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Graduate Student Journal of Psychology (GSJP), Volume 18, Special Issue 2022 

Correlates of Perceived Discrimination in Healthcare 
Amongst Black Women 

TyKera Marrow, M.S. 
Department of Psychology, Jackson State University 

This paper examined the impact of medical racism on Black women. Topics explored 
include Black racial identity, emotion regulation, group-based medical mistrust, 
perceived social support, and perceived discrimination experiences. The Socioecological 
Model was used to examine the interplay of factors at the interpersonal, intrapersonal, 
and institutional levels concerning experiences of perceived discrimination in healthcare 
settings. The research interest is in how implicit biases contribute to health disparities 
amongst Black American women.  Bivariate correlations suggest relationships between 
centrality, social support, group-based medical mistrust, and perceived discrimination. 
Hierarchical regression analysis was indicative of medical mistrust as the most 
meaningful indicator of perceived discrimination. This study significantly identified 
relationships between centrality and group-based medical mistrust, centrality, and 
perceived discrimination, with group-based medical mistrust as a considerable standalone 
predictor.  

Keywords: medical mistrust, perceived discrimination, social support, emotion 
regulation, Black women, health, health disparities 

The Centers for Disease Control and Prevention (2018) defines health disparities as 
"preventable differences in the burden of disease, injury, violence, or opportunities to 
achieve optimal health that are experienced by socially disadvantaged populations" (p.1). 
Researchers studying health disparities have observed the intersection of societal factors 
such as race, education levels, employment, socioeconomic status, and many other factors 
that impact different population groups differently. Drayton-Brooks & White (2004) state, 
"African Americans account for only 12% of the population in the United States, yet 
African Americans, as a group, have the poorest health status indicators in the nation and 
are disproportionately represented among underserved populations. 55 % of the 33.9 
million African Americans in this country are women" (p. 84). Stewart & Nápoles-
Springer (2013) suggest minority patients receive suboptimal medical care compared to 
White Americans, with discrimination inside healthcare systems compounding the 
physiological and psychological effects of discrimination felt from the outside (p. 1213). 
Implicit biases, unconscious attitudes about a person or group, and discriminatory 
practices within the healthcare system have long been examined and reported, with 
implicit biases favoring White Americans. Also, implicit bias is a significant predictor of 
Black patients either mistreated or not receiving treatment (Dehon et al., 2017).  Efforts to 
explain racial differences in healthspan from institutional barriers, employment, lifestyle 
choices, physiological factors, and legislation (Massoglia, 2008). Comparatively, minority 
women in America are increasingly vulnerable to unequal healthcare treatment, 
particularly low-income, uninsured Black women in comparison to higher income and 
insured White women (Karliner et al., 2016). A report published by the Institute of 
Medicine in 2003 cited that even when controlling for patient outcomes, insurance status, 
and access factors, African American patients still did not receive equal treatment 
compared to their white counterparts (Townsend & Belgrave, 2009). 

© 2022, Graduate Student Journal of Psychology, Teachers College, Columbia University. ALL 
RIGHTS RESERVED. Graduate Journal of Psychology 18, pp-pp. 



Marrow 

Graduate Student Journal of Psychology 

Understanding the historical and cultural influences that impact healthcare services is 
essential, especially for women of ethnic/racial minorities. The general mistrust and 
anticipation of stigmatization that African Americans feel in general and concerning the 
medical context and larger American systems can negatively impact the utilization of 
healthcare services (Penner et al., 2009). Black people who report discrimination from their 
healthcare providers report decreased likelihood of critical health care screenings such as 
cancer, diabetes, cholesterol screenings, and other health-related behaviors like getting 
the flu shot (Penner et al., 2009). Additionally, Black patients who experienced increased 
discrimination related to deteriorating physical and mental health and more significant 
chronic illnesses when treated by a medical physician (Penner et al., 2009).  

For this study, the term Black, a socio-political racial construct, is used to refer to 
descendants of the African diaspora or those who self-identify as Black. In an effort not to 
exclude, women from various ethnic groups such as Haitian, Jamaican, continental 
African and others that fall under the racial stratification of Black were included in this 
study. This paper focuses on the experiences of Black women and the American healthcare 
system. While the terms Black and African American are used synonymously in research, 
it is understood that the terms differ. 

