Date of Award

Spring 5-7-2021

Level of Access Assigned by Author

Open-Access Thesis

Degree Name

Master of Arts (MA)

Department

Psychology

Advisor

Mollie Ruben

Second Committee Member

Shannon McCoy

Third Committee Member

Emily Haigh

Abstract

Beyond a provider’s interpersonal skills, static cues such as a provider’s attire can greatly impact patient impressions. Attire has been found to be an important early determinant of patient confidence, trust, and satisfaction (Petrilli et al., 2015). While previous literature has investigated the impact of providers in white coats, limited studies have looked at the impact of military uniforms. This is an important research question as providers in military treatment facilities always wear their military uniforms. Additionally, service members suffer from high rates of PTSD and depression (Novotney, 2020). Beyond overcoming the initial stigma to make an appointment, disclosure is likely the most important step toward healing trauma-related distress. However, many individuals with trauma-related distress fail to disclose this to their providers (Defever, 2014). Consequently, the suicide rate for military members is at an all-time high, likely due to undiagnosed mental health disorders (Novotney, 2020). Therefore, the present research aimed to examine how provider attire (military uniform vs. medical white coat) impacts ratings of provider trustworthiness and ultimately military members’ anticipated willingness to disclose mental health related information. I hypothesized: 1) Patients viewing providers who were wearing white coats, as opposed to military uniforms, would report greater anticipated disclosure of mental health information; 2) Greater perceptions of provider’s trustworthiness would elicit greater anticipated disclosure of mental health information; and 3) The relationship between provider attire and anticipated willingness to disclose mental health related information would be partially explained by perceptions of provider’s trustworthiness such that a higher rating of trustworthiness would elicit greater anticipated disclosure. Veteran participants recruited through social media and online platforms (N = 95) were randomly assigned to view 1 of 2 provider photograph sets in an online rating study. Each set contained 30 photographs split evenly between provider gender (male vs. female) and attire (military uniform vs. white coat). Participants only saw one photograph per provider (i.e., their white coat or military uniform photograph) so that attire varied within-subjects. The stimuli photos were taken from the Chicago Face Database and each individual was photoshopped to be wearing a white coat and a military uniform. Participants were shown each provider photograph one at a time and asked to make ratings of the provider’s trustworthiness as well as indicate their anticipated mental health related disclosure. Results indicated a significant effect of attire such that there was more disclosure to white coat providers (M = 4.38, SD = .22) compared to military uniform providers (M = 4.27, SD = .24) [F(1, 28) = 8.00, p = .009, ηp2 = .22] and an effect of provider gender such that there was more disclosure to female (M = 4.42, SD = .22) compared to male providers (M = 4.24, SD = .21) [F(1, 28) = 7.46, p = .011, ηp2 = .21]. These results have a multitude of clinical implications. First, providers in military treatment facilities always wear their uniforms with patients. The results of this study suggest that by mandating a white coat policy instead of a military uniform policy, veterans may be more likely to disclose health relevant information. Second, it is likely that provider photographs influence patient decisions to make or keep appointments and also set expectations as to how the provider will act during their first appointment. Therefore, these findings can inform marketing campaigns around mental health within military medicine and the VA healthcare system.

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