A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions

Ramos, S. Raquel; Warren, Ricks; Shedlin, Michele; Melkus, Gail D’Eramo; Kershaw, Trace; Vorderstrasse, Allison

doi:10.1080/08964289.2019.1570074

Cited by 36 publications

(27 citation statements)

References 82 publications

(119 reference statements)

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“…The United States Public Health Service Study of Untreated Syphilis in the Negro Male is often mentioned as proof that concerns about unethical research are justified, but a number of examples of unethical medical research have occurred well after this study ended and even after the historic Belmont Report set standards for human research protections in 1979 3 . Given numerous and well-documented instances of unethical research conducted on racial and ethnic minority populations and other historically marginalized groups 4,[11][12][13] , it is important to reframe notions of trust to recognize that it is in fact logical and rational for members of these populations to approach medical research with some level of skepticism. In addition, increasing numbers of financial relationships between university scientists and industry and other events that cast doubt on the objectivity of individual scientists, their institutions, and the larger system of academic research have fueled skepticism about research trustworthiness 14 .…”

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confidence: 99%

Determinants of Trustworthiness to Conduct Medical Research: Findings from Focus Groups Conducted with Racially and Ethnically Diverse Adults

et al. 2020

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BACKGROUND: Potential research participants, particularly those from racial and ethnic groups underrepresented in medical research, often decide to participate based on how they judge people, places, and study protocols as trustworthy. And yet, few studies have explored notions of trustworthiness or determinants of trustworthiness from the perspective of potential medical research participants. OBJECTIVE: This paper describes how racially and ethnically diverse potential medical research participants conceptualize what makes researchers, research settings, and research protocols seem trustworthy. DESIGN: Using a criterion sampling strategy, we recruited African American, Latinx, and White adults for participation in focus groups conducted at a community center servings the Latinx community and at a health clinic that primarily serves the African American community. PARTICIPANTS: A total of 57 African American, Latinx, and White adults APPROACH: We conducted seven focus groups that explored perceptions and determinants of research, trust, privacy, confidentiality, and research participation. We used a phenomenological thematic analytic approach to explore the determinants of trustworthiness to conduct medical research. RESULTS: In our effort to identify the factors that affect potential research participants' perspectives on the trustworthiness of medical research, we found three themes: Who is trustworthy to conduct medical research? What influences perceptions of trustworthiness in medical research? And what institutions or settings are trustworthy to conduct medical research? CONCLUSIONS: These findings highlight that one's willingness to participate in research is driven in part by their perception of the trustworthiness of researchers, research institutions, and the information they are given about potential research opportunities. There are important and modifiable determinants of trustworthiness that may facilitate minority participation in research. We found that research, researchers, and research institutions each have things that can be done to increase trustworthiness and minority participation in research.

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confidence: 99%

Determinants of Trustworthiness to Conduct Medical Research: Findings from Focus Groups Conducted with Racially and Ethnically Diverse Adults

et al. 2020

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“…While there is a lack of evidence-based interventions for improving trust in medicine, there are promising approaches available for future research [ 34 ]. For example, eHealth technology may be leveraged to increase trustworthiness and trust in medicine, and community-based participatory approaches can help design healthcare services that address medical mistrust [ 35 , 36 ]. In addition, lessons from AIDS denialism may have renewed relevance during the COVID-19 pandemic [ 28 ], and interventions effective in reducing HIV stigma, such as the Popular Opinion Leader model, may be adapted to address medical mistrust in SGM communities [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine Acceptance among an Online Sample of Sexual and Gender Minority Men and Transgender Women

et al. 2021

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Sexual and gender minority (SGM) populations are particularly vulnerable to poor COVID-19 outcomes and are more likely to experience stigma and medical mistrust that may impact COVID-19 vaccine acceptance. This study examined the prevalence of COVID testing and diagnosis and assessed COVID-19 vaccine acceptance among a large sample of SGM. Participants were recruited as part of an online cross-sectional study focused on an HIV biomedical prevention technology willingness in the United States at increased risk for HIV sero-conversion. Multivariate linear analysis was conducted to examine COVID-19 vaccine acceptance. The study sample included 1350 predominately gay (61.6%), Black (57.9%), cis-gender (95.7%) males with a mean age of 32.9 years. Medical mistrust and social concern regarding COVID-19 vaccine stigma were significantly associated with decreased COVID-19 vaccine acceptance, and altruism was significantly associated with increased vaccine acceptance. Black participants were significantly less likely to accept a COVID-19 vaccine, and Asian participants were significantly more likely to accept a vaccine, compared to White peers. As the planning of COVID-19 vaccine rollout efforts is conceptualized and designed, these data may inform equitable implementation strategies and prevent worsening health inequities among SGM populations.

