Skip to main content

Advertisement

Log in

Differences in the Patterns of Health Care System Distrust Between Blacks and Whites

  • Populations at Risk
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Context

Although health care-related distrust may contribute to racial disparities in health and health care in the US, current evidence about racial differences in distrust is often conflicting, largely limited to measures of physician trust, and rarely linked to multidimensional trust or distrust.

Objective

To test the hypothesis that racial differences in health care system distrust are more closely linked to values distrust than to competence distrust.

Design

Cross-sectional telephone survey.

Participants

Two hundred fifty-five individuals (144 black, 92 white) who had been treated in primary care practices or the emergency department of a large, urban Mid-Atlantic health system.

Primary measures

Race, scores on the overall health care system distrust scale and on the 2 distrust subscales, values distrust and competence distrust.

Results

In univariate analysis, overall health care system distrust scores were slightly higher among blacks than whites (25.8 vs 24.1, p = .05); however, this difference was driven by racial differences in values distrust scores (15.4 vs 13.8, p = .003) rather than in competence distrust scores (10.4 vs 10.3, p = .85). After adjustment for socioeconomic status, health/psychological status, and health care access, individuals in the top quartile of values distrust were significantly more likely to be black (odds ratio = 2.60, 95% confidence interval = 1.03–6.58), but there was no significant association between race and competence distrust.

Conclusions

Racial differences in health care system distrust are complex with far greater differences seen in the domain of values distrust than in competence distrust. This framework may be useful for explaining the mixed results of studies of race and health care-related distrust to date, for the design of future studies exploring the causes of racial disparities in health and health care, and for the development and testing of novel strategies for reducing these disparities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lewicki RJ, Bunker BB. Developing and maintaining trust in work relationships. In: Kramer RM, Tyler TR, eds. Trust in Organizations: Frontiers of Theory and Research. Thousand Oaks, CA: Sage; 1996.

    Google Scholar 

  2. Fukuyama F. Trust: the social virtues and the creation of prosperity. New York, NY: Free; 1995.

    Google Scholar 

  3. Dunn J. Trust and political agency. In: Gambetta D, ed. Trust: Making and Breaking Cooperative Relations. Oxford, UK: Oxford University Press; 1988:73–93.

    Google Scholar 

  4. Armstrong K, Rose A, Peters N, Long JA, McMurphy S, Shea JA. Distrust of the health care system and self-reported health in the United States. J Gen Intern Med. 2006;21(4):292–7.

    Article  PubMed  Google Scholar 

  5. Piette JD, Heisler M, Krein S, Kerr EA. The role of patient–physician trust in moderating medication nonadherence due to cost pressures. Arch Intern Med. 2005;165(15):1749–55.

    Article  PubMed  Google Scholar 

  6. Thom DH, Hall MA, Pawlson LG. Measuring patients’ trust in physicians when assessing quality of care. Health Aff. 2004;23(4):124–32.

    Article  Google Scholar 

  7. Gilson L. Trust and the development of health care as a social institution. Soc Sci Med. 2003;56(7):1453–68.

    Article  PubMed  Google Scholar 

  8. 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(4): 613–39, v.

    Article  PubMed  CAS  Google Scholar 

  9. Hall MA, Camacho F, Lawlor JS, Depuy V, Sugarman J, Weinfurt K. Measuring trust in medical researchers. Med Care. 2006;44(11):1048–53.

    Article  PubMed  Google Scholar 

  10. Halbert CH, Armstrong K, Gandy OH Jr., Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166(8):896–901.

    Article  PubMed  Google Scholar 

  11. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003;118(4):358–65.

    PubMed  Google Scholar 

  12. 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(1):146–61.

    Article  PubMed  Google Scholar 

  13. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.

    Google Scholar 

  14. Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The group-based medical mistrust scale: psychometric properties and association with breast cancer screening. Prev Med. 2004;38(2):209–18.

    Article  PubMed  Google Scholar 

  15. O’Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Prev Med. 2004;38(6):777–85.

    Article  PubMed  Google Scholar 

  16. Hall MA. Researching medical trust in the United States. J Health Organ Manag. 2006;20(5):456–67.

    Article  PubMed  Google Scholar 

  17. Keating NL, Gandhi TK, Orav EJ, Bates DW, Ayanian JZ. Patient characteristics and experiences associated with trust in specialist physicians. Arch Intern Med. 2004;164(9):1015–20.

