Purpose: The aim of this study was to investigate the current status of patients’ presupposed distrust, and to clarify the causes of high presupposed distrust.
Patients and Methods: An explanatory sequential mixed methods study was conducted using a two-stage design. The first phase was a quantitative cross-sectional survey, a total of 384 patients by convenience sampling completed the survey. Study instruments including demographic and clinical characteristics sheet, patients’ presupposed distrust scale. In the qualitative phase, 16 patients on the basis of their mean score for all PPDS items were higher than 4 were identified as extreme cases participated in one-to-one semi-structured interviews.
Results: The total item mean score for all patients on PPDS was 3.59(3.18, 4.09), which above the median range of the PPDS (item mean score of 3). Personal income level and educational level were significant predictive influencing factors of patients’ presupposed distrust, which could explain 17.347% of the variance. The reasons of high patients’ presupposed distrust were as follows: moral character, health knowledge, patient perceptions, and the social circumstance.
Conclusion: The level of patients’ presupposed distrust was high, which needs to be further decreased. Demographic and clinical variables (personal income level, educational level) are identified to be the major contributing factors. The main causes for the formation of the high patients’ presupposed distrust are patients internal factors and social circumstance.

Keywords: patients, presupposed distrust, root cause analysis, cross-sectional investigation, qualitative research