Primary care physicians' views on the factors for enhancing patients' trust in rural areas of Zhejiang province, China: a cross-sectional study

OBJECTIVES: To examine primary care physicians' (PCPs) perception of patients' trust and associated factors for enhancing perceived trust in rural China. DESIGN: A cross-sectional questionnaire study. SETTING: All township health centres (primary care facilities in rural areas of China) in both developed and less developed counties of Zhejiang province, China, were chosen as the study sites. PARTICIPANTS: A total of 849 questionnaires were distributed from December 2019 to January 2020, and 673 PCPs working in township health centres completed the questionnaires. The response rate was 79.3%. OUTCOME MEASURES: PCPs' perceived patients' trust in them, PCPs' practices to meet patients' expectations and PCPs' perceived conflicting patient and employer interests were measured by a self-designed and verified questionnaire. Confirmatory factor analysis was applied to verify the measurement model of PCPs' practices. Multivariable logistic regression analyses were performed to explore the association between clinical practice characteristics, discordant patient and employer interests and perceived patient trust after controlling for social-demographic characteristics. RESULTS: Among all participants, 572 (85.0%) PCPs often/always perceived patients' trust in their clinical competence, and over two-thirds of PCPs reported ever perceived patient worries about overprescriptions. After adjustment for social-demographic characteristics, regression model results indicated that, among PCPs' clinical practices characteristics, emotional support (OR=1.23, 95% CI=1.06 to 1.42) and accurate diagnosis and treatment (OR=1.35, 95% CI=1.17 to 1.55) were positively associated with PCPs' perceived patients' trust in their clinical competence. A strong association was found between accurate diagnosis and treatment (OR=1.20, 95% CI=1.08 to 1.34, p<0.001; OR=1.22, 95% CI=1.10 to 1.35, p<0.001), conflicting patient and employer interests (OR=1.35, 95% CI=1.12 to 1.63, p<0.01; OR=1.29, 95% CI=1.07 to 1.54, p