Abstract：
Structural barriers, which impede access to healthcare, are often seen as tangible expressions of structural racism. Those who experience more structural barriers to healthcare access are likely to experience poor health. Expanding on this notion, our research integrated the Internalized Racism Framework (James, 2022) with the Structural Vulnerability Framework (Bourgois et al., 2017; Metzl and Hansen, 2014) to explore how encountering barriers to healthcare access influences healthcare seeking attitudes across four health domains: mental, medical, dental, and vision. Our study included a sample of 780 Black American adults (average age = 37.68) who were recruited to participate in an anonymous web-based cross-sectional survey. Our findings revealed that internalized racism explained the direct effect of healthcare access structural barriers on healthcare attitudes in the mental, medical, and vision health domains, but not in the dental health domain. Specifically, the experience of more structural barriers in accessing healthcare (mental, medical, and vision) correlated with heightened internalized racism, which, in turn, was associated with more negative attitudes towards seeking (mental, medical, and vision) healthcare. Notably, our results also showed variations in the frequency and types of structural barriers encountered across the four health domains, along with differences in participants\' positive healthcare seeking attitudes. Our findings underscore an urgent need for targeted interventions addressing both structural and internalized racism. Removing healthcare access barriers is crucial for fostering equitable healthcare access for Black Americans. Future research should explore additional factors influencing healthcare seeking attitudes, as well as strategies that mitigate the negative effects of racism on said attitudes.
摘要：
结构性障碍,这阻碍了人们获得医疗保健，通常被视为结构性种族主义的切实表现。那些在获得医疗保健方面遇到更多结构性障碍的人可能会遇到健康状况不佳。扩展这个概念，我们的研究整合了内部化种族主义框架(詹姆斯，2022)与结构脆弱性框架(Bourgois等人。,2017；Metzl和Hansen，2014)探索遇到医疗保健准入障碍如何影响四个健康领域的医疗保健寻求态度：精神，medical,牙科,和视觉。我们的研究包括780名美国黑人成年人（平均年龄=37.68）的样本，他们被招募参加基于网络的匿名横断面调查。我们的发现表明，内在化的种族主义解释了医疗保健获得结构性障碍对精神上的医疗保健态度的直接影响，medical,和视力健康领域，但不在牙齿健康领域。具体来说,在获得医疗保健方面存在更多结构性障碍的经验(精神，medical,和愿景)与高度内化的种族主义相关，which,反过来,与对寻求的更消极的态度(心理，medical,和愿景)医疗保健。值得注意的是,我们的结果还显示了四个健康领域遇到的结构性障碍的频率和类型的变化，以及参与者积极寻求医疗保健的态度的差异。我们的发现强调了迫切需要有针对性的干预措施，以解决结构性和内部化的种族主义。消除医疗保健障碍对于促进美国黑人的公平医疗保健至关重要。未来的研究应该探索影响医疗保健寻求态度的其他因素，以及减轻种族主义对上述态度的负面影响的策略。
