Export file:

Format

  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text

Content

  • Citation Only
  • Citation and Abstract

African American women perceptions of physician trustworthiness: A factorial survey analysis of physician race, gender and age

1 Department of Health Policy and Management, College of Public Health, University of South Florida
2 Department of Quantitative Health Sciences, University of Massachusetts Medical Center
3 Research Design and Statistics Unit, School of Nursing, University of Wisconsin-Madison
4 School of Public Health, Samford University

Background/Objective: Physical concordance between physicians and patients is advocated as a solution to improve trust and health outcomes for racial/ethnic minorities, but the empirical evidence is mixed. We assessed women’s perceptions of physician trustworthiness based on physician physical characteristics and context of medical visit. Methods: A factorial survey design was used in which a community-based sample of 313 African American (AA) women aged 45+ years responded to vignettes of contrived medical visits (routine versus serious medical concern visit) where the physician’s race/ethnicity, gender, and age were randomly manipulated. Eight physician profiles were generated. General linear mixed modeling was used to assess separately and as an index, trust items of fidelity, honesty, competence, confidentiality, and global trust. Trust scores were based on a scale of 1 to 5, with higher scores indicating higher trust. Mean scores and effect sizes (ES) were used to assess magnitude of trust ratings. Results: No significant differences were observed on the index of trust by physician profile characteristics or by medical visit context. However, the white-older-male was rated higher than the AA-older-female on fidelity (4.23 vs. 4.02; ES = 0.215, 95% CI: 0.001–0.431), competence (4.23 vs. 3.95; ES = 0.278, 95% CI: 0.062–0.494) and honesty (4.39 vs. 4.19, ES = 0.215, 95% CI: 0.001–0.431). The AA-older male was rated higher than the AA-older-female on competence (4.20 vs. 3.95; ES = 0.243, 95% CI: 0.022–0.464) and honesty (4.44 vs. 4.19; ES = 0.243, 95% CI: 0.022–0.464). The AA-young male was rated higher than AA-older-female on competence (4.16 vs. 3.95; ES = 0.205, 95% CI: 0.013–0.423). Conclusions: Concordance may hold no salience for some groups of older AA women with regards to perceived trustworthiness of a physician. Policies and programs that promote diversity in the healthcare workforce in order to reduce racial/ethnic disparities should emphasize cultural competency training for all physicians, which is important in understanding patients and to improving health outcomes.
  Figure/Table
  Supplementary
  Article Metrics

Keywords trust in physicians; concordance; African Americans

Citation: Jacqueline Wiltshire, Jeroan J. Allison, Roger Brown, Keith Elder. African American women perceptions of physician trustworthiness: A factorial survey analysis of physician race, gender and age. AIMS Public Health , 2018, 5(2): 122-134. doi: 10.3934/publichealth.2018.2.122

