Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 11:13:1557921.
doi: 10.3389/fpubh.2025.1557921. eCollection 2025.

Trust in healthcare and perceived discrimination in Sweden: a fixed effects analysis of individual heterogeneity and discriminatory accuracy

Maria Wemrell  1   2 , Mariam Hassan  2   3   4 , Raquel Perez-Vicente  2 , Martin Lindström  5   6 , Johan Öberg  2   3 , Juan Merlo  2   5
Affiliations

Trust in healthcare and perceived discrimination in Sweden: a fixed effects analysis of individual heterogeneity and discriminatory accuracy

Maria Wemrell et al. Front Public Health. .

Abstract

Introduction: Trust in healthcare is central to the delivery of care and unequally distributed between groups in society. Experiences of perceived discrimination have been associated with lack of such trust. Although the importance of trust in healthcare has been highlighted in recent years, studies in this area are relatively scarce.

Materials and methods: We investigated the risk of low trust in healthcare in Sweden, using data from 11 consecutive National Public Health Surveys conducted in 2004-2014 (n = 83,135). Applying an analysis of individual heterogeneity and discriminatory accuracy (AIHDA), we investigated the risk of low trust in healthcare across intersectional strata defined by experiences of perceived discrimination as well as sex/gender, educational level, migration status and age. We calculated strata-specific prevalences and prevalence ratios (PR) with 95% confidence intervals (CI). The area under the receiver operating characteristic curve (AUC) was computed to evaluate the discriminatory accuracy (DA) of the intersectional strata.

Results: The overall prevalence of low trust in healthcare was 25.9%. While low trust was more common among individuals born abroad, with low education and of younger age, discrimination increased the risk of low trust in healthcare over and above the sociodemographic characteristics. The strata with the highest risk of low trust were foreign-born men aged 55-64 years with low income who had experienced discrimination (PR 3.13 [95% CI 2.49-3.95]) and foreign-born women aged 25-34 years with high education who had experienced discrimination (PR 3.05 [95% CI 2.50-3.73]). The DA of the intersectional strata was small (AUC = 0.64), indicating large overlaps between and heterogeneities within strata.

Conclusion: As experiences of discrimination, in healthcare and elsewhere, are associated with lack of trust in healthcare, it is incumbent on healthcare professionals to maintain trustworthiness by mitigating discriminatory practices including through striving toward patient-centered communication and care. Such efforts should be universal, although proportionally tailored to mitigate discrimination against patients with a migration background.

Keywords: AIHDA; Sweden; discrimination; health inequities; intersectionality; trust in healthcare.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study sample, with inclusion/exclusion criteria and missing data.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Hall MA, Dugan E, Zheng BY, Mishra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. (2001) 79:613–39. doi: 10.1111/1468-0009.00223, PMID: - DOI - PMC - PubMed
    1. Mohseni M, Lindstrom M. Social capital, trust in the health-care system and self-rated health: the role of access to health care in a population-based study. Soc Sci Med. (2007) 64:1373–83. doi: 10.1016/j.socscimed.2006.11.023, PMID: - DOI - PubMed
    1. Williamson LD, Smith MA, Bigman CA. Does discrimination breed mistrust? Examining the role of mediated and non-mediated discrimination experiences in medical mistrust. J Health Commun. (2019) 24:791–9. doi: 10.1080/10810730.2019.1669742, PMID: - DOI - PubMed
    1. Schiavo R, Chou WYS. Reflections and key learnings on the science of trust. J Commun Healthc. (2023) 16:315–9. doi: 10.1080/17538068.2023.2281731, PMID: - DOI - PubMed
    1. Chen D, Yang TC. The pathways from perceived discrimination to self-rated health: an investigation of the roles of distrust, social capital, and health behaviors. Soc Sci Med. (2014) 104:64–73. doi: 10.1016/j.socscimed.2013.12.021, PMID: - DOI - PMC - PubMed