Negative experiences with health care have caused some minority patients, particularly African American men, to distrust the medical system.
Experts say these patients are less likely to visit the doctor or participate in screenings and medical research, which can negatively impact their health.
Researchers are finding community venues like barber shops and churches can help encourage patients to live healthier lifestyles and catch potential problems before they get worse.
Dr. Joseph Ravenell, an internist with NYU Langone Health and associate professor of population health at NYU School of Medicine, said minority communities have a history of experiencing racism in the health care system.
Most notorious may be the Tuskegee Syphilis Study in the mid-1900s. Throughout the 40-year span of the study, federal health workers knowingly misled and mistreated black men with syphilis in order to study the disease.
“Unfortunately, much of the medical mistrust that we have heard about stems in part from these historical instances, but also from instances much closer to home, either from family, friends or personal experiences of mistreatment,” Ravenell said.
“It only takes one negative experience to confirm for someone that they should not seek medical care, and when that happens, it’s often very difficult to regain someone’s trust.”
Ravenell said across many scientific fields, there is lower participation in medical research among minority patients compared to white patients.
“Often we don’t know how some of the cutting edge treatments that are being developed impact minority patients,” he said.
The same goes for screening tests for conditions like colorectal cancer.
“And we know one of the major drivers of the higher incidents and higher mortality for colorectal cancer in African Americans compared to other populations is the fact that we often don’t get screened in a timely way, and I do think medical mistrust is certainly a contributing factor,” Ravenell said.
Over the course of Dr. Ravenell’s career, he has teamed up with other researchers to look into how non-clinical settings can be used to overcome barriers like medical mistrust to improve outcomes for conditions that effect a larger percentage of African Americans, including high blood pressure and colorectal cancer.
“We’ve been able to work with trusted community organizations and community venues such as barber shops and churches to see how we can get people to listen to some of the messages about high blood pressure and colorectal cancer, getting screened and diagnosed in a timely way, which we know is really important for improving outcomes for high blood pressure and colorectal cancer,” he said.
In 2010 Ravenell published a report about a study he led in Dallas where researchers trained barbers how to measure blood pressure to improve early identification of black men with hypertension. The goal was to encourage these men to seek treatment for high blood pressure and avoid some of the more dangerous consequences of that condition like stroke, heart attack and kidney disease.
He then went on to expand that model in New York City to include colorectal cancer. Last year he published a study about that effort. His team trained community health workers that were from the communities they were targeting in New York City and placed them in barber shops. There, they looked for people who were not up-to-date on their colorectal cancer screenings and encourage them to get screened.
“What we found was that those men who were connected to a community health worker in the barbershops, they were twice as likely to get screened in a timely way compared to those people who only had a referral from their doctors,” Ravenell said.
Most recently, Ravenell has been studying how churches play a role in reducing hypertension. He said churches, particularly black churches, have long been leaders in community health efforts. They were some of the first institutions to take up blood pressure interventions in the 1960’s when the American Medical Association started allowing non-medical professionals to measure blood pressure. Ravenell said that helped raise awareness about the importance of healthy blood pressure in the black community.
In this particular study, Ravenell looked at churches in the southeastern U.S. and studied their effectiveness in targeting young black men with their blood pressure interventions. The results are meant to help design future efforts to improve health.
The challenge, Ravenell said, is how to take successful research and implement it in broader communities.
“That’s an important question we’re thinking about now, but the Centers for Disease Control and Prevention has really picked up the ball in a really important way by basically compiling some of these evidence-based, community-engaged strategies,” he said. “It really gives these strategies a level of credibility where they can be supported by state and local governments.”
New York City has become a strong partner for scaling some of these evidence-based programs, Ravenell said. He said his team is looking to improve breast and colorectal cancer screening in low-income New Yorkers, largely based on the success of his barber shop study, and that the city is helping support that effort.
