title: Trust in one's physician: the role of ethnic match, autonomy, acculturation, and religiosity among Japanese and Japanese Americans.
abstract: OBJECTIVE
  Trust is a cornerstone of the physician-patient relationship. We investigated the relation of patient characteristics, religiosity, acculturation, physician ethnicity, and insurance-mandated physician change to levels of trust in Japanese American and Japanese patients.
  
  
  METHODS
  A self-administered, cross-sectional questionnaire in English and Japanese (completed in the language of their choice) was given to community-based samples of 539 English-speaking Japanese Americans, 340 Japanese-speaking Japanese Americans, and 304 Japanese living in Japan.
  
  
  RESULTS
  Eighty-seven percent of English-speaking Japanese Americans, 93% of Japanese-speaking Japanese Americans, and 58% of Japanese living in Japan responded to trust items and reported mean trust scores of 83, 80, and 68, respectively, on a scale ranging from 0 to 100. In multivariate analyses, English-speaking and Japanese-speaking Japanese American respondents reported more trust than Japanese respondents living in Japan (P values <.001). Greater religiosity (P <.001), less desire for autonomy (P <.001), and physician-patient relationships of longer duration (P <.001) were related to increased trust. Among Japanese Americans, more acculturated respondents reported more trust (P <.001), and Japanese physicians were trusted more than physicians of another ethnicity. Among respondents prompted to change physicians because of insurance coverage, the 48% who did not want to switch reported less trust in their current physician than in their former physician (mean score of 82 vs 89, P <.001).
  
  
  CONCLUSIONS
  Religiosity, autonomy preference, and acculturation were strongly related to trust in one's physician among the Japanese American and Japanese samples studied and may provide avenues to enhance the physician-patient relationship. The strong relationship of trust with patient-physician ethnic match and the loss of trust when patients, in retrospect, report leaving a preferred physician suggest unintended consequences to patients not able to continue with their preferred physicians.
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA. dtarn@mednet.ucla.edu
authors.forename: Derjung M
authors.initials: DM
authors.lastname: Tarn
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Meredith
authors.forename: Marjorie
authors.initials: M
authors.lastname: Kagawa-Singer
authors.forename: Shinji
authors.initials: S
authors.lastname: Matsumura
authors.forename: Seiji
authors.initials: S
authors.lastname: Bito
authors.forename: Robert K
authors.initials: RK
authors.lastname: Oye
authors.forename: Honghu
authors.initials: H
authors.lastname: Liu
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
mesh_terms: D000069:Acculturation; D000368:Aged; D001213:Asian / Q000523:psychology*; D003266:Continuity of Patient Care; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D012067:Religion; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035502:Trust; D014481:United States