Statement of the Problem 
Black American women are dually marginalized due to their race and gender. Despite 
recent public health efforts to promote health equity in the United States, research 
suggests that physical and sexual health conditions disproportionately impact Black 
American women than women of other races. Molina and colleagues (2015) assert, "the 
unique and severe forms of racism African Americans experience, including segregated 
healthcare systems and overt interpersonal racism by providers, can contribute to 
elevated levels of medical mistrust and sub-optimal adherence as well as lower 
satisfaction and quality of life" (p. 4). A meta-analysis of 66 studies examining the effects 
of racism on mental health conducted by Pieterse and Carter (2007) found that in a sample 
of 18,140 Black Americans, there was a positive correlation between perceived racism and 
psychological distress. Research efforts in trying to understand the relationship between 
individual beliefs, interpersonal relationships, medical mistrust, patient-practitioner 
relationships, and health outcomes for Black women are severely lacking. Noting this gap 
in the literature, this paper aims to answer the following questions: what is the association 
between racial salience and medical mistrust on experiences of discrimination? How do 
emotion regulation and social support affect the perception of discrimination in 
healthcare settings? How do sociodemographic factors influence the perception of 
discriminatory experiences? 

Literature Review 
Theoretical Framework 
The socioecological model (SEM) identifies the social determinants of health and how 
factors are produced and sustained across various overlapping subsystems. Within the 
SEM, there are five levels of interaction: (1) the individual/intrapersonal level, (2) 
interpersonal level, (3) organizational/institutional level, (4) community level, and (5) the 
policy level (Family and Youth Services Bureau, 2015). Due to its vast applicability, the 
SEM can be used to understand social determinants of issues across multiple disciplines. 

The SEM allows for the linkage between biopsychosocial factors and individual and 
community health outcomes based on examining individuals' systemic and 
epidemiological distribution accounting for demographic and economic variables. While 
utilized heavily in public health, the SEM has its place in psychological research, and 



Correlates of Perceived Discrimination in Healthcare Amongst Black Women 

Graduate Student Journal of Psychology 

many of its core components are rooted in psychological theory. Due to the complex 
interrelationships of health determinants, targeted research and interventions are most 
effective when examined at all levels. McLeroy and colleagues (1988) insert "the 
importance of ecological models in the social sciences is that they view behavior as being 
affected by and affecting the social environment. Many models—like Bronfenbrenner's—
also divide the social environment into analytic levels that can focus on different levels 
and types of social influences and develop appropriate interventions. Thus, ecological 
models are system models, but they differ from traditional systems models viewing 
patterned behavior—of individuals or aggregates—as the outcomes of interests" (p. 355).  

The version of SEM most used to address health education and behavior change is Dr. 
Kenneth McLeroy's. In this version, two main concepts are identified: multiple levels and 
reciprocal causation (Winch, 2012). Reciprocal causation, a concept like Bandura's 
reciprocal determinism, states that their surrounding environment shapes their behaviors. 
A prominent example of reciprocal causation can be viewed with seat belts. Seat belt use 
is impacted by the cultural norms and attitudes surrounding their use. Still, norms and 
attitudes are mutually affected based on the laws and regulations encompassing usage. 
For this study, the interaction between the first three levels of Leroy's SEM was examined. 

Emotion Regulation 
The American Psychological Association (2018) defines emotion regulation as "the ability 
of an individual to modulate an emotion or set of emotions" (p. 1). Emotion Regulation 
(ER) is typically identified through two strategies; cognitive reappraisal and expressive 
suppression. Gross and John (2003) outline cognitive reappraisal as "the attempt to 
reinterpret an emotion-eliciting situation in a way that alters its meaning and changes its 
emotional impact" and expressive suppression as "the attempt to hide, inhibit or reduce 
ongoing emotion-expressive behavior" (p. 14). It is difficult to classify which type of 
regulation strategy is adaptive or maladaptive as gender and cultural differences must be 
accounted for. Research examining cultural differences between Black Americans and 
other racial groups is limited as a vast amount of research centers around differences 
between Asian and White populations. ER deficits have been linked to poor outcomes for 
both mental and physiological disorders such as cardiovascular disease (Sirois & Burg, 
2003), early mortality (Harburg et al., 2003), and anxiety and depression (Consedine et al., 
2005). Pascoe and Richman (2004) state, "…some work suggests that active coping 
strategies, such as confrontation, positive reappraisal, and seeking social support, may 
buffer the effect of discrimination distress by enabling an individual to challenge the 
validity of discriminatory events and reduce negative feelings about the self, thereby 
reducing the chance that discriminatory experiences will exert an enduring impact on 
mental health outcomes" (p. 9). For this study, ER was explored to examine how ER 
strategies impact African American women's health. 

