Year of Publication
BACKGROUND: Low-income and marginalized adults disproportionately bear the burden of poor asthma outcomes. One consequence of the structural racism which preserves these inequities is decreased trust in government and healthcare institutions.
OBJECTIVE: We examined whether such distrust extends to health care providers during the pandemic.
METHODS: We enrolled adults living in low-income neighborhoods who had had a hospitalization, ED visit, or prednisone course for asthma in the prior year. Trust was a dichotomized measure derived from a 5-item questionnaire with a 5-point Likert scale response The items were translated to a binary variable "strong" versus "weak" trust. Communication was measured using a 13-item questionnaire with a 5-point Likert scale. Logistic regression was used to examine the association between communication and trust, controlling for potential confounders.
RESULTS: We enrolled 102 patients, 18-78 years, 87% female, 90% Black, 60% some post-high school education, 57% receiving Medicaid. 58 patients were enrolled prior to the March 12, 2020 pandemic start date. 70 (68%) patients named doctors as their most trusted source of health information. Strong trust was associated with a negative response to: "It is hard to reach a person in my doctor's office by phone." There was no evidence of an association between the overall communication scores and trust. Satisfaction with virtual messaging was weaker among those with less trust.
CONCLUSIONS: These patients trust their physicians, value their advice, and need to have accessible means of communication.