Trust and distrust among Appalachian women regarding cervical cancer screening: a qualitative study

Patient Educ Couns. 2012 Jan;86(1):120-6. doi: 10.1016/j.pec.2011.02.023. Epub 2011 Apr 1.


Objective: To explore Appalachian women's perceptions of trust and distrust of healthcare providers and the medical care system as they relate to views about cervical cancer and screening.

Methods: Thirty-six Ohio Appalachia female residents participated in community focus groups conducted by trained facilitators. Discussion topics included factors related to cervical cancer, and the issues of trust and distrust in medical care. The tape-recorded focus groups were transcribed and analyzed to identify salient themes.

Results: Five themes emerged related to trust in healthcare. Patient-centered communication and encouragement from a healthcare provider led women to trust their physicians and the medical care system. In contrast, lack of patient-centered communication by providers and perceptions of poor quality of care led to distrust. Physician gender concordance also contributed to trust as women reported trust of female physicians and distrust of male physicians; trust in male physicians was reported to be increased by the presence of a female nurse.

Conclusions: Important factors associated with trust and distrust of providers and the medical care system may impact health-seeking behaviors among underserved women.

Practice implications: Opportunities to improve patient-centered communication around the issues of prevention and cervical cancer screening (such as providing patient-focused information about access to appropriate screening tests) could be used to improve patient care and build patients' trust.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Appalachian Region
  • Communication
  • Early Detection of Cancer / psychology*
  • Fear
  • Female
  • Focus Groups
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Middle Aged
  • Ohio
  • Patient Satisfaction*
  • Patient-Centered Care / methods
  • Physician-Patient Relations*
  • Qualitative Research
  • Sex Factors
  • Tape Recording
  • Trust / psychology*
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / psychology
  • Women's Health*
  • Young Adult