Abstract B76: Examining medical mistrust and breast cancer screening behaviors among African American, Latina and Arab American women

Objective: The purpose of this study was to examine levels of medical mistrust among African American, Latina and Arab American women and to assess the association between their medical mistrust and breast cancer screening behaviors. We hypothesized high levels of medical mistrust in all groups of women and a negative correlation between medical mistrust and breast cancer screening.

Methods: Using community health workers from our partner health organizations a 7-item Medical Mistrust Index measured on a 4-point rating scale was administered to 341 women (116 African American, 113 Latina and 112 Arab American women). The previously validated index (reliability 0.70–0.93) was orally administered in English, Spanish or Arabic depending on the respondent's choice. Data on breast cancer screenings and sociodemographics were also collected. We performed frequency distribution analyses to estimate the levels of medical mistrust. Bivariate associations between medical mistrust and screening behaviors were assessed using cross-tabulations and Fisher's exact tests were employed to assess statistical significance

Results: High levels of medical mistrust were found, regardless of the racial-ethnic group; more than 40% of women in any of the racial-ethnic groups agreed or strongly agreed with all the mistrust statements in the Medical Mistrust Index. For instance, 49% of the women agreed with the statement “Patients have sometimes been deceived or mislead by healthcare organizations” while 18% strongly agreed. African American women were found to have higher levels of mistrust, e.g. 39% strongly agreed with statement “Health care organizations don't always keep your information totally private” compared to 15% for Latina and 9% for Arab American women (Chi-square = 88.960; Fisher's exact P < 0.001). Results on screening behaviors showed higher levels of mistrust among women who did not adhere to appropriately timed breast cancer screenings. For example, 44% of women who had never received a clinical breast exam agreed with the statement “Healthcare organizations have sometimes done harmful experiments on patients without their knowledge” compared to 38% for women who had ever received a clinical breast exam (Chi-square = 8.344; Fisher's exact P = 0.037). Similarly 49% of women who had not received a clinical breast exam in the last 12 months agreed with the same statement compared to 33% who had received a clinical breast exam in the last 12 months (Chi-square = 11.352; Fisher's exact P = 0.011). Also, 64% of women who did not received a clinical breast exam in the last 12 months agreed with the statement “Sometimes I wonder if health care organizations really know what they are doing”. This was compared to 47% for those who had received a clinical breast exam in the last 12 months (Chi-square = 11.937; Fisher's exact P = 0.008).

Conclusion: This study reveals an important association between medical mistrust and appropriately timed breast cancer screening among African American, Latina and Arab-American women. Women who had not received appropriately timed clinical breast exams were found to have higher levels of medical mistrust than those who had. Understanding medical mistrust is important for better design of tailored breast cancer screening educational programs.