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Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust
Ramona Benkert1, Adolfo Cuevas2, Hayley S Thompson3,4
1a Wayne State University, College of Nursing.
Abstract:
Peer-reviewed articles (n = 124) examining associations between medical mistrust (MM) and health outcomes from four databases, between January 1998 and May 2018, were reviewed; 36 qualitative and 88 quantitative studies met the inclusion criteria. The Williams and Mohammed framework guided our narrative synthesis of the studies; it argues that basic causes (e.g., biased institutions) affect the social status of marginalized groups which in turn effects multiple proximal pathways leading to responses and poor health. Most studies were cross-sectional with US-based samples. The MM in qualitative studies were categorized as interpersonal (n = 30), systemic (n = 22), and/or vicarious (n = 18); 25% did not explicitly note the basic causes of MM and race/ethnicity was often confounded with socioeconomic status (SES). All but three studies discussed an association between MM and a behavior response; no study focused on an actual health outcome. Most quantitative studies used multivariate regression analyses; only 15 of the 88 utilized advanced modeling techniques (e.g., mediation). Most (75%) studies did not describe basic causes for MM and 43% utilized low income samples. MM was conceptualized as a predictor/proximal pathway (in 73 studies) associated with a variety of responses, most commonly behavioral (e.g., diminished adherence); 14 studies found an association between MM and a specific health measure. This review underscores the need for future qualitative studies to place MM central to their research questions as in-depth descriptions of MM were limited. Future quantitative studies should replicate findings using more advanced analytical strategies that examine the relationship between MM and health outcomes.
Insights
Medical mistrust (MM) is linked to health behaviors, but research often overlooks its root causes and direct health impacts. Future studies need deeper qualitative insights and advanced quantitative methods to explore this crucial relationship.
Area of Science:
- Public Health
- Health Disparities
- Medical Sociology
Background:
- Medical mistrust (MM) is a significant factor influencing patient-provider interactions and health-seeking behaviors.
- Existing research often examines MM as a predictor of behavioral responses rather than a direct determinant of health outcomes.
- The social and systemic determinants of MM, particularly among marginalized populations, require further investigation.
Purpose of the Study:
- To systematically review and synthesize existing literature on the associations between medical mistrust and health outcomes.
- To identify gaps in the current research regarding the conceptualization, measurement, and analysis of medical mistrust.
- To provide recommendations for future research directions in understanding the complex relationship between MM and health.
Main Methods:
- A comprehensive literature search was conducted across four databases, yielding 124 peer-reviewed articles published between January 1998 and May 2018.
- Studies were categorized into qualitative (n=36) and quantitative (n=88) based on inclusion criteria.
- A narrative synthesis, guided by the Williams and Mohammed framework, was employed to analyze the selected studies.
Main Results:
- Most studies focused on behavioral responses (e.g., diminished adherence) associated with MM, with few directly measuring health outcomes.
- Qualitative studies identified interpersonal, systemic, and vicarious forms of MM, but 25% did not specify root causes.
- Quantitative studies predominantly used cross-sectional designs and basic regression analyses; only 15% employed advanced modeling techniques.
Conclusions:
- Current research frequently conceptualizes medical mistrust as a predictor of behaviors, often neglecting its fundamental causes and direct impact on health.
- There is a critical need for qualitative research to deeply explore the nuances of MM and for quantitative studies to utilize advanced analytical strategies.
- Future research should prioritize investigating the direct links between medical mistrust and measurable health outcomes, particularly within diverse and underserved populations.
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