# Trust in Healthcare Providers Among American Indians in the Midwest

## TL;DR

This study finds that low trust in healthcare providers is linked to prescription drug misuse among American Indians in the Midwest, suggesting that improving trust could help reduce this public health issue.

## Contribution

The study provides new evidence linking trust in healthcare providers to prescription drug misuse in American Indian communities, emphasizing structural factors like continuity of care.

## Key findings

- Participants who misused prescription drugs reported significantly lower trust in healthcare providers than those who did not.
- Trust in providers was higher among women, individuals with private insurance, and those with a personal healthcare provider.
- High staff turnover and vacancy rates in IHS and tribal clinics hinder the development of patient trust.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This research addresses the critical public health issue of prescription drug misuse, which affected approximately 14.4 million Americans in 2023.The study identifies a statistically significant association between low trust in healthcare providers and the misuse of prescription medications among American Indians.

This research addresses the critical public health issue of prescription drug misuse, which affected approximately 14.4 million Americans in 2023.

The study identifies a statistically significant association between low trust in healthcare providers and the misuse of prescription medications among American Indians.

Public health significance—Why is this work of significance to public health?
It highlights that misuse, including sharing medications or not finishing antibiotic courses, leads to severe community health problems such as antibiotic resistance.Practitioners and policymakers should focus on increasing continuity of care, as having a personal doctor is positively related to higher trust and better health outcomes.

It highlights that misuse, including sharing medications or not finishing antibiotic courses, leads to severe community health problems such as antibiotic resistance.

Practitioners and policymakers should focus on increasing continuity of care, as having a personal doctor is positively related to higher trust and better health outcomes.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Researchers and administrators need to address high staff turnover and vacancy rates in the Indian Health Service (IHS) and tribal clinics, as these structural issues currently prevent the long-term relationships necessary to build patient trust.

Researchers and administrators need to address high staff turnover and vacancy rates in the Indian Health Service (IHS) and tribal clinics, as these structural issues currently prevent the long-term relationships necessary to build patient trust.

Prescription drug misuse disproportionately impacts American Indian communities, yet limited research explores how trust in healthcare settings affects behaviors related to prescription drug use. Using data from a 2017 cross-sectional survey of 781 American Indian adults in the Plains region, this study aims to examine the association between trust in health information provided by physicians and the misuse of prescribed medication, while identifying demographic and structural factors that influence trust levels. To assess trust, the study utilized a tool consisting of questions adapted from the Health Information National Trends (HINTS) survey, which asked respondents to rate how much they trust health and medical information from their doctors. Results showed that 29.3% of participants reported high trust in provider information. Trust was significantly higher among women, individuals with private insurance, and those with a personal healthcare provider. Notably, participants who misused prescription drugs reported significantly lower trust (30.0%) than those who did not (40.0%). The study concludes that while historical trauma influences mistrust, structural factors like continuity of care and regular provider access are vital. Improving patient–provider relationships may reduce medication misuse and associated risks like antibiotic resistance.