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, nonadherence 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 was to investigate whether trust matters to patients and doctors/providers within the context of hypertension care in rural Tanzania. Methods: The research employed qualitative approach. In-depth audio-taped interviews with patients and providers in both western care and traditional healing system were conducted in two predominantly rural districts of Tanzania. The interview transcripts were coded and analysed 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 choices, participation in care and disclosure, adherence practices, return for hospital care, reduced financial burden and relief, healing or cure. Trust in doctors was also described to increase doctor/provider’s societal reputation, work morale and income. Further, trust in doctors was described to increase hospitals’ and health sector’s societal reputation, income and drive healthcare resource increment. Despite the benefits, disadvantages of patient trust in doctors were also mentioned. Some participants indicated that trust in doctors may increase patient’s vulnerability to malpractices when doctors misuse the trust vested in them. Also, trust was considered as potentially contributing to trusted doctors’ behaviour changes 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 non-communicable disease response in low income African countries.