Research Explores Trust Factor in Health Care

Family physicians may find a new study compelling for what it says about black and white patients' trust in health care professionals and about how that trust relates to where patients receive care. The study, "Racial Differences in Trust in Health Care Providers," appears in the April 24 issue of Archives of Internal Medicine and suggests remedies to the trust gap.

The study was based on information from a 1999 survey conducted by the Kaiser Family Foundation. The Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care collected information via telephone interviews with African-Americans, Hispanics and non-Hispanic whites. The current study explores responses from 432 African-Americans and 522 whites. Of those 954 respondents, 44.7 percent of African-Americans indicated they had low trust in health care professionals, compared with 33.5 percent of non-Hispanic whites who reported low trust.

To gauge trust levels, interviewers asked how often respondents thought they could trust physicians or other health care professionals to do what was best for the respondent. In addition, interviewers explored the quality of respondents' interactions with health care professionals by asking whether respondents thought the professionals asked enough questions about medical history, provided clear explanations and were attentive during the most recent medical visit.

The researchers in the study report a correlation in both respondent groups between low trust and less-than-satisfactory interactions with health care professionals. The researchers advise, "Experiences with health care providers who communicate well (e.g., use direct and empathetic communication) may improve patient trust among both populations. Thus, interventions that focus on improving physician behaviors, such as communication skills and partnership building, may improve trust among African-Americans and whites."

Interviewers for the 1999 survey also obtained information about characteristics such as health insurance status and respondents' usual source of care. The current study notes, "African-Americans who usually obtained medical care at facilities other than a physician's office were most likely to report low trust." Among African-Americans who reported low trust, 38.5 percent said their usual source of care was a physician's office, whereas 52.3 percent said they usually received care in other locations.

The researchers comment, "The interpersonal relationship between patients and health care providers is a critical component of patient trust; it is possible that the environmental characteristics of hospital emergency departments, outpatient departments, health maintenance organizations, and clinics and health centers may not be amenable to establishing an effective patient-physician relationship. … Increased access to care through physicians' offices, where effective relationships with providers may be more likely to develop because of greater physician continuity, is a significant challenge because access is influenced by health insurance coverage. … It may be especially important to direct training efforts for enhancing communication with patients to health care providers practicing in settings where continuity may be limited."