(O-J1) Medical Mistrust Amongst Donald Trump Supporters During the COVID-19 Pandemic

Objectives: In this study, we use the lens of medical mistrust - distrust of medical personnel and organizations - to understand how far-right conservatives discuss and make sense of medical information in the context of the COVID-19 pandemic. Few studies have focused on the relationship between politics and medical mistrust.

Background: Medical mistrust is negatively associated with health behavior engagement including participating in routine checkups, cancer screening, donating organs, and treatment adherence. Indeed, medical mistrust profoundly impacts overall health and well-being as well as satisfaction with the medical system. Most literature examining medical mistrust focuses on communities of color and those belonging to sexual minority groups; a paucity of research examines the intersections of politics, conspiracy thinking, and medical mistrust. However, in the US, Republican and Republican-leaning individuals have lower baseline confidence that scientists will act in the public’s best interest, which may have contributed to partisan COVID-19 mortality disparities.

Methods: We analyze content from a far-right conservative website called TheDonald.Win. TheDonald.Win was launched in 2019 in response to sanctions against the Reddit community (r/theDonald). For seven days preceding the start of data collection, we gathered usage data on the top 100 posts per 24 hours to establish cut-off criteria for high-visibility posts. We then combed the forum for posts whose title included one of 60 search terms related to COVID-19 and were posted within the date parameters. We included posts from the time of the site’s rebranding and Biden’s inauguration (January 20/21, 2021) to June 29, 2020 – the day TheDonald.Win’s Reddit forum was permanently banned, sparking the migration to TheDonald.Win. We analyze a subset of the 101,060 original posts based on 21 search terms related to the health care system (e.g., ambulance, ventilator, intubation, doctor, nurse, quack, scientist). We take a semantic and inductive approach to thematic analysis, and we analyzed forum posts in reverse chronological order. Thematic analysis involved developing a broad coding scheme and coding the data, searching for and reviewing themes, and reevaluating and defining those themes.

Results: We found that (1) users experienced institutional mistrust in part founded in misperceptions of how a pandemic should look. Users repeatedly commented on the desolate outside appearance of hospitals and lack of ambulances with sirens running as evidence that the pandemic was being falsified. We also found that (2) perceived financial and political incentives were powerful mechanisms to undermine both institutional and physician-level trust. In particular, users propagated information about how doctors and hospitals were being incentivized to falsify COVID-19 statistics in order to receive money from the government. Finally, we found that (3) trust in medical professionals was also heavily politicized with users highlighting the bravery of “whistleblowers” who were willing to speak out about the “inaccuracies” and “falsehoods” regarding COVID-19 while expressing mistrust in medical professionals and the scientific research and medical equipment they used to direct care. In particular, users identified intubation and ventilation as causes of death rather than treatments for advanced COVID-19. Users also expressed concerns regarding the complex financial relationship between the pharmaceutical industry, hospitals, and individual physicians, particularly with regard to preventative measures such as vaccinations.

Conclusions: In this first-of-its kind study of Trump supporters and COVID-19, we examine the dialog around medical mistrust and deaths during the COVID-19 pandemic on a far-right conservative webspace. Aligned with prior research examining medical mistrust, we demonstrate that mistrust is explored both at the interpersonal physician-patient level and at higher institutional levels, which conflicts with findings from other countries. We also show that COVID-19 uniquely drew attention to lesser explored topics of medical mistrust including proper utilization of medical equipment, grounds for authority and medical decision-making, and financial incentives for medical care.

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Funding (Optional): no disclosures