Finding Common Ground: Can Provider-Patient Race Concordance and Self-disclosure Bolster Patient Trust, Perceptions, and Intentions?

  • Samantha NazioneEmail author
  • Evan K. Perrault
  • David M. Keating



Improvements in provider-patient relationships may help alleviate health disparities. Provider-patient race concordance and provider self-disclosure are variables that may help improve this relationship.


This study sought to answer if provider-patient race concordance and provider self-disclosure may improve patient trust, rapport, similarity, likeability, intention to disclose, satisfaction, behavioral intention to keep a provider, and intention to recommend a provider, while using empathy as a covariate.


Using 882 White or Black participants, the current research used a 2 × 2 online experimental design. Participants were asked to read a vignette in which they were told they had borderline high cholesterol and needed to eat a healthier diet, by either a Black or White male physician, who either self-disclosed or did not self-disclose regarding their own struggle to eat a healthy diet. After reading this vignette, participants were surveyed regarding the dependent variables of interest.


Participants in a Black concordant dyad reported higher levels of similarity than those in any other dyad. Provider self-disclosure led to higher levels of trust, rapport, similarity, likeability, intention to disclose, satisfaction, behavioral intention to continue using the provider, and intention to recommend the provider. No interaction effects were found.


While it is possible, based on past research, that race-concordant pairings may lead to trust via similarity, provider self-disclosure directly increased perceptions of trust as well as providing numerous other benefits. This study supports the importance of trainings for providers on health-related self-disclosure to benefit both parties in provider-patient dyads.


Provider-patient communication Race concordance Self-disclosure Trust 


Funding Information

This research was funded by startup funds provided by Purdue University, College of Liberal Arts.

