Differences in the patterns of health care system distrust between blacks and whites
Differences in the patterns of health care system distrust between blacks and whites
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DOI：
10.1007/s11606-008-0561-9
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发表时间：
2008-06-01
影响因子：
5.7
通讯作者：
Shea, Judy A.
中科院分区：
文献类型：
--
作者：
Armstrong, Katrina;McMurphy, Suzanne;Shea, Judy A.
背景：虽然与医疗保健相关的不信任可能会导致美国在健康和医疗保健方面的种族差异，但目前关于不信任的种族差异的证据往往是相互矛盾的，主要限于医生信任的措施，很少与多维信任或不信任联系在一起。目的：为了检验这一假设，即医疗保健系统不信任的种族差异与价值观不信任的关系比与能力不信任的关系更密切。设计：参与者：255名个体（144名黑人，92名白色）曾在初级保健实践或一个大的，城市中大西洋卫生系统的急诊科治疗.主要措施：种族，整体卫生保健系统不信任量表和2个不信任子量表，价值不信任和能力不信任的分数.在单变量分析中，黑人的总体医疗保健系统不信任得分略高于白人（25.8 vs 24.1，p=.05）;然而，这种差异是由价值观不信任分数的种族差异造成的，（15.4 vs 13.8，p= 0.003），而不是能力不信任评分（10.4 vs 10.3，p= 0.85）。在调整了社会经济地位、健康/心理状况和医疗保健的可及性之后，在价值观不信任度上处于前四分位的人更有可能是黑人。（比值比=2.60，95%可信区间=1.03-6.58），但种族与能力不信任之间没有显著关联。医疗保健系统不信任的种族差异是复杂的，在价值观不信任领域的差异远远大于能力不信任。这一框架可能是有用的解释混合结果的种族和医疗保健相关的不信任的研究，为设计未来的研究探索种族差异的原因，在健康和医疗保健，并为开发和测试新的战略，以减少这些差距。
CONTEXT: Although health care-related distrust may contribute to racial disparities in health and health care in the US, current evidence about racial differences in distrust is often conflicting, largely limited to measures of physician trust, and rarely linked to multidimensional trust or distrust.OBJECTIVE: To test the hypothesis that racial differences in health care system distrust are more closely linked to values distrust than to competence distrust.DESIGN: Cross-sectional telephone survey.PARTICIPANTS: Two hundred fifty-five individuals (144 black, 92 white) who had been treated in primary care practices or the emergency department of a large, urban Mid-Atlantic health system.PRIMARY MEASURES: Race, scores on the overall health care system distrust scale and on the 2 distrust subscales, values distrust and competence distrust.RESULTS: In univariate analysis, overall health care system distrust scores were slightly higher among blacks than whites (25.8 vs 24.1, p=.05); however, this difference was driven by racial differences in values distrust scores (15.4 vs 13.8, p=.003) rather than in competence distrust scores (10.4 vs 10.3, p=.85). After adjustment for socioeconomic status, health/psychological status, and health care access, individuals in the top quartile of values distrust were significantly more likely to be black (odds ratio=2.60, 95% confidence interval=1.03-6.58), but there was no significant association between race and competence distrust.CONCLUSIONS: Racial differences in health care system distrust are complex with far greater differences seen in the domain of values distrust than in competence distrust. This framework may be useful for explaining the mixed results of studies of race and health care-related distrust to date, for the design of future studies exploring the causes of racial disparities in health and health care, and for the development and testing of novel strategies for reducing these disparities.