The Influence of Patient-Centeredness on Minority and Socioeconomically-Disadvantaged Patientsâ•Ž Trust in their Physicians: An Evidence-Based Structural Equation Modeling Investigation

The purpose of this investigation was to determine the eff ect of physician patient-centeredness on patient trust across randomly selected groups of patients from an inner city medical practice serving a preponderance of minority and socioeconomically-disadvantaged patients. METHODS: A two-factor multigroup structural equation modeling design was employed, with randomly selected test (N = 300) and cross-validation (N = 300) samples of medical practice patients. Equality constraints were established to test the invariance of eff ects across groups. The model was compared to its unconstrained counterpart to further test its trustworthiness. An additional 5,000 nonparametric bootstrapped samples for each group were generated to further cross-validate and assess the stability of eff ect estimates. RESULTS: The model fi t well. Physician patient-centeredness signifi cantly infl uenced patient trust, explaining 82 percent of its variability. When physician patient-centeredness increased by one unit, the predicted value for patient trust increased by 1.043 units (.903 standardized). Patient-centered physician behaviors increased patients’ confi dence in and likelihood to recommend their physician. This pa ern of eff ects held across the test and cross-validation groups. The hypothesized model was sustained when compared to its competing counterpart. CONCLUSIONS: Evidence supported the factor and structural validity of the model. This study off ers a plausible two-factor model for the measurement and improvement of patient-centeredness, and concomitantly, patient trust in an inner city medical clinic serving minority and socioeconomically-disadvantaged patients. In addition to quality improvement and outcome measurement, the results have implications for improving patient-centeredness, patient trust, the patient–provider relationship, medical education, and reducing health care disparities. , pp. 63–74 64 Journal of Health Disparities Research and Practice • Vol. 1, No. 1 • Fall 2006