Perceived Social Support 
Social support is an interpersonal exchange of emotions and cognitions between various 
friend groups, familial networks, and organizations. Social support is quantified based on 
the number of social relationships individuals have, such as their marital status, religious 
affiliation and membership to select groups. Gülaçti (2010) defines perceived social 
support as "the existence of support resources when they are needed, and it can be 
identified in subjective qualitative perspectives and be measured and also it is reported 
that perceived social support is more determinative than received social support." In other 
words, perceived social support is the overall impression of the amount of support 
individuals receive from their social network.  This is significant to the SEM as it posits 



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Marrow 

that individuals are influenced by their friends, families, and colleagues – their social 
environment. Culture is a significant predictor of health behavior. Gersteen (1997), as cited 
by Harvey and Alexander (2012), posits, "Considerable evidence links social support with 
increased health-promoting behaviors and decreased health-compromising behaviors," 
providing examples of "dietary habits, physical activity, smoking habits, alcohol intake, 
and adherence to medical regimens" (Allgöwer et al., 2001; Campbell et al., 2000; Cohen et 
al., 2000; Povey et al., 2000; Sternfeld et al., 1999).  

Perceived Discrimination 
The University of Cambridge (2019) defines perceived discrimination as "discrimination 
based on a perception that an individual is a member of a relevant protected group" (p. 
1). The federal government identifies protected group membership to the following 
designations based on age, race, gender, physical or mental disability, religion, and 
nationality. Perceived discrimination in healthcare settings has been associated with a 
myriad of adverse psychological and physical health outcomes, including but not limited 
to less engagement with medical physicians, decreased treatment compliance and 
medication adherence, increased use of alternative medicine, and less utilization of 
preventative care (Hausmann et al., 2011). Blanchard and Lurie (2004) posit "over 14% of 
Blacks, 19% of Hispanics, and 20% of Asians reported they had been treated with 
disrespect by their doctor. Members of these groups were also more likely than whites to 
report that they were maltreated because of their race or their language and that they 
would have received better care had they belonged to a different race" (p. 725). African 
Americans are also more likely to report perceived discrimination following an 
emergency room visit related to the increased stress and fatigue associated with emergent 
health crises and frustrations concerning their medical concerns being dismissed if they 
are discharged with minimal medical attention (Abramson et al., 2015).  

Black Racial Identity 
Perry and colleagues (2016) assert "racial identity—a specific form of social identity—can 
play a crucial role in the psychological well-being of African American 
children, adolescents, and adults" (p.2). Racial identity is a construct related to an 
individual's relationship to and understanding of in and out-group 
differences. This self-conceptualization of identity can lend itself to how one self-
identifies, interacts with other people within their racial classification, and 
moderate experiences within the macrosystem. Although steeped in racial 
superiority and sociopolitical constructions, racial categorizations have a level of 
individual agency, allowing individuals or communities to subvert the meaning of 
the classification in empowering ways (Crenshaw, 1991). Chae and colleagues (2017) 
state "…individuals who diminish the salience of race or the significance of racism may 
be less likely to interpret negative interactions as being instances of racial 
discrimination”. 

On the other hand, those emphasizing the importance of race or who show a 
greater awareness of systemic social inequalities may be more inclined to attribute 
motivationally ambiguous experiences of unfair treatment to racial discrimination. 
Reports of racial discrimination can sometimes be dependent on an individual's 
perception of whether negative life experiences are racially motivated. Pascoe and 
Richman (2004) states, 



Correlates of Perceived Discrimination in Healthcare Amongst Black Women 

Graduate Student Journal of Psychology 

"although higher levels of stigmatized identity may be capable of buffering the effect of 
discriminatory experiences by making negative stereotypes less likely to be incorporated 
into one's self-concept, these high levels of identity might also lead to a higher vigilance 
regarding discriminatory experiences, potentially increasing the number of times 
discrimination is perceived" (p. 10).  