    Article  PubMed  Google Scholar 

  18. Hall MA, Camacho F, Dugan E, Balkrishnan R. Trust in the medical profession: conceptual and measurement issues. Health Serv Res. 2002;37(5):1419–39.

    Article  PubMed  Google Scholar 

  19. Taira DA, Safran DG, Seto TB, et al. Do patient assessments of primary care differ by patient ethnicity? Health Serv Res. 2001;36(6 Pt 1):1059–71. Dec.

    PubMed  CAS  Google Scholar 

  20. Stepanikova I, Mollborn S, Cook KS, Thom DH, Kramer RM. Patients’ race, ethnicity, language, and trust in a physician. J Health Soc Behav. 2006;47(4):390–405.

    PubMed  Google Scholar 

  21. Benkert R, Peters RM, Clark R, Keves-Foster K. Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. J Natl Med Assoc. 2006;98(9):1532–40.

    PubMed  Google Scholar 

  22. Rose A, Shea J, Armstrong K. Development of the health care system distrust scale. J Gen Intern Med. 2004;19:57–63.

    Article  PubMed  Google Scholar 

  23. Balkrishnan R, Dugan E, Camacho FT, Hall MA. Trust and satisfaction with physicians, insurers, and the medical profession. Med Care. 2003;41(9):1058–64.

    Article  PubMed  Google Scholar 

  24. Mainous AG 3rd, Smith DW, Geesey ME, Tilley BC. Development of a measure to assess patient trust in medical researchers. Ann Fam Med. 2006;4(3):247–52.

    Article  PubMed  Google Scholar 

  25. Mechanic D. The functions and limitations of trust in the provision of medical care. J Health Polit Policy Law. 1998;23(4):661–87.

    PubMed  CAS  Google Scholar 

  26. Pearson SD, Raeke LH. Patients’ trust in physicians: many theories, few measures, and little data. J Gen Intern Med. 2000;15:509–13.

    Article  PubMed  CAS  Google Scholar 

  27. Gray BH. Trust and Trustworthy Care in the Managed Care Era. Health Aff. 1997;16(1):34–49.

    Article  CAS  Google Scholar 

  28. Rowe R, Calnan M. Trust relations in health care: developing a theoretical framework for the “new” NHS. J Health Organ Manag. 2006;20(5):376–96.

    Article  PubMed  Google Scholar 

  29. Meredith LS, Eisenman DP, Rhodes H, Ryan G, Long A. Trust influences response to public health messages during a bioterrorist event. J Health Commun. 2007;12(3):217–32.

    Article  PubMed  Google Scholar 

  30. Jacobs EA, Rolle I, Ferrans CE, Whitaker EE, Warnecke RB. Understanding African Americans’ views of the trustworthiness of physicians. J Gen Intern Med. 2006;21(6):642–7.

    Article  PubMed  Google Scholar 

  31. Wright EB, Holcombe C, Salmon P. Doctors’ communication of trust, care, and respect in breast cancer: qualitative study. BMJ. 2004;328(7444):864.

    Article  PubMed  Google Scholar 

  32. Charatz-Litt C. A chronicle of racism: the effects of the white medical community on black health. J Natl Med Assoc. 1992;84(8):717–25.

    PubMed  CAS  Google Scholar 

  33. Randall VR. Slavery, segregation and racism: trusting the health care system ain’t always easy! An African American perspective on bioethics. St Louis Univ Public Law Rev. 1996;15(2):191–235.

    PubMed  Google Scholar 

  34. Collins TC, Clark JA, Petersen LA, Kressin NR. Racial differences in how patients perceive physician communication regarding cardiac testing. Med Care. 2002;40(1 Suppl):I27–34.

    PubMed  Google Scholar 

  35. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient–physician relationship. JAMA. 1999;282(6):583–9.

    Article  PubMed  CAS  Google Scholar 

  36. Siminoff LA, Graham GC, Gordon NH. Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors. Patient Educ Couns. 2006;62(3):355–60.

    Article  PubMed  Google Scholar 

  37. Armstrong K, Hughes-Halbert C, Asch DA. Patient preferences can be misleading as explanations for racial disparities in health care. Arch Intern Med. 2006;166(9):950–4.

    Article  PubMed  Google Scholar 

  38. Evans SM, Berry JG, Smith BJ, Esterman AJ. Consumer perceptions of safety in hospitals. BMC Public Health. 2006;6:41.

    Article  PubMed  Google Scholar 

  39. The American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. Lenexa, Kansas: The American Association for Public Opinion Research; 2004.

