• Advanced practice;
  • advanced nursing practice;
  • nursing practice;
  • primary health care;
  • community health;
  • nurse-patient relations;
  • quality improvement;
  • quality of care;
  • quality of services;
  • racial identity


Purpose: To analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary-care nurse practitioners using Cox's Interaction Model of Client Health Behaviors.

Design: A descriptive-correlational study was conducted with a convenience sample of 100 community-dwelling adults.

Methods: Participants completed the Cultural Mistrust Inventory; Group Based Medical Mistrust Scale; Black Racial Identity Attitude Scale; Trust in Physician Scale; Michigan Academic Consortium Patient Satisfaction Questionnaire; and provided demographic and primary care data.

Analysis: Correlations and stepwise multiple regression techniques were used to examine the study aims and correlational links between the theoretical constructs of client singularity, client-professional interaction, and outcome.

Findings and Conclusions: Cox's model indicated a complex view of African American patients’ perspectives on nurse practitioners. Participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse-practitioner (NP) providers explained 41% of variance in satisfaction.

Clinical Relevance: An African American patient's own attitudes about racial identity and the client-professional relationship have a significant effect on satisfaction with primary care.