongoing crisis, the current study sought to examine the cross-sectional relationship between knowledge of medical racism, belief of current misconduct, and accessibility to a Black doctor on the healthcare utilization of Black women.

Methodology: Data and Sample: An analytical sample of non-institutionalized Black women aged 18 and older living in the United States (n=2,047) was derived from the American Trends Panel (ATP) dataset. The ATP Wave 100 was conducted from Nov. 30 to Dec. 12, 2021, and assessed Black & Hispanic perspectives on science and society with questions related to their healthcare practices. Among study participants, 67.3% were 50 years of age or older, 59.1% had a college education, and 54.4% had an annual income of less than $50,000.

Measures: Knowledge of medical racism assessed participants’ knowledge of one of three historical events of medical racism, and responses included no (0) and yes (1=one of three historical events). Belief of current medical research misconduct assessed participants’ belief that current procedures prevent medical research misconduct, with responses consisting of 0=no and 1=yes. Accessibility measured participants' access to a Black doctor, with no (0) and yes (1) responses. Healthcare utilization was measured by whether participants saw a doctor in the past twelve months, with no (0) and yes (1) as responses. Covariates included preference to be seen by a Black doctor (0=no,1=yes), age (0=<50 years, 1=>50 years), income (0=<$50,000, 1=>$50,000), and education (0=no college, 1=college). A binary logistic regression (BLR) was conducted to examine the relationship between knowledge of medical racism, belief of current medical research misconduct, and accessibility to a Black doctor on healthcare utilization among Black women, controlling for age, education, income, and doctor preference.

Results: Accessibility to a Black doctor was the only statistically significant predictor (p=.002), indicating that participants with access to a Black doctor are almost twice as likely to utilize healthcare compared to those without access (OR=1.670; 95% CI[1.202,2.321]), controlling for age, education, income, and preference. Among covariates, participants 50 years of age and older compared to their younger counterparts are almost three times more likely (OR=2.973; 95% CI[2.156,4.089]; p=<.001), and those with an annual income of $50,000 or greater compared to those earning less are almost twice as likely (OR=1.734; 95% CI[1.198,2.508]; p=.003) to utilize healthcare. The model was statistically significant, χ2(8) =1.966, p=<.05, and explained 87% (R2=.87) of the variance in healthcare utilization and correctly classified 89.8% of cases.

Conclusion/Implications: These findings align with previous studies on the racial concordance between patient and physician, which has been found to lead to better health outcomes, higher patient satisfaction, and more healthcare utilization among Black women. This study highlights important implications for social work practice, policy, and future research, which are discussed.