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Understanding African Americans’ views of the trustworthiness of physicians

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Abstract

BACKGROUND: Many scholars have written about the historical underpinnings and likely consequences of African Americans distrust in health care, yet little research has been done to understand if and how this distrust affects African Americans’ current views of the trustworthiness of physicians.

OBJECTIVE: To better understand what trust and distrust in physicians means to African Americans.

DESIGN: Focus-group study, using an open-ended discussion guide.

SETTING: Large public hospital and community organization in Chicago, IL.

PATIENTS: Convenience sample of African-American adult men and women.

MEASUREMENTS: Each focus group was systematically coded using grounded theory analysis. The research team then identified themes that commonly arose across the 9 focus groups.

RESULTS: Participants indicated that trust is determined by the interpersonal and technical competence of physicians. Contributing factors to distrust in physicians include a lack of interpersonal and technical competence, perceived quest for profit and expectations of racism and experimentation during routine provision of health care. Trust appears to facilitate care-seeking behavior and promotes patient honesty and adherence. Distrust inhibits care-seeking, can result in a change in physician and may lead to nonadherence.

CONCLUSIONS: Unique factors contribute to trust and distrust in physicians among African-American patients. These factors should be considered in clinical practice to facilitate trust building and improve health care provided to African Americans.

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References

  1. Ayanian JZ, Celary PD, Weissman JS, Epstein AM. The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med. 1999;341:1661–9.

    Article  CAS  Google Scholar 

  2. Connelly JE, Campbell C. Patients who refuse treatment in medical offices. Arch Intern Med. 1987;147:1829–33.

    Article  CAS  Google Scholar 

  3. Mostashari F, Riley E, Selwyn PA, Altice FL. Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility. J Acquir Immune Def Syndr Hum Retroviol. 1998;18:341–8.

    Article  CAS  Google Scholar 

  4. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.

    CAS  Google Scholar 

  5. Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD. How are patients specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians. J Gen Intern Med. 2002;17:29–39.

    Article  Google Scholar 

  6. Safran DG, Montgomery JE, Chang H, Murphy J, Rogers WH. Switching doctors: predictors of voluntary disenrollment from a primary physician’s practice. J Fam Pract. 2001;50:130–6.

    CAS  Google Scholar 

  7. Thom DH, Bloch DA, Segal ES. An intervention to increase patients’ trust in their physicians: Stanford Trust Study Group. Acad Med. 1999;74:195–8.

    Article  CAS  Google Scholar 

  8. Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA. 1998;280:1708–14.

    Article  CAS  Google Scholar 

  9. Kao AC, Green DC, Davis NA, Koplan JP, Cleary PD. Patients’ trust in their physicians: effects of choice, continuity, and payment method. J Gen Intern Med. 1998;13:681–6.

    Article  CAS  Google Scholar 

  10. Anderson LA, Dedrick RF. Development of the trust in physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67(part 2):1091–100.

    CAS  Google Scholar 

  11. Gamble VN. A legacy of distrust: African Americans and medical research. Am J Prev Med. 1993;9(suppl. 6):35–8.

    Article  CAS  Google Scholar 

  12. Gamble V. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997;87:1773–8.

    Article  CAS  Google Scholar 

  13. Peterson L. Racial differences in trust. Reaping what we have sown? Med Care. 2002;40:81–4.

    Article  Google Scholar 

  14. Hall MA, Dugan E, Zheng B, Mishra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79:613–39.

    Article  CAS  Google Scholar 

  15. Blackhall LJ, Frank G, Murphy ST, Michel V, Palmer JM, Azen SP. Ethnicity and attitudes towards life sustaining technology. Soc Sci Med. 1999;48:1779–89.

    Article  CAS  Google Scholar 

  16. Corbie-Smith G, Thomas SB St., George DM. Distrust, race, and research. Arch Intern Med. 2002;162:2458–60.

    Article  Google Scholar 

  17. Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 1999;14:537–46.

