This cross-sectional study examined the relationships among healthcare provider trust, social identity concordance (i.e. race, sex/gender, sexual orientation), internalized racism, everyday discrimination, and healthcare discrimination across four healthcare settings: dental, medical, mental, and vision. The study sample included Black American adults (Mean age = 37.68). Findings showed that, after accounting for demographic factors and identity concordance: (a) race concordance did not relate to provider trust, (b) sex/gender concordance was positively linked to trust in medical, mental, and vision healthcare providers, (c) sexual orientation concordance was associated with greater trust in dental and mental healthcare providers, (d) internalized racism and healthcare discrimination were associated with lower provider trust in all settings, and (e) everyday discrimination was negatively linked to trust in dental providers only. These results suggest identity concordance alone is insufficient in fostering trust in healthcare providers, highlighting the need for further research on addressing internalized and systemic racism.
AcquayeAGOHullSC (2023) Ethics of identity concordance requests in patient-clinician encounters. Journal of the National Medical Association115(6): 539–544.
2.
AlangSMcAlpineDMcClainM, et al. (2021) Police brutality, medical mistrust and unmet need for medical care. Preventive Medicine Reports22: 101361.
3.
AlsanMGarrickOGrazianiG (2019) Does diversity matter for health? Experimental evidence from Oakland. American Economic Review109(12): 4071–4111.
4.
AltmanMRMcLemoreMROsegueraT, et al. (2020) Listening to women: Recommendations from women of color to improve experiences in pregnancy and birth care. Journal of Midwifery & Women’s Health65(4): 466–473.
5.
AndersonLADedrickRF (1990) Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychological Reports67(3): 1091–1100.
6.
AndersonLNTaylorTRSiwemukeT, et al. (2025) Navigating communication in racially concordant care: Considerations for medical education. Family Medicine57(1): 35–40.
7.
ArmstrongKPuttMHalbertCH, et al. (2013) Prior experiences of racial discrimination and racial differences in health care system distrust. Medical Care51(2): 144–150.
8.
BaileyZDFeldmanJMBassettMT (2017a) How structural racism works—Racist policies as a root cause of U.S. racial health inequities. New England Journal of Medicine384(8): 768–773.
9.
BaileyZDKriegerNAgénorM, et al. (2017b) Structural racism and health inequities in the USA: Evidence and interventions. Lancet389(10077): 1453–1463.
10.
BauerGR (2014) Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science & Medicine110: 10–17.
11.
BenderDJ (2007) Patient preference for a racially or gender-concordant student dentist. Journal of Dental Education71(6): 726–745.
12.
BirkhäuerJGaabJKossowskyJ, et al. (2017) Trust in the health care professional and health outcome: A meta-analysis. PLoS One12(2): e0170988.
13.
BoulwareLECooperLARatnerLE, et al. (2003) Race and trust in the health care system. Public Health Reports118: 358–365.
14.
BrennanNBarnesRCalnanM, et al. (2013) Trust in the health-care provider-patient relationship: A systematic mapping review of the evidence base. International Journal for Quality in Health Care25(6): 682–688.
15.
BrownAFMaGXMirandaJ, et al. (2019) Structural interventions to reduce and eliminate health disparities. American Journal of Public Health109(S1): S72–S78.
16.
BrownCEMarshallARSnyderCR, et al. (2023) Perspectives about racism and patient-clinician communication among black adults with serious illness. JAMA Network Open6(7): e2321746.
17.
BrownJATaffeBDRichmondJA, et al. (2024) Racial discrimination and health-care system trust among American adults with and without cancer. Journal of the National Cancer Institute116(11): 1845–1855.
18.
BrownPCalnanMScrivenerA, et al. (2009) Trust in mental health services: A neglected concept. Journal of Mental Health18(5): 449–458.
19.
CabralRRSmithTB (2011) Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology58(4): 537–554.
20.
ChekijianSKinsmanJTaylorRA, et al. (2021) Association between patient-physician gender concordance and patient experience scores: Is there gender bias?American Journal of Emergency Medicine45: 476–482.
CuevasAGO’BrienKSahaS (2016) African American experiences in healthcare: “I always feel like I’m getting skipped over”. Health Psychology35(9): 987–995.
23.
CyrusK (2017) Multiple minorities as multiply marginalized: Applying the minority stress theory to LGBTQ people of color. Journal of Gay & Lesbian Mental Health21(3): 194–202.
24.
