Racial and ethnic disparities in health care continue to be problematic in the United States. Although many Americans experience the negative effects associated with health disparities (e.g., negative perceptions of care, lack of access to care, and poorer health outcomes), health disparities have been shown to be increasingly problematic for many members of African American populations. In addition, cultural mistrust of providers and health care systems have also been shown to impact perceptions of care and utilization of health care services. Recent literature suggests that integrated health care could be a possible solution to improving care, although a gap in the research currently exists regarding how members of African American populations view integrated health care. The current study was designed to fill this gap. In order to achieve this goal, the current project consisted of two studies. The purpose of Study 1 was to develop an instrument to measure attitudes toward integrated health care among African Americans. The purpose of Study 2 was to validate the integrated health care measure and to test gender as a potential moderator of the effects of cultural mistrust on attitudes toward integrated health care for a sample of African American adults. Through Exploratory Factor Analysis in Study 1, eigenvalues, scree plots, factor loadings, and orthogonal rotations were examined to identify the underlying factors and overall reliability of the Patient Attitudes Toward Integrated Health Care scale. Results from Study 1 indicated that this scale was reliable and valid among the current sample of American adults. Study 2 used Confirmatory Factor Analysis to examine the validity of the Patient Attitudes Toward Integrated Health Care scale. The results of the CFA confirmed that the Patient Attitudes Toward Integrated Health Care scale was reliable and valid among the current sample. Study 2 also used moderated regression analysis to test the hypothesis that gender would moderate the relationship between cultural mistrust and attitudes toward integrated health care. Results from the regression analysis showed that gender did not significantly moderate the effects of cultural mistrust on attitudes toward integrated health care. However, results suggested that gender significantly influenced attitudes toward integrated health care. The findings further suggested that cultural mistrust and attitudes toward seeking psychological help to be significant predictors of attitudes toward integrated health care. Although the original hypothesis was not supported in the current study, these results provide useful insight into predictors of attitudes toward integrated health care among African Americans. These results can be used to assist in improving integrated health care systems to better meet the needs of this population.

Mistrust in the medical field can be generated through experiences of racism and discrimination during interactions with members of the medical community. Black and African American individuals find themselves facing increased rates of morbidity including heart disease, and diabetes, and increased rates of mortality as compared to White individuals yet are treated less frequently and to a lesser extent. This thesis examines the mistrust black people have towards the medical field, as well as differences within the black community in terms of experiences with medical racism. In order to collect this information, I created a survey that enquires about race and ethnicity and the types of encounters that individuals have had with medical professionals. I analyzed the responses and found that a majority of those surveyed believe that medical racism does exist. Although the production of medical mistrust is evident, it is a difficult task to eliminate it. Therefore, this thesis recommends that more emphasis be placed on the sociological aspects of medicine.

Sexual victimization has been associated with significant negative health outcomes as well as increased healthcare utilization (e.g., Breiding et al., 2013; Sickel et al., 2002). However, due to fear, embarrassment, or confidentiality concerns (Logan et al., 2004; Nasta et al., 2005), women may mistrust medical advice and not adhere to treatment recommendations, exacerbating development of negative health outcomes. Some research (Meade et al., 2009) has identified sexual victimization as a predictor of medical nonadherence, but to our knowledge no research has examined the role of medical mistrust in this relationship. A sample of 857 women was recruited via social media. Regression analyses in R Markdown revealed that sexual trauma was a significant predictor of both medical nonadherence (b = 0.4, SE = .08, p < .0001) and medical mistrust (b = 1.36, SE = .027 p < .0001), and further that medical mistrust predicted medical nonadherence (b = 0.06 SE = .01, p < .0001). Additionally, medical mistrust was found to significantly mediate the relationship between sexual trauma and medical nonadherence (b = .09, SD = .03, 95% CI =.04, .14). Results emphasize the importance of trauma-informed care and patient-provider rapport in bolstering resiliency and strengthening survivors’ adherence to medical recommendations. Suggestions for further application and intervention will be discussed.

Abstract available in the Annals of Behavioral Medicine.

Abstract available in the Annals of Behavioral Medicine.

African Americans (AA) are twice as likely as White Americans (WA) to experience diabetes-related foot amputation due to foot ulcers. Foot ulcers are often caused by high plantar pressure, and several factors can impact plantar loading. Thus, there is a need to determine if race is a significant predictor of plantar loading. Additionally, with the current state of racial health disparities there is a need to determine racial differences in research engagement and mistrust between AA and WA. Data was collected from 107 participants, aged 18-30, in this Institutional Review Board approved study. An EMED pressure-measurement system (Novel Electronics, St. Paul, MN, USA) was used to collect plantar loading data. Additional measurements collected from each participant included arch height index (AHI), standing height, gait speed, and weight. Participants also completed two surveys focused on research engagement and research mistrust. A multiple linear regression was used to test if race and other factors significantly predicted plantar loading. Non-parametric tests were used to test if there were significant differences in research engagement and mistrust between AA and WA. The analysis determined that race was a significant predictor for plantar loading, along with age, AHI, gait speed, sex, and body mass index (BMI). Additionally, it was found that research engagement practices and feelings of research mistrust differed significantly between AA and WA young adults. These findings could improve our understanding as to why AA are more likely to have diabetic foot ulcers than WA, and why AA are less likely to participate in research than WA. / M.S. / African Americans (AA) are twice as likely than White Americans (WA) to experience diabetes-related foot amputation due to foot ulcers. Foot ulcers are often caused by high plantar pressure, and several factors can alter plantar loading. Thus, there is a need to determine if race is a significant predictor of plantar loading. Additionally, with the current state of racial health disparities, there is a need to determine racial differences in research engagement and mistrust between AA and WA. Data was collected from 107 participants, aged 18-30. A pressure-measurement system was used to collect plantar loading data in seven regions of the foot during self-selected speed walking. The measurements collected from each participant, included arch height, standing height, gait speed, and weight. Participants were also asked to complete two surveys focused on research engagement and research mistrust. We used this data to evaluate if race and other factors predicted plantar loading and to compare survey responses between AA and WA. It was found that race, age, arch height, gait speed, sex, and BMI were considered significant predictor variables for plantar loading measures. Additionally, research engagement practices and feelings of research mistrust differed significantly between this younger sample of AA and WA. These findings help to improve our understanding of why AA are more likely to have diabetic foot ulcers than WA, and why AA are less likely to participate in research than WA, even as young adults.

