All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Andrea Cherrington

Elizabeth Jacobs

Maria Pisu

M Paige Powell

Bisakha Sen

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


The purpose of this dissertation is to examine patient-related factors that predict trust in one's physician, and subsequently identify the role of patient trust in health care utilization and clinical outcomes among African Americans with hypertension. Three separate studies are conducted using an adapted version of the Interaction Model for Client Health Behavior (IMCHB). The first paper is a three-step review of quantitative studies investigating the (a) patient characteristics that influence trust; (b) impact of trust on health care utilization; and (c) impact of trust on outcomes. Based on the predictors identified, the second study examines the significance of these predictors among African Americans, a group that tends to report lower trust. The final study uses the same sample from the second study and examines the association of perceived racism and low trust on low utilization and uncontrolled blood pressure and blood glucose. In the first study, the main patient-related predictors are race, perceived racism, and experiences of discrimination. Previous research exposes a recurring association between trust and adherence, preventive screening, delayed check-ups and unmet health needs. Patient satisfaction and clinical improvement are two major outcomes. In the second study, the results indicate that perceived racism and an active response to discrimination are significantly associated with trust but in opposing directions. The final study reveals that perceived racism and low trust are associated with low utilization, but trust does not mediate the relationship between perceived racism and utilization. Low trust is associated with low utilization and poor glycemic control, but neither perceived racism or trust have a significant relationship with uncontrolled blood pressure. The findings from this dissertation contribute to the current literature on patient trust by describing its significance in a chronic condition that often requires frequent health care interactions for optimal health management. Patients with low trust may anticipate a negative encounter with their physician and avoid health care visits. Although this potential avoidance is not associated with their blood pressure levels, it was associated with poor glycemic control. Health care avoidance among individuals with chronic diseases leads to poor disease management and increased risk for negative outcomes.



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