The Legacy of Tuskegee and Trust in Medical Care: DISCUSSION

The results indicate that there was little difference between black and white respondents in knowledge of the Tuskegee study. Most people were unaware of the Tuskegee study, with only approximately two-fifths of both black and white participants indicating they had heard of it. Among those that were aware of the study, there was limited accurate knowledge of the details, including when it began and ended, the total number of participants, the organizations that conducted the study and how the subjects were infected with syphilis. These findings suggest that misinformation and incomplete information concerning the Tuskegee study are quite prevalent. Moreover, these findings emphasize that Tuskegee is not a central event in the African-American ethos; instead for some, the Tuskegee study represents another example of why the medical system cannot be trusted.

Nearly twice as many black respondents believed that Tuskegee study research investigators infected the study participants with syphilis, and blacks— compared to whites—were much more inclined to believe a study similar to Tuskegee could happen today regardless of initial awareness of the study. These two questions relate more to the issue of trust than the others, which are more fact-based questions about a specific set of historical events. Finally, the results show that black race—but not knowledge of the Tuskegee study—was predictive of medical care mistrust, controlling for demographic variables. While there are not significant race differences in knowledge about the historical events, there are clear racial differences in trust. Put another way, trust varies by race, but it is unlikely that the Tuskegee study is a primary reason for widespread mistrust of medical care among African Americans. Going without your pills? Buy cheap aciphex 20 mg online

The findings are supportive of the notion that historical and continuing patterns of negative interactions with the healthcare system are likely more important determinants of medical care mistrust among African Americans than awareness or knowledge of the Tuskegee study. Most likely, African-American mistrust of the medical care stems from a general mistrust of societal institutions. Like a number of other American institutions, healthcare has a long history of mistreatment of African Americans. The experience of discrimination and devaluation faced by African Americans fosters an environment of skepticism and mistrust for large healthcare systems or organizations as well as individual providers.

The greater level of medical care mistrust experienced by African Americans compared to whites has been implicated in lower levels of patient satisfaction with care, decreased participation in health promotion, lower participation in health research and less willingness to donate blood or cadaveric organs among African Americans. As long as high levels of mistrust exist among African Americans, there may be continued higher rates of underutilization of healthcare within this population. The Tuskegee study is a form of confirmation of what is already known or speculated about African-American treatment in medical systems. This continued detachment from the medical establishment will complicate efforts to eliminate racial disparities in health.The study does have several limitations. For instance, the results may not generalize to a national sample. The refusal rate was relatively high, which could affect the generalizability of the findings. Moreover, we do not have data on respondents who refused to participate in the survey. As a result, we do not know if nonparticipation is associated with higher levels of mistrust. In addition, the analyses included only black and white participants; therefore, we cannot be sure how knowledge of the Tuskegee study may be related to medical mistrust in other minority groups. Although interviewers were trained and monitored, voice inconsistencies by interviewers reading the CDC script may have influenced responses, yet we have no reason to believe there were such inconsistencies. In spite of these limitations, we believe this remains a strong study and advances our understanding of race differences in mistrust of medical care. viagra soft tabs online

The results suggest that it is time that we move beyond Tuskegee as a catch-all for why African Americans mistrust medical care and begin to address the root causes. Moving beyond the focus on the Tuskegee study has implications for increasing African-American participation in timely research studies and health promotion as well as potentially reducing health disparities. Addressing medical mistrust must begin with a process of engagement with African Americans on the part of medical care providers as well as researchers. However, once breached, trust is difficult to re-establish.

Through the implementation of policies that address the concerns over a Tuskegee-like experiment happening again, major strides have been made in insuring protection for participants in research. Moreover, an increasing number of training programs now offer cultural competency training. Many of these improvements may not be fully comprehended among those whom the policies were implemented to protect. These important strides need to be articulated and presented to communities of color to improve the ability of members to advocate for themselves. More importantly, healthcare providers, workers and staff should focus on improving the overall experience of African-American healthcare consumers.

Category: Health

Tags: African Americans, health disparities, medical mistrust, race differences, Tuskegee study