Health equity and medical mistrust: a mixed-methods analysis of medical and social determinants among transgender women of colour in the TURNNT cohort study

Medical mistrust as a construct often places the onus of blame for adverse health outcomes on individuals rather than on social structures. In this study, we aimed to determine if medical mistreatment and access to transgender care were potential determinants of medical mistrust. We used longitudinal survey data from 193 transgender women of colour living in New York City. We measured medical mistrust using the Group-Based Medical Mistrust (GBMM) scale. Additionally, we analysed and coded open-ended survey data from participants regarding their trust towards medical institutions to identify potential determinants of medical mistrust. From the quantitative analysis, we found that individuals who experienced mistreatment in healthcare and those who reported poor access to transgender care had higher GBMM scores. Qualitative findings suggested that negative experiences within the healthcare system and historical trauma were key factors contributing to mistrust in medical institutions. Addressing medical mistrust should not occur at the individual level, but rather at the structural level. Potential interventions include improving access to gender affirming care and training health professionals.