Understanding Black Women's Lived Experiences of Medical Mistrust and Trust in the Reproductive Care Setting: A Nested Sequential Explanatory Mixed Methods Study

Background Medical mistrust inhibits positive healthcare-seeking behavior, resulting in negative health outcomes. We assessed Black women’s medical mistrust and concepts of trust-building provider characteristics in the reproductive health setting in Alachua County, Florida. Methods A nested, sequential, explanatory mixed-methods design was employed. In addition, an Integrated Black Women's Reproductive Health Social Ecological Model (IBWRH-SEM) was developed to construct the survey, interview tools, participant engagement, data collection, and analysis. A sample of 255 self-identified Black women aged 18 and older completed an online survey, with a subsample of 16 completing semi-structured follow-up interviews. Results The survey findings highlighted higher mistrust amongst younger, married, and women seeking both allopathic and holistic care. Women who sought both allopathic and holistic settings experienced higher mistrust, lack of support, suspicion, and higher health disparity scores. Also, younger women, women without children experienced lack of support. In addition, findings showed that younger women, women possessing a graduate/professional level degree had higher suspicion and higher health disparity scores. Women who did not have children had higher health disparity score. Furthermore, semi-structured interviews revealed five key trust-building characteristics: transparency, humanizing interactions, comfort and provider tone, acknowledgment of patient insight, and time spent with the patient. These characteristics were essential for trust-building during patient-provider interactions in the reproductive healthcare setting. Conclusions Findings suggest structural changes to improve institutional systems and interpersonal provider characteristics in the reproductive healthcare setting. Intervention strategies need to center Black women, so they are supported and, over time, unburdened of the need to self-advocate and vigilant.