Medical Mistrust 
Black Americans have a discomfiting history with the medical institution in America, and 
centuries of crude unethical and inhumane experimentation on Black bodies have 
contributed to the legacy of mistrust. The Tuskegee Syphilis Experiment, the Relf Cases 
of 1974, and the gynecological experiments of Dr. Marion J. Sims are examples of medical 
abuse, coercion, and institutional racism in Black communities. Prather and colleagues 
(2018) assert, "the legacy of medical experimentation and inadequate healthcare has 
exacerbated African American women's complex relationship with healthcare systems, 
past and present, and laid a foundation of mistrust of the medical establishment" (p. 30). 
"Mississippi appendectomy" was a phrase created by African Americans from the South 
to denote the routine medical practice of sterilizing African-American women who were 
admitted to the hospital for other operations – these procedures continued into the early 
1970s. While many research studies have focused on the impact of medical mistrust on 
Black American males, research centered around women's health has also denoted 
significant areas of need. Kolar and colleagues (2015) state "medical mistrust is associated 
with disparities in cancer stage at diagnosis, breast cancer surgical and postsurgical 
adjuvant treatment and quality of life, underutilization of health services, routine health 
examinations, and cancer screening" (p. 78). Although anecdotal, the history of racism in 
America and atrocities carried out by the healthcare system has contributed to a legacy of 
mistrust in Black Americans that has spanned decades, negatively impacting generations. 

Methods 
Participants 
This study's total sample size was n =205, with a little more than half of the respondents 
relating that they were mothers, n = 105, (51.2%). Table 1 illustrates that most women were 
between the ages of 21-30 years old, n = 75, (36.6%). Married women compromised the 
largest relational group, n = 75, (36.6%), with fewer than 20 respondents identifying as 
lesbian or bisexual, n = 18, (8.8%). The majority of respondents were employed full-time 
(n = 157). 

Research Design 
A correlational research design was used to describe the relationship between the 
variables. With this design, measures were conducted once. As this design does not 
require the manipulation of any variables, a control group is not required. Moreover, a 
quantitative rather than qualitative design was employed for this study as it intended to 
serve as a pilot study to gather preliminary results and examine the feasibility of future 
research.   

Procedures 
The Collaborative Institutional Training Initiative (CITI) Training courses were completed 
as required by all active researchers. Certificates of completion were submitted for both 
the principal investigator and the supervising clinician. Permission to conduct this 
research was granted by the institutional review board (IRB) of Jackson State University. 
The Qualtrics database was then used to house the consent forms and approved measures 
(demographic questionnaire, ERQ, MSSPS, EDS, MMBI, GBMMS) for the study. A 
recruitment flyer with a generic description of the study and the principal and supervising 



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investigator's contact information was created and publicly uploaded to the social media 
platform Facebook and the Qualtrics link to access the study. 

The public link allowed other Facebook members to publicly disseminate and access the 
study with other members within their networks. Participants who meet the inclusion 
criteria were then directed to the Qualtrics site to complete the study. Inclusion criteria 
consisted of the participants' self-identification as Black American women over the age of 
21. Exclusion from participation was limited to age (under 21) and race (non-Black). After 
reviewing the consent form, potential participants provided or declined consent to 
participate in the research study. Participants who consented to their involvement in the 
study were instructed to create a participant identification number using the first two 
letters of their last name and their date of birth, e.g. JA012386. The participant 
identification number allowed the researcher to track and maintain all documentation 
related to the said participant.

However, no other identifying information (name, address, social security number) was 
collected. Participants then completed the survey instruments within the database taking 
approximately 30-40 minutes for completion. Upon completing the study, participants 
were provided with a debriefing form explaining the minimally associated risks and the 
principal and supervising investigator's contact information. Following the data collection 
period, the data was transferred from the Qualtrics database directly into SPSS for data 
analysis.  The raw data was securely stored on an encrypted USB drive. Deidentified 
printed copies of the data are also secured in a locked file cabinet for five years. 
Remuneration was not provided for participation in this survey.  