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“…As is common with e-health behavioural interventions [ 45 , 48 ], the theories of change underpinning interventions in this review tended to rely on individually focused psychological theories of behaviour or behaviour change. Whilst these are unlikely to address structural factors contributing to the syndemic such as marginalisation, homophobia and discrimination [ 19 , 101 ], the accessibility and anonymity of e-health interventions offer one approach to reducing barriers to service access stemming from stigma and discrimination [ 26 ] and might form an important element of a broader mix of interventions addressing individual and structural factors.…”

Section: Discussionmentioning

confidence: 99%

“…e-Health interventions are a promising approach for reaching MSM with targeted health interventions [ 26 ], and existing evidence drawn from general or other populations suggests they might be effective in reducing sexual risk behaviour [ 39 , 41 ] and substance use [ 30 ] and addressing common causes of mental ill health [ 31 – 37 ]. Our synthesis has identified three distinct theory of change pathways underpinning existing e-health interventions for MSM targeting sexual health, substance use and mental health outcomes, two of which underpin interventions targeting all three of these outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Stigma and discrimination pose barriers to appropriate services for MSM worldwide [ 24 – 26 ]. Online global surveys of MSM have found that only 11% of substance-using participants reported accessible treatment programmes, with only 5% reporting use [ 27 ], and that fewer than half of participants had easy access to condoms and HIV testing [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Theories of change for e-health interventions targeting HIV/STIs and sexual risk, substance use and mental ill health amongst men who have sex with men: systematic review and synthesis

et al. 2021

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Background Sexual risk, substance use, and mental ill health constitute a syndemic of co-occurring, mutually reinforcing epidemics amongst men who have sex with men (MSM). Developed since 1995, e-health interventions offer accessible, anonymous support and can be effective in addressing these outcomes, suggesting the potential value of developing e-health interventions that address these simultaneously amongst MSM. We conducted a systematic review of e-health interventions addressing one or more of these outcomes amongst MSM and in this paper describe the theories of change underpinning relevant interventions, what these offer and how they might complement each other. Methods We identified eligible reports via expert requests, reference-checking and database and Google searches. Results were screened for reports published in 1995 or later; focused on MSM; reporting on e-health interventions providing ongoing support to prevent HIV/STIs, sexual risk behaviour, substance use, anxiety or depression; and describing intervention theories of change. Reviewers assessed report quality, extracted intervention and theory of change data, and developed a novel method of synthesis using diagrammatic representations of theories of change. Results Thirty-three reports on 22 intervention theories of change were included, largely of low/medium-quality. Inductively grouping these theories according to their core constructs, we identified three distinct groupings of theorised pathways. In the largest, the ‘cognitive/skills’ grouping, interventions provide information and activities which are theorised to influence behaviour via motivation/intention and self-efficacy/perceived control. In the ‘self-monitoring’ grouping, interventions are theorised to trigger reflection, self-reward/critique and self-regulation. In the ‘cognitive therapy’ grouping, the theory of change is rooted in cognitive therapy techniques, aiming to reframe negative emotions to improve mental health. Conclusions The synthesised theories of change provide a framework for developing e-health interventions that might holistically address syndemic health problems amongst MSM. Improving reporting on theories of change in primary studies of e-health interventions would enable a better understanding of how they are intended to work and the evidence supporting this. The novel diagrammatic method of theory of change synthesis used here could be used for future reviews where interventions are driven by existing well-defined behaviour and behaviour change theories. Systematic review registration PROSPERO CRD42018110317

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A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions

Cited by 36 publications

References 82 publications

Determinants of Trustworthiness to Conduct Medical Research: Findings from Focus Groups Conducted with Racially and Ethnically Diverse Adults

Determinants of Trustworthiness to Conduct Medical Research: Findings from Focus Groups Conducted with Racially and Ethnically Diverse Adults

COVID-19 Vaccine Acceptance among an Online Sample of Sexual and Gender Minority Men and Transgender Women

Theories of change for e-health interventions targeting HIV/STIs and sexual risk, substance use and mental ill health amongst men who have sex with men: systematic review and synthesis

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