Understanding the Influence of Stigma and Medical Mistrust on Engagement in Routine Healthcare Among Black Women Who Have Sex with Women

Abstract

Purpose: For Black women who have sex with women (BWSW), obtaining routine healthcare can be obstructed by a number of psychosocial barriers, including experiences of stigma, related to both sexual orientation and race, and medical mistrust, both race-based and global. Previous research demonstrates that sexual orientation and race-based stigma, as well as global and race-based medical mistrust, each have a negative impact on health outcomes and engagement in care (EIC) independently. This study addresses gaps in the literature by examining the impact of these psychosocial barriers and their interactions among BWSW, an understudied population. Methods: Participants (256 BWSW) were surveyed at a Black Gay Pride festival. Separate generalized linear models assessed the independent and multiplicative effects of participants' self-reported sexual orientation stigma, race-based stigma, race-based medical mistrust, and global medical mistrust related to their engagement in routine physical exams and blood pressure screenings. Results: Prevalence rates of both stigma measures were low, but prevalence rates of global and race-based medical mistrust were high. The results show that experiencing sexual orientation stigma or having race-based medical mistrust predicts significantly lower EIC. Furthermore, the frequencies of obtaining recent physical examinations and blood pressure screenings were significantly related to three-and two-way interactions between stigma and medical mistrust, respectively. Conclusion: There is an urgent need to address the intersectionality of these psychosocial barriers in an effort to increase BWSW's EIC.Keywords: barriers to care, lesbian, race/ethnicity/culture, women who have sex with women (WSW)

Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust

“…Cross-sectional designs with multivariate (linear [n = 38] and/or logistic [n = 42]) regression analyses were the predominant analytic methodologies. Few studies utilized path analysis, 22,55,56 mediation modeling, 14,[56][57][58][59][60][61][62][63] or moderation modeling [64][65][66] and advanced modeling techniques, such as structural equation modeling 62,67,68 or repeated measures with longitudinal designs; e.g., 3,[69][70][71][72] Eighteen studies (see Appendix A) tested existing theoretical models. Those that did most frequently (n = 8) tested Anderson's behavioral model of service use.…”

“…Despite the mediation modeling, Lin 62 and Abraido-Lanza 79 provided the only studies that examined MM as a potential mediator of the relationship with other mediators and a behavioral response. Similarly, only three studies [64][65][66] examined MM as a moderator of the strength of the relationship between MM as proximal pathway predictor and a response. For instance, in their sample of Black women who have sex with women, Brenick and colleagues 66 reported moderator effects of MM as demonstrated by significant two-way interactions between MM and race-based stigma, such that when both predictors were high, self-report of a recent physical exam was lower.…”

“…Similarly, only three studies [64][65][66] examined MM as a moderator of the strength of the relationship between MM as proximal pathway predictor and a response. For instance, in their sample of Black women who have sex with women, Brenick and colleagues 66 reported moderator effects of MM as demonstrated by significant two-way interactions between MM and race-based stigma, such that when both predictors were high, self-report of a recent physical exam was lower. These authors 66 also found an interaction between MM and sexual orientation stigma such that high MM was associated with less recent engagement, regardless of the level of stigma.…”

“…For instance, in their sample of Black women who have sex with women, Brenick and colleagues 66 reported moderator effects of MM as demonstrated by significant two-way interactions between MM and race-based stigma, such that when both predictors were high, self-report of a recent physical exam was lower. These authors 66 also found an interaction between MM and sexual orientation stigma such that high MM was associated with less recent engagement, regardless of the level of stigma. There was also a significant three-way interaction: high MM with high race-based stigma was related to less recent engagement in health care, regardless of whether sexual orientation stigma was high or low, and participants who were low on all three variables reported more recent engagement with care.…”

High Stakes for the Health of Sexual and Gender Minority Patients of Color

“…36 Realize that patients' lack of trust stems from actual negative experiences and a legacy of discrimination. 23,25,43 Similarly, providers should be aware that great diversity exists among SGM patients of color. For example, Asian-American and Pacific Islander sexual and gender minorities represent a group that varies tremendously in income, employment, education, English proficiency, and health status.…”