Understanding Black Women’s Lived Experiences of Medical Mistrust and Trust in the Reproductive Care Setting: a nested sequential explanatory mixed methods study

Medical mistrust inhibits positive healthcare-seeking behavior, resulting in negative health outcomes. We assessed Black women’s medical mistrust and concepts of trust-building provider characteristics in the reproductive healthcare setting in Alachua County, Florida. A nested, sequential, explanatory mixed-methods design was employed. In addition, an Integrated Black Women’s Reproductive Health Social Ecological Model (IBWRH-SEM) was developed to construct the survey, interview tools, participant engagement, data collection, and analysis. Psychometric analysis was conducted to validate the scale for this study population. A sample of 255 self-identified Black women aged 18 and older completed an online survey, with a subsample of 16 completing semi-structured follow-up individual and group interviews. Confirmatory Factor Analysis indicated the validity of the Group Based medical mistrust scale with excellent internal reliability (⍺=0.80) and marginal to excellent model fit indices [CFI = 0.87, TLI = 0.83, RMSEA = 0.07 (90% CI), and SRMR = 0.07]. The survey findings highlighted higher mistrust amongst younger, married, and women seeking both allopathic and holistic care. Women who sought both allopathic and holistic settings experienced higher mistrust, and suspicion scores. In addition, findings showed that younger women, women possessing a graduate/professional level degree had higher suspicion and higher health disparity scores. Furthermore, semi-structured interviews revealed five key trust-building characteristics: transparency, humanizing interactions, comfort and provider tone, acknowledgment of patient insight, and time spent with the patient. These characteristics were essential for trust-building during patient-provider interactions in the reproductive healthcare setting. Findings suggest structural changes are needed to improve institutional systems and interpersonal provider characteristics in the reproductive healthcare setting. Intervention strategies need to center Black women, so they are supported and, over time, unburdened of the need to self-advocate and be vigilant.