Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults
Background: COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccin...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | SSM: Population Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352827322002579 |
| _version_ | 1811299687286702080 |
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| author | Jennifer D. Allen Qiang Fu Shikhar Shrestha Kimberly H. Nguyen Thomas J. Stopka Adolfo Cuevas Laura Corlin |
| author_facet | Jennifer D. Allen Qiang Fu Shikhar Shrestha Kimberly H. Nguyen Thomas J. Stopka Adolfo Cuevas Laura Corlin |
| author_sort | Jennifer D. Allen |
| collection | DOAJ |
| description | Background: COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccine, although few studies to date have investigated medical mistrust and perceived discrimination together. Method: We conducted a cross-sectional online survey between April 23-May 3, 2021, among a national sample of U.S. adults ages 18 years and older. We assessed receipt of and intention to be vaccinated for COVID-19 and associations with the validated Medical Mistrust Index and Everyday Discrimination Scale. Results: 1449 individuals responded, of whom 70.2% either had ≥1 dose of COVID-19 vaccine or reported that they were ‘very’ or ‘somewhat’ likely to be vaccinated in the future. In bivariate analyses, vaccination status was significantly associated with age, race/ethnicity, education, income, employment, marital status, health insurance, and political party affiliation. In multivariable analyses comparing those who had ≥1 vaccine dose or were likely to get vaccinated in the future with those who had not had any vaccine doses or did not intend to be vaccinated, each additional point in the Medical Mistrust Index was independently associated with a 16% decrease in the odds of vaccination (adjusted odds ratio = 0.84; 95% confidence interval = 0.81, 0.86). Discriminatory experiences were not associated with vaccination behavior or intention in bivariate or multivariable analyses. Conclusions: Medical mistrust is significantly associated with vaccination status and intentions. Increasing uptake of COVID-19 vaccines will likely require substantive efforts on the part of public health and healthcare officials to build trust with those who are not yet fully vaccinated. We recommend that these efforts focus on building the ‘trustworthiness’ of these entities, an approach that will require a paradigm shift away from a focus on correcting individual beliefs and knowledge, to acknowledging and addressing the root causes underlying mistrust. |
| first_indexed | 2024-04-13T06:39:32Z |
| format | Article |
| id | doaj.art-ad0d3e003a004f718783d5ffd0f3dfbb |
| institution | Directory Open Access Journal |
| issn | 2352-8273 |
| language | English |
| last_indexed | 2024-04-13T06:39:32Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM: Population Health |
| spelling | doaj.art-ad0d3e003a004f718783d5ffd0f3dfbb2022-12-22T02:57:47ZengElsevierSSM: Population Health2352-82732022-12-0120101278Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adultsJennifer D. Allen0Qiang Fu1Shikhar Shrestha2Kimberly H. Nguyen3Thomas J. Stopka4Adolfo Cuevas5Laura Corlin6Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA; Corresponding author.Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USADepartment of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USADepartment of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USADepartment of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USADepartment of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USADepartment of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA, 02155, USABackground: COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccine, although few studies to date have investigated medical mistrust and perceived discrimination together. Method: We conducted a cross-sectional online survey between April 23-May 3, 2021, among a national sample of U.S. adults ages 18 years and older. We assessed receipt of and intention to be vaccinated for COVID-19 and associations with the validated Medical Mistrust Index and Everyday Discrimination Scale. Results: 1449 individuals responded, of whom 70.2% either had ≥1 dose of COVID-19 vaccine or reported that they were ‘very’ or ‘somewhat’ likely to be vaccinated in the future. In bivariate analyses, vaccination status was significantly associated with age, race/ethnicity, education, income, employment, marital status, health insurance, and political party affiliation. In multivariable analyses comparing those who had ≥1 vaccine dose or were likely to get vaccinated in the future with those who had not had any vaccine doses or did not intend to be vaccinated, each additional point in the Medical Mistrust Index was independently associated with a 16% decrease in the odds of vaccination (adjusted odds ratio = 0.84; 95% confidence interval = 0.81, 0.86). Discriminatory experiences were not associated with vaccination behavior or intention in bivariate or multivariable analyses. Conclusions: Medical mistrust is significantly associated with vaccination status and intentions. Increasing uptake of COVID-19 vaccines will likely require substantive efforts on the part of public health and healthcare officials to build trust with those who are not yet fully vaccinated. We recommend that these efforts focus on building the ‘trustworthiness’ of these entities, an approach that will require a paradigm shift away from a focus on correcting individual beliefs and knowledge, to acknowledging and addressing the root causes underlying mistrust.http://www.sciencedirect.com/science/article/pii/S2352827322002579COVID-19CoronavirusVaccine hesitancyMedical mistrustDiscriminationAttitudes and beliefs |
| spellingShingle | Jennifer D. Allen Qiang Fu Shikhar Shrestha Kimberly H. Nguyen Thomas J. Stopka Adolfo Cuevas Laura Corlin Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults SSM: Population Health COVID-19 Coronavirus Vaccine hesitancy Medical mistrust Discrimination Attitudes and beliefs |
| title | Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults |
| title_full | Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults |
| title_fullStr | Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults |
| title_full_unstemmed | Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults |
| title_short | Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults |
| title_sort | medical mistrust discrimination and covid 19 vaccine behaviors among a national sample u s adults |
| topic | COVID-19 Coronavirus Vaccine hesitancy Medical mistrust Discrimination Attitudes and beliefs |
| url | http://www.sciencedirect.com/science/article/pii/S2352827322002579 |
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