Demographic Questionnaire 
A demographic questionnaire was created to collect background information such as age, 
sexual orientation, socioeconomic status, educational history, employment status, marital 
status, general health history. 

Emotion Regulation Questionnaires (ERQ) 
The ERQ (Gross & John, 2003) was developed to measure engagement in two broad 
categories of regulatory strategies: cognitive reappraisal (six items) and expressive 
suppression (four items). Independent scores are computed for each emotion regulation 
strategy. The 10-item ERQ measures respondents' reports of aspects of their emotional life 
using a 7-point Likert scale with options ranging from one (strongly disagree) to seven 
(strongly agree). A neutral selection, four, is available as well. Items such as "I control my 
emotions by changing the way I think about the situation I'm in" (reappraisal) and "I 
control my emotions by not expressing them" (suppression) are inserted within the ERQ. 
Since its development, the ERQ has presented good psychometric properties with internal 
consistency based on Cronbach's alpha of α = .82 for cognitive reappraisal and α = .76 for 
expressive suppression (Wiltnik et al., 2011). 

Multidimensional Scale of Perceived Social Support (MSPSS) 
The MSPSS authored by Zimet and colleagues (1988) is a 12-item 7-point Likert scale with 
options ranging from one (very strongly disagree) to seven (very strongly agree). Total 
scores range from 12 to 84, with total scores of 50 and over indicative of beneficial 
perceived social support. The MSPSS measures subjective perceptions of emotional 
support based on three dimensions; family, friends, and significant others.  An example 
of an item on the measure is, "I get the emotional help and support I need from my 
family" The MSPSS has strong internal consistency based on Cronbach's alpha of α 
=.81 to .98 (Zimet et al., 2011).  



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Graduate Student Journal of Psychology 

The Everyday Discrimination Scale (EDS) 
The EDS is a nine-item self-report questionnaire created by Williams and colleagues in 
1997 to measure the frequency in which ethnic and gender minorities experience 
discrimination throughout areas of life including, lifetime and daily discrimination. The 
EDS is based on a 6-point Likert scale with options ranging from one (never) to six (almost 
every day). Respondents are asked to provide the frequency to which they have 
experienced discrimination through items such as "You are treated with less courtesy than 
other people." The EDS has strong internal consistency based on Cronbach's alpha of 
α=.88 (Kim et al., 2014). 

The Multidimensional Model of Black Identity (MMBI) 
The MMBI (Sellers, 1997) was adapted from the Multidimensional Model of Racial 
Identity (MMRI) to measure the multidimensional conceptualization of Black identity 
based on three fundamental scales; centrality, regard, and ideology. The 56-item MMBI 
measures respondents; reports using a 7-point Likert scale response system with items 
ranging from one (strongly disagree) to seven (strongly agree); neutral selection, four, is 
also available. As the MMBI assesses racial identity from a multidimensional view, 
independent scores are computed for each subscale; an overall scale score is 
inappropriate. For this study, centrality was used to assess Black racial identity. Centrality 
(10 items) is an autonomous scale, with four subscales for ideology (Nationalist, 
Assimilation, Minority, and Humanist) and two subscales for regard (Public and Private 
Regard).  An example of an item listed on the MMBI is "Blacks and Whites have more 
commonalities than differences." Since its development, the MMBI has presented sound 
psychometric properties with internal consistency based on Cronbach's alpha ranging 
from low, α = .60 for private regard and high for nationalism, α = .79 for expressive 
suppression (Sellers et al., 1997).  

The Group-Based Medical Mistrust Scale (GBMMS) 
The GBMMS (Thompson et al., 2004) is a 12-item self-report measure that assesses 
individual beliefs about group-based mistreatment within medical communities. The 
GBMMS uses a 5-point Likert scale response system with selections ranging from one 
(strongly disagree) to five (strongly agree). There are three subscales within the GBMSS; 
suspicion (6 items), discrimination (3 items), and lack of support (3 items). Typical items 
within the measure are phrased as, "people of my ethnic group should not confide in 
doctors and healthcare workers because it will be used against them." The GBMSS is a 
new assessment tool with psychometric properties being reviewed thus far for gender 
(male and female) and cultural differences (African Americans and Latinos). However, in 
its' infancy, it shows a strong internal consistency with Cronbach's alpha α = .87-.88 
(Shelton et al., 2010; Thompson et al., 2004).   

