A positive veterinarian-client-patient relationship is critical for promoting trust and confidence between a veterinarian and client and for fostering client compliance and patient care.1,2 Studies3–6 in human medicine have found that first impressions are important for establishing a positive physician-patient relationship. In human medicine, attire is often a component of a patient's first impression of a physician or health-care provider.4–6 Attire, facial expressions, gestures, posture, and overall body language are considered forms of nonverbal communication.7 Although attire may not directly reflect the skills or competency of the individual wearing it, research from human medicine suggests it may influence others’ perceptions of an individual.6,8 In addition, a person's perception of another individual is likely to depend on a variety of factors such as their own expectations, age, culture, and geographic location.8 This perception may play a role in enhancing or inhibiting communication between 2 individuals.8 In veterinary medicine, a veterinarian's professional persona is likely to have an important role in forming relationships with clients, especially during initial interactions. In addition, a veterinarian's appearance, including attire, may also affect clients’ perceptions of the level or quality of care given to their animal. Therefore, understanding the role of veterinarians’ attire and whether it influences the veterinarian-client-patient relationship is important.
In human medicine, physician attire has been found to affect patients’ trust,6,9,10 confidence,4,6,8,11 and comfort,6,8,9,11 with most research identifying patients’ perceptions of trust or confidence being positively impacted when physicians are seen in attire that includes a white laboratory coat.4,6,8–10 In addition, trust has been found to be an important mediator of health outcomes,12 where a patient's trust or mistrust in the health-care provider can have a positive or negative impact on a person's acceptance of medical advice. Similarly, confidence in a medical provider is likely to impact a person's perception of their health-care provider and the health-care provider's competence. In a focus-group study,13 independent pet-owner and veterinarian focus groups identified that it is difficult for clients to evaluate a veterinarian's competence and that the confidence a veterinarian shows in communicating with a client can indirectly reinforce the client's trust in the veterinarian's knowledge and skills. Finally, client comfort with a health-care provider has also been considered an important attribute of health-care relationships,6,8,9,11 considering that a person's comfort level is likely to influence the sharing of sensitive information (eg, subjects related to the end of life or personal matters affecting care) as well as follow-through with care decisions. In veterinary medicine, the veterinarian-client relationship is the foundation for providing care to veterinary patients, which is likely to be influenced by the client's feelings of trust in, confidence in, and comfort with a veterinarian. Attire, unlike verbal communication, cannot be easily changed to accommodate different situations or clients14; therefore, understanding the influence veterinary attire may have on a client's feelings of trust, confidence, and comfort is an important consideration for veterinary professionals.
Although patients’ perceptions of physician, nurse, psychiatrist, and dentist attire have been investigated extensively in the literature,3,4,6,8,15–17 to the authors’ knowledge, research focused specifically on clients’ perception of veterinarians’ attire has only just begun to receive attention.18,19 Given the unique health-care context in which veterinarians work, understanding the influence veterinary attire may have on client impressions is important, as findings from human medicine suggest it may indirectly influence the veterinarian-client relationship and, in turn, veterinary patient care. The objective of the study reported here was to examine companion animal owners’ perceptions of veterinarian attire and to investigate potential associations between a veterinarian's attire and clients’ ratings of trust in, confidence in, and comfort with a veterinarian.
Materials and Methods
Study design
A survey-based, cross-sectional observational study of pet owners was performed from June 4 to July 3, 2015. The study protocol was reviewed and approved by the University of Guelph Research Ethics Board.
Questionnaire development
The study questionnaire was created to determine companion animal owners’ perceptions of and preferences for veterinary attire. Prior to development of the questionnaire, several existing studies and instruments investigating attire in different health-care settings4,6,8,9,15–17,20 were reviewed to inform questionnaire style and content. The final questionnaire contained photographs of 1 male model veterinarian and 1 female model veterinarian, each dressed in 8 different types of attire (Figure 1). The photographs were all original and captured with a digital single lens reflex camera.a One facial expression was chosen for each model veterinarian and subsequently copied to all photos in that model veterinarian's image set to ensure there was no variation in facial expression among the photographs. The photo background, model stance, hairstyle, and stethoscope placement were identical in all photographs, with attire being the only differentiating feature. The original photographs were edited with photo-editing software.b,c
Photographs depicting 8 types of attire for female (left) and male (right) model veterinarians included in a survey of 449 pet owners from Ontario, Canada, in a cross-sectional study to examine companion animal owners’ perceptions of appropriate veterinarian attire and investigate potential associations between a veterinarian's attire and clients’ ratings of trust in, confidence in, and comfort with a veterinarian. Participants were randomly assigned to provide input related to images for the male or female model veterinarian. A—Formal attire (white dress shirt and black skirt and white dress shirt, black pants, and necktie for the female and male model veterinarians, respectively). B—White dress shirt and black pants. C—White casual shirt and khaki pants. D—Surgical scrubs. E—White casual shirt and jeans. F—Surgical scrub top and jeans. G—Surgical scrub top and khaki pants. H—White laboratory coat and khaki pants.
