Minority Health and Health Equity Archive
Permanent URI for this collectionhttp://hdl.handle.net/1903/21769
Welcome to the Minority Health and Health Equity Archive (MHHEA), an electronic archive for digital resource materials in the fields of minority health and health disparities research and policy. It is offered as a no-charge resource to the public, academic scholars and health science researchers interested in the elimination of racial and ethnic health disparities.
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Item Trust, Mistrust, Racial Identity and Patient Satisfaction in Urban African American Primary Care Patients of Nurse Practitioners(2009) Benkert, Ramona; Hollie, Barbara; Nordstrom, Cheryl K.; Wickson, Bethany; Bins-Emerick, LisaPURPOSE: To analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary-care nurse practitioners using Cox's Interaction Model of Client Health Behaviors. DESIGN: A descriptive-correlational study was conducted with a convenience sample of 100 community-dwelling adults. METHODS: Participants completed the Cultural Mistrust Inventory; Group Based Medical Mistrust Scale; Black Racial Identity Attitude Scale; Trust in Physician Scale; Michigan Academic Consortium Patient Satisfaction Questionnaire; and provided demographic and primary care data. ANALYSIS: Correlations and stepwise multiple regression techniques were used to examine the study aims and correlational links between the theoretical constructs of client singularity, client-professional interaction, and outcome. FINDINGS AND CONCLUSIONS: Cox's model indicated a complex view of African American patients' perspectives on nurse practitioners. Participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse-practitioner (NP) providers explained 41% of variance in satisfaction. CLINICAL RELEVANCE: An African American patient's own attitudes about racial identity and the client-professional relationship have a significant effect on satisfaction with primary care.Item Trust of nurse practitioners and physicians among African Americans with hypertension(2008) Benkert, Ramona; Peters, Rosalind; Tate, Nutrena; Dinardo, EllenPURPOSE: 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. DATA SOURCES: 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. CONCLUSIONS: 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. IMPLICATIONS FOR PRACTICE: 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.