Access Type
Open Access Embargo
Date of Award
January 2024
Degree Type
Dissertation
Degree Name
Ph.D.
Department
Nursing
First Advisor
Wanda Gibson-Scipio
Abstract
Problem: Little is known about the relationship between medical mistrust and health outcomes in adolescents, particularly minority adolescents with chronic illness. There is also a paucity in knowledge on the relationship between caregivers’ trust or mistrust in a provider and if this is similar or dissimilar in their adolescent’s beliefs. To address this critical gap in research, this study aims to explore medical mistrust in AA adolescents with high-risk asthma and their caregivers. Asthma is currently the leading pediatric chronic respiratory condition in the United States, with a reported 60% had uncontrolled asthma symptoms. Asthma disproportionately affects urban, disadvantaged, minority children. It is 26% more prevalent among African American (AA) children than Caucasian children, and AA children experience more emergency visits, hospitalizations, and fatalities from asthma than Caucasians, even after controlling for socioeconomic variables. Adolescents with asthma are at higher risk than younger children for increased morbidity and mortality, with minority adolescents at highest risk. Purpose: The overarching purpose of this study is to explore medical mistrust among African American adolescents with high-risk asthma and their primary caregivers. The study was guided by three aims that compared medical mistrust between both groups of participants, and explored associations between medical mistrust, asthma knowledge, asthma self-management, asthma related health outcomes and health care utilization. Methods: This study is a cross-sectional descriptive secondary analysis of the parent study, an R01 clinical trial. It enrolled 19 caregiver-adolescent dyads of African American individuals aged 12 years, 0 months to 16 years 11 months, with moderate to severe persistent poorly controlled asthma. Participants completed study questionnaires sent through Qualtrics links. The research questions were tested using statistical analyses such as multiple linear regression analysis, Pearson correlation analysis and independent sample t-test. This study was guided by the Behavioral Model for Vulnerable Populations theoretical framework. Results: As adolescents increased in age, medical mistrust levels increased as well. Male adolescents had higher mistrust scores than female adolescents. Caregivers with lower educational achievement and lower household income had higher medical mistrust scores than caregivers with higher education achievement and higher household incomes. An inverse relationship was noted between adolescent medical mistrust scores and adolescent trust in provider scores. Adolescent trust and caregiver trust were positively correlated, with similar scores noted. Caregiver medical mistrust in their own adult healthcare provider and adolescent mistrust in their pediatric provider were not correlated. A negative correlation was found between caregiver medical mistrust and adolescent trust in their provider. Medical mistrust did not predict asthma knowledge, medication adherence, symptom assessment or environmental control. However, medical mistrust did predict poor asthma control. A negative correlation was found between caregiver medical mistrust levels and emergency visits for asthma. A positive correlation was found between caregiver trust in the adolescent’s pediatrician and emergency department visits for asthma. Note: statistical significance of study findings was nullified due to small sample size. Conclusion: This study is the first documented study of intergenerational medical mistrust and among urban minority adolescents with high risk asthma. Study findings indicate that the phenomenon of medical mistrust is complex in nature and therefore more detailed research study approaches are required in the future. Future research is needed to extend the current study results, including utilizing mixed methods research, replicating findings in a larger more diverse sample size to ensure the generalizability of findings, and investigating change in medical mistrust over time, especially in developing adolescents across various adolescent ages. These future research studies should focus on better understanding how adolescents conceptualize medical mistrust. and also examine adolescent medical mistrust towards non-physician healthcare providers. Nurses should focus on developing targeted interventions to mitigate medical mistrust, improve asthma related health outcomes, and to advance health equity in asthma care. This study has provided novel findings that have the potential to contribute to the frontier of examining the development of and various aspects of medical mistrust in youth with chronic illnesses.
Recommended Citation
Shukla, Meghna, "An Exploration Of Medical Mistrust In Urban African American Adolescents With High Risk Asthma" (2024). Wayne State University Dissertations. 4107.
https://digitalcommons.wayne.edu/oa_dissertations/4107