Citation: Journal of the American Veterinary Medical Association 256, 11; 10.2460/javma.256.11.1268
Photographs depicting 8 types of attire for female (left) and male (right) model veterinarians included in a survey of 449 pet owners from Ontario, Canada, in a cross-sectional study to examine companion animal owners’ perceptions of appropriate veterinarian attire and investigate potential associations between a veterinarian's attire and clients’ ratings of trust in, confidence in, and comfort with a veterinarian. Participants were randomly assigned to provide input related to images for the male or female model veterinarian. A—Formal attire (white dress shirt and black skirt and white dress shirt, black pants, and necktie for the female and male model veterinarians, respectively). B—White dress shirt and black pants. C—White casual shirt and khaki pants. D—Surgical scrubs. E—White casual shirt and jeans. F—Surgical scrub top and jeans. G—Surgical scrub top and khaki pants. H—White laboratory coat and khaki pants.
Citation: Journal of the American Veterinary Medical Association 256, 11; 10.2460/javma.256.11.1268
Photographs depicting 8 types of attire for female (left) and male (right) model veterinarians included in a survey of 449 pet owners from Ontario, Canada, in a cross-sectional study to examine companion animal owners’ perceptions of appropriate veterinarian attire and investigate potential associations between a veterinarian's attire and clients’ ratings of trust in, confidence in, and comfort with a veterinarian. Participants were randomly assigned to provide input related to images for the male or female model veterinarian. A—Formal attire (white dress shirt and black skirt and white dress shirt, black pants, and necktie for the female and male model veterinarians, respectively). B—White dress shirt and black pants. C—White casual shirt and khaki pants. D—Surgical scrubs. E—White casual shirt and jeans. F—Surgical scrub top and jeans. G—Surgical scrub top and khaki pants. H—White laboratory coat and khaki pants.
Citation: Journal of the American Veterinary Medical Association 256, 11; 10.2460/javma.256.11.1268
The questionnaire was created with online survey software.d,e One of 2 versions of the questionnaire was randomly administered to each participant by use of the randomizer function of the online survey software. One version displayed photographs of the female model veterinarian, and the other displayed photographs of the male model veterinarian, each wearing the 8 different types of attire. Aside from the gender of the models and potential gender-associated attire differences in some photos (eg, the female model veterinarian wearing a skirt and a white dress shirt vs the male model veterinarian wearing dress pants, a white dress shirt, and a necktie), the 2 surveys were identical.
The first 8 questions of the survey randomly displayed a photo of the male or female model veterinarian (1 photo/page) wearing 1 of the 8 styles of clinical attire selected by the question randomization function of the online survey software. For these multipart questions, participants were asked to separately rate their trust in, confidence in, and comfort with the model veterinarian in each photo according to a 7-point adjectival response format anchored at 1 with the label of low trust, low confidence, or low comfort and anchored at 7 with the label of high trust, high confidence, or high comfort. Next, participants were shown all 8 photos as a set and asked to rank them according to their personal preference for each style of veterinarian attire worn on a scale from 1 (most preferred) to 8 (least preferred). Participants were also asked to respond to statements that veterinarian attire is important and that veterinarians should wear name tags when interacting with clients and animals; each of these statements was rated with a 5-point Likert response format (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree). Participants were then asked to rate a series of appearance-related subjects or items of attire (visible tattoo or tattoos, running shoes, sleeveless tops, female with pierced ears, male with pierced ears, facial piercing or piercings, male with facial hair, male with necktie, female with skirt, and long hair worn down) as not appropriate, neutral, or appropriate for veterinarians.