Compliance with Ethical Standards

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Centers for Disease Control and Prevention. CDC health disparities & inequalities report. 2013. Accessed 1 March 2018.
  2. 2.
    Levy BS, Sidel VW, editors. Social injustice and public health. New York: Oxford Press; 2006.Google Scholar
  3. 3.
    Smedley BD. Introduction and literature review. In: Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic inequalities in health care. Washington, DC: National Academic Press; 2003. p. 29–79.Google Scholar
  4. 4.
    Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaetner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67:478–86. Scholar
  5. 5.
    Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic difference in physician distrust in the United States. Am J Public Health. 2007;97:1283–9. Scholar
  6. 6.
    Street RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74:295–301. Scholar
  7. 7.
    Street RL, O’Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient-physician relationships: persona and ethnic dimensions of shared identity. Ann Fam Med. 2008;6:2008–205. Scholar
  8. 8.
    Berger CR, Calabrese RJ. Some explorations in initial interaction and beyond: toward a developmental theory of interpersonal communication. Hum Commun Res. 1975;1:99–112.CrossRefGoogle Scholar
  9. 9.
    Bylund CL, Peterson EB, Cameron KA. A practitioner’s guide to interpersonal communication theory: an overview and exploration of selected theories. Patient Educ Couns. 2012.
  10. 10.
    Gabbard GO, Nadelson C. Professional boundaries in the physician-patient relationship. JAMA. 1995;273:1445–9.CrossRefPubMedGoogle Scholar
  11. 11.
    McDaniel SH, Beckman HB, Morse DS, Siberman J, Seaburn DB, Epstein RM. Physician self-disclosure in primary care visits. Arch Intern Med. 2007;167:1321–6. Scholar
  12. 12.
    Persky S, Kaphingst KA, Allen VC, Senay I. Effects of patient-provider race concordance and smoking status on lung cancer risk perception accuracy among African Americans. Ann Behav Med. 2013;45:308–17. Scholar
  13. 13.
    Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000;9:287–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Jones J. Bad blood: the Tuskegee syphilis experiment. New York: Free Press; 1993.Google Scholar
  15. 15.
    Brandon DT, Issac LA, LaVeist TA. The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? J Natl Med Assoc. 2005;97:951–6.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Cooper LA, Roter DL, Carson KA, Beach MA, Sabin JA, Greenwald AG, et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Pub Health. 2012;102:979–87. Scholar
  17. 17.
    Schoenthaler A, Montague E, Bair Manwell L, Brown R, Schwartz MD, Linzer M. Patient-physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence. Ethn Health. 2014;19:565–78. Scholar
  18. 18.
    Freimuth VS, Quinn SC, Thomas SB, Cole G, Zook E, Duncan T. African Americans’ views on research and the Tuskegee syphilis study. Soc Sci Med. 2001;52:797–808.CrossRefPubMedGoogle Scholar
  19. 19.
    LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust and satisfaction with care among African-American and white cardiac patients. Med Care Res Rev. 2000;571:46–161.Google Scholar
  20. 20.
    Boulware LE, Ratner LE, Cooper LA, Sosa JA, LaVeist TA. Powe NR understanding disparities in donor behavior: race and gender differences in willingness to donate blood and cadaveric organs. Med Care. 2002;40:85–95.CrossRefPubMedGoogle Scholar
  21. 21.
    Boulware LE, Cooper LA, Ratner LL, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003;118:358–65.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Gordon HS, Street RL, Sharf BF, Soucheck J. Racial differences in doctor’s information-giving and patient participation. Cancer. 2006;107:1313–20. Scholar
  23. 23.
    Harvey VW, Ozoemena U, Paul J, Beydoun HA, Clemetson NN, Okoye GA. Patient-provider communication, concordance and ratings of care in dermatology: results of a cross-sectional study. Dermatol Online J. 2016;22:11.Google Scholar
  24. 24.
    Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139:907. Scholar
  25. 25.
    Meghani SH, Brooks JM, Gipson-Jones T, Waite R, Whitfield-Harris L, Deatrick JA. Patient-provider race-concordance: does it matter in improving minority patients’ health outcomes. Ethn Health. 2009.
  26. 26.
    Alegria M, Roter DL, Valentine A, Chen C, Li X, Lin J, et al. Patient-clinician ethnic concordance and communication in mental health intake visits. Patient Educ Couns. 2013;93:188–96. Scholar
  27. 27.
    Carpenter A, Greene K. Social penetration theory. In: Berger CR, Roloff ME, editors. The international encyclopedia of interpersonal communication, vol. 31. Hoboken: Wiley; 2016. Scholar
  28. 28.
    Gudykunst WB. An exploratory comparison of close intracultural and intercultural friendships. Commun Q. 1985;33:270–83.CrossRefGoogle Scholar
  29. 29.
    Papsdorf M, Alden L. Mediators of social rejection in social anxiety: similarity, self-disclosure, and overt signs of anxiety. J Res Pers. 1998;32:351–69.CrossRefGoogle Scholar
  30. 30.
    Arroll B, Allen EF. To self-disclose or not self-disclose? A systematic review of clinical self-disclosure in primary care. Br J Gen Pract. 2015;65:e609–16. Scholar
  31. 31.
    Wheeless LR, Grotz J. The measurement of trust and its relationship to self-disclosure. Human Commun Res. 1977;3:250–7.CrossRefGoogle Scholar
  32. 32.
    Zink KL, Perry M, London K, Floto O, Bassin B, Burkhardt J, et al. “Let me tell you about my…” provider self-disclosure in the emergency department builds patient rapport. West J Emerg Med. 2017;18:43–9. Scholar
  33. 33.
    Collins NL, Miller LC. Self-disclosure and liking: a meta-analytic review. Psychol Bull. 1994;116:457–75. Scholar
  34. 34.
    Montoya RM, Horton RS, Kirchner J. Is actual similarity necessary for attraction? A meta-analysis of actual and perceived similarity. J Soc Pers Relatsh. 2008;25:889–922. Scholar
  35. 35.
    Sprecher S, Treger S, Wondra JD, Hilaire N, Wallpe K. Taking turns: reciprocal self-disclosure promotes liking in initial interactions. J Exp Soc Psychol. 2013;49:860–6. Scholar
  36. 36.
    Chen YR, Chen XP, Portnoy R. To whom do positive norm and negative norm or reciprocity apply? Effects of inequitable offer, relationship, and relational-self orientation. J Exp Soc Psychol. 2009;45:24–34. Scholar
  37. 37.
    Perrault EK, Silk KJ. Reducing communication apprehension for new patients through information found within physicians' biographies. J Health Commun. 2015, 20:743-750.
  38. 38.
    Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Gutsell JN, Inzlicht M. Intergroup differences in the sharing of emotive states: neural evidence of an empathy gap. Soc Cogn Affect Nerosci. 2012;7:596–603. Scholar
  40. 40.
    American Heart Association [AHA]. Heart disease and stroke statistics - at a glance. Available at Accessed 1 March 2018.
  41. 41.
    American Heart Association [AHA]. Prevention and treatment of high cholesterol [hyperlipidemia]. Available at Accessed 1 March 2018.
  42. 42.
    United States Department of Agriculture [USDA]. What foods are in the vegetable group? Available at Accessed 1 March 2018.
  43. 43.
    Nazione S, Silk KJ. Patient race and perceived illness responsibility: Effects on provider helping and bias. Med Educ. 2013, 47:780-789.
  44. 44.
    McCroskey JC, Teven JJ. Goodwill: a reexamination of the construct and its measurement. Commun Monogr. 1999;66:90–103. Scholar
  45. 45.
    Ohanian R. Construction and validation of a scale to measure celebrity endorsers’ perceived expertise, trustworthiness, and attractiveness. J Advert. 1990;19:39–52.CrossRefGoogle Scholar
  46. 46.
    McCroskey JC, McCain T. The measure of interpersonal attraction. Speech Monographs. 1974;41:261–6.CrossRefGoogle Scholar
  47. 47.
    Cohen DS, Colliver JA, Marcy MS, Fried ED, Swartz MH. Psychometric properties of a standardized-patient checklist and rating scale form to assess interpersonal and communication skills. Acad Med. 1996;71:S87–9. Scholar
  48. 48.
    McCroskey LL, McCroskey JC, Richmond VP. Analysis and improvement of the measurement of interpersonal attraction and homophily. Commun Q. 2006;54:1–31.CrossRefGoogle Scholar
  49. 49.
    Richmond VP, Smith RS, Heisel AM, McCroskey JC. The impact of communication apprehension and fear of talking with a physician on perceived medical outcomes. Commun Res Rep. 1998;15:344–53. Scholar
  50. 50.
    Davis MH. Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol. 1983;25:70–87.Google Scholar
  51. 51.
    Office of Disease Prevention and Health Promotion 2018 [ODPHP]. Disparities. Available at Accessed 1 March 2018.
  52. 52.
    Gordon HS, Street RL, Sharf B, Kelly A, Souchek J. Racial difference in trust and lung cancer patients’ perception of physician communication. J Clin Oncol. 2006;24:904–9. Scholar
  53. 53.
    Beach M, Inui T. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21:S3–8. Scholar
  54. 54.
    Association of American Medical Colleges [AAMC] 2010. Diversity in the physician workforce. Facts and figures 2010. Accessed 1 March 2018.

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Communication DepartmentBerry CollegeMount BerryUSA
  2. 2.Brian Lamb School of CommunicationPurdue UniversityWest LafayetteUSA
  3. 3.California State University, Northridge, Communication StudiesNorthridgeUSA

Personalised recommendations