Abstract: Understanding the Antecedents of Medical Mistrust: Testing the Ecological Medical Mistrust Antecedents (EMMA) Model

◆ Lillie D. Williamson, University of Wisconsin-Madison

Medical mistrust, distrust in the motives of medical personnel and institutions (Omodei & McLennan, 2000), has been associated with decreased likelihood of engaging in several health behaviors (e.g., Meng et al., 2016; Morgan et al., 2008). As a result, medical mistrust is a pervasive barrier that cuts across health contexts and topics. Thus, addressing medical mistrust is a critical step towards improving health outcomes. This may be of particular importance for Black Americans who consistently report higher levels of medical mistrust than their White counterparts (e.g., Thompson et al., 2003; Tekeste et al., 2018). Furthermore, the relationship between race and medical mistrust exists when controlling for a variety of factors (e.g., trust in physician, Brandon et al., 2005; demographic variables, Durant et al., 2011), suggesting that race may play a critical role in our understanding of medical mistrust. Despite calls for investigation into medical mistrust (e.g., Adams & Simoni, 2016; Scharff et al., 2010), little work has been done that explicitly examines medical mistrust as a phenomenon of interest, focuses on antecedents of medical mistrust, or investigates the nuanced role of race.

To address these gaps, the current study tests a new model – the Ecological Medical Mistrust Antecedents (EMMA) model. The EMMA model takes previously noted antecedents (see Hammond, 2010) and uses Street’s (2003) ecological model of medical encounters to reconceptualize these antecedents. It posits that negative health-care socialization (NHS), negative health-care experiences (NHE), and racial discrimination experiences (RDE) influence medical mistrust and that these relationships are mediated by perceived racism and perceived financial corruption in health care.

Black (n = 204) and White (n = 232) participants completed a survey that assessed the constructs associated with the EMMA model. Analysis was conducted utilizing structural equation modeling (SEM), specifically using a multigroup model. For both Black and White participants, there was a) an indirect effect of personal NHE on medical mistrust via perceived racism and b) indirect effects of both personal NHE and vicarious media NHE on medical mistrust via perceived financial corruption. For White participants, there were also indirect effects of vicarious interpersonal NHE, personal RDE, and vicarious interpersonal RDE on medical mistrust through perceived racism. For Black participants, vicarious media RDE exerted an indirect effect on medical mistrust via both perceived racism and perceived financial corruption.

Based on these findings, the inclusion of communication expands our understanding of medical mistrust. The current study suggests that scholarship’s previous focus on the Tuskegee Syphilis Study (Jaiswal & Halkitis, 2019) is limiting. Hearing stories (vicarious interpersonal experiences) and exposure to news stories (vicarious media experiences) showing negative health-care experiences or racial discrimination experiences influence medical mistrust. Not only this, but also the ways in which these communicative events influence medical mistrust, differ for Blacks and Whites. As scholars interested in improving health outcomes answer Benkert et al.’s (2019) call for investigations into the antecedents of medical mistrust, it will be important for communication scholars to be at the forefront of this work.