Results 
Table 3 presents the correlation matrix between variables based on predicted hypotheses. 
A bivariate correlational analysis was conducted with results suggesting a significant 
relationship between centrality and perceived discrimination r(198) = -.29, p <.01. Thus, 
as respondents' centrality scores decreased, they tended to perceive more discrimination. 
The opposite was true for centrality and group-based medical mistrust r(202) = .15, p <.05. 
As centrality increased, group-based mistrust increased. Additionally, a positive 
relationship was established between social support and perceived discrimination, r(195) 
= .21, p <.01. More specifically, familial social support depicted a very weak correlation to 
perceived discrimination, r(196) = .18, p <.05, and support from friends depicted a weak 



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correlation, r(197) = .21, p <.01. Additionally, group-based medical mistrust reports and 
perceived discrimination frequency have a moderate negative correlation, r(197) = -.41, p 
<.01. The third research question was not substantiated as a significant correlation 
between age, education, employment, relationship status, and perceived discrimination 
was not identified. As such, there was no clear influence of sociodemographic factors on 
the perception of discriminatory experiences. 

Table 4 reflects the results of the stepwise hierarchical regression.  GBMSS, Centrality, and 
Friend Support, as a regression model, explained 24% of the variance in perceived 
discrimination. Significant variables comprising the regression equation indicated 
centrality, which explained 6%, and friends' social support contributed 3% of the variance 
in the dependent variable of perceived discrimination. Medical mistrust emerged as the 
most significant predictor, b = -.79, t(194) = - 6.03, p < .01. Group-based medical mistrust 
explained a significant percentage of the variance in perceived discrimination, F(1, 194) = 
36.35, p < .001, R2 = .16. Thus, this variable is a significant standalone variable in this 
equation. Collectively, group-based medical mistrust, centrality, and perceived social 
support from friends account for 25% of the variance, not attributed to chance, in 
perceived discrimination.  

Discussion 
Over the years, the socioecological model has presented itself as a comprehensive and 
inclusive theoretical framework. In the context of this study, the SEM was used to examine 
how those varying levels interplay and influence factors related to health. At the 
individual level, appreciating the significance of Black racial identity and cultural 
experiences can hypothetically improve patient-practitioner relationships and decrease 
perceptions of discrimination and mistrust. Recent studies have provided evidence to 
support incorporating socio-cultural factors like religiosity holistic treatments in 
communications about health practices with Black women to bolster communications and 
increase adherence (Sheppard et al., 2011).  In considering community-level interactions, 
support networks, specifically between friends and family, are essential to Black women's 
psychological well-being and their ability to mitigate discriminatory events. Similar 
findings have established that targeted social support can decrease depressive symptoms 
in Black women who have experienced racists or discriminatory events (Seawell et al., 
2014). Enabling and empowering Black women to be more reliant on their support 
networks when navigating the medical community's interactions can increase comfort 
and communication with physicians and other health professionals. Engaging Black 
women as stakeholders in policy at the legislative level and as outreach partners at the 
community level can encourage peers and families to further their involvement and 
advocacy within medical communities. By respectfully incorporating the lived 
experiences of Black women in culturally sensitive non-disposal roles, this potentially can 
assist in bridging the gap between the Black and medical community. 

While relationships between social support and Black racial identity were weak, it is 
important to note how these correlations impact Black women's experiences working 
through the American healthcare system's various and sometimes rugged terrain. This is 
historically and presently relevant as Black women face preventative and tertiary health 
disparities. Altering and improving the healthcare landscape in America through 
systemic changes from public and health policy theoretically can transform the culture of 
health practices that moderate and maintain racism in healthcare and, subsequently, 
medical mistrust. These changes can be made by increasing implementation strategies 
that enhance patient-practitioner relationships, encourage implicit bias training to dispel 



Correlates of Perceived Discrimination in Healthcare Amongst Black Women 

misconceptions about Black health, and increasing cultural competency training for 
medical professionals  

