ORIGINAL RESEARCH
Arshdeep Kaur, MSPH; Laura M. Gottlieb, MD, MPH; Stephanie Ettinger de Cuba, PhD, MPH; Elena Byhoff, MD, MSc; Eric W. Fleegler, MD, MPH; Alicia Cohen, MD, MSc; Nathaniel J. Glasser, MD, MPP; Mark J. Ommerborn, MPH; Cheryl R. Clark, MD, ScD; Emilia H. De Marchis, MD, MAS
Corresponding Author: Arshdeep Kaur, MSPH; California University of Science and Medicine
Email: arshdeep.kaur@student.cusm.edu
DOI: 10.3122/jabfm.2023.230182R1
Keywords: Caregivers, Cross-Sectional Studies, Doctor-Patient Relations, Emergency Departments, Health Care Disparities, Health Services, Logistic Regression, Outcomes Assessment, Perceived Discrimination, Primary Health Care, Screening, Social Determinants of Health, Trust
Dates: Submitted: 05-12-2023; Revised: 03-04-2024; Accepted: 03-11-2024
FINAL PUBLICATION: |HTML| |PDF|
BACKGROUND: Higher trust in healthcare providers has been linked to better health outcomes and satisfaction. Lower trust has been associated with healthcare-based discrimination.
OBJECTIVE: Examine associations between experiences of healthcare discrimination and patients’ and caregivers of pediatric patients’ trust in providers, and identify factors associated with high trust, including prior experience of healthcare-based social screening.
METHODS: Secondary analysis of cross-sectional study using logistic regression modeling. Sample consisted of adult patients and caregivers of pediatric patients from 11 U.S. primary care/emergency department sites.
RESULTS: Of 1012 participants, low/medium trust was reported by 26% identifying as nonHispanic Black, 23% Hispanic, 18% non-Hispanic multiple/other race, and 13% non-Hispanic White (p=0.001). Experience of any healthcare-based discrimination was reported by 32% identifying as non-Hispanic Black, 23% Hispanic, 39% non-Hispanic multiple/other race, and 26% non-Hispanic White (p=0.012). Participants reporting low/medium trust had a mean discrimination score of 1.65/7 vs. 0.57/7 for participants reporting high trust (p<0.001). In our adjusted model, higher discrimination scores were associated with lower trust in providers (aOR 0.74, 95%CI=0.64, 0.85). A significant interaction indicated that prior healthcare-based social screening was associated with reduced impact of discrimination on trust: as discrimination score increased, odds of high trust were greater among participants who had been screened (aOR=1.28, 95%CI=1.03, 1.58).
CONCLUSIONS: Patients and caregivers reporting more healthcare-based discrimination were less likely to report high provider trust. Interventions to strengthen trust need structural anti-racist components. Increased rapport with patients may be a potential byproduct of social screening. Further research is needed on screening and trust.