African-Americans report less trust in health care providers than whites

A national survey suggests that African-Americans may have lower levels of trust in physicians, nurses and other health care providers than whites, especially if they regularly receive care in a facility other than a physician's office, according to an article in the April 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Physicians and researchers are increasingly recognizing the importance of trust in medical care, according to background information in the article. "Trust has been described as an expectation that medical care providers (physicians, nurses and others) will act in ways that demonstrate the patient's interests are a priority," the authors write. Many factors contribute to a patient's trust level, including perceptions of the provider's medical and interpersonal skills. Patients with low trust in their providers may be less likely to comply with treatment, receive recommended screening exams or develop long-term, quality relationships with their physicians.

Chanita Hughes Halbert, Ph.D., Abramson Cancer Center and University of Pennsylvania, Philadelphia, and colleagues evaluated responses from a national survey of 954 adults, including 432 African-Americans and 522 whites. Researchers conducted telephone interviews between July 7 and Sept. 19, 1999. Participants responded to 46 items that assessed their sociodemographic characteristics, prior health care experiences, where they usually receive care and whether their provider's racial background matched their own. Trust in health care providers was rated on a scale of one to four, with one indicating that the participant could trust providers to do what is best for patients almost all of the time and four almost none of the time. Low trust was defined as a rating of three or four.

Low levels of trust were reported by 44.7 percent of African-Americans and 33.5 percent of whites. Although fewer quality interactions with providers predicted low trust among all participants, other factors that influenced trust appeared different between African-Americans and whites. African-Americans who usually accessed medical care at facilities other than physicians' offices were most likely to report low trust, while among whites, lack of health insurance, fewer annual health care visits and gender were more likely to predict low trust, with women more likely to have low trust than men.

Understanding the factors that influence trust in different patient communities could help physicians take steps to enhance trust and thereby improve medical care, the authors conclude. "Training designed to improve provider communication with patients may be needed to improve trust for African-Americans and whites," they write. "However, it may be especially important to direct these efforts to health care providers practicing in settings where continuity with patients may be limited to improve trust among African-Americans. In addition, greater access to health care settings (e.g. physicians' offices) where more effective relationships with providers can be developed may also improve trust in health care providers among African-Americans."

(Arch Intern Med. 2006; 166: 896-901. Available pre-embargo to media at www.jamamedia.org.)

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Editor's Note: This study was supported by a grant from the National Cancer Institute, Bethesda, Md.

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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