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Characteristic English-speaking Japanese Americans Japanese-speaking Japanese Americans Japanese Living in Japan HRQOL= health-related quality of life. * P <.001. † Japanese yen converted to US dollars (¥140 = $1). ‡ P <.01. § Autonomy Preference Index ranges from 1 to 5; higher score indicates greater autonomy. || Acculturation score ranges from 0 to 100; higher score indicates more acculturation. ¶ Health-related quality of life measured by SF-12 on 0 to 100 scale; higher score is better. Number 467 315 175 Mean age, y (SD)* 64.5 (13.5) 74.7 (9.1) 65.8 (8.6) Male, %* 61.7 35.1 40.2 Marital status, %* Married 70.0 50.7 76.4 Divorced or separated 5.6 10.4 6.9 Widowed 19.9 33.3 14.4 Never married 4.5 5.6 2.3 Household income ≤$50,000, %*† 58.4 84.6 79.3 Working, %* 43.5 23.1 35.3 Mean years of education (SD)* 14.1 (2.9) 11.5 (2.6) 11.3 (2.6) Religious affiliation, %* Christian 37.1 14.3 2.9 Buddhist 47.7 61.5 70.4 No specific affiliation 13.1 19.3 24.4 Other religion 2.2 5.0 2.3 Religiosity, %* Not religious 48.6 47.0 57.6 Religious, not a church member 16.3 23.0 27.3 Religious, church member 35.1 30.0 15.1 Health Insurance, %* National insurance NA NA 100 Medicare 41.5 32.8 NA Private 55.7 46.8 NA Medicaid alone/no insurance 2.8 20.4 NA Have a regular doctor, %‡ 99.8 98.0 100 Ethnicity of regular doctor, %* Japanese 35.7 66.2 NA White 40.2 12.8 NA Other Asian 17.0 19.0 NA Other ethnicity 7.2 2.0 NA Mean years with regular doctor (SD)‡ 3.5 (1.3) 3.7 (1.3) 3.8 (1.1) Autonomy Preference Index (SD)*§ 3.1 (1.2) 1.7 (0.8) 2.3 (0.99) Mean acculturation score (SD)*|| 69.1 (23.8) 26.0 (23.7) NA HRQOL, mean (SD)¶ Physical summary score* 48.9 (9.6) 47.1 (8.8) 46.2 (8.5) Mental summary score* 53.6 (7.8) 49.8 (8.8) 45.6 (7.5) Mean number of chronic conditions (SD) 2.2 (1.7) 2.0 (1.6) 2.0 (1.5) Hospitalization in past 6 months, %‡ 6.2 12.6 9.1 - Table 2.
Bivariate Relationship of Patient Characteristics and Patient-Physician Relationship with Trust
Characteristics n Mean Trust Score R2 PValue HRQOL = health-related quality of life. *Sample limited to Japanese Americans. Group 957 <.001 English-speaking Japanese Americans 83.2 Japanese-speaking Japanese Americans 80.3 Japanese living in Japan 67.5 Male 946 80.4 .08 Female 78.4 Age, years 935 — 0.16 <.001 Marital status 943 <.001 Divorced or separated 71.9 Never married 80.2 Married 78.6 Widowed 83.9 Household income 872 .70 <$50,000 79.3 >$50,000 78.7 Education 934 — 0.00 .87 Religious affiliation 932 <.001 Christian 83.1 Buddhist 79.7 Other; no specific religion 74.4 Religiosity 932 <.001 Not religious 75.9 Religious, not a church member 79.5 Religious, church member 85.3 Health Insurance 773 <.01 Medicare 84.8 Private 80.3 Medicaid only/no insurance 81.3 Other insurance 83.3 HRQOL from SF-12 Physical summary score 806 — 0.02 .53 Mental summary score 806 — 0.21 <.001 Chronic conditions 932 — 0.01 .78 Hospitalization in past 6 months 934 82.0 .20 No hospitalization past 6 months 79.3 Ethnicity of regular doctor* 765 <.001 Japanese 84.7 White 82.1 Other ethnicity 77.2 Years with regular doctor 940 — 0.22 <.001 Autonomy preference index 901 — −0.12 <.001 Acculturation score* 780 — 0.10 .004 - Table 3.
Two Multivariate Models of Patients’ Trust in One’s Physician: Including Patients’ Demographic and Clinical Variables, and Adding Patients’ Autonomy Preference and Length of Relationship With Physician*
Independent Variables* Including Demographic and Clinical Variables (95% CI) Including Demographic and Clinical Variables, Plus Autonomy and Length of Relationship With Physician (95% CI) Note: Coefficients presented from multiple linear regression model that includes demographic and clinical variables and has n = 876 and adjusted R2 = 0.19. Model including demographics, clinical variables, autonomy and physician relationship has n = 826 and adjusted R2 = 0.26. CI = confidence interval; HRQOL = health-related quality of life. * Independent variables have reference groups as follows: Group – Japanese living in Japan; female – male; age – per year; marital status – married; education – per year; religiosity – not religious; physical HRQOL score – per point on 100-point scale; mental HRQOL score – per point on 100-point scale; hospitalization in past 6 months – no hospitalization; years with regular doctor – per year; Autonomy Preference Index – per point on 5-point scale. Group English-speaking Japanese Americans 13.6 (10.2–17.0) 16.6 (13.25–20.04) Japanese-speaking Japanese Americans 9.44 (6.02–12.9) 9.87 (6.52–13.25) Female −2.88 (−5.40– v0.34) −2.16 (−4.62–0.30) Age 0.19 (0.08–0.31) 0.04 (−0.08–0.16) Marital status Divorced/separated −5.02 (−9.38 to −0.66) −4.84 (−9.18 to −0.50) Never married 2.68 (−2.71–8.07) 2.05 (−3.06–7.17) Widowed 3.22 (0.09-6.35) 4.05 (0.98–7.12) Education −0.40 (−0.84-0.04) −0.28 (−0.72-0.15) Religiosity Religious, not a church member 4.94 (2.09–7.79) 4.51 (1.73–7.29) Religious, church member 7.41 (4.82–9.99) 7.45 (4.93–9.97) Physical summary score 0.16 (0.02–0.30) 0.19 (0.06–0.32) Mental summary score 0.19 (0.05–0.34) 0.16 (0.02–0.31) Hospitalization in past 6 months 4.86 (0.94–8.78) 3.85 (−0.04–7.73) Years with regular doctor — 2.94 (2.07–3.80) Autonomy preference index — −3.00 (−4.12 to -1.88) - Table 4.