    Article  CAS  Google Scholar 

  18. Freimuth VS, Quinn SC, Thomas SB, Cole G, Zook E, Duncan T. African Americans’ views on research and the Tuskegee Syphilis Study. Soc Sci Med. 2001;52:797–808.

    Article  CAS  Google Scholar 

  19. Kraukauer EL, Truog RD. Case study: mistrust, racism and end-of-life treatment. Hastings Cent Rep. 1997;27:23–5.

    Article  Google Scholar 

  20. LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57(suppl 1):146–61.

    Article  Google Scholar 

  21. Lillie-Blanton M, Brodie M, Rowland D, Altman D, McIntosh M. Race, ethnicity, and the health care system: public perceptions and experiences. Med Care Res Rev. 2000;57(suppl 1):218–35.

    Article  Google Scholar 

  22. Plawecki HM, Plawecki PJ. Improving organ donation rates in the black community. J Holist Nurs. 1992;10:34–46.

    Article  CAS  Google Scholar 

  23. Glaser B, Strauss A. The Discovery of Grounded Theory. New York: Hawthorne; 1967.

    Google Scholar 

  24. Thom DH, Campbell B. Patient-physician trust: an exploratory study. J Fam Pract. 1997;44:169–76.

    CAS  Google Scholar 

  25. Hall MA, Dugan E, Balkrishnan R, Bradley D. How disclosing HMO physician incentives affects trust. Health Aff (Millwood). 2002;21:197–206.

    Article  Google Scholar 

  26. Boulware LE, Ratner LE, Cooper LA, Sosa JA, LaVeist TA, Powe NR. Understanding disparities in donor behavior: race and gender differences in willingness to donate blood and cadaveric organs. Med Care. 2002;40:85–95.

    Article  Google Scholar 

  27. Boulware LE, Ratner LE, Sosa JA, Cooper LA, LaVeist TA, Powe NR. Determinants of willingness to donate living related and cadaveric organs: identifying opportunities for intevention. Transplantation. 2002;73:1683–91.

    Article  Google Scholar 

  28. Caterinicchio RP. Testing plausible path models of interpersonal trust in patient physician treatment relationships. Soc Sci Med. 1979;13A:81–99.

    CAS  Google Scholar 

  29. Gilson L. Trust and the development of health care as a social institution. Soc Sci Med. 2003;56:1453–68.

    Article  Google Scholar 

  30. Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9:1156–63.

    Article  CAS  Google Scholar 

  31. Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc Sci Med. 2000;51:657–68.

    Article  CAS  Google Scholar 

  32. Smedley BD, Stith AY, Nelson AR, eds. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press; 2003.

    Google Scholar 

  33. La Veist TA, Nuru-Jeter A, Jones KE. The association of doctor-patient race concordance with health services utilization. J Public Health Policy. 2003;24:324–7.

    Google Scholar 

  34. La Veist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43:296–306; [PMID: 12467254].

    Article  Google Scholar 

  35. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159:997–1004.

    Article  CAS  Google Scholar 

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Correspondence to Elizabeth A. Jacobs MD, MPP.

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None of the authors have any conflicts of interest to declare.

The research presented in this paper was supported by Cancer Prevention, Control, and Population Sciences Career Development Award #5K07CA089421-03 from the National Cancer Institute. An earlier version of this work was presented at the Society of General Internal Medicine 25th Annual Meeting, Atlanta, GA, May 2 to 4, 2002 and the Academy for Health Services Research and Health Policy Annual Meeting, Washington, DC, June 23 to 25, 2002.

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Jacobs, E.A., Rolle, I., Ferrans, C.E. et al. Understanding African Americans’ views of the trustworthiness of physicians. J Gen Intern Med 21, 642–647 (2006). https://doi.org/10.1111/j.1525-1497.2006.00485.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00485.x

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