Trust and gender in patient-practitioner relationships
This research investigates the phenomenon of patient trust in primary health care providers. Using the qualitative methodology of Memory Work, this research draws largely on social constructionism to understand gendered 'lived' experiences of trust within the patient-practitioner relationship. The central question of this research, then, was: How do male and female patients describe and perceive their experience, both positive and negative, of trust in primary health care practitioners (PHCPs)? Following the Memory Work method, two groups of participants, one comprising four men, the other five women, independently wrote detailed narratives of their lived experiences of trust. These experiences were evoked by agreed 'trigger' topics that each group felt explored and represented trust within the patient-practitioner relationship. The participants then came together as a group to discuss and analyse the individual narratives for the 'common' sense or the social aspects of the experiences common to the group, and the processes used to make sense of them. Both the women's research group and the men's research group met for five sessions, each session lasting at least three hours. Between them the research participants wrote 43 individual narratives (two absences) and generated more than 30 hours of recorded group work. From their written descriptions and verbal discussions of their individual narratives, this research describes and explains the trust that these participants experienced, and explores the meaning that these men and women themselves ascribe to trust in various health care service contexts. Specifically, Memory Work facilitated the participants' own understanding of how their individual experiences of trust have been constructed by the self, and the social processes of gender on self. This research worked at two levels of analysis and interpretation (textual and crosssectional), examining the experiences both within and between the men and women in the study. A number of common themes were found to be critical to patient trust for these women and men showing important gender differences in how trust is lived and understood within the patient-practitioner relationship. The themes that the women use to make sense of their trust in PHCPs are: Vulnerability, Knowledge, Affirmation, Voice, Clinical Skills, Responsiveness, Professional Confidence, Thoroughness, Acceptance, Personal Connection, Honesty, Empathy, Reciprocity, Safety, and Empowerment. Collectively the men develop the following themes: Risk, Evidence, Autonomy, Personal Connection, Clinical Skills, Professionalism, Empathy, Friendliness, 'Reading' Skills, Honesty, Reciprocity, and Alliance. Finally, the discussion elaborates the participants' theorising by connecting it to existing marketing literature. The research finds that there are both profound relational and social dimensions to trust in this service context. Trust is understood as a relational phenomenon through the heuristic device of the 'She' /'He', 'Other', and 'They'. This research extends the relationship marketing literature by developing a deep understanding of the phenomenon of trust from the patients' perspective, and the interconnections between this trust and gender as it is lived in health care service contexts. These insights provide a sound base for implementing improvements to current health care practice that are valued by the patient, and therefore have immediate practical relevance for health care practitioners, health care policy makers, and patients. This research also contributes academically by establishing a new way of analysing and interpreting relational phenomena such as trust.
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