Trust and distrust of health care institutions among African Americans, Non-Hispanic whites and Hispanics

Introduction: African Americans, Hispanics and non-Hispanic whites in the United States are likely to have different levels of trust in healthcare institutions given differences in culture and experiences of mistreatment. Despite the likelihood of these differences, few studies examine how trust and distrust in healthcare vary across racial/ethnic groups.

Objective: The objective of this study was to better understand what contributes to trust and distrust of healthcare institutions and how these contributors might vary across these three racial/ethnic groups.

Methods: We conducted 17 focus groups: 9 African American, 5 Hispanic and 3 non-Hispanic White. 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: Across racial groups, institutional trust was fostered by quality of care, physician competence, staff treatment, and care delivery in not-for-profit and teaching hospitals. Distrust was cultivated by poor quality of care, poor treatment by physicians and staff, institutional for-profit motivation, and access barriers such as long waiting periods. African American and Hispanic respondents discussed discrimination based on cultural, racial and linguistic differences as additional contributors to distrust. African Americans also distrusted institutions that they perceived as experimenting on patients without their consent. Across groups trust and distrust in healthcare institutions played a major role in care-seeking behavior.

Conclusions: Contributors to trust and distrust in healthcare institutions vary in some important ways across racial/ethnic groups. This variation should be taken into account when working to improve trust in healthcare institutions.