Lth care system [6,11,13?7]. This distrust may help in part to explain racial/ethnic disparities in health outcomes by affecting treatment seeking and adherence to treatment [5,6,18]. Thus, trust is an important factor in the health system’s capacity to deliver high-quality, responsive care to minorities and marginalized groups [2]. Much of the existing literature on patient-physician trust draws on research in the U.S. and Europe [9,19]. Comparatively less has been written about trust in physicians in low- and middle-income countries, particularly among minority populations [2,20]. But health care providers in low- and middle-income countries increasingly must provide culturally appropriate services for a diverse population. South-South purchase Q-VD-OPh migration (migration between countries of the global South) accounts for a large proportion of global population movement [21]. Since the late 1990s, as Sino-ZM241385 web African ties have deepened, bidirectional travel and migration between China and countries in Africa have increased [22]. They face a number of barriers to health care, including the cost of health services, discrimination, and a lack of interpreter services [23]. Establishing a relationship of mutual trust and providing high-quality medical care to this diverse population pose challenges for Chinese physicians. We undertook a qualitative study in Guangzhou, China in order to better understand trust relationships between African patients and Chinese physicians. Our aim was to identify interpersonal, social network, health system, and socio-cultural factors related to African migrants’ trust in Chinese physicians.Methods Setting and populationLocated on China’s southeastern coast, Guangzhou is the third largest city in China with a population of more than 12 million [24]. It is part of the highly developed Pearl River Delta region of Guangdong Province, a major hub for economic development [25]. The size of the African migrant population in Guangzhou has grown dramatically since the 1997 Asian financial crisis led many African traders to leave Thailand, Indonesia, and other countries in Southeast Asia for opportunities in China [22]. Although African migrants are found in all of China’s major cities, they have historically been concentrated in Guangzhou [22,26]. More than 100,000 African migrants are estimated to live in Guangzhou alone [22,27]. Previous studies have documented an emergence of increased racist discourse in the Chinese media and online, as migration been China and Africa has increased over the last decade and a half [28]. Several surveys undertaken in Guangzhou have found that African migrants are predominately from West Africa, with Nigerians comprising the largest group [22,29]. Most Africans sampled were men who identified as businessmen and traders, who fall into two main groups:PLOS ONE | DOI:10.1371/journal.pone.0123255 May 12,2 /African Migrant Patients’ Trust in Chinese Physiciansexporters who reside in Guangzhou and importers (to Africa) who make frequent visits to Guangzhou, often staying for a week to a month [22,30]. However, the population also includes a large group of students from Africa studying at universities in Guangzhou, as well as a number of female traders, businesswomen, and housewives. The socioeconomic backgrounds of African migrants span a wide range, but many are traders with limited resources who engage in small-scale, informal trade activities [30?2]. Although publicly available official figures are lack.Lth care system [6,11,13?7]. This distrust may help in part to explain racial/ethnic disparities in health outcomes by affecting treatment seeking and adherence to treatment [5,6,18]. Thus, trust is an important factor in the health system’s capacity to deliver high-quality, responsive care to minorities and marginalized groups [2]. Much of the existing literature on patient-physician trust draws on research in the U.S. and Europe [9,19]. Comparatively less has been written about trust in physicians in low- and middle-income countries, particularly among minority populations [2,20]. But health care providers in low- and middle-income countries increasingly must provide culturally appropriate services for a diverse population. South-South migration (migration between countries of the global South) accounts for a large proportion of global population movement [21]. Since the late 1990s, as Sino-African ties have deepened, bidirectional travel and migration between China and countries in Africa have increased [22]. They face a number of barriers to health care, including the cost of health services, discrimination, and a lack of interpreter services [23]. Establishing a relationship of mutual trust and providing high-quality medical care to this diverse population pose challenges for Chinese physicians. We undertook a qualitative study in Guangzhou, China in order to better understand trust relationships between African patients and Chinese physicians. Our aim was to identify interpersonal, social network, health system, and socio-cultural factors related to African migrants’ trust in Chinese physicians.Methods Setting and populationLocated on China’s southeastern coast, Guangzhou is the third largest city in China with a population of more than 12 million [24]. It is part of the highly developed Pearl River Delta region of Guangdong Province, a major hub for economic development [25]. The size of the African migrant population in Guangzhou has grown dramatically since the 1997 Asian financial crisis led many African traders to leave Thailand, Indonesia, and other countries in Southeast Asia for opportunities in China [22]. Although African migrants are found in all of China’s major cities, they have historically been concentrated in Guangzhou [22,26]. More than 100,000 African migrants are estimated to live in Guangzhou alone [22,27]. Previous studies have documented an emergence of increased racist discourse in the Chinese media and online, as migration been China and Africa has increased over the last decade and a half [28]. Several surveys undertaken in Guangzhou have found that African migrants are predominately from West Africa, with Nigerians comprising the largest group [22,29]. Most Africans sampled were men who identified as businessmen and traders, who fall into two main groups:PLOS ONE | DOI:10.1371/journal.pone.0123255 May 12,2 /African Migrant Patients’ Trust in Chinese Physiciansexporters who reside in Guangzhou and importers (to Africa) who make frequent visits to Guangzhou, often staying for a week to a month [22,30]. However, the population also includes a large group of students from Africa studying at universities in Guangzhou, as well as a number of female traders, businesswomen, and housewives. The socioeconomic backgrounds of African migrants span a wide range, but many are traders with limited resources who engage in small-scale, informal trade activities [30?2]. Although publicly available official figures are lack.