Considering the other SEM levels, the consequences of medical mistrust can impact Black 
women, their families, and communities. At the institutional level, issues with 
accessibility, affordability, and quality of care can culminate in an environment that can 
reduce discrepant health outcomes. Disproportionate health outcomes and instances of 
decreased quality of care experienced by women may contribute to their perceptions of 
discrimination and overall feelings of mistrust towards medical institutions. Medical 
mistrust can present negative consequences like decreased healthcare services and 
inadequate management of health conditions at the individual level. Such experiences can 
impact the overall family as they may relate to delays in scheduling or attending medical 
appointments, medication compliance, vaccinations, engaging in health-
promoting behaviors, and participation in clinical trials. These experiences 
consequently lend themselves to a detrimental rippling effect through communities and 
generations. At the organizational-institutional level, with group-based medical 
mistrust contributing to decreased health utilization and compliance, late 
identification of chronic illnesses, and limited participation in clinical trials, laws, and 
policies cannot be put in place to meet population-specific needs appropriately. Thus, 
the interaction between variables at one level interplay and impact factors in more 
distal levels.  

Limitations 
Several limitations of the current study should be considered, including the inability to 
determine causality. Given the research's correlational nature and the possibility 
of bidirectional effects, the findings should be interpreted cautiously. While the study 
aimed to be inclusive of all female gender identities, it was later realized that 
some of the questions included in the demographic questionnaire were not trans-
inclusive. For example, questions about motherhood and delivery methods only 
had traditional delivery modes--vaginal and caesarean. This demographic question 
ignored the birthing routes of trans-women and missed the alternative modes to 
motherhood that cis-gendered women also utilize, such as adoption and surrogacy. 
Future studies will include more inclusive responses. Another noted limitation of the 
study is its reliance on quantitative measures. Despite the extensive evidence 
highlighting the adverse health outcomes for Black American women due to medical 
racism, simple Likert scales may not adequately encapsulate the breadth of these lived 
experiences. Qualitative questions would have allowed women to share their 
direct medical racism experiences to showcase the disparities through first-person 
recollections. Qualitative statements could have provided powerful, impactful, and 
insightful declarations that could have provided a more exploratory, thorough, 
and personalized depiction of this unfortunate phenomenon. 

Moreover, data collection was conducted using snowball sampling from 
Facebook. Provisions were made via Qualtrics to reduce ballot stuffing; however, there 
is no way to ensure that participants met the requested inclusion criteria. Additionally, 
the link was shared within my professional network, comprised of many professional 
women who further disseminated the study within their networks. This potentially 
resulted in an over-representation of Black women with post-secondary education 
and, as a result, underestimates levels of perceived discrimination. Other college-
educated women shared the initial survey link within the principal investigators' 
social network and in professional groups like "PhDiva," "Black Women in Public 
Health," "Ethnic Counselors," and "Black Girl Doctorate. Accurate probability sampling 
would have included a more diverse collection of Black women from various 
educational and socioecological backgrounds. Furthermore, internet data 
collection raises concerns about sample 

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selectivity as participants would have access to mobile or computer-based internet 
access to complete the questionnaire digitally. In future studies, the 
methodological issues related to sample representation should be considered to 
secure a more representative sample. 

Conclusion 
In summary, exposure to racism and discrimination in medical institutions can 
influence medical mistrust in various manners. There is an urgent need to provide 
more research data documenting the interplay of interpersonal, intrapersonal, and 
institutional factors concerning the impacts of medical racism on the health 
outcomes of Black Women. A comprehensive evaluation of group-based medical 
mistrust in Black and other minority communities will. The medical community 
must be held accountable for their past injustices and actively work toward 
correcting present inequalities. Due to the racist origins and maintenance of medical 
mistrust, long-term interventions at the interpersonal and institutional levels need to 
be enacted to elicit significant change. Implementation strategies and interventions 
can include but should not be limited to increasing the representation of minorities 
in the medical field, collaboration with faith-based and other culturally relevant 
resources, encouragement of shared-decision making practices between patients 
and practitioners, and implicit biases training throughout medical school and 
throughout training. Future considerations should focus on the importance of 
incorporating natural support networks in treatment interventions and other aspects 
of medical care as relational support is positively associated with increased 
patient-practitioner communications and potentially increased compliance with 
medical advice. Incorporating natural supports also allow for culturally sensitive 
practice in communities that value their health impacts on the overall family system. 
These insights can generally be used to develop or strengthen population-specific 
interventions that address the multisystemic factors related to medical mistrust and 
decreased health outcomes. Thus, reducing medical mistrust as a barrier is an essential 
first step toward eliminating health disparities experienced by Black Women and other 
vulnerable racial, gender, sexual, and socioecological minority groups.  