DuongLAZoupouEBogaCI, et al. (2025) Gender, race/ethnicity, and patient-therapist matching on gender and race/ethnicity: Predictors/moderators of the effectiveness of trust/respect feedback. Administration and Policy in Mental Health and Mental Health Services Research52(1): 59–73.
25.
EgedeLEEllisC (2008) Development and testing of the multidimensional trust in health care systems scale. Journal of General Internal Medicine23(6): 808–815.
26.
ElshamiMAlfaqawiMAbdalghafoorT, et al. (2019) Public awareness and barriers to seeking medical advice for colorectal cancer in the Gaza Strip: A cross-sectional study. Journal of Global Oncology (JGO) 5. DOI: 10.1200/jgo.18.00252
27.
FabianAJBaladoRLChaseMG, et al. (2025) Patient-provider race concordance and medication adherence: A systematic review. Journal of Racial and Ethnic Health Disparities. 1–8. DOI: 10.1007/s40615-025-02330-y
28.
FitzGeraldCMartinABernerD, et al. (2019) Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: A systematic review. BMC Psychology7(1): 29.
29.
GagnonKWQuinnKWalshJL, et al. (2025) Characteristics of healthcare providers, healthcare systems, and patient strategies related to medical mistrust among Black and African Americans. BMC Primary Care26(1): 203.
30.
GoldsteinEChokshiBMelendez-TorresGJ, et al. (2024) Effectiveness of trauma-informed care implementation in health care settings: Systematic review of reviews and realist synthesis. Permanente Journal28(1): 135–150.
31.
GonzalezDNelsonTSmedleyB (2025) Racially Minoritized Patients Can Benefit From Racially Concordant Providers But Struggle to Find Them. Urban Institute.
32.
Goode-CrossDTGrimKA (2016) “An unspoken level of comfort”: Black therapists’ experiences working with black clients. Journal of Black Psychology42(1): 29–53.
33.
GrantBSorokaOBaqueroE, et al. (2025) Patient perceptions of provider race concordance and quality of chronic illness care. Journal of General Internal Medicine40: 2218–2225.
34.
GreeneJSilverDVerrierE, et al. (2023) Is patients’ trust in clinicians related to patient-clinician racial/ethnic or gender concordance?Patient Education and Counseling112: 107750.
35.
GreenwoodBNHardemanRRHuangL, et al. (2020) Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences117(35): 21194–21200.
36.
HallMADuganEZhengB, et al. (2001) Trust in physicians and medical institutions: What is it, can it be measured, and does it matter?Milbank Quarterly79(4): 613–39, v.
37.
HamedSBradbyHAhlbergBM, et al. (2022) Racism in healthcare: A scoping review. BMC Public Health22(1): 988.
38.
HausmannLRMKwohCKHannonMJ, et al. (2013) Perceived racial discrimination in health care and race differences in physician trust. Race and Social Problems5(2): 113–120.
39.
JamesD (2020) The seemingly ‘protective’effect of internalised racism on overall health among 780 Black/African Americans: The serial mediation of stigma consciousness and locus of control. Psychology & Health36(4): 427–443.
40.
JamesD (2022) An initial framework for the study of internalized racism and health: Internalized racism as a racism-induced identity threat response. Social and Personality Psychology Compass16(11): p.e12712.
41.
JamesDBowlingAMMoeyaertMet al. (2025) Internalized racism, stress, and health: A comprehensive meta-analytic structural equation model test of the internalized racism framework. Psychological Bulletin151(8): 986–1039.
42.
JamesDHorneL (2024) Examining barriers to dental, medical, mental, and vision healthcare access, attitudes towards seeking healthcare, and internalized racism among Black Americans. Social Science & Medicine357: 117193.
43.
JettyAJabbarpourYPollackJ, et al. (2022) Patient-physician racial concordance associated with improved healthcare use and lower healthcare expenditures in minority populations. Journal of Racial and Ethnic Health Disparities6: 8–81.
44.
KaczynskiMABenitezGShehadehF, et al. (2025) Perceived discrimination in the healthcare setting and medical mistrust: Findings from the health information national trends survey, 2022. Journal of General Internal Medicine40: 2491–2498.
45.
KaurAGottliebLMEttingerdeCubaS, et al. (2024) Associations between patient/caregiver trust in clinicians and experiences of healthcare-based discrimination. Journal of the American Board of Family Medicine37: 607–636.
46.
KuLVichareA (2023) The association of racial and ethnic concordance in primary care with patient satisfaction and experience of care. Journal of General Internal Medicine38: 727–732.
47.
