Communication in medicine; Decision making; Minorities; Patient participation; Patient satisfaction; Patient trust; Patient-centered health care; Patient-centeredness; Physician and patient; Poor; Primary Provider Theory; Structural equation modeling; Trust


Community-Based Research | Demography, Population, and Ecology | Inequality and Stratification | Medicine and Health | Public Health


The purpose of this investigation was to determine the effect 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 effects 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 effect estimates.

RESULTS: The model fit well. Physician patient-centeredness significantly influenced 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’ confidence in and likelihood to recommend their physician. This pattern of effects 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 offers 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.