Improving Perceptions of Preventative Care Among Underserved Female Populations: Testing Two Cultural Approaches to Medical Marketing

Theoretical Background and research questions/hypothesis:

Data suggest primary care utilization is decreasing among American adults, particularly among minority groups (Levine et al., 2020). With greater unmet medical needs, individuals from these groups face higher risks of preventable illnesses (Black/African American - Office of Minority Health, n.d.; Hispanic/Latino - Office of Minority Health, n.d.; Hargraves & Hadley, 2003; Torres, 2018). Moreover, maternal mortality rates are disproportionately high among these groups (Hoyert, 2022). Given these and other disparities, improving perceptions of preventative care among underserved female populations is crucial.

Evidence suggests that collectivist values are prioritized by African American and Hispanic communities (Korzenny et al., 2017; Westjohn et al., 2022). However, medical marketing messages often promote individualistic paradigms by emphasizing self-care (Gans, 2021). Consequently, individuals from collectivist backgrounds may be less inclined to trust the guidance of out-group medical experts, particularly when framed from an individualistic lens (Gans, 2021). To enhance medical trust among potential patients from collectivist backgrounds, health communication interventions can consider culture-sensitive or culture-centered approaches. Culture-sensitive approaches involve adapting communication practices to patients' cultural backgrounds, and have been shown to be effective in some interventions (Enciso, 2020; Schiavo, 2007). However, cultural sensitivity can inadvertently perpetuate ‘othering’ of the audience and reinforce existing power structures, potentially harming marginalized cultures (Dutta, 2007).

Methods:

To test the hypothesis that a culture-centered primary care message would engender more trust amongst collective culture participants, a 2x3 experiment examined the impact of culture-sensitive (CS) and culture-centered (CC) design approaches in primary care physician advertisements. Participants included young adult African American women (n = 114), Hispanic women (n = 66), and non-Hispanic White women (n = 112), who were randomly assigned to view either the CS or CC message. Using an adaptation of the Trust in Doctors in General (T-DiG) and Trust in My Doctor (T-MD) scales (Richmond et al., 2022), the participants' levels of medical trust were assessed before and after the intervention, focusing on areas that could be impacted by a still advertisement (i.e., communication competency, fidelity, fairness, and general trust).

Results:

ANOVA analysis indicated that, in the T-Dig pretest, African Americans scored communication competency and fidelity significantly lower than both Hispanic and White participants. Additionally, African American participants scored overall trust in doctors significantly lower than White participants. Still, the African American’s scores were most effected by exposure to the interventions. To test the change in pre- and post-trust levels (between CC and CS messages) on communication competency, fidelity, fairness, and general trust, a MANOVA tested for variance between MiG and adapted T-MD scores with the between-subjects factors of cultural approach and ethnicity. Wilks’ criterion revealed statistically significantly different pre- and post-stimuli trust levels among the cultural approaches, with the greatest gains occurring in post-intervention fidelity among African American participants exposed to the culture-centered message.

Conclusions:

These findings suggest that culture-centered messages created with the participation of in-group members may be more effective at building trust among participants from ethnically similar backgrounds.

Implications for research and/or practice:

This inquiry suggests the significance of direct in-group experience in the design of preventative healthcare marketing messages.