Exploring lack of trust in care providers and the government as a barrier to health service use.
ABSTRACT We examined associations between trust of health care providers and the government and health service use and outcomes.
Interviews with a sample of 611 HIV-positive individuals included an attitudinal assessment measuring beliefs concerning the creation of AIDS, information being withheld about the disease, and trust of care providers.
Trust in care providers was associated with increased HIV-related out-patient clinic visits, fewer emergency room visits, increased use of antiretroviral medications, and improved reported physical and mental health. Trusting the government was associated with fewer emergency room visits and better mental and physical health. More than one quarter of the respondents believed that the government created AIDS to kill minorities, and more than half believed that a significant amount of information about AIDS is withheld from the public. Ten percent did not trust their provider to give them the best care possible.
Distrust may be a barrier to service use and therefore to optimal health. Distrust is not isolated in minority communities but also exists among members of nonminority communities and equally interferes with their use of services and health outcomes.
Full-textDOI: · Available from: Dalene Stangl, Aug 26, 2014
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ABSTRACT: Objectives. We assessed how health care-related stigma, global medical mistrust, and personal trust in one's health care provider relate to engaging in medical care among Black men who have sex with men (MSM). Methods. In 2012, we surveyed 544 Black MSM attending a community event. We completed generalized linear modeling and mediation analyses in 2013. Results. Twenty-nine percent of participants reported experiencing racial and sexual orientation stigma from heath care providers and 48% reported mistrust of medical establishments. We found that, among HIV-negative Black MSM, those who experienced greater stigma and global medical mistrust had longer gaps in time since their last medical exam. Furthermore, global medical mistrust mediated the relationship between stigma and engagement in care. Among HIV-positive Black MSM, experiencing stigma from health care providers was associated with longer gaps in time since last HIV care appointment. Conclusions. Interventions focusing on health care settings that support the development of greater awareness of stigma and mistrust are urgently needed. Failure to address psychosocial deterrents will stymie progress in biomedical prevention and cripple the ability to implement effective prevention and treatment strategies. (Am J Public Health. Published online ahead of print December 18, 2014: e1-e8. doi:10.2105/AJPH.2014.302322).American Journal of Public Health 12/2014; 105(2):e1-e8. DOI:10.2105/AJPH.2014.302322 · 4.23 Impact Factor
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ABSTRACT: Electronic health records (EHRs) are expected to bring a variety of health benefits, including reducing disparities in health-care access, but only if they are valued by all patient populations. We used the 2007 Health Information and National Trends Survey to characterize which health-care users report that electronic access to their health records is important for themselves and their providers. Respondents from populations that generally experience health-care disparities (Blacks, Latina/os, and patients with psychological distress) were among the most likely to report that the EHR was very important for themselves. Women were less likely than men to deem the EHR very important for their providers. Findings remained consistent after controlling for respondents’ socioeconomic status, health status, and health care. By identifying the characteristics of current health-care users who see electronic access to records as important for themselves and providers, we can better understand potential barriers as well as motivators to adoption that could contribute to equitable usage across groups or a digital divide.Information Communication and Society 02/2015; 18(7):1-15. DOI:10.1080/1369118X.2015.1006657 · 0.70 Impact Factor
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ABSTRACT: Exposure to trauma is associated with significant emotional and behavioral difficulties among children (Perepletchikova & Kaufman, 2010). Overall, reports of trauma and violence experienced by children are discrepant from those of their caregivers (Lewis et al., 2012). Even less is known about the extent of concordance between orphans and their caregivers. This study examines the correlates of concordance in reported traumatic experiences between 1,269 orphaned and abandoned children (OAC) and their caregivers. The OAC lived in family-settings in 5 low and middle income countries and were part of a longitudinal study, "Positive Outcomes for Orphans" (POFO) that enrolled children aged 6 to 12 at baseline. By examining concordance with respect to specific types of trauma reported, this study expands the understanding of who reports which types of traumas experienced by orphaned and abandoned children, thereby improving the potential to provide targeted interventions for children who have experienced such events. In this study, children and caregivers were asked separately if the child had experienced different types of potentially traumatic events. Children were significantly more likely to report physical abuse, sexual abuse and family violence than were caregivers. Caregivers were significantly more likely than children to report natural disasters and accidents. High levels of concordance were found in the reporting of wars, riots, killings, and deaths in the family. The impacts of trauma on behavior and mental health are profound, and highly effective interventions targeting sequelae of childhood trauma are currently being developed for use in low resource areas. Findings from this study demonstrate that it is feasible to conduct screening for potentially traumatic events utilizing child self-report in resource limited settings and that child self-report is crucial in evaluating trauma, particularly family violence and physical or sexual assault.Vulnerable Children and Youth Studies 01/2014; 9(3):220-233. DOI:10.1080/17450128.2013.855346