References

  • 1. Hall MA, Dugan E, Zheng B, et al. (2001) Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q 79: 613–639.    
  • 2. Boulware LE, Cooper LA, Ratner LE, et al. (2003) Race and trust in the health care system. Public Health Rep 118: 358–365.    
  • 3. Armstrong K, Ravenell KL, McMurphy S, et al. (2007) Racial/ethnic differences in physician distrust in the United States. Am J Public Health 97: 1283–1289.    
  • 4. Halbert CH, Armstrong K, Gandy OH, et al. (2006) Racial differences in trust in health care providers. Arch Intern Med 166: 896–901.    
  • 5. Jacobs EA, Rolle I, Ferrans CE, et al. (2006) Understanding African Americans' views of the trustworthiness of physicians. J Gen Intern Med 21: 642–647.    
  • 6. Street RL, O'Malley KJ, Cooper LA, et al. (2008) Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med 6: 198–205.    
  • 7. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. (1999) Race, gender, and partnership in the patient-physician relationship. JAMA 282: 583–589.    
  • 8. Malat J, Hamilton MA (2006) Preference for same-race health care providers and perceptions of interpersonal discrimination in health care. J Health Soc Behav 47: 173–187.    
  • 9. LaVeist TA, Nuru-Jeter A, Jones KE (2003) The association of doctor-patient race concordance with heatlh services utilization. J Public Health Policy 24: 312–323.    
  • 10. Johnson RL, Roter D, Powe NR, et al. (2004) Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health 94: 2084–2090.    
  • 11. Saha S, Komaromy M, Koepsell TD, et al. (1999) Patient-physician racial concordance and the perceived quality and use of health care. Arch Internal Med 159: 997–1004.    
  • 12. Chen FM, Fryer GE, Phillips RL, et al. (2005) Patients' beliefs about racism, preferences for physician race, and satisfaction with care. Ann Fam Med 3: 138–143.    
  • 13. Benkert R, Hollie B, Nordstrom CK, et al. (2009) Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners. J Nurs Scholarsh 41: 211–219.    
  • 14. Meghani SH, Brooks JM, Gipson-Jones T, et al. (2009) Patient-provider race-concordance: does it matter in improving minority patients' health outcomes? Ethn Health 14: 107–130.    
  • 15. Saha S, Shipman S (2006) The rationale for diversity in the health professions: A review of the evidence. In: Administration HRaS, editor. Rockville, MD.
  • 16. Traylor AH, Subramanian U, Uratsu CS, et al. (2010) Patient race/ethnicity and patient-physician race/ethnicity concordance in the management of cardiovascular disease risk factors for patients with diabetes. Diabetes care 33: 520–525.    
  • 17. Chan KS, Bird CE, Weiss R, et al. (2006) Does patient-provider gender concordance affect mental health care received by primary care patients with major depression? Womens Health Issues 16: 122–132.    
  • 18. Garcia JA, Paterniti DA, Romano PS, et al. (2003) Patient preferences for physician characteristics in university-based primary care clinics. Ethn Dis 13: 259–267.
  • 19. Derose KP, Hays RD, McCaffrey DF, et al. (2001) Does Physician Gender Affect Satisfaction of Men and Women Visiting the Emergency Department? J Gen Intern Med 16: 218–226.    
  • 20. Bertakis KD, Franks P, Epstein RM (2009) Patient-centered communication in primary care: physician and patient gender and gender concordance. J Women's Health 18: 539–545.    
  • 21. Hall JA, Roter DL, Blanch-Hartigan D, et al. (2014) How patient-centered do female physicians need to be? Analogue patients' satisfaction with male and female physicians' identical behaviors. Health Commun 30: 1–7.
  • 22. Saha S, Taggart SH, Komaromy M, et al. (2000) Do patients choose physicians of their own race? Health Aff 19: 76–83.    
  • 23. Rossi PH, Nock SL (1982) Measuring social judgments: The factorial survey approach. Beverly Hills, CA: SAGE Publications.
  • 24. Brown RL, Saunders LA, Castelaz CA, et al. (1997) Physicians' decisions to prescribe benzodiazepines for nervousness and insomnia. J Gen Intern Med 12: 44–52.    
  • 25. Musa D, Schulz R, Harris R, et al. (2009) Trust in the health care system and the use of preventive health services by older black and white adults. Am J Public Health 99: 1293–1299.    
  • 26. Mascarenhas OA, Cardozo LJ, Afonso NM, et al. (2006) Hypothesized predictors of patient-physician trust and distrust in the elderly: implications for health and disease management. Clin Interv Aging 1: 175–188.    
  • 27. Lauder W (1999) A survey of self-neglect in patients living in the community. J Clin Nurs 8: 95–102.    
  • 28. Atzmüller C, Steiner PM (2010) Experimental vignette studies in survey research. Methodol Eur J Res Methods Behav Soc Sci 6: 128–138.
  • 29. Muller-Engelmann M, Krones T, Keller H, et al. (2008) Decision making preferences in the medical encounter--a factorial survey design. BMC Health Serv Res 8: 260.    
  • 30. Shlay AB (2010) African American, White and Hispanic child care preferences: A factorial survey analysis of welfare leavers by race and ethnicity. Soc Sci Res 39: 125–141.    
  • 31. Reysen S (2005) Construction of a new scale: The Reysen Likability scale. Soc Behav Personal An Int J 33: 201–208.    
  • 32. Cabral D, Napoles-Springer A, Miike R, et al. (2003) Population- and community-based recruitment of African Americans and Latinos: the San Francisco Bay Area Lung Cancer Study. Am J Epidemiol 158: 272–279.    
  • 33. Lipsey MW (1990) Design sensitivity: statistical power for experimental research. Newbury Park, CA: Sage Publications.
  • 34. Hall MA, Zheng B, Dugan E, et al. (2002) Measuring patients' trust in their primary care providers. Med Care Res Rev 59: 293–318.    
  • 35. Babbie E (2009) The Practice of Social Research. CA: Wadsworth Publishing.
  • 36. Hox JJ, Kreft IGG, Hermkens PLJ (1991) The analysis of factorial surveys. Sociol Methods Res 19: 493–510.    
  • 37. Rabash J, Steele F, Browne WJ, et al. (2012) A User's Guide to MLwiN, v2.26. University of Bristol: Centre for Multilevel Modeling.
  • 38. Brown RL, Brown RL, Edwards JA, et al. (1992) Variation in a medical faculty's decisions to transfuse: Implications for modifying blood product utilization. Med Care 30: 1083–1096.    
  • 39. Hintze J (2007) NCSS 2007. Kaysville, Utah, USA: NCSS, LLC.
  • 40. Roter DL, Erby LH, Adams A, et al. (2014) Talking about depression: An analogue study of physician gender and communication style on patient disclosures. Patient Educ Couns 96: 339–348.    
  • 41. Kumar D, Schlundt DG, Wallston KA (2009) Patient-physician race concordance and its relationship to perceived health outcomes. Ethn Dis 19: 345–351.
  • 42. Cohen PN, Huffman ML (2003) Occupational segregation and the devaluation of women's work across U.S. labor markets. Soc Forces 81: 881–908.    
  • 43. Hall JA, Blanch-Hartigan D, Roter DL (2011) Patients' satisfaction with male versus female physicians: a meta-analysis. Med Care 49: 611–617.    
  • 44. Beavers FP, Satiani B (2010) Diversity in vascular surgery: Adapting to America's new face. Vasc Surg 51.

 

Reader Comments

your name: *   your email: *  

© 2018 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Copyright © AIMS Press All Rights Reserved