Trust and distrust of physicians among African American, Non-Hispanic White and Hispanic respondents

Introduction: Understanding the role that trust and distrust play in the patient-physician relationship trust is essential to improve care delivery and to understand care seeking behaviors across racial/ethnic groups. However, few studies have examined how trust and distrust in physicians care vary across African American, non-Hispanic White, and Hispanic populations in the United States.

Objective: The objective of this study is to better understand how views of trustworthiness of physicians vary across these ethnic groups.

Methods: We conducted 17 focus groups: 9 African American, 5 Hispanic and 3 non-Hispanic Whites. The numbers of participants differed by racial/ethnic groups because it took fewer participants in the non-Hispanic White group to reach theme saturation. Discussions were audio taped, transcribed and coded for interpretation using grounded theory analysis. Latino focus groups were conducted in Spanish and translated verbatim before transcription.

Results: Physician demonstration of interpersonal and technical competencies was a major determinant of physician trust across all three racial/ethnic groups. The race/ethnicity of the physician was not an important factor in determining trust in any group, but culturally competent and Spanish-speaking physicians enhanced trust levels for Hispanic patients. Interpersonal and technical incompetence, inadequate communication, and for-profit motives increased distrust in physicians across all three racial/ethnic groups. Additional contributors to distrust among Hispanics were cultural and language barriers and language-based discrimination. Additional contributors to distrust among African American participants included expectation of experimentation and racial discrimination in their interactions with physicians. All three racial/ethnic groups indicated that trust in physicians enhances care-seeking behavior, adherence, and quality of care and that distrust in physicians often led patients to forgo care by refusing surgery or other treatment, withdrawing from care all together, changing health care providers, or not seeking care in the first place.

Conclusions: Trust and distrust play major roles in care-seeking behaviors across racial/ethnic groups. However factors contributing to distrust across racial groups vary due to linguistic, cultural, and historical differences. These differences should be taken into account by physicians, policy makers, and administrators in efforts to increase physician-related trust in these populations.