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AIMS Public Health

2024, Volume 11, Issue 4: 1030-1048. doi: 10.3934/publichealth.2024053
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Affordability, negative experiences, perceived racism, and health care system distrust among black American women aged 45 and over

  • 1.
    Indiana University Fairbanks School of Public Health, Indianapolis, IN USA
  • 2.
    Robert F. Wagner Graduate School of Public Service, New York University, NY USA
  • 3.
    College for Public Health and Social Justice, Saint Louis University, MO USA
  • 4.
    College of Nursing and School of Allied Health, Northwestern State University, LA USA
  • 5.
    Indiana University School of Medicine, Indianapolis, IN USA
  • 6.
    Saint Xavier University, Chicago, IL USA
  • Received: 25 January 2024 Revised: 18 June 2024 Accepted: 02 July 2024 Published: 26 September 2024

  • Black Americans (AA) face a confluence of challenges when seeking care including unaffordable costs, negative experiences with providers, racism, and distrust in the healthcare system. This study utilized linear regressions and mediation analysis to explore the interconnectedness of these challenges within a community-based sample of 313 AA women aged 45 and older. Approximately 23% of participants reported affordability problems, while 44% had a negative experience with a provider. In the initial linear regression model excluding perceived racism, higher levels of distrust were observed among women reporting affordability problems (β = 2.66; p = 0.003) or negative experiences with a healthcare provider (β = 3.02; p = <0.001). However, upon including perceived racism in the model, it emerged as a significant predictor of distrust (β = 0.81; p = < 0.001), attenuating the relationships between affordability and distrust (β = 1.74; p = 0.030) and negative experience with a provider and distrust (β = 1.79; p = 0.009). Mediation analysis indicated that perceived racism mediated approximately 35% and 41% of the relationships between affordability and distrust and negative experience with a provider and distrust, respectively. These findings underscore the critical imperative of addressing racism in the efforts to mitigate racial disparities in healthcare. Future research should explore the applicability of these findings to other marginalized populations.

    Citation: Jacqueline Wiltshire, Carla Jackie Sampson, Echu Liu, Myra Michelle DeBose, Paul I Musey, Keith Elder. Affordability, negative experiences, perceived racism, and health care system distrust among black American women aged 45 and over[J]. AIMS Public Health, 2024, 11(4): 1030-1048. doi: 10.3934/publichealth.2024053

    Related Papers:

  • Black Americans (AA) face a confluence of challenges when seeking care including unaffordable costs, negative experiences with providers, racism, and distrust in the healthcare system. This study utilized linear regressions and mediation analysis to explore the interconnectedness of these challenges within a community-based sample of 313 AA women aged 45 and older. Approximately 23% of participants reported affordability problems, while 44% had a negative experience with a provider. In the initial linear regression model excluding perceived racism, higher levels of distrust were observed among women reporting affordability problems (β = 2.66; p = 0.003) or negative experiences with a healthcare provider (β = 3.02; p = <0.001). However, upon including perceived racism in the model, it emerged as a significant predictor of distrust (β = 0.81; p = < 0.001), attenuating the relationships between affordability and distrust (β = 1.74; p = 0.030) and negative experience with a provider and distrust (β = 1.79; p = 0.009). Mediation analysis indicated that perceived racism mediated approximately 35% and 41% of the relationships between affordability and distrust and negative experience with a provider and distrust, respectively. These findings underscore the critical imperative of addressing racism in the efforts to mitigate racial disparities in healthcare. Future research should explore the applicability of these findings to other marginalized populations.



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    Acknowledgments


    This study is not funded by any agency and is being conducted by the authors independently.

    Author contributions


    Jacqueline Wiltshire devised the project, the main conceptual ideas, and wrote the manuscript. Carla Jackie Sampson contributed to the conceptualization and writing of the manuscript. Echu Liu contributed to the methods, statistical analysis, results, and discussion sections of the manuscript. Myra Michelle DeBose, Paul I Musey, and Keith Elder contributed to the conceptual ideas and worked on the discussion section of the manuscript.

    Conflict of interest


    Keith Elder is an editor-in-chief for AIMS Public Health and was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

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