Acknowledgements

The authors declare no conflict of interest associated with the publication, and no 
significant financial support for this work that could have influenced its outcome.
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Appendix 

Table 1 
Frequency Distribution for Age, Sexual Orientation, Employment, Marital Status, and 
Education 

Variables Frequency Valid Percent 
Age 

21-30 75 36.6 
31-40 56 27.3 
41-50 40 19.5 
51-60 25 12.2 
61 and Older 9 4.4 

Sexual Orientation 
Heterosexual 187 91.2 
Homosexual 8 3.9 
Bisexual 10 4.9 

Relationship Status 
Single 62 30.2 
Dating 46 22.4 
Married 73 35.6 
Divorced or 
Widowed 

24 11.7 

Employment Status 
Full Time 157 77.0 
Part-Time 30 14.7 
Unemployed 13 6.4 
Retired 4 2.0 

Education 
Less than High 
School 

1 .5 

High School, GED 24 11.7 
Bachelor’s Degree 
(B.A, B.S) 

40 19.5 

Master's Degree 110 53.7 
Professional 
Degree (MD, Ph.D., 
JD) 

30 14.6 



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Table 2 
Frequency Distribution for Access to Health Insurance, Primary Care Physician, Physician 
Gender and Race 
Variables Frequency Valid Percent 
Health Insurance 

Yes 195 95.1 
No 10 4.9 

Primary Care 
Physician 

Yes 174 84.9 
No 31 15.1 

Primary Care 
Physician Gender 

Male 45 25.7 
Female 130 743 

Primary Care 
Physician Race 

Black or African 
American 

63 30.7 

Hispanic or Latino 9 4.4 
Native Hawaiian or 
Other Pacific Islander 

2 1.0 

American Indian or 
Alaska Native 

4 2.0 

Asian 14 6.8 
White 71 34.6 
Other 14 6.8 

Table 3 
Correlations Matrix 
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 

Age 1 

Sexual Orientation -.138* 1 

Education -.074 -.200** 1 

Employment .103 .094 -.050 1 

Health Insurance -.040 .090 -.054 .096 1 

Perceived Discrimination .081 -.023 -.022 .026 -.119 1 

Centrality -.099 .048 .065 -.078 .018 -.290** 1 

Medical Mistrust -.078 .173* -.151* -.029 .030 -.411** .154* 1 

Perceived Social Support .029 .042 .069 -.068 .045 .206** .113 -.298** 1 

Family Support  -.007 -.011 .083 -.034 .046 .180* .080 -.235** .845** 1 

Significant Other Support .042 .067 .016 -.047 .064 .119 .033 -.224** .842** .595** 1 

Friend Support  .036 .051 .059 -.092 -.003 .214** .149* -.279** .771** .443** .488** 1 

Reappraisal  .058 .056 -.016 -.015 .056 -.058 .138* -.009 .052 -.016 .003 .138 1 

Suppression  -.132 -.081 -.050 -.084 -.043 -.066 -.112 .144* -.406** -.309** -.310** -.358** -.124 1 



Correlates of Perceived Discrimination in Healthcare Amongst Black Women 

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Table 4 
Regression Analysis Summary for Perceived Discrimination 
Model Summary 

Model R 
R 
Square 

Adjusted R 
Square 

Std. Error 
of the 
Estimate 

Change Statistics 
R Square 
Change 

F 
Change df1 df2 

Sig. F 
Change 

1 .397a .158 .153 8.78020 .158 36.352 1 194 .000 
2 .464b .215 .207 8.49828 .057 14.085 1 193 .000 
3 .491c .242 .230 8.37568 .026 6.691 1 192 .010 
a. Predictors: (Constant), GBMSS Composite Score
b. Predictors: (Constant), GBMSS Composite Score, Centrality
c. Predictors: (Constant), GBMSS Composite Score, Centrality, Friend Support Scale Score




