A Mixed Methods Examination of Health Care Provider Behaviors That Build Patients’ Trust (original) (raw)
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Patient Trust: Is It Related to Patient-Centered Behavior of Primary Care Physicians
Medical Care, 2004
Background: Patients' trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients. Methods: We assessed physician behavior and length of visit using audio tapes of encounters of 2 unannounced standardized patients (SPs) with 100 community-based primary care physicians participating in a large managed care organization. Physician behavior was assessed via 3 components of the Measure of Patient-Centered Communication (MPCC) scale. The Primary Care Assessment Survey (PCAS) trust subscale was administered to 50 patients from each physician's practice and to SPs. We used multilevel modeling to examine the associations between physicians' Patient-Centered Communication during the SP visits and ratings of trust by both patients and SPs. Results: Component 1 of the MPCC, which explored the patient's experience of the disease and illness, was independently associated with patient's rating of trust in their physician. A 1 SD increase in this score was associated with 0.08 SD increase in trust (95% confidence interval 0.02-0.14). Each additional minute spent in SP visits was also independently associated with 0.01 SD increase in patient trust. (95% confidence interval 0.0001-0.02). Component 1 and visit length were also positively associated with SP trust ratings. Conclusions: Physician verbal behavior during an SP encounter is associated with trust reported by SPs and patients. Research is needed to determine whether interventions designed to enhance physicians' exploration patients' experiences of disease and illness improves trust.
Research Square (Research Square), 2022
Background Trust occurs when a person feels they can be vulnerable to others because of the sincerity, benevolence, truthfulness and sometimes the competence they perceive. This project examines the various types of trust expressed in written re ections of developing healthcare clinicians. Our goal is to understand the roles trust plays in residents' self-examination and to offer insight from relationship science to inform the teaching and clinical work for better trust in healthcare. Methods We analyzed 767 re ective writings of 33 residents submitted anonymously, to identify explicit or implicit indicators attention to trust or relationship development. Two authors independently coded the entries based on inductively identi ed dimensions. Three authors developed a nal coding structure that was checked against the entries. These codes were sorted into nal dimensions. Results We identi ed 114 written re ections that contained one or more indicators of trust. These codes were compiled into ve code categories: Trust of self/trust as the basis for con dence in decision making; Trust of others in the medical community; Trust of the patient and its effect on clinician; Assessment of the trust of them exhibited by the patient; and Assessment of the effect of the patient's trust on the patient's behavior. Discussion Broadly, trust is both relationship-centered and institutionally situated. Trust is a process, built on reciprocity. There is tacit acknowledgement of the interplay among what the residents do is good for the patient, good for themselves, and good for the medical institution. A focus on moments in which trust is experienced or missed, as well as on types of trust, misses this complexity. Conclusion A greater awareness of how trust is present or absent could lead to a greater understanding and healthcare education for bene cial effects on clinicians' performance, personal and professional satisfaction, and improved quality in patients' interactions.
BMC health services research, 2005
Despite the recent proliferation in research on patient trust, it is seldom a primary outcome, and is often a peripheral area of interest. The length of our original scales to measure trust may limit their use because of the practical needs to minimize both respondent burden and research cost. The objective of this study was to develop three abbreviated scales to measure trust in: (1) a physician, (2) a health insurer, and (3) the medical profession. Data from two samples were used. The first was a telephone survey of English-speaking adults in the United States (N = 1117) and the second was a telephone survey of English-speaking adults residing in North Carolina who were members of a health maintenance organization (N = 1024). Data were analyzed to examine data completeness, scaling assumptions, internal consistency properties, and factor structure. Abbreviated measures (5-items) were developed for each of the three scales. Cronbach's alpha was 0.87 for trust in a physician (te...
The health care relationship (HCR) trust scale: Development and psychometric evaluation
Research in Nursing & Health, 2006
A sequential multi-method approach using focus groups, individual interviews, and quantitative instrument development procedures was used to develop and evaluate a scale to measure patient trust in health care providers (HCPs). The resulting 15-item Health Care Relationship (HCR) Trust Scale was tested for internal consistency, test-retest reliability, and construct validity. The Cronbach alphas were .92 (time 1) and .95 (time 2), respectively. Test-retest reliability was .59 (p < .01). The HCR Trust Scale did not correlate with the Marlowe-Crowne Social Desirability Scale (r ¼ .20, p ¼ .07) or the Rapid Estimate of Adult Literacy in Medicine scale (r ¼ À.21, p ¼ .13). Principal component factor analysis with varimax rotation revealed a three-factor solution that explained 69% of the estimated common variance in the HCR trust scale. Cronbach alphas for the 3 factors ranged from .81 to .89. Findings of this study support the use of the HCR Trust Scale for measuring trust in various HCPs by diverse patient populations. More work is needed to test the usefulness of the scale with a greater number of patients and in other chronic illness populations.
An improved scale for assessing patients’ trust in their physician
Health Marketing Quarterly, 2001
Patients' trust in their primary care physician is a critical concept for healthcare practitioners and scholars. At the clinical level, such trust buttresses patient-physician treatment relationships; at the organizational level, such trust fosters enhanced organizational effectiveness and other positive outcomes. To empirically assess various trust-related issues on both levels, we develop a comprehensive, bi-dimensional trust scale specific to patient-physician relationships. Response analysis from two samples suggests that the scale's benevolence dimension comprises understanding patients' individual experiences, expressing caring, communicating clearly and completely, building partnership and sharing power, demonstrating honesty and respect, and keeping information confidential. The scale's technical competence dimension comprises evaluating problems thoroughly, providing appropriate and effective treatment, predisposing factors, and structural and staffing factors.
Reciprocal trust in health care relationships
Journal of Advanced Nursing, 1988
Reciprocal trust in health care relationships This paper examines the phenomenon of trust in health care relationships from a new perspective, that ofthe recipients ofcare for chronic illness. The authors argue that reciprocal trust is a necessary component of satisfying, effective health care relationships when the illness is of an ongoing nature. From the patient's perspective, reciprocal trust has a significant impact on the experience of being a receiver of health care and on the development of competency with illness management. Because of this, the authors claim that it is imperative for health care professionals to alter their traditional beliefs with regard to sick role and trust. With a new perspective, they may then develop the specific skills necessary to enact the caring aspect ofthe service they offer. The authors offer a number of suggestions for actualizing this reciprocal trust in clinical practice.
Managed care members talk about trust
Social Science & Medicine, 2002
Informed choice of health insurance could morally justify later, potentially harmful rationing decisions the way informed consent justifies potentially harmful medical interventions. In complex and technical areas, however, individuals may base decisions more on trust than informed choice.
Determinats of Trust in Medical Personal
Although research of the public’s trust in doctors is burgeoning, little attention has been given to examining how much trust is professed for other medical personnel, beyond doctors. This is a salient issue given the increase in patients’ clinical time with auxiliary medical staff. Using logistic regression techniques, we analyzed data from the 2008 Survey of Quality of Life in Arkansas to identify predictors of trust in doctors, other medical personnel, and medical personnel of different racial or ethnic back-grounds among Latinos and non-Hispanic White respondents. Results indicate that health insurance coverage was the most consistent predictor across multiple measures of trust in medical personnel. However, race and ethnicity and citizenship status of the respondents were more salient. Implications and future research are also discussed in this article.