Trust matters: Patients’ and providers’ accounts of the role of trust in hypertension care in rural Tanzania

Background: Recent research indicates that biomedical response to the growing burden of non-communicable diseases in low income African countries is impacted by poor health care seeking, non-adherence to medication and poor continuation with hospital care. One of the potential entry points to addressing these challenges is improving patient trust in doctors. The objective of this study is to investigate whether trust matters to patients and doctors/providers within the context of hypertension care in rural Tanzania as a case study.
Methods: The research employed a qualitative approach. In-depth interviews with patients and providers engaged in either western care or traditional healing systems were conducted in two predominantly rural districts of Shinyanga. The interview transcripts were coded and analyzed thematically.
Results: A total of 36 patients and 8 providers were interviewed. There was a consensus among patients and providers in both western and traditional healing systems that patient trust in doctors matters for NCDs response in rural Tanzania. Benefits of trust in doctors were cited by participants as extending beyond patients to doctors, hospitals and health sector. Trust in doctors was described to facilitate patient’s health care seeking behaviours, participation in care and disclosure, adherence to medication, return for follow up, reduced financial burden and relief, healing or cure. Trust in doctors was also described as increasing doctor/provider’s societal reputation, work morale and income. Further, trust in doctors was described as increasing hospitals’ and health sector’s societal reputation, income and drive healthcare resource increment. Despite the benefits, disadvantages of patient trust in doctors were also raised. Some participants indicated that trust in doctors may increase patient’s vulnerability to malpractice when doctors misuse the trust vested in them. Also, trust was considered as potentially contributing to behaviour changes amongst doctors such as excessive self-pride, faking being busy and sluggishness in care provision as well as increasing their work load.
Conclusion: The findings suggest that trust in patient-doctor relationship matters for hypertension care in rural Tanzania. Improving trust in the patient - doctor relationship may be one of the important lenses in addressing some of the challenges of NCDs response in low income African countries

Keywords
doctor; provider; patient; trust; hypertension; non-communicable diseases; healthcare; Tanzania