Member Research and Reports

Member Research and Reports

UNC’s Systematic Review Reveals Reasons for Mistrust Linked to Colorectal Cancer Screenings in African-Americans

A new article in the Journal of Community Health explores the current evidence linking medical mistrust to colorectal cancer (CRC) screening rates among African-Americans.

Despite well-documented benefits of CRC screening, African-Americans are less likely to be screened. They also have higher CRC incidence and mortality than do whites. To explore emerging evidence that suggests medical mistrust may influence CRC screening disparities among African-Americans, a team of researchers conducted a systematic review of the literature to summarize reported associations between medical mistrust and CRC screening.

[Photo: Despite well-documented benefits of colorectal cancer screening, African-Americans are less likely to be screened than are whites – and have a higher incidence of and mortality rate from colorectal cancer. A new literature review explores emerging evidence suggesting that medical mistrust may influence screening disparities among African-Americans.]

The authors are Ms. Leslie B. Adams and Ms. Jennifer Richmond, doctoral students, and Dr. Wizdom Powell, associate professor, all in the department of health behavior in the UNC Gillings School of Global Public Health, along with Dr. Giselle Corbie-Smith, professor of social medicine in UNC’s School of Medicine. Dr. Powell also is a member of the UNC Center for Health Equity Research, where Dr. Corbie-Smith serves as director.

After conducting a review of 27 articles, the researchers found that the majority of studies linked higher mistrust scores with lower rates of CRC screening among African-Americans. While most studies examined mistrust at the physician level, a few analyzed mistrust at an organizational level (e.g., health-care systems, insurance).

“While we know there are disparate rates of CRC screening, this review highlights the role that mistrust in providers and health-care systems plays in driving these outcomes, particularly in the African-American community,” said Ms. Adams, the study’s first author.

The review also focused on gender differences related to medical mistrust and found key distinctions in themes of mistrust between African-American men and women. Several studies illustrated that mistrust centered on questioning provider motives and competence existed across genders, while mistrust based on the fear of experimentation and/or discomfort with the intrusiveness of screening methods were unique themes among African-American men.

“Future studies should focus on more nuanced investigations of gender role norms in the context of CRC-related preventive services use,” Ms. Adams noted.

The research article concludes with recommendations for future research and practice in this area, including development of multi-level measures of medical mistrust and inclusion of robust measures of CRC screening completion in clinical practice. The authors hope the findings from their review will facilitate more in-depth studies and interventions to reduce trust-related barriers to CRC screening among African-Americans.

The article, “Medical Mistrust and Colorectal Cancer Screening Among African Americans,” was published online April 24.

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