Final answer:
African Americans may mistrust health care institutions and providers due to historical instances of betrayal by healthcare providers, as well as difficulties in understanding and accessing healthcare systems.
Step-by-step explanation:
Studies have found that African Americans have a history of mistrust towards health care institutions and providers. This mistrust can be attributed to historical episodes of medical exploitation, such as the Tuskegee syphilis study, where patients were betrayed by healthcare providers. Additionally, underserved patients often face difficulties in understanding and accessing healthcare systems, which can further contribute to their mistrust. Therefore, the correct option is d) A and C.