Black, Asian and Hispanic Patients Report Lower Levels of Trust in Their Healthcare Providers Compared to White Patients
(January 2025)
MHQP’s Annual Statewide Patient Experience Survey Documents Disparities for Fourth Year in a Row
Patient-provider trust is widely viewed as a foundational element of quality patient care. Research shows that higher levels of trust are associated with patients’ willingness to seek treatment,1,2 adherence to treatment recommendations,3,4 and improved health outcomes.5 This dynamic is particularly important in primary care, where long-term relationships are intended to provide patients with a trusted source for comprehensive and continuous care.
That is why, four years ago, MHQP added validated questions about trust to its annual statewide Patient Experience Survey. This scientifically rigorous survey of patients’ experiences with primary care, which is made possible through a collaborative initiative between MHQP, health plans and provider organizations, establishes accountability and reliable comparisons of provider performance for Massachusetts. The newly added trust questions ask respondents to evaluate the level of trust they place in their provider’s decisions, honesty about treatment options, and overall trust in their provider. Responses are aggregated to form a “Trust Composite Score” for each respondent, which are then combined to create overall statewide scores.
Now, in anticipation of Martin Luther King Day on January 20th and the National Day of Racial Healing on January 21st, MHQP is sharing the Trust Composite Scores from its 2024 Patient Experience Survey stratified by race and ethnicity. For the fourth year in a row, these data reveal that commercially insured Black, Asian, and Hispanic patients consistently report significantly lower levels of trust in their healthcare providers compared to White patients.
In 2024, adult White respondents reported an overall score of 88.3% on the Trust Composite Score, while Black, Asian, and Hispanic respondents reported scores of 85.4%, 82.7% and 85.7%, respectively. Similarly, pediatric White patients (whose parents or guardians usually complete the survey) reported an overall score of 93.3% on the Trust Composite Score in 2024, while Black, Asian, and Hispanic respondents reported scores of 90.5%, 88.4% and 91.9%, respectively. These disparities are all statistically significant and reflect consistent patterns observed over the previous three years, as shown in the charts below:
These findings are consistent with qualitative feedback MHQP has heard from Black patients who were asked to speak about trust in healthcare as part of a project aimed at identifying research directions to reduce mistrust. Here, for example, are some patient quotes from that project:
“You talk about mistrust. It …took my entire family to say ‘this just isn’t what care looks like.’ But then how do you [as] a Black person, sit back and say, ‘what does care look like when you’ve never had it before?’”
“It’s just things we go through that makes us look at ‘should I believe in this doctor?’ or if something comes up again, ‘what do I do? …how do I live through this? Do I go ahead and get it done?’ It’s just a matter of life and death with some of us, and we have to make a decision…But there’s something we need to look at and…really have trust in doctors and…understand the treatment that’s at hand…”
“I understand more [that] we as Black folks have become so intimidated by somebody that we think knows more than we do about us or our bodies that we just sort of sit there, take it, go somewhere quietly and suffer. That’s what they want us to do. We need to stop.”
“These deeply troubling quotes shed light on the persistent disparities we see in patient-provider trust,” says Barbra Rabson, MHQP’s President and CEO. “Quality healthcare is built on strong, supportive relationships between patients and their healthcare team. It is simply unacceptable that systemic inequities leave some populations with fundamentally worse experiences of care. We need to address the root causes of these disparities related to trust, starting with understanding the many layers of mistrust and developing community-centered solutions.”
MHQP plans to continue to push this agenda forward through a multi-pronged approach of policy and practice improvement, in partnership with leaders and stakeholders across the state. For more information, please contact Molly Totman, MHQP’s Senior Director of Quality Initiatives at mtotman@mhqp.org.