LaiYCohodesMGriffinM (2024) Trust in physicians among young sexual minority men. Journal of Mens Health20: 39.
48.
LauESHayesSNVolgmanAS, et al. (2021) Does patient-physician gender concordance influence patient perceptions or outcomes?Journal of the American College of Cardiology77: 1135–1138.
49.
LiuMPatelVRSandhuS, et al. (2024) Health care discrimination and care avoidance due to patient-clinician identity discordance among sexual and gender minority adults. Annals of Family Medicine22: 329–332.
50.
LoebSRavenellJEGomezSL, et al. (2023) The effect of racial concordance on patient trust in online videos about prostate cancer: A randomized clinical trial. JAMA Network Open6: e2324395.
51.
MeghaniSHBrooksJMGipson-JonesT, et al. (2009) Patient-provider race-concordance: Does it matter in improving minority patients’ health outcomes?Ethnicity and Health14: 107–130.
52.
MichelJAWellsK (2022) The impact of physician self-disclosure of sexual identity on patient trust. Pediatrics149(1): 593.
53.
MolinaKMJamesD (2016) Discrimination, internalized racism, and depression: A comparative study of African American and Afro-Caribbean adults in the US. Group Processes & Intergroup Relations19(4): 439–461.
54.
MooreCCoatesEWatsonA, et al. (2023) Correction to: “It’s important to work with people that look like me”: Black patients’ preferences for patient-provider race concordance. Journal of Racial and Ethnic Health Disparities10: 2614.
Office of Disease Prevention and Health Promotion, no date. Social Determinants Of Health. Healthy People 2020. U.S. Department of Health and Human Services. Available at: https://www.cdc.gov/nchs/healthy_people/hp2020.htm
57.
OtteSV (2022) Improved patient experience and outcomes: Is Patient-provider concordance the key?Journal of Patient Experience9: 23743735221103033.
58.
PeekMENunez-SmithMDrumM, et al. (2011) Adapting the everyday discrimination scale to medical settings: Reliability and validity testing in a sample of African American patients. Ethnicity & Disease21(4): 502–509.
59.
PughMJrPerrinPBRybarczykB, et al. (2021) Racism, mental health, healthcare provider trust, and medication adherence among black patients in safety-net primary care. Journal of Clinical Psychology in Medical Settings28: 181–190.
60.
SacksTK (2013) Race and gender concordance: Strategy to reduce healthcare disparities or red herring? Evidence from a qualitative study. Race and Social Problems5: 88–99.
61.
ScheidTLSmithGH (2017) Is physician-patient concordance associated with greater trust for women of low socioeconomic status?Women & Health57: 631–649.
62.
SelwynCNLathanECRichieF, et al. (2021) Bitten by the system that cared for them: Towards a trauma-informed understanding of patients’ healthcare engagement. Journal of Trauma & Dissociation22(5): 636–652.
63.
SmithGHHamptonCBrandonWP (2018) Physicians, physician extenders and health outcomes: Race, gender and patient-health provider concordance in North Carolina Medicaid. Journal of Health Care for the Poor and Underserved29(1): 530–555.
64.
SongYLuzziLBrennanDS (2020) Trust in dentist-patient relationships: Mapping the relevant concepts. European Journal of Oral Sciences128(2): 110–119.
65.
SouvatziEKatsikidouMArvanitiA, et al. (2024) Trust in healthcare, medical mistrust, and health outcomes in times of health crisis: A narrative review. Societies14(12): 269.
66.
StanfordFC (2020) The importance of diversity and inclusion in the healthcare workforce. Journal of the National Medical Association112(3): 247–249.
67.
StreetRLJrO’MalleyKJCooperLA, et al. (2008) Understanding concordance in patient-physician relationships: Personal and ethnic dimensions of shared identity. Annals of Family Medicine6(3): 198–205.
68.
WilliamsDRYanYUJacksonJS, et al. (1997) Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology2(3): 335–351.
69.
WilliamsKKABaidoobonsoSHaggertyJ, et al. (2024) Anti-black discrimination in primary health care: A qualitative study exploring internalized racism in a Canadian context. Ethnicity and Health29(3): 343–352.
70.
WorrellFCVandiverBJCrossWE, et al. (2004) Reliability and structural validity of cross racial identity scale scores in a sample of African American adults. Journal of Black Psychology30(4): 489–505.
71.
WuQJinZWangP (2022) The relationship between the physician-patient relationship, physician empathy, and patient trust. Journal of General Internal Medicine37(6): 1388–1393.
