African American women perceptions of physician trustworthiness: A factorial survey analysis of physician race, gender and age

Physical concordance between physicians and patients is advocated as a solution to improve trust and health outcomes for racial/ethnic minorities, but the empirical evidence is mixed. We assessed women's perceptions of physician trustworthiness based on physician physical characteristics and context of medical visit. A factorial survey design was used in which a community-based sample of 313 African American (AA) women aged 45+ years responded to vignettes of contrived medical visits (routine versus serious medical concern visit) where the physician's race/ethnicity, gender, and age were randomly manipulated. Eight physician profiles were generated. General linear mixed modeling was used to assess separately and as an index, trust items of fidelity, honesty, competence, confidentiality, and global trust. Trust scores were based on a scale of 1 to 5, with higher scores indicating higher trust. Mean scores and effect sizes (ES) were used to assess magnitude of trust ratings. No significant differences were observed on the index of trust by physician profile characteristics or by medical visit context. However, the white-older-male was rated higher than the AA-older-female on fidelity (4.23 4.02; ES = 0.215, 95% CI: 0.001-0.431), competence (4.23 3.95; ES = 0.278, 95% CI: 0.062-0.494) and honesty (4.39 4.19, ES = 0.215, 95% CI: 0.001-0.431). The AA-older male was rated higher than the AA-older-female on competence (4.20 3.95; ES = 0.243, 95% CI: 0.022-0.464) and honesty (4.44 4.19; ES = 0.243, 95% CI: 0.022-0.464). The AA-young male was rated higher than AA-older-female on competence (4.16 3.95; ES = 0.205, 95% CI: 0.013-0.423). Concordance may hold no salience for some groups of older AA women with regards to perceived trustworthiness of a physician. Policies and programs that promote diversity in the healthcare workforce in order to reduce racial/ethnic disparities should emphasize cultural competency training for all physicians, which is important in understanding patients and to improving health outcomes.