Elsevier

Preventive Medicine

Volume 38, Issue 6, June 2004, Pages 777-785
Preventive Medicine

The role of trust in use of preventive services among low-income African-American women

https://doi.org/10.1016/j.ypmed.2004.01.018Get rights and content

Abstract

Background. This study explored factors that predict higher trust in primary care providers, and examined the role of patient trust on the use of preventive services for low-income African-American women.

Methods. We conducted a cross-sectional, population-based telephone survey of 961 African-American women over age 40 in Washington, DC. Two dimensions of trust were examined: overall trust in one's regular primary care provider, and trust that the regular provider had no financial conflict of interest. Self-reported use of mammography, Pap tests, clinical breast exams, colorectal cancer screening, blood pressure, height and weight measurement, diet counseling, and depression screening, as delivered by one's primary care provider, were assessed. An index summarizing overall use of these interventions was the main outcome variable.

Results. More than two-thirds of respondents reported high trust in their physician. Older respondents (>65) were more trusting of their physicians overall than were younger respondents (P < 0.01). Primary care characteristics (continuity of care, accessibility of the practice, coordination of specialty care by one's regular provider) were more strongly associated with having high trust than were sociodemographic, health status, and insurance characteristics. Higher trust was significantly associated with greater use of recommended preventive services (OR: 2.3, 95% CI: 1.3, 4.0), controlling for the effects of insurance status, primary care, and patient characteristics.

Conclusions. Trust is associated with use of recommended preventive services in low-income African-American women. Stronger patient–provider relationships, with high levels of trust, may indirectly lead to better health through adherence to recommended preventive services for low income African-American women.

Introduction

Low-income African-American women report lower receipt of medical risk information and health advice from physicians than higher income and nonminority women [1], [2], [3], [4], [5]. In addition to insurance and a regular source of care [6], [7], [8], [9], [10], [11], [12], an additional important predictor of preventive services utilization is having a physician recommendation for the test [13], [14], [15], [16]. Thus, it is possible that the lower use of preventive services by low-income African-American women may be due in part to deficits in the patient–provider relationship [17], [18]. A strong patient–provider relationship has been found to be critical in this population's attainment of necessary services [19], [20], [21], [22], [23], [24].

Trust is a central feature of the patient–provider relationship [25], [26], [27], [28], [29]. Patient trust has been found to be positively correlated with willingness to seek care and adherence to treatment recommendations [25], [30], [31], [32]. Understanding predictors of patient trust and how it impacts use of preventive services is useful because a decline in patient trust may lead to lower patient and provider satisfaction, increased disenrollment from care, poorer patient compliance with treatment recommendations, and indirectly, lower health status [20], [28], [33], [34], [35], [36], [37], [38], [39], [40]. However, data are limited regarding the influence of patient trust on use of preventive services, particularly among low-income African-American women [25].

Given both the historical treatment and documented health disparities faced by African-Americans, there is an additional vulnerability that this group faces in encountering the medical system [25], [41]. In the face of such vulnerability, trust is likely to be especially important as a potential determinant of use of medical services. Future interventions to reduce health disparities through the improved use of recommended preventive services can be informed through a better understanding of factors associated with trust and whether it affects service use. In this study, we examine data from a population-based survey of African-American women in low-income census tracts of Washington DC to (1) explore factors that predict higher trust in one's primary care provider and (2) examine the role of patient trust on utilization evidence-based of preventive services.

Section snippets

Survey design and sampling

This study was approved by the Georgetown University Medical Center's Institutional Review Board.

Results

Respondent characteristics as well as associations between those characteristics and trust are presented in Table 1. Less educated and older women had higher overall trust in their primary care providers. More visit continuity with a specific provider and longer duration relationships were both associated with higher levels of both dimensions of trust. Women in primary care sites characterized by more organizational accessibility (time one could spend with her doctor, hours open, ability to

Discussion

This cross-sectional study of trust and utilization of evidence-based preventive services among low-income African-American women found that primary care characteristics were more predictive of patient trust than patient characteristics; and, that overall trust in providers was significantly associated with use of preventive services. For low-income African-American women, higher overall trust in one's primary care provider makes a notable contribution to the use of recommended preventive

Acknowledgements

This work was funded in part by grants # KO7 CA91848 (ASO) and by NCI-RO3 CA83338-02 (ASO).

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