Japanese Americans Only: Multivariate Models of Trust Including Acculturation and Physician Ethnicity
Independent Variables* Demographic and Clinical Variables (95% CI) Including Demographic and Clinical Variables, Plus Autonomy and Length of MD Relationship (95% CI) Note: Coefficients presented from multiple linear regression model that includes demographics and clinical variables has n = 705 and adjusted R2 = 0.08. Model including demographics, clinical variables, autonomy and physician relationship has n = 652 and adjusted R2 = 0.19. MD = physician; CI = confidence interval; HRQOL = health-related quality of life. * Independent variables have reference groups as follows: Group – Japanese living in Japan; female – male; age – per year; marital status – married; education – per year; religiosity – not religious; physical HRQOL score – per point on 100-point scale; mental HRQOL score – per point on 100-point scale; hospitalization in past 6 months – no hospitalization; ethnicity of regular doctor – Japanese; years with regular doctor – per year; Autonomy Preference Index – per point on 5-point scale; acculturation score – per point on a 100-point scale. Female −2.43 (−5.16-0.29) −1.77 (−4.36-0.82) Age 0.14 (0.02-0.25) −0.052 (−0.18-0.07) Marital status Divorced/separated −7.25 (−12.0 to −2.54) −6.75 (−11.4 to −2.07) Never married 1.62 (−3.86–7.09) 0.49 (−4.74–5.72) Widowed 2.98 (−0.37–6.33) 4.50 (1.26–7.74) Education −0.12 (−0.57-0.33) −0.07 (−0.54-0.40) Religiosity Religious, not a church member 3.49 (0.30–6.68) 4.01 (0.94–7.09) Religious, church member 6.29 (3.62–8.97) 6.76 (4.21–9.32) Physical summary score 0.10 (−0.04-0.24) 0.14 (0.00–0.28) Mental summary score 0.28 (0.13–0.43) 0.25 (0.10–0.40) Hospitalization in past 6 months 4.37 (0.13–8.60) 4.31 (0.06–8.57) Ethnicity of regular doctor White — −3.18 (−6.01 to −0.36) Other ethnicity — −6.46 (−9.48 to −3.44) Years with regular doctor — 2.59 (1.67–3.52) Autonomy Preference Index — −2.70 (−3.84 to −1.57) Acculturation score — 0.08 (0.03–0.12) - Table 5.
Japanese Americans Only: Relationship of Changing Physicians and Physician (MD) Ethnicity With Trust in Physician
Did Not Want to Change MD OK to Change MD Previous MD Current MD n Mean Previous MD Trust Mean Current MD Trust Change n Mean Previous MD Trust Mean Current MD Trust Change Overall Difference * P value <.05. † P value <.01. ‡ P value <.001. Japanese Japanese 46 88.9 85.8 −3.1 32 74.7 79.2 4.5 7.6* White 6 93.1 80.5 −12.6 9 75.0 82.4 7.4 20.0 Other 6 91.7 68.1 −23.6 6 66.7 68.1 1.4 25.0 White Japanese 7 89.3 85.7 −3.6 6 61.1 80.6 19.5 43.1* White 23 91.3 84.8 −6.5 21 73.4 79.8 6.4 12.9* Other 6 81.9 77.8 −4.1 16 72.4 77.1 4.7 8.8 Other Japanese 4 85.4 72.9 −12.5 3 63.9 83.3 19.4 31.9 White 4 87.5 64.6 −22.9 12 69.4 75.7 6.3 29.2† Other 10 89.2 75.8 −13.4 16 66.7 65.6 −1.1 12.3* Overall 112 89.3 81.8 −7.5‡ 121 71.3 76.7 5.4† 12.9‡
Additional Files
The Article in Brief
Background: Do cultural factors affect trust in the relationship between patient and doctor? This study examined a variety of factors related to trust in the patient-doctor relationship for Japanese individuals from Japan and for Japanese Americans.
What This Study Found: Among Japanese and Japanese Americans, the following characteristics are related to having more trust in their doctor: being married, being more religious, having a longer relationship with a doctor, and being less interested in making independent medical decisions. For Japanese Americans, adapting to Western culture and being of an ethnic background similar that of the doctor were related to having more trust, while having to change doctors because of insurance was related to less trust.
Implications:
� These characteristics can alert doctors to patients who might have lower levels of trust.
� Doctors may need to make special efforts to build trust with patients who are of different ethnic backgrounds.
� Training doctors to understand and accept different cultural norms may help them build trust with patients of different ethnic backgrounds.
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