The next portion of the survey contained demographic questions (respondent gender, age, highest education level, and annual household income) and questions related to their pet and veterinarian, including the frequency with which they took their pet or pets to the veterinarian within a year, the number of years they had known their current veterinarian on a professional basis, the gender of their current veterinarian, and the type of attire commonly worn by that veterinarian. Upon survey completion, individuals interested in entering a drawing for $100 were directed to a separate survey in which to provide their email addresses so that all initial survey responses would remain anonymous.
A pretest was conducted with individuals known to the researchers (undergraduate and graduate students, friends, family members, and acquaintances) to assess the feasibility and clarity of questions and face validity of the overall survey. In total, 20 participants of various ages, genders, education levels, and socioeconomic statuses completed the pretest. All individuals were interviewed in person or by telephone after the pretest to gain feedback. In response to the feedback received, a preamble was added to the beginning of the survey explaining that the gender of the model veterinarian shown in the survey would be randomly assigned for each participant and asking the participants to assess the veterinarian's attire in the context of their arriving with their pet for a regular appointment.
Participant recruitment
Pet owners were recruited for study participation by 2 methods. In the first method, participants were recruited at various dog parks located in 3 cities in southern Ontario, Canada (Guelph, Toronto, and Kitchener-Waterloo). Dog parks were found by locating all designated off-leash areas on official government websites for the applicable cities. The dog parks used for recruitment were chosen on the basis of convenience for the research team and prior general knowledge of the foot traffic of pet owners at these locations. Recruitment of pet owners at dog parks took place during June 2015 from 7:30 am to 8:00 pm. With the exception of pet owners known to have been previously invited to participate on another date, any individual observed entering the park with ≥ 1 dog during the time a team member was present was approached and asked to participate. When approached, these individuals were told of the study purpose, what was involved in participating, and that there was an incentive for participation (a 1-in-100 chance of winning $100 [Canadian currency]). Participants were required to be 18 years of age or older. Pet owners who agreed to participate were then offered the choice of taking a postcard with the website address to participate in the survey or providing their email address to the research assistant to be emailed a link to the survey ≤ 24 hours after agreeing to enroll. After selecting an option, the pet owner was given dog waste bags with a dispenser (valued at $2.50 [Canadian currency]) as an expression of appreciation and to encourage follow-through with the survey.
Participants were also recruited by use of snowball sampling methods through social media. A notice including a link to the survey and encouraging distribution of the link to others was posted on a social media websitef on a variety of personal pages belonging to research team members or their colleagues and on pet-oriented group pages. The group pages were found by entering the names of major southern Ontario cities and towns in combination with the terms dog, cat, or pet in the search bar of the social media website.
Statistical analysis
Data obtained with the 2 recruitment methods (ie, in person and through social media) were merged. Descriptive statistics were calculated for demographic data and general attire-related variables (preference in veterinarian attire, importance of attire, whether veterinarians should wear name tags, and ratings for specific appearance-related subjects or attire items), including frequencies for categorical variables, and mean, SE, median, range, and minimum and maximum values for continuous variables.
Three linear mixed regression analyses were produced, each investigating factors associated with participants’ ratings of trust in, confidence in, or comfort with the model veterinarians. Random effects introduced by participant nested in participant gender, gender of the randomly assigned model veterinarian, and recruitment method were controlled for in the models. For each regression, independent variables included the following: recruitment method, model veterinarian gender, attire worn by the model veterinarian, participant gender, participant age, participant level of education, annual income level of the participant, gender of the participants’ regular veterinarian, and attire worn by participants’ regular veterinarian. Listwise deletion was used to handle missing data.
The first stage of model building consisted of producing univariable regressions involving all independent variables and each of the dependent variables (trust, confidence, and comfort scores). All variables associated with the dependent variable at values of P ≤ 0.10 in the univariable regressions were included in an initial multivariable regression of main effects for the dependent variable of interest. Manual backward selection was used to remove nonsignificant (P ≥ 0.05) variables, starting with the variable that had the highest P value. The presence of confounding was assessed by adding potential confounders (ie, participant gender, recruitment method, participant income, participant age, gender of participants’ regular veterinarian, and attire worn by participants’ regular veterinarian) into the main-effects regression analysis. An additional confounder assessed in the confidence regression analysis included the gender of the model veterinarian. Coefficients of the significant variables were compared when potential confounders were included in the main-effects regression model. If the removal of a potential confounder resulted in a change of ≥ 20% in the coefficient of the significant variable or variables in the model, the potential cofounder was deemed to be confounding and retained in the final model.21 Residual analyses were conducted on the final regression models to assess the assumptions of the linear-mixed regression analyses.
