Trust in Physicians Among U.S. Chinese Older Adults

Trust is fundamental in clinical patient–physician relationships (1). Patients’ trust in physicians (TIP) measures the extent to which patients believe that their physicians will act in their best interest to provide medical suggestions, care, and treatment (2). TIP is essential in assessing the quality and effectiveness of medical care because it influences patients’ willingness to seek care, adherence to physicians’ instructions, continuity of care, and overall health outcomes (3). In particular, TIP is critical for older adults due to the high prevalence of multimorbidity and complex medical needs for chronic disease management (4,5). With the rapidly evolving nature of the health care system, there is a growing need to advance our knowledge on TIP among older adults. Prior studies found that older age is associated with a higher level of TIP (2,5,6). However, these studies were based on the general population and were thus limited in providing detailed information on older adults specifically. Although we have improved knowledge about TIP among older adults in the recent years, most prior studies were based on more selected populations of older adults (7,8) or a single measure of TIP (9). Furthermore, TIP as a multidimensional construct was measured qualitatively in many studies, and fewer studies explored TIP with quantitative measures (10). In addition, in quantitative studies, TIP was often conceptualized and measured in diverse ways with different subcomponents, which may make meaningful comparisons challenging (10). For instance, although fidelity and competence components are constantly enforced in most scales estimating TIP, Kao’ scale excludes honesty and behavior component, Wake Forest’s scale excludes confidentiality and behavior components, and Anderson et al. Trust in Physician Scale provides a coverage of all six components including fidelity, competence, honesty, confidentiality, global, and behavioral (11). An increasing body of literature documents racial/ethnic disparities in TIP. Although factors contributing to trust and distrust in physicians may differ across racial/ethnicity groups (12), minority groups were more likely to report greater distrust and lower satisfactory toward their physicians compared with dominant groups. In particular, literature suggests that Asian Americans displayed the lower level of satisfactory and less sharing in patient–physician relationship based on a 100-point self-reported rating (13). A national survey suggests that Asian Americans are more likely than whites to report their physicians as not understanding of their needs and not spending enough time with them (14) based on a dichotomized measure of TIF (14). Despite that Asian Americans are often underrepresented in many studies, they are frequently treated as a homogeneous group in research, limiting our capability to distinguish cultural beliefs and health behaviors in diverse Asian subgroups with respect to TIP. The Chinese community is the oldest and largest Asian American subgroup in the United States (15). Older adults constitute a large segment of the general Chinese population in the United States, of whom 15.4% are aged 65 or older (15). More than 80% of Chinese older adults were foreign born, and approximately 30% of them immigrated to the United States after the age of 60. Their immigration experiences, degree of acculturation, and previous physician–patient relationships before residing in the United States may contribute to their current levels of TIP in the United States (16). A case study based on a U.S. Chinese immigrant family identified how TIP was influenced by their understanding of different cultures (17). However, the vast intragroup diversity in languages, education levels, socioeconomic status, and degree of acculturation among U.S. Chinese older adults contributes to the dearth of evidence-based research targeting at Chinese older adults (18). This study aims to contribute to the existing knowledge base of TIP among U.S. community-dwelling Chinese older adults by examining their level of TIP and the correlations between TIP and sociodemographic, overall health, and quality-of-life characteristics.