What Influences Trust in Health Professionals?: An Examination of Social Networks of Latinx Patients with Type 2 Diabetes Mellitus

Background and Purpose: Trust in health professionals is fundamental to health outcomes for patients with type 2 diabetes mellitus (T2DM). However, the legacy of discrimination based on race and ethnicity in health care undermines trust in health professionals among Latinx patients. Trust in health professionals further decline in the United States among Spanish-speaking Latinx. A lack of cultural competency and Spanish-speaking providers in many health care settings additionally create community-level distrust toward health professionals. According to social contagion theory, if a majority of community members trust health professionals, this social norm can be contagious throughout an individual’s social network. Our study explored this proposition that patient’s trust in health professionals is explained by characteristics of social networks in which Latinx patients with T2DM are situated.

Methods: A bilingual interviewer completed cross-sectional surveys with 102 Latinx patients with T2DM, recruited from a community health center in the Southwest region of the United States between February and December 2019. Each patient completed a psychosocial survey and a personal network analysis (PNA). The PNA consisted of nine name generating questions (e.g., “Who do you discuss your health with?”) and a series of name interpreting questions (e.g., “Do you think [network member] trusts doctors to take care of people’s problems?”). The proportion of network members trusting health professionals and the proportion of network members identifying as Latinx were used to measure degree of embeddedness in a social environment whose social norm is to distrust health professionals. We examined heterogeneity of network members’ trust in health professionals to measure diversity of social norms related to trust. The Trust in Physician Scale was used to measure trust in health professionals. In order to meet normality assumptions, we conducted a natural log transformation of this variable. We controlled for patient-level attributes such as gender, age, education, and language preference. A series of linear regression analyses were performed to identify correlates for trust in health professionals (N=93).

Results: Latinx patients with a greater proportion of network members who had a lot of trust in health professionals reported more trust in health professionals (β=.24; p<.05). However, Latinx patients reported less trust in health professionals when a greater proportion of their network members identified as immediate kin (β=-.28; p<.05). Latinx patients also reported less trust in health professionals when their networks had more heterogeneity with trust in health professionals (β=-.43; p<.05).

Conclusions and Implications: Our study uncovered nuances of social environment relevant to Latinx patient’s trust in health professionals. Consistent with social contagion theory, Latinx patients surrounded by more network members who trust health professionals reported higher trust in health professionals. Yet, patients with a higher share of immediate kin in their social networks surprisingly reported lower trust in health professionals. In addition, those surrounded by network members with higher variation of trust in health professionals reported lower trust in health professionals. These mixed findings hint at complicated and nuanced social dynamics affecting Latinx patients within their social environment.