Designing with Medical Mistrust: Perspectives from Black Older Adults in Publicly Subsidized Housing

2026-03-03

AI Summary

This study addresses the longstanding neglect of medical mistrust—a critical social determinant of health—in user-centered health technology design, particularly concerning low-income Black older adults. Conducted in publicly subsidized housing in the U.S. South, the research employs qualitative interviews with Black elders, integrating Black feminist theory and community-engaged methods. Through reflexive thematic analysis, it uncovers mistrust mechanisms rooted in racial and historical experiences. The work makes a novel contribution by incorporating race-centered medical mistrust into human-computer interaction design frameworks, proposing culturally responsive design principles and reflexive researcher positioning practices. Key themes include medical credentialing, skepticism toward economic motives, and perceptions of health AI intent. These insights offer both theoretical grounding and practical guidance for developing trustworthy, equitable health technologies.

Technology Category

• Humans and AI: Intelligent User Interfaces
• Data Mining & Knowledge Management: Representing, Reasoning, and Using Provenance, Trust
• Philosophy and Ethics of AI: Safety, Robustness & Trustworthiness

Application Category

• Economics, Online Markets and Human Computation: Trust and reliance of crowd workers and data experts on GenAI
• User Modeling, Personalization and Recommendation: Accountability, Transparency, and Ethics for personalization
• Responsible Web: Machine-in-the-loop, human agency and autonomy

Abstract

Despite increasing interest in culturally-sensitive health technologies, medical mistrust remains largely unexplored within human-centered computing. Considered a social determinant of health, medical mistrust is the belief that healthcare providers or institutions are acting against one's best interest. This is a rational, protective response based on historical context, structural inequities, and discrimination. To center race-based medical mistrust and the lived experiences of Black older adults with low income, we conducted interviews within publicly subsidized housing in the Southern United States. Our reflexive themes describe community perspectives on health care and medical mistrust, including accreditation and embodiment, skepticism of financial motivations, and the intentions behind health AI. We provide a reflective exercise for researchers to consider their positionality in relation to community engagements, and reframe our findings through Black Feminist Thought to propose design principles for health self-management technologies for communities with historically grounded medical mistrust.

Problem

• medical mistrust
• health technologies
• Black older adults
• structural inequities
• culturally-sensitive design

Innovation

• medical mistrust
• health technology design
• Black Feminist Thought
• positionality
• culturally-sensitive AI