Providing health care to low-income women: a matter of trust

• Published in: Family practice 2004-10, Vol.21 (5), p.484-491
• Main Authors: Sheppard, Vanessa B, Zambrana, Ruth E, O'Malley, Ann S
• Format: Article
• Language: English
• Subjects: Delivery of Health Care; Female; Humans; Low income women; Maternal health care; Minority Groups - psychology; minority women; patient trust; Physician-Patient Relations; Postpartum Period; Poverty; Prenatal Care; Trust; Trust - psychology; USA
• ISSN: 0263-2136; 1460-2229; 1460-2229
• DOI: 10.1093/fampra/cmh503

Background. Trust is an important indicator of quality in patient–provider relationships and predicts adherence to certain protective health behaviours. It has been relatively unexplored among low-income or minority women. Objectives. We explored health care experiences that influence patient trust among low-income women in the USA with respect to professionals and lay health workers (LHWs). Methods. Focus groups were conducted with 33 prenatal and postpartum women, aged 18–45 years, recruited from community-based public prenatal care programmes. Focus groups were audio-recorded, transcribed, and independently coded by readers. A model of factors associated with trust was developed based on the major thematic categories. Results. Most women were Black (67%) and had completed high school (85%). Factors related to greater trust specific to patient–provider relationships were: continuity of the patient–provider relationship, effective communication, demonstration of caring and perceived competence. Women with less trust in their physicians reported an unwillingness to follow his/her advice. Most women reported having more trusting relationships with LHWs and nurses than with physicians, probably due to greater contact with these staff. Several women with a low level of trust reported experiences of discrimination due to lack of insurance. Conclusions. Prenatal care presents a unique opportunity for providers to contribute to the elimination of health disparities among low-income women. Improving continuity with public health prenatal care providers and building strong relationships with LHWs may enhance quality of care and contribute to achieving this goal. Better patient–provider communication is also a practical area of focus towards improving patient trust.