title: A chasm between injury and care: experiences of black male victims of violence.
abstract: BACKGROUND
  Despite higher rates of stabbing and shooting violence among black men, healthcare systems have not demonstrated an efficacious response to these patients. This study describes challenges and promotive factors for engaging black male violence victims of violence with medical and mental healthcare.
  
  
  METHODS
  Black male victims of stabbings and shootings were recruited through fliers and word of mouth, and were interviewed individually (n = 12) or in pairs (n = 4) using a semistructured guide. A racially diverse multidisciplinary team analyzed the data using Grounded Theory methods.
  
  
  RESULTS
  Challenges to engagement with healthcare included the following: (1) Disconnect in the aftermath; e.g. participants reported not realizing they were seriously injured ("just a scratch" "poke"), were disoriented ("did not know where I was"), or were consumed with anger. (2) Institutional mistrust: blurred lines between healthcare and police, money-motivated care. (3) Foreshortened future: expectations they would die young. (4) Self-reliance: fix mental and substance abuse issues on their own. (5) Logistical issues: postinjury mental health symptoms, disability, and safety concerns created structural barriers to recovery and engagement with healthcare. Promotive factors included the following: (1) desire professionalism, open personality, and shared experience from clinicians; (2) turning points: injury or birth of a child serve as a "wake up call"; and (3) positive people, future-oriented friends and family.
  
  
  CONCLUSIONS
  For black male violence victims, medical treatment did not address circumstances of and reactions to injury. Policies delineating boundaries between medical care and law enforcement and addressing postinjury mental health symptoms, disability, and safety concerns may improve the recovery process.
authors.affiliation: Clinical Addictions Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA. Jane.Liebschutz@bmc.org
authors.forename: Jane
authors.initials: J
authors.lastname: Liebschutz
authors.forename: Sonia
authors.initials: S
authors.lastname: Schwartz
authors.forename: Joel
authors.initials: J
authors.lastname: Hoyte
authors.forename: Lauren
authors.initials: L
authors.lastname: Conoscenti
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Christian
authors.forename: Leroy
authors.initials: L
authors.lastname: Muhammad
authors.forename: Derrick
authors.initials: D
authors.lastname: Harper
authors.forename: Thea
authors.initials: T
authors.lastname: James
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D003430:Cross-Sectional Studies; D006801:Humans; D007407:Interviews as Topic; D035846:Law Enforcement; D008297:Male; D014481:United States / Q000453:epidemiology; D014754:Violence; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D014951:Wounds, Stab / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*