76 - Experiences of Discrimination and Trust in Healthcare Providers

Poster Number: 76
Publication Number: 76.210

Arshdeep Kaur, California University of Science and Medicine-School of Medicine, Colton, CA, United States; Laura M. Gottlieb, UCSF, SF, CA, United States; Stephanie Ettinger de Cuba, Boston University School of Medicine, Boston, MA, United States; Eric W. Fleegler, Boston Children's Hospital, Boston, MA, United States; Elena Byhoff, Tufts University School of Medicine, Boston, MA, United States; Alicia Cohen, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Nathaniel J. Glasser, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Chicago, IL, United States; Mark J. Ommerborn, Brigham and Women's Hospital, Boston, MA, United States; Cheryl R. Clark, Brigham and Women’s Hospital, Boston, MA, United States; Ardis Olson, Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Emilia De Marchis, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Higher trust in one’s healthcare provider has been linked to increased patient satisfaction and better health outcomes. Lower trust has been associated with experiences of healthcare-based discrimination. In this study, we further explored the relationship between trust and discrimination.

Objective: To assess levels of trust in healthcare providers and prevalence of healthcare-based discrimination, and to identify factors associated with trust.

Design/Methods: Secondary analysis of a cross-sectional study of a convenience sample of adult patients and adult caregivers of pediatric patients from 11 primary care and emergency department sites across the U.S. Participants self-completed a survey including questions about level of trust in their own or their child’s provider, their experiences of seven types of discrimination in healthcare, their or their child’s health status, and experiences with healthcare-based social risk screening. We used chi-square testing for descriptive analyses and multivariable logistic regressions to examine associations between covariates and trust.

Results: Of 1013 participants, low/medium trust (defined as 1-7 on a scale of 1-10, vs. 8-10 for high trust) was reported by 13% of non-Hispanic white, 26% of non-Hispanic Black, 23% of Hispanic, and 18% of non-Hispanic multiple/other race participants (p=0.001). Experience of any healthcare-based discrimination was reported by 23% of Hispanic, 26% of non-Hispanic white, 32% of non-Hispanic Black, and 39% of non-Hispanic multiple/other race participants (p=0.012). Participants reporting low/medium trust had an average discrimination score of 1.65/7, vs. 0.57/7 for participants reporting high trust (p < 0.001). In our adjusted model, higher discrimination score was associated with lower odds of high trust (AOR=0.74, 95% CI=0.64, 0.85), and better self-rated health was associated with higher odds of high trust (AOR=3.15, 95% CI=2.01, 4.92). A significant interaction indicated that prior social risk screening was associated with reduced impact of discrimination on trust: as discrimination score increased, odds of high trust were greater among participants who had been screened (AOR=1.28, 95% CI=1.03, 1.58).Conclusion(s): Patients’ and caregivers’ experiences of healthcare-based discrimination influence provider trust, which may be one mechanism through which discrimination leads to poor health outcomes. Anti-racist practices are needed to reduce discrimination and strengthen patient-provider relationships. In addition, social risk screening may mitigate the impact of discrimination on trust; future work should explore this pathway.
Table 1Sample characteristics by level of trust in healthcare provider
Table 2Trust in healthcare provider and experiences of healthcare discrimination by race/ethnicity