‘Yeah, they suck. It’s like they don’t care about our health.’ Medical mistrust among Black women under community supervision in New York city

Abstract

Black women in the USA experience some of the poorest health outcomes and this is especially true for those involved in the carceral system who are at elevated risks for HIV/STIs, reproductive health, and chronic diseases. This study aimed to investigate Black women’s experience accessing healthcare services. We conducted semi-structured interviews with 43 women from Project EWORTH under community supervision in New York City. We analysed responses focusing on barriers to healthcare engagement. All interviews were recorded, and data analysis was conducted using NVivo. Themes influencing Black women’s ability to engage with healthcare providers and systems included: 1) disclosed provider mistrust/judgement; 2) feeling disrespected by providers and the medical system; 3) mistrust of medical providers/system/hospital/government; 4) lack of health communication; 5) low health literacy; 6) provider gender preference. Findings highlight the need to improve trust and collaboration between healthcare providers and Black women. This study addresses the critical gap in understanding perceptions of discrimination, stigma, and barriers to attaining health care. Funders and accreditation agencies must hold providers and organisations accountable for acquiring and making available diversity, equity and inclusion training for providers, demonstrating increasingly equitable medical relationships through responsiveness to patient feedback, and increasing the number of Black providers.

Keywords:

• PrEP
• medical mistrust
• Black women
• community supervision
• STI

Acknowledgments

Thanks go to the New York City Department of Probation, The Fortune Society, and the Centre for Court Innovation for collaboration and assistance in this project. Special thanks go to the women who agreed to share their stories and experiences. We also thank the study’s research assistants: Jasmine Akuffo, Charmaine Black, Mary Brown, Carol Cruise, Mark John Mineo, Hermonie Moses, Michael Nkereuwem, and Caroline Prichard, who conducted the interviews and coded the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data access

The data from this study are available from the authors upon reasonable request and with the permission of the principal investigators, LG and NE

Trial registration

ClinicalTrials.gov Identifier: NCT02391233.

Additional information

Funding

This study was funded by a US National Institute of Drug Abuse (NIDA) grant R01DA038122. Work by Kristi Stringer was supported by institutional training grants from the US National Institute of Drug Abuse (T32DA037801; R25DA037190). Jennifer Hall and Ariel Richer were supported by the National Institute of Drug Abuse (NIDA) T32DA037801.