This theory-driven thesis explores the notably low levels of brand trust in Sweden through the lens of digitalization. Employing qualitative research methods, the authors conducted eight interviews with experienced experts in Sweden's marketing and communication sector. The study aims to provide an expert view on the current state of consumer trust and the factors contributing to mistrust. The study intends to identify effective strategies for building brand reliability and brand intentions, collectively fostering long-term brand trust, all from the digitalization perspective.  The results show that the rise of digitalization has contributed to lower trust in brands, identifying several reasons behind this mistrust, all connected to digitalization. Six strategies are identified as effective ways for brands to increase long-term brand trust. More specifically, email marketing, data privacy, and brand communities are shown to enhance brand reliability. Whereas trust recovery, ethical marketing, and influencer marketing enhance brand intentions. This is portrayed in a re-conceptualized framework based on an already established conceptual framework, showing how brand reliability and brand intentions collectively creates brand trust. This thesis contributes to the existing literature by offering a detailed analysis of the mistrust in brands and presents strategies to address this issue within the Swedish market by fostering long-term brand trust.

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This study explored interpersonal trust, racial identity, perceived racism, and religious orientation as predictors of preference for a Black counselor and cultural mistrust. The unique variance of interpersonal trust and cultural mistrust in predicting preference for a Black counselor was also explored. The relationship between cultural mistrust and interpersonal trust was tested to determine whether or not they are independent constructs. This study also examined the relationship between racial identity and religious orientation. Gender differences in religious orientation, cultural mistrust and preference for a Black counselor were examined. Previous studies provide support that cultural mistrust contributes to negative help-seeking attitudes and underutilization of mental health services. Researchers have identified racial identity and perceived racism as correlates to and/or predictors of cultural mistrust and preference for a Black counselor (Whaley, 2001). This study involved participants recruited in part from the Educational Psychology (EDP) Subject Pool at The University of Texas at Austin (UT). Participants were also recruited from five student organizations at UT. Participants completed the survey using an online survey tool or a paper copy of the survey. One stratum was used for selection of participants: students who racially identify as African-American or Black. Results of the study revealed interpersonal trust as a significant predictor of preference for a Black counselor. However, exploratory analyses indicated that cultural mistrust served as the sole predictor of Black counselor preference when seeking a counselor for dealing with racial concerns. Interpersonal trust, immersion-emersion anti-white racial identity attitudes (IEAW) and extrinsic religious orientation were significant predictors of cultural mistrust. Results also indicated a positive relationship between Internalization Multiculturalist (IMCI) racial identity attitudes and intrinsic religious orientation. A negative correlation was found to exist between intrinsic religious orientation and IEAW. High cultural mistrust levels were also positively associated with high IEAW attitudes. Additionally, a small, yet statistically significant negative relationship was found to exist between cultural mistrust and interpersonal trust. Cultural mistrust did not account for a significant amount of variance above that of interpersonal trust in predicting preference for a Black counselor. Finally, no mean sex differences were found among levels of Black counselor preference, cultural mistrust, and intrinsic or extrinsic religious orientation. Exploratory analyses also revealed a positive relationship between cultural mistrust and seven out of ten scenarios for Black counselor preference. Individuals with a preference for a Black counselor reported higher levels of cultural mistrust related to issues concerning: excessive worry/anxiety, drinking too much alcohol/using drugs, relationship problems, feelings of harassment/feeling threatened, sexual issues, racial issues, and difficulty controlling anger. Results of the study bear implications for understanding cultural mistrust and interpersonal trust as it relates to counselor preference. Implications for counselors are also discussed regarding the intersection of racial and religious identities. Limitations and future directions for research are also discussed. / text

This proposed study will explore how university racial composition impacts the relationship between cultural mistrust, campus comfort, and help-seeking attitudes in a sample of African American college students. A moderated hierarchical regression will be conducted to determine if the cultural and contextual variables predict a significant amount of variance in help-seeking attitudes, and to discover if the variables’ interaction with university type significantly increased the amount of explained variance. The results will demonstrate how one’s comfort in the university environment and degree of trust in the majority group can contribute to seeking psychological services. Counseling and university policy implications will be delineated from the results. Limitations will also be discussed. / text