Defense Date


Document Type


Degree Name

Master of Science



First Advisor

Paul Perrin, Ph.D.

Second Advisor

Bruce Rybarczyk, Ph.D.

Third Advisor

Joseph Tan, Ph.D.


Integrated primary care has been incorporated into a variety of healthcare settings. The benefits of these services are empirically supported by a plethora of studies, which highlight the integration of behavioral and physical healthcare to be beneficial for both patient and healthcare providers. Integrated care models are typically incorporated in Veterans Affairs hospitals, general primary care facilities, and community clinics. Community-based clinics, such as safety-net clinics, typically serve underrepresented populations, and research has shown several mental and physical health disparities to exist among minority populations. Further, the minority stress model posits that distal and proximal minority-based stress processes can result in a cascade of negative health outcomes, such as increased symptomology or poor health-management behaviors. Although minority stressors can lead to this series of consequences, several community and personal strengths may serve as protective factors for marginalized individuals. These processes may occur within safety-net primary care, considering that the populations of interest are underserved. Black patient populations face numerous barriers to healthcare, such as racism, discrimination, and provider bias. Prior literature has shown that prior experiences of racism result in poorer mental and physical health outcomes for Black patient populations. Further, these outcomes have been shown to negatively impact healthcare attitudes and behaviors. The current study aimed to examine how aspects of the minority stress model may operate within safety-net primary care services for Black patient populations. It was hypothesized that racism would predict poorer mental health, which would negatively impact provider trust, and therefore predict lower medication adherence. Using a strengths-based approach, grit and social support were hypothesized to serve as personal and collective buffers to this series of relationship. A path analysis showed that racism significantly predicted mental health, which predicted poorer provider trust; however, the last path of this model, provider trust to medication adherence, was not found to be statistically significant. Thus, the path analysis was broken up into a series of mediations, which explored the relationship between racism and both provider trust and medication adherence through mental health. Mental health was found to mediate the relationship from racism to provider trust and from racism to medication adherence. The moderated mediation effect of social support was found to be non-significant for all mediations, except that grit was moderated the mediation between racism to medication adherence through mental health. These results showed grit served as a personal strength to dampen the associated effects of racism, which may suggest improving intrinsic attitudes and motivation towards long-term health related goals may increase treatment adherence behaviors. Results from this study also confirm the importance of integrated primary care services, as the data suggested high rates of mental health problems, which typically go underreported among Black patients in healthcare settings.


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