All statistical analyses were done with standard statistical software.g In the final analyses, values of P < 0.05 were considered significant.
Results
Study sample
Of 1,310 individuals contacted in dog parks, 148 (11.3%) participated in the study. Overall, 449 individuals participated in the study, with 301 (67%) recruited through social media in addition to the 148 (33%) recruited in person. The mean age of participants was 37.9 years (median, 35.0; range, 18 to 72). Additional demographic information is summarized (Table 1). Participants reported taking their pet to the veterinarian a mean of 2.4 times (median, 2 times; range, 0 to 10 times) annually. The mean duration that participants reported having a professional relationship with their veterinarian was 6.7 years (median, 4 years; range, 0.08 to 35 years). Most participants agreed (245/445 [55.1%]) or strongly agreed (72/445 [16.2%]) that a veterinarian's attire is important, and most agreed (309/449 [68.8%]) or strongly agreed (140/449 [31.2%]) that veterinarians should wear a name tag when interacting with clients and their animals.
Demographic information for 449 pet owners from Ontario, Canada, who participated in a survey-based, cross-sectional study to examine companion animal owners’ perceptions of appropriate veterinarian attire and investigate potential associations between a veterinarian's attire and clients’ ratings of trust in, confidence in, and comfort with a veterinarian.
| Variable | No. (%) of respondents |
|---|---|
| Gender (n = 438) | |
| Male | 77 (17.6) |
| Female | 361 (82.4) |
| Education (n = 444) | |
| Less than grade 12 | 2 (0.5) |
| High school | 48 (10.8) |
| College | 102 (23.0) |
| University | 177 (39.9) |
| Graduate degree | 79 (17.8) |
| Professional degree* | 36 (8.1) |
| Annual household income (n = 421) | |
| < $35,000 | 79 (18.8) |
| $35,000–$60,000 | 79 (18.8) |
| $61,000-$100,000 | 137 (32.5) |
| > $100,000 | 126 (29.9) |
| Pets (n = 441)† | |
| Dogs (no cats) | 249 (56.5) |
| Cats (no dogs) | 70 (15.9) |
| Both dogs and cats | 119 (27.0) |
| Other (no dogs or cats) | 3 (0.7) |
Not all respondents answered every question.
Examples that were provided included MD and DVM.
Respondents who owned dogs, cats, or both included owners of species other than dogs or cats as well.
Of the 449 respondents, 226 and 223 were randomly assigned to provide input on female and male model veterinarian attire, respectively. Participants’ rankings for the 8 types of attire indicated that surgical scrubs were most commonly preferred for both male and female veterinarians (Table 2). In contrast, more formal attire (ie, a white dress shirt, black pants, and necktie for the male model veterinarian and a white dress shirt and black skirt for the female model veterinarian) was most frequently ranked as least preferred by participants.
Rankings for female and male model veterinarian attire from most preferred (1) to least preferred (8) by the 449 pet owners in Table 1.
| Rank (No. [%] of responses) | ||||||||
|---|---|---|---|---|---|---|---|---|
| Variable | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| Female model veterinarian | ||||||||
| Surgical scrubs | 64 (32) | 39 (19.5) | 21 (10.5) | 22 (11) | 13 (6.5) | 17 (8.5) | 7 (3.5) | 17 (8.5) |
| Laboratory coat and khaki pants | 51 (25.5) | 32 (16) | 29 (14.5) | 27 (13.5) | 17 (8.5) | 8 (4) | 22 (11) | 14 (7) |
| Scrub top and khaki pants | 17 (8.5) | 42 (21) | 51 (25.5) | 36 (18) | 22 (11) | 18 (9) | 12 (6) | 2 (1) |
| Scrub top and jeans | 16 (8) | 31 (15.5) | 36 (18) | 40 (20) | 27 (13.