Trust in African Americans' Healthcare Experiences

Purpose The purpose of the study is to clarify the concept of trust, identify its defining attributes, antecedents, and consequences, and apply to the healthcare experiences of African Americans. Background For African Americans, mistrust in the healthcare system is the result of unequal treatment that began in slavery. Fear and negative experiences engender a reluctance to trust healthcare providers, which contributes to health disparities. Design Walker and Avant's method of concept analysis was used to clarify the concept of trust. The concept was applied to African Americans’ healthcare experiences with discussion of opportunities for trust building. Data Source Data support for concept development was done using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and online reference sources. Review Methods Literature review was guided by using the keyword trust. Further contextual explication was done by adding a review of literature from sociology and history regarding the evolution of African American mistrust of the U.S. healthcare system. Results The defining attributes of trust are dependence, willingness, and met expectations. Antecedents to trust include a need requiring the help of another and prior knowledge or experience. The consequence of trust is an evaluation of the congruence between expected and actual behaviors of the trusted person or thing. Literature review of the African American culture adds a dynamic aspect for nurses to consider when developing relationships in minority communities. Conclusion Trust is the willingness to enter a dependent relationship to have the needs addressed, and is maintained by met expectations. Rebuilding trusting relationships between providers and African American patients is a vital step toward reducing health disparities. Murray