title: Providing health care to low-income women: a matter of trust.
abstract: BACKGROUND
  Trust is an important indicator of quality in patient-provider relationships and predicts adherence to certain protective health behaviours. It has been relatively unexplored among low-income or minority women.
  
  
  OBJECTIVE
  We explored health care experiences that influence patient trust among low-income women in the USA with respect to professionals and lay health workers (LHWs).
  
  
  METHODS
  Focus groups were conducted with 33 prenatal and postpartum women, aged 18-45 years, recruited from community-based public prenatal care programmes. Focus groups were audio-recorded, transcribed, and independently coded by readers. A model of factors associated with trust was developed based on the major thematic categories.
  
  
  RESULTS
  Most women were Black (67%) and had completed high school (85%). Factors related to greater trust specific to patient-provider relationships were: continuity of the patient-provider relationship, effective communication, demonstration of caring and perceived competence. Women with less trust in their physicians reported an unwillingness to follow his/her advice. Most women reported having more trusting relationships with LHWs and nurses than with physicians, probably due to greater contact with these staff. Several women with a low level of trust reported experiences of discrimination due to lack of insurance.
  
  
  CONCLUSIONS
  Prenatal care presents a unique opportunity for providers to contribute to the elimination of health disparities among low-income women. Improving continuity with public health prenatal care providers and building strong relationships with LHWs may enhance quality of care and contribute to achieving this goal. Better patient-provider communication is also a practical area of focus towards improving patient trust.
authors.affiliation: Georgetown University Medical Center, 2233 Wisconsin Ave, NW, Washington, DC 20007, USA.
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Sheppard
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Zambrana
authors.forename: Ann S
authors.initials: AS
authors.lastname: O'Malley
mesh_terms: D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008913:Minority Groups / Q000523:psychology*; D010817:Physician-Patient Relations; D049590:Postpartum Period; D011203:Poverty; D011295:Prenatal Care; D035502:Trust / Q000523:psychology*