Ographic characteristics of African migrants interviewed). Fourteen African countries were represented. Nigerians constituted the largest number of ICG-001 site participants (16), followed by participants from Guinea (5), Zimbabwe (3), and Ghana (3). The average age was 34 years, and 90 of participants were male, reflecting the greater proportion of men in the African migrant population. Most had limited or no Chinese language proficiency. The participants had a wide range of experience with the Chinese health care system, ranging from one health care encounter to years of health care visits. Participants primarily reported using modern medicine; a small number also reported using traditional Chinese medicine. Although most of the African migrants in our sample described challenges in their interactions with Chinese physicians, a subset reported high levels of trust in their physicians. This trust was influenced by a complex set of factors at the interpersonal, social network, health system, and socio-cultural levels. Key supporting quotes for these themes are provided in S2 Table (supporting information, S2 Table. Quotes supporting study themes).Interpersonal levelFactors at the patient-physician level were the most frequently discussed factors influencing participants’ trust of physicians. Often participants entered the patient-physician interaction with ideas about the buy MK-5172 trustworthiness of Chinese physicians in general based on the experiences of others in their social networks, encounters with Chinese citizens outside the health care setting, and previous experiences with Chinese institutions. However, participants evaluated and tested the physician’s trustworthiness during the clinical interaction. Two participants stated that they had no choice but to trust the physician they sought care from, but most participants reported critically evaluating the trustworthiness of the physicians they encountered. Many reported trust in the individual physicians they saw, even as they described mistrust in Chinese physicians in general or the broader health system. Among the most frequently cited factors at the patient-physician level was the physician’s interpersonal treatment of the patient. When discussing physicians they trusted, participants used descriptors like “caring,” “kind,” and “looks after you.” They trusted physicians who demonstrated willingness to answer questions and who provided encouragement to them. Several participants described their relationship with these physicians as one of friendship. In contrast, other participants described physicians who failed to demonstrate positive interpersonal treatment of patients, by shouting, ordering them around, or ignoring them. One student described a colleague whose trust in the physicians and the medication they prescribed was underminedPLOS ONE | DOI:10.1371/journal.pone.0123255 May 12,6 /African Migrant Patients’ Trust in Chinese Physicianswhen his doctor ignored him and people at the clinic laughed at his Chinese language skills. On his way out of the hospital, he discarded the medication he had been prescribed. In evaluating the trustworthiness of their physicians, participants also considered whether the physicians were qualified. Participants used different strategies to assess the technical competence of their physicians, but often it was based on the outcome of care. One participant reported trusting his doctor in China because after failing to receive a diagnosis in his home country, the d.Ographic characteristics of African migrants interviewed). Fourteen African countries were represented. Nigerians constituted the largest number of participants (16), followed by participants from Guinea (5), Zimbabwe (3), and Ghana (3). The average age was 34 years, and 90 of participants were male, reflecting the greater proportion of men in the African migrant population. Most had limited or no Chinese language proficiency. The participants had a wide range of experience with the Chinese health care system, ranging from one health care encounter to years of health care visits. Participants primarily reported using modern medicine; a small number also reported using traditional Chinese medicine. Although most of the African migrants in our sample described challenges in their interactions with Chinese physicians, a subset reported high levels of trust in their physicians. This trust was influenced by a complex set of factors at the interpersonal, social network, health system, and socio-cultural levels. Key supporting quotes for these themes are provided in S2 Table (supporting information, S2 Table. Quotes supporting study themes).Interpersonal levelFactors at the patient-physician level were the most frequently discussed factors influencing participants’ trust of physicians. Often participants entered the patient-physician interaction with ideas about the trustworthiness of Chinese physicians in general based on the experiences of others in their social networks, encounters with Chinese citizens outside the health care setting, and previous experiences with Chinese institutions. However, participants evaluated and tested the physician’s trustworthiness during the clinical interaction. Two participants stated that they had no choice but to trust the physician they sought care from, but most participants reported critically evaluating the trustworthiness of the physicians they encountered. Many reported trust in the individual physicians they saw, even as they described mistrust in Chinese physicians in general or the broader health system. Among the most frequently cited factors at the patient-physician level was the physician’s interpersonal treatment of the patient. When discussing physicians they trusted, participants used descriptors like “caring,” “kind,” and “looks after you.” They trusted physicians who demonstrated willingness to answer questions and who provided encouragement to them. Several participants described their relationship with these physicians as one of friendship. In contrast, other participants described physicians who failed to demonstrate positive interpersonal treatment of patients, by shouting, ordering them around, or ignoring them. One student described a colleague whose trust in the physicians and the medication they prescribed was underminedPLOS ONE | DOI:10.1371/journal.pone.0123255 May 12,6 /African Migrant Patients’ Trust in Chinese Physicianswhen his doctor ignored him and people at the clinic laughed at his Chinese language skills. On his way out of the hospital, he discarded the medication he had been prescribed. In evaluating the trustworthiness of their physicians, participants also considered whether the physicians were qualified. Participants used different strategies to assess the technical competence of their physicians, but often it was based on the outcome of care. One participant reported trusting his doctor in China because after failing to receive a diagnosis in his home country, the d.
