Trust and Mistrust in the Healthcare Safety-net: Experiences and Expectations of Aging Adults Experiencing Homelessness

• In Event: Aging and the Life Course Section Roundtables
  In Refereed Roundtable (90 minute): 8: Living Arrangements and Housing (In)stability

Abstract

People experiencing homelessness face substantial barriers to health care access and engagement, including stigma and discrimination within clinical settings. Stigma and discrimination are known contributors to medical mistrust, and medical mistrust is a key determinant of healthcare engagement outcomes. However, less is known about the role of medical mistrust or experiences that influence mistrust among people experiencing homelessness. Cultural Health Capital (CHC) has been proposed as a theoretical framework for understanding inequity experienced through healthcare encounters. We conducted a qualitative study with aging adults experiencing homelessness to better understand their perspectives on trust and mistrust related to healthcare interactions. Participants acquired and accumulated health resources, or CHC, through prior healthcare experiences practices. These resources were mobilized through “habitus” to guide how they navigated healthcare interactions. They drew on assets such as knowledge about medications and health-related communication skills, mobilized to secure social privilege and exercise of influence within healthcare settings. This form of capital was then leveraged to effectively engage with clinical providers and optimize relationships with professionals and the care they received, promoting better outcomes. We extend the theory of CHC to further include resources gained through navigation of healthcare structures. Patients described discrimination in their healthcare interactions and expressed skepticism toward prescribing practices, which they associated with biomedicalization and pharmaceutical profit motives. These perceptions reinforced mistrust of providers operating within a revenue-driven system. Promoting medical trust among people experiencing homelessness may therefore require strengthening cultural health capital through improved medication knowledge, clearer communication, and greater transparency about insurance and system constraints which can support more equitable healthcare interactions.

Authors

• Natrina Johnson, University of California San Francisco

• Margot Kushel, University of California San Francisco Department of Medicine

• Kelly Knight, University of California, San Francisco