title: Cultural identity and patient trust among older American Indians.
abstract: BACKGROUND
  Patients' trust in healthcare providers and institutions has been identified as a likely contributor to racial-ethnic health disparities. The likely influence of patients' cultural characteristics on trust is widely acknowledged but inadequately explored.
  
  
  OBJECTIVE
  To compare levels of patients' trust in primary care provider (interpersonal trust) with trust in healthcare organizations (institutional trust) among older American Indians (AIs), and determine associations with cultural identity.
  
  
  METHODS
  Patient survey administered following primary care visits.
  
  
  METHODS
  Two-hundred and nineteen American Indian patients ≥ 50 years receiving care for a non-acute condition at two clinics operated by the Cherokee Nation in northeastern Oklahoma.
  
  
  METHODS
  Self-reported sociodemographic and cultural characteristics. Trust was measured using three questions about interpersonal trust and one measure of institutional trust; responses ranged from strongly agree to strongly disagree. Finding substantial variation only in institutional trust, we used logistic generalized estimating equations to examine relationships of patient cultural identity with institutional trust.
  
  
  RESULTS
  Ninety-five percent of patients reported trusting their individual provider, while only 46 % reported trusting their healthcare institution. Patients who strongly self-identified with an AI cultural identity had significantly lower institutional trust compared to those self-identifying less strongly (OR: 0.6, 95 % CI: 0.4, 0.9).
  
  
  CONCLUSIONS
  Interpersonal and institutional trust represent distinct dimensions of patients' experience of care that may show important relationships to patients' cultural characteristics. Strategies for addressing low institutional trust may have special relevance for patients who identify strongly with AI culture.
authors.affiliation: Department of Community and Behavioral Health, College of Public Health, University of Iowa, 105 River Street, N428 CPHB, Iowa City, IA, 52242, USA, Vanessa-simonds@uiowa.edu.
authors.forename: Vanessa W
authors.initials: VW
authors.lastname: Simonds
authors.forename: R Turner
authors.initials: RT
authors.lastname: Goins
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Krantz
authors.forename: Eva Marie
authors.initials: EM
authors.lastname: Garroutte
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000208:ethnology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009825:Oklahoma / Q000208:ethnology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D035502:Trust / Q000523:psychology