    Google Scholar 

  40. Behavioral Risk Factor Surveillance System 2001 Questionnaire: Center for Disease Control. http://www.cdc.gov/brfss/questionnaires/english.htm. Accessed 20 February 2008.

  41. National Health Interview Survey Questionnaire. National Center for Health Statistics, 2001. Available at http://www.cdc.gov/nchs/nhis.htm. Accessed 6 January 2007.

  42. Ware JE, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: Summary of results from the Medical Outcomes Study. Med Care. 1995;33:64–79.

    Article  Google Scholar 

  43. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a re-evaluation of the Life Orientation Test. J Pers Soc Psychol. 1994;67:1063–78.

    Article  PubMed  CAS  Google Scholar 

  44. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12(7):439–45.

    Article  PubMed  CAS  Google Scholar 

  45. Cook K. Networks, Norms and Trust: The Social Psychology of Social Capital* 2004 Cooley Mead Awards Address. Soc Psychol Q. 2005;68(1):1–14.

    Article  Google Scholar 

  46. Whetten K, Leserman J, Whetten R, et al. Exploring lack of trust in care providers and the government as a barrier to health service use. Am J Public Health. 2006;96(4):716–21.

    Article  PubMed  Google Scholar 

  47. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlow AR. Linking Primary Care Performance to Outcomes of Care. J Fam Pract. 1998;47(3):213–20.

    PubMed  CAS  Google Scholar 

  48. Thom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999;37(5):510–7.

    Article  PubMed  CAS  Google Scholar 

  49. Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics. 2006;117(5):1532–41.

    Article  PubMed  Google Scholar 

  50. Rodriguez HP, Wilson IB, Landon BE, Marsden PV, Cleary PD. Voluntary physician switching by human immunodeficiency virus-infected individuals: a national study of patient, physician, and organizational factors. Med Care. 2007;45(3):189–98.

    Article  PubMed  Google Scholar 

  51. Balkrishnan R, Hall MA, Blackwelder S, Bradley D. Trust in insurers and access to physicians: associated enrollee behaviors and changes over time. Health Serv Res. 2004;39(4 Pt 1):813–23.

    Article  PubMed  Google Scholar 

  52. Mohseni M, Lindstrom M. Social capital, trust in the health-care system and self-rated health: the role of access to health care in a population-based study. Soc Sci Med. 2007;64(7):1373–83.

    Article  PubMed  Google Scholar 

  53. Gilson L. Trust in health care: theoretical perspectives and research needs. J Health Organ Manag. 2006;20(5):359–75.

    Article  PubMed  Google Scholar 

  54. McKinstry B. Ashcroft RE, Car J, Freeman GK, Sheikh A. Interventions for improving patients’ trust in doctors and groups of doctors. Cochrane Database Syst Rev. 2006;3:CD004134.

    PubMed  CAS  Google Scholar 

  55. McCallum JM, Arekere DM, Green BL, Katz RV, Rivers BM. Awareness and knowledge of the U.S. Public Health Service syphilis study at Tuskegee: implications for biomedical research. J Health Care Poor Underserved. 2006;17(4):716–33.

    Article  PubMed  Google Scholar 

  56. Brandon DT, Isaac LA, LaVeist TA. The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? J Natl Med Assoc. 2005;97(7):951–6.

    PubMed  Google Scholar 

  57. Levinson W, Kao A, Kuby AM, Thisted RA. The effect of physician disclosure of financial incentives on trust. Arch Intern Med. 2005;165(6):625–30.

    Article  PubMed  Google Scholar 

  58. Hunt KA, Gaba A, Lavizzo-Mourey R. Racial and ethnic disparities and perceptions of health care: does health plan type matter? Health Serv Res. 2005;40(2):551–76.

    Article  PubMed  Google Scholar 

  59. Shenolikar RA, Balkrishnan R, Hall MA. How patient–physician encounters in critical medical situations affect trust: results of a national survey. BMC Health Serv Res. 2004;4(1):24.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Alex Quistberg provided valuable assistance with the Spanish-speaking focus groups. This work was supported by R01 HG02689 from the National Human Genome Research Institute and a Research Scholar Grant from the American Cancer Society.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Katrina Armstrong MD, MSCE.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Armstrong, K., McMurphy, S., Dean, L.T. et al. Differences in the Patterns of Health Care System Distrust Between Blacks and Whites. J GEN INTERN MED 23, 827–833 (2008). https://doi.org/10.1007/s11606-008-0561-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0561-9

KEY WORDS

Navigation