Exploring Lack of Trust in Care Providers and the Government as a Barrier to Health Service Use

Center for Health Policy, Box 90253, 125 Old Chemistry Bldg, Durham, NC 27708, USA.
American Journal of Public Health (Impact Factor: 4.55). 05/2006; 96(4):716-21. DOI: 10.2105/AJPH.2005.063255
Source: PubMed


We examined associations between trust of health care providers and the government and health service use and outcomes.
Interviews with a sample of 611 HIV-positive individuals included an attitudinal assessment measuring beliefs concerning the creation of AIDS, information being withheld about the disease, and trust of care providers.
Trust in care providers was associated with increased HIV-related out-patient clinic visits, fewer emergency room visits, increased use of antiretroviral medications, and improved reported physical and mental health. Trusting the government was associated with fewer emergency room visits and better mental and physical health. More than one quarter of the respondents believed that the government created AIDS to kill minorities, and more than half believed that a significant amount of information about AIDS is withheld from the public. Ten percent did not trust their provider to give them the best care possible.
Distrust may be a barrier to service use and therefore to optimal health. Distrust is not isolated in minority communities but also exists among members of nonminority communities and equally interferes with their use of services and health outcomes.

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Available from: Dalene Stangl, Aug 26, 2014
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    • "There is a growing literature on the importance of trust between patients (or clients) and their health workers and health systems, with trust acknowledged as essential for effective therapeutic encounters (Armstrong et al., 2006; Buchman & Ho, 2013; Gidman, Ward, & McGregor, 2012; Jauffret-Roustide et al., 2012; Meyer, Ward, Coveney, & Rogers, 2008; Nummela, Sulander, Rahkonen, & Uutela, 2009; Ostertag, Wright, Broadhead, & Altice, 2006; Rowe & Calnan, 2006; Tarrant, Stokes, & Baker, 2003; van der Schee, Groenewegen, & Friele, 2006; Whetten et al., 2006). Most research in this field has been conducted with samples of 'patients' – that is, people who are required to place trust in health workers and systems because they are unwell and require professionals with technical capacity and knowledge to provide appropriate care and/or therapy. "
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    ABSTRACT: Aims: Interest in health-care related trust is growing with the recognition that trust is essential for effective therapeutic encounters. While most trust-related research has been conducted with general patient groups, the experiences of people who inject drugs cannot be understood without acknowledging the critical role social stigma plays in shaping (mis)trust, both generally and in regards to health services specifically. This study examined the experiences of trust among clients and staff of Needle and Syringe Programs (NSPs) in one area of Sydney, Australia. Method: In-depth interviews with 12 NSP staff and 31 NSP clients were conducted. Analysis was informed by a five component model of trust, with particular emphasis on the notion of "global trust" as encompassing experiences of stigma and other negative social processes related to injecting drug use. Participant experiences of trust in NSPs were compared with those within other drug-related health services. Particular attention was paid to understanding the relationship between 'identity' (as a drug user) and 'legitimacy' (as a service user) and the centrality of this relationship to the experience of global trust for PWID. Results: Notions of identity and legitimacy were inextricably bound up with the stigmatisation of drug use, shaping participants' experiences and accounts of trust in NSPs and drug treatment services. Client participants reported high levels of trust in NSPs, especially when compared with drug treatment services, describing being treated like "any other person" even when negotiating 'sensitive' issues. NSP staff participants described the establishment of trust as not only underpinning their work with clients but as something that required ongoing renewal and demonstration. Conclusion: "Global trust" assists us to better understand the complex experiences shaping PWID decisions to engage with and trust health services. The high levels of trust reported between client and NSP need to be recognised as a valuable resource for the delivery of effective health care for people who inject drugs, including encouraging behaviours to support the prevention of blood-borne viruses.
    The International journal on drug policy 09/2015; DOI:10.1016/j.drugpo.2015.08.018 · 2.54 Impact Factor
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    • "Support for ethnoracial differences in trusting personal physicians Given past histories of abuse and exploitation toward Black patients by medical actors (e.g., Tuskegee Syphilis Study, Henrietta Lacks, the Mississippi Appendectomy, gynecological experiments on slaves), ethnoracial differences in perceptions of the honesty of physicians are expected to be substantial. Blacks have been found to be less trusting of medical actors' honesty about a range of ethical and privacy issues, including blood tests, experimentation, medication, public health information , and mistakes made during medical care (Armstrong et al., 2006, 2008; Whetten et al., 2006). Assessments of honesty with measures of mistrust in hospitals suggest that Blacks, more so than Whites, often perceive violations of their privacy (LaVeist et al., 2000). "
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    ABSTRACT: Past research yields mixed evidence regarding whether ethnoracial minorities trust physicians less than Whites. Using the 2002 and 2006 General Social Surveys, variegated ethnoracial differences in trust in physicians are identified by disaggregating a multidi-mensional physician trust scale. Compared to Whites, Blacks are less likely to trust the technical judgment and interpersonal competence of doctors. Latinos are less likely than Whites to trust the fiduciary ethic, technical judgment, and interpersonal competence of doctors. Black–Latino differences in physician trust are a function of ethnoracial differences in parental nativity. The ways ethnoracial hierarchies are inscribed into power-imbalanced clinical exchanges are discussed.
    Social Science Research 07/2015; 54:1-20. DOI:10.1016/j.ssresearch.2015.06.020 · 1.27 Impact Factor
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    • "Health Care Participation Individuals living in impoverished neighborhoods may experience several environmental obstacles to maintaining optimum health, including inadequacies in access and utilization of information and health care resources for which they are typically eligible (Richards & Smith, 2006; Williams & Jackson, 2005). Experiences with poorly staffed or inadequate neighborhood health services and the lack of culturally relevant educational materials and advice, combined with a legacy of distrust in physicians born of historic abuses during slavery through the Tuskegee study and beyond can be significant barriers to accessing and complying with advice from health care providers (Whetten, et al. 2006). Health literacy is one of the most significant social influences that increase the disparities in health care access and participation between races (Osborn, et al. 2007). "
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    ABSTRACT: HIV-positive individuals are living longer today as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases such as diabetes, and hypertension. These conditions result in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished African American women may represent an especially high-risk group due to disparities in health care, racial discrimination, and limited resources. This article describes an intervention that is based on the conceptual framework of the socio-ecological model. Project THANKS uses a community-based participatory, and empowerment building approach to target the unique personal, social, and environmental needs of African American women faced with the dual diagnosis of HIV and one or more chronic diseases. The long-term goal of this project is to identify features in the social and cultural milieu of these women that if integrated into existing harm reduction services can reduce poor health outcomes among them.
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