Open Access Dissertation
Date of Award
Dr. R. Khari Brown
AFRICAN AMERICAN MEN’S PERCEPTIONS OF TRUST IN PHYSICIANS
RONDRELL TAYVAN TAYLOR
Advisor: Dr. R. Khari Brown
Major: Sociology (Medical)
Degree: Doctor of Philosophy
Trust is the foundation of the doctor-patient relationship. It promotes healing and medical efficacy. Patient trust in physicians exists when doctors act in their patients’ best interests. Moreover, trust literature demonstrates that historically (and contemporarily), African Americans are less likely than Whites to trust clinicians and the medical community due to the history of discrimination, clinical racism, unethical medical practices, implicit or unconscious racial biases, and exploitation by the health care system. This is the first study that qualitatively and exclusively examines how African American men conceptualize (define) trust in physicians. It specifically explores factors that influence trust, how trust in physicians impact medical compliance, and how the doctor-patient interaction impacts trust in physicians.
Using a qualitative, grounded theory methodology, this study explored 20 African American men’s perceptions of trust in physicians. The project revealed that most of the participants were trusting patients and they viewed trust as an iterative, bi-directional process that was formed from the initial doctor’s appointment. Some of the responses that promoted trust in physicians included, caring, technical competence, thoroughness in evaluation, providing appropriate treatment and information, good communication, partnership-building, being personable or relatable, and feeling a sense of security. Respect, kindness, compassion, empathy, sensitivity, and maintaining confidentiality also increased trust in doctors. Participants who trusted their physicians also indicated feeling like they mattered, and that their lives had value. Nevertheless, apathy, disrespect, and technical incompetence emerged as the most salient factors that reduced trust the men’s physicians.
The results of this study reveal that trust in physicians positively influenced medical compliance. The majority of the men in this study indicated following treatment recommendations. Moreover, trust in doctors, along with being provided information regarding medications or treatment recommendations facilitated medical compliance, which promoted trust. Furthermore, medical adherence was also based on the rapport and the well-established relationships that the men had with their doctors. Consistent with trust research, the findings of the interviews support research that physician behavior and personality are the strongest predictors of patient trust in physicians. However, this study challenges existing theoretical precepts about race and trust because the narratives reveal that almost all of the participants in this study received patient-centered care, which increased the men’s agency and control during medical interactions, which encouraged them to engage in shared decision-making.
Also, many respondents viewed medical trust from a macro perspective. The men explained that examining and improving the interwoven systems of power and inequality within the health care system, is needed to increase trust. Furthermore, the narratives revealed that it was important for health care to involve connectivity and inclusivity, irrespective of an individual’s race, gender, SES, or other variables. This study may raise consciousness and encourage physicians and other health care professionals to interact and communicate differently and more effectively with Black male patients, which may reduce health disparities and increase medical compliance. Further qualitative studies are needed to gain a deeper understanding of the underlying issues, attitudes, and experiences that Black men have in medical realms.
Taylor, Rondrell Tayvan, "Affirming Expectations: African American Men's Perceptions Of Trust In Physicians" (2015). Wayne State University Dissertations. 1321.