Journal Article

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

Bernhardt, Barbara, Dean, Lorraine T., Halbert, Chanita Hughes, Sankar, Pamela, Shea, Judy A., Armstrong, Katrina, Putt, Mary, Pyeritz, Reed E., Micco, Ellyn, Schwartz, J. Sanford, McMurphy, Suzanne

2008

Overview

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.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Adult / African Americans / Aged / Biological and medical sciences / Black or African American - psychology / Cross-Sectional Studies / Delivery of Health Care / Emergency medical care / Emergency Service, Hospital / Female / General aspects / Health care networks / Humans / Internal Medicine / Interviews as Topic / Male / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Miscellaneous / Patient Satisfaction - ethnology / Philadelphia / Populations at Risk / Primary care / Primary Health Care / Public health. Hygiene / Public health. Hygiene-occupational medicine / Quality of Health Care / Race / Social Values / Trust / Values / White people / White People - psychology