An Exploratory Study of How Trust in Health Care Institutions Varies across African American, Hispanic and white Populations


  • Elizabeth Jacobs University of Wisconsin-Madison
  • Emily Mendenhall Northwestern University
  • Ann Scheck-McAlearney The Ohio State University
  • Italia Rolle University of Illinois at Chicago
  • Eric Whitaker University of Chicago
  • Richard Warnecke University of Illinois at Chicago
  • Carol Ferrans University of Illinois-Chicago



trust, distrust, institution, health care, race/ethnicity


Background: Minority and non-minority patients in the United States have different levels of trust in health care; however, few studies have examined how determinants of trust and distrust in health care vary across diverse groups. Objective: To explore how trust in health care institutions varies across diverse populations. Methods: We conducted 17 focus groups with 117 participants in Chicago: 9 with African American, 5 with Hispanic, and 3 with white participants. Discussions were audiotaped, transcribed verbatim and coded using grounded theory analysis to identify dominant themes. Results: We found a core set of factors that contribute to trust and distrust across racial/ethnic groups. In addition, there were unique factors that contributed to distrust among African Americans and Hispanics. Both of these groups discussed expectations of discrimination in the health care setting and African Americans discussed expectations of being experimented on as determinants of distrust. Based on these findings, we developed a hypothetical model of how different factors influence trust and distrust in health care across these different racial/ethnic groups. Conclusions: Contributors to trust and distrust in health care institutions are not always uniform across racial/ethnic groups. These differences should be addressed in future research and efforts to enhance trust in health care institutions.

Author Biographies

Elizabeth Jacobs, University of Wisconsin-Madison

Elizabeth Jacobs, MD, MAPP, FACP, received her MD from the University of California, San Francisco and trained as a general internist at Brigham and Women’s Hospital in Boston. She is currently Associate Vice Chair for Health Services Research in the Department of Medicine at the University of Wisconsin, Madison, where she conducts research on minority disparities in health care. She is recognized as an expert on the provision of linguistically accessible and culturally competent care and has served on Office of Minority Health, JCAHO and AHRQ expert panels.

Emily Mendenhall, Northwestern University

Emily Mendenhall is a PhD candidate in medical anthropology at Northwestern University. Her dissertation examines the syndemic relationship of gender-based violence, depression, and diabetes among women of Mexican descent in the United States. She also received her masters in global public health from the Rollins School of Public Health at Emory University where she studied gender dynamics among HIV sero-discordant couples in Lusaka, Zambia. She recently published an edited volume, "Global Health Narratives: A Reader for Youth" (2009, University of New Mexico Press).

Ann Scheck-McAlearney, The Ohio State University

Ann Scheck McAlearney received her ScD in Health Policy and Management from Harvard. She is currently Associate Professor of Health Services Management and Policy at Ohio State University. Her research interests include the areas of quality improvement and information technology innovations in healthcare, access to care, and leadership development. She has published three books, most recently the ninth edition of Health Care Management: Cases, Readings and Commentary (2010, Health Administration Press).

Italia Rolle, University of Illinois at Chicago

Italia Rolle received her PhD in Public Health (Epidemiology and Maternal and Child Health) from the School of Public Health at the University of Illinois, Chicago. She currently is an Epidemiologist working in global health at the Center for Disease Control and Prevention. Her research interests include examining the global burden of chronic diseases and developing and implementing chronic disease surveillance systems.

Eric Whitaker, University of Chicago

Eric E. Whitaker, MD, MPH, received his MD from the University of Chicago and MPH from Harvard University. His clinical training is in Internal Medicine as well as Preventive Medicine. A former Illinois state health commissioner, he is currently Executive Vice President, University of Chicago Medical Center where he heads its Urban Health Initiative (UHI). The UHI aims to improve the health of the Medical Center's surrounding neighborhoods through its mission of patient care, teaching and research.

Richard Warnecke, University of Illinois at Chicago

Richard B. Warnecke received his PhD in sociology from Duke University in 1966. He has conducted cancer control research with populations of color and low socioeconomic status since 1968 using a variety of quantitative and qualitative approaches in his work. He currently co-directs an NCI-funded Center for Population Health and Health Disparities at the University of Illinois at Chicago. He is Professor Emeritus (Sociology, Epidemiology, and Public Administration).

Carol Ferrans, University of Illinois-Chicago

Carol Estwing Ferrans, RN, FAAN, received her PhD in biobehavioral health science from the University of Illinois-Chicago (UIC). She is currently Professor and Associate Dean for Research in the UIC College of Nursing, as well as Co-Director of the UIC Center of Excellence in Eliminating Health Disparities. Her program of research has focused on quality of life and health disparities for more than 20 years.



How to Cite

Jacobs, E., Mendenhall, E., Scheck-McAlearney, A., Rolle, I., Whitaker, E., Warnecke, R., & Ferrans, C. (2011). An Exploratory Study of How Trust in Health Care Institutions Varies across African American, Hispanic and white Populations. Communication and Medicine, 8(1), 89–98.