The role of trust in use of preventive services among low-income African-American women.
BACKGROUND
This study explored factors that predict higher trust in primary care providers, and examined the role of patient trust on the use of preventive services for low-income African-American women.


METHODS
We conducted a cross-sectional, population-based telephone survey of 961 African-American women over age 40 in Washington, DC. Two dimensions of trust were examined: overall trust in one's regular primary care provider, and trust that the regular provider had no financial conflict of interest. Self-reported use of mammography, Pap tests, clinical breast exams, colorectal cancer screening, blood pressure, height and weight measurement, diet counseling, and depression screening, as delivered by one's primary care provider, were assessed. An index summarizing overall use of these interventions was the main outcome variable.


RESULTS
More than two-thirds of respondents reported high trust in their physician. Older respondents (>65) were more trusting of their physicians overall than were younger respondents (P < 0.01). Primary care characteristics (continuity of care, accessibility of the practice, coordination of specialty care by one's regular provider) were more strongly associated with having high trust than were sociodemographic, health status, and insurance characteristics. Higher trust was significantly associated with greater use of recommended preventive services (OR: 2.3, 95% CI: 1.3, 4.0), controlling for the effects of insurance status, primary care, and patient characteristics.


CONCLUSIONS
Trust is associated with use of recommended preventive services in low-income African-American women. Stronger patient-provider relationships, with high levels of trust, may indirectly lead to better health through adherence to recommended preventive services for low income African-American women.
O'Malley
Ann S
AS
Cancer Control Program, Departments of Oncology and Internal Medicine, Georgetown University Medical Center, Washington, DC 20007, USA. omalleya@georgetown.edu
Sheppard
Vanessa B
VB
Schwartz
Marc
M
Mandelblatt
Jeanne
J
D001741:Black or African American; D000368:Aged; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004219:District of Columbia / Q000208:ethnology; D004522:Educational Status; D005260:Female; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011203:Poverty; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D035502:Trust