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Abstract title: Trust in Physician, Facility, and System: Qualitative Differences Between Ethnic Groups

Author(s):
KJ O’Malley - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, Texas
P Haidet - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, Texas
B Sharf - Texas A & M University
C Ladd - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, Texas
T Collins - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, Texas
M Johnson - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, Texas
A Tran - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, Texas
S Chu - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, Texas
NP Wray - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, Texas
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Objectives: Patient decision-making preferences have been shown to contribute to ethnic disparities in health care. Researchers have posited that patient trust plays an important role in patients’ decisions; however, no study has explicitly focused on qualitative differences in patient trust between ethnic groups, where trust is examined at multiple levels of the system. The objective of this qualitative study was to explore African American (AA), Mexican American (MA), Vietnamese American (VA) and White American (WA) patients’ feelings of trust toward physicians, health care facilities, and health care in general and to examine whether patients feelings of trust differ qualitatively across ethnic groups.

Methods: We recruited 75 patients stratified by ethnicity and type of health system (city/charity, private, veterans administration) who reported interaction with multiple levels of the system over the past year. Three trained interviewers conducted 24 in-depth focus groups designed to elicit patients’ feelings of trust in multiple levels of the health care system. Two primary and five secondary reviewers analyzed transcripts and identified initial themes. Reviewers compared findings, resolved discrepancies, and incorporated emergent themes into a hierarchy.

Results: Regardless of ethnicity and type of system, patients associated trust in their physician with listening, disclosing of information, and caring. Patients reported that trust in the facility related to staff members taking them seriously. Patients’ feelings of trust or mistrust with the healthcare system were generally associated with equal access to care for all patients and concerns that making money was more important than providing the best care. We identified numerous qualitative differences in patients’ trust across ethnic groups. For example, AA patients associated mistrust with health care providers who spoke to them in a disrespectful way, and MA patients associated mistrust with lack of communication across staff members and from doctor to doctor.

Conclusions: Patients share many feelings of trust or distrust in physicians, facilities, and the system; however, certain aspects of trust differed qualitatively across ethnic groups.

Impact statement: Understanding aspects of trust that patients consider when deciding whether or not to undergo recommended procedures and changing the system to improve these aspects will help eliminate ethnic disparities in health care.