Medical Trustworthiness and COVID-19: Examining Health Beliefs and Vaccine Uptake in Disinvested Black Communities

Disinvested Black communities in the US exhibit the highest levels of skepticism about the trustworthiness of medical institutions due to historical and ongoing structural racism, which the COVID-19 pandemic further exposed. Black individuals experienced a COVID-19 mortality rate 3.60 times higher than their white counterparts. This study investigates the mediating role of medical distrust between health beliefs and vaccine uptake among residents living in disinvested Black communities in New Jersey and Illinois (historically disinvested neighborhoods with large Black populations where residents have lower access to stable employment, quality education, and safe housing). Data was drawn from two randomized controlled trials aimed at increasing COVID-19 testing in disinvested Black communities. Using a multi-level understanding of medical distrust, along with the Health Belief Model (HBM), a cross-sectional analysis of baseline data from 1,159 individuals was conducted. Independent variables included demographics (e.g., gender, age, race, religion), structural factors (e.g., income, marital status), multi-level medical distrust (e.g., Kalichman COVID-19 Assessment), and HBM domains (e.g., perceived benefits, perceived barriers). The outcome variable was self-reported COVID-19 vaccination status. Results revealed that higher distrust was linked to lower vaccine uptake. Structural equation modeling demonstrated that marital status and religious affiliation moderated these relationships, while race, income, and gender had no significant effects. These findings highlight the critical need for intersectional strategies to improve vaccine acceptance in disinvested Black communities, addressing the complex influence of medical distrust. TRN (NCT04757298) and (NCT05305443) dates of registration are February 15, 2021, and March 30, 2022.