title: Trust of nurse practitioners and physicians among African Americans with hypertension.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: College of Nursing, Wayne State University, Detroit, Michigan 48202, USA. ramonabenkert@wayne.edu
authors.forename: Ramona
authors.initials: R
authors.lastname: Benkert
authors.forename: Rosalind
authors.initials: R
authors.lastname: Peters
authors.forename: Nutrena
authors.initials: N
authors.lastname: Tate
authors.forename: Ellen
authors.initials: E
authors.lastname: Dinardo
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology*; D008297:Male; D008489:Medical Indigency / Q000208:ethnology; D008824:Michigan; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration / Q000523:psychology*; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D017060:Patient Satisfaction / Q000208:ethnology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000458:organization & administration / Q000523:psychology*; D011203:Poverty / Q000208:ethnology; D011287:Prejudice; D011795:Surveys and Questionnaires; D035502:Trust / Q000523:psychology*