Journal of General Internal Medicine

, Volume 29, Issue 3, pp 500–506 | Cite as

Cultural Identity and Patient Trust Among Older American Indians

  • Vanessa W. Simonds
  • R. Turner Goins
  • Elizabeth M. Krantz
  • Eva Marie Garroutte
Original Research



Patients’ trust in healthcare providers and institutions has been identified as a likely contributor to racial-ethnic health disparities. The likely influence of patients’ cultural characteristics on trust is widely acknowledged but inadequately explored.


To compare levels of patients’ trust in primary care provider (interpersonal trust) with trust in healthcare organizations (institutional trust) among older American Indians (AIs), and determine associations with cultural identity.


Patient survey administered following primary care visits.


Two-hundred and nineteen American Indian patients ≥ 50 years receiving care for a non-acute condition at two clinics operated by the Cherokee Nation in northeastern Oklahoma.


Self-reported sociodemographic and cultural characteristics. Trust was measured using three questions about interpersonal trust and one measure of institutional trust; responses ranged from strongly agree to strongly disagree. Finding substantial variation only in institutional trust, we used logistic generalized estimating equations to examine relationships of patient cultural identity with institutional trust.


Ninety-five percent of patients reported trusting their individual provider, while only 46 % reported trusting their healthcare institution. Patients who strongly self-identified with an AI cultural identity had significantly lower institutional trust compared to those self-identifying less strongly (OR: 0.6, 95 % CI: 0.4, 0.9).


Interpersonal and institutional trust represent distinct dimensions of patients’ experience of care that may show important relationships to patients’ cultural characteristics. Strategies for addressing low institutional trust may have special relevance for patients who identify strongly with AI culture.


trust intercultural communication patient–provider communication Indians, North American cultural identity ethnic minority patient 



The authors gratefully acknowledge the guidance of the Cherokee Nation Institutional Review Board, as well as help in data collection and Cherokee translation from Research Assistants George Stopp and Amanda Bighorse Dominick, and from staff and volunteers at the research site. The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of Boston College, the University of Iowa, Oregon State University, University of Washington, University of Colorado-Denver, or the Cherokee Nation.


Data collection and analysis was supported by a grant from the National Institute on Aging [1K01 AG022434-01A2, PI: Garroutte]. Data analysis and manuscript preparation was also supported by a grant under the Resource Centers for Minority Aging Research program [P30AG015292, PI: Manson].

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Vanessa W. Simonds
    • 1
  • R. Turner Goins
    • 2
    • 5
  • Elizabeth M. Krantz
    • 3
  • Eva Marie Garroutte
    • 4
  1. 1.Department of Community and Behavioral Health, College of Public HealthUniversity of IowaIowa CityUSA
  2. 2.College of Health and Human Sciences, Department of Social WorkWestern Carolina UniversityCullowheeUSA
  3. 3.Vaccine and Infectious DiseaseFred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.Department of SociologyBoston CollegeBostonUSA
  5. 5.Mountain State Area Health Education CenterCenter for Healthy AgingAshevilleUSA

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