Benkert Ramona, Peters Rosalind, Tate Nutrena, Dinardo Ellen
College of Nursing, Wayne State University, Detroit, Michigan 48202, USA.
J Am Acad Nurse Pract. 2008 May;20(5):273-80. doi: 10.1111/j.1745-7599.2008.00317.x.
To examine correlates of low-income African Americans' level of trust in healthcare providers. Specific aims were to (a) describe the levels and correlations of trust, mistrust, and satisfaction; (b) compare trust scores by provider type (nurse practitioner [NP] and medical doctor) and clinic type (nurse-managed clinic [NMC] and joint-managed clinic [JMC]); and (c) examine the relationship of patient and provider demographic factors (e.g., race concordance) with trust in the provider.
This descriptive cross-sectional study was conducted with 145 low-income African Americans (51% women, 49% men; mean age = 49.4 years). All participants were enrolled in a larger study that examined the effect of psychosocial variables on hypertension outcomes. Participants completed three questionnaires: Trust in Provider Scale, Cultural Mistrust Inventory, and the Michigan Academic Consortium Patient Satisfaction tool. Chart audits were performed to collect clinical data.
Trust and satisfaction were moderately high, M = 3.9 (0.56), M = 4.1 (0.57), respectively, on the 5-point scales, and cultural mistrust was in the moderate range, M = 3.9 (0.79), on a 7-point scale. No significant differences in mistrust, t(142) =-1.43, p = .155, or satisfaction, t(142) = 0.716, p = .475, were noted by provider type. Trust was significantly higher for patients seen by NPs, t(142) = 2.57, p = .011. Additionally, patients seen in the NMC reported significantly higher levels of trust than those seen in the JMC, t(143) = 3.62, p < .001. Race concordance between provider and patient did not change these findings.
Low-income African American patients have experienced unequal and discriminatory treatment, which can result in a cultural mistrust of providers; yet, providers in this study were able to engender high trust and satisfaction among these respondents. Still, the sociocultural effects of race concordance require further exploration to better understand the impact on trust in the patient-provider relationship. Finally, the high levels of trust in the NMC may offer a promising solution to the health disparities of African Americans; yet, more research is needed.
研究低收入非裔美国人对医疗服务提供者的信任程度的相关因素。具体目标为：（a）描述信任、不信任和满意度的水平及相关性；（b）比较不同类型提供者（执业护士[NP]和医生）以及不同类型诊所（护士管理诊所[NMC]和联合管理诊所[JMC]）的信任得分；（c）研究患者和提供者的人口统计学因素（如种族一致性）与对提供者的信任之间的关系。
这项描述性横断面研究对145名低收入非裔美国人进行了调查（51%为女性，49%为男性；平均年龄 = 49.4岁）。所有参与者都参与了一项更大规模的研究，该研究考察了心理社会变量对高血压结果的影响。参与者完成了三份问卷：对提供者的信任量表、文化不信任量表以及密歇根学术联盟患者满意度工具。进行病历审核以收集临床数据。
在5分制量表上，信任和满意度分别处于中等偏高水平，均值分别为M = 3.9（0.56）和M = 4.1（0.57）；在7分制量表上，文化不信任处于中等范围，均值为M = 3.9（0.79）。按提供者类型划分，在不信任程度（t(142) = -1.43，p = 0.155）或满意度（t(142) = 0.716，p = 0.475）方面未发现显著差异。由执业护士诊治的患者的信任度显著更高，t(142) = 2.57，p = 0.011。此外，在护士管理诊所就诊的患者报告的信任水平显著高于在联合管理诊所就诊的患者，t(143) = 3.62，p < 0.001。提供者与患者之间的种族一致性并未改变这些结果。
低收入非裔美国患者曾经历不平等和歧视性的治疗，这可能导致对提供者产生文化上的不信任；然而，本研究中的提供者能够在这些受访者中赢得较高的信任和满意度。尽管如此，种族一致性的社会文化影响仍需进一步探索，以更好地理解其对医患关系中信任的影响。最后，对护士管理诊所的高度信任可能为解决非裔美国人的健康差距提供一个有前景的解决方案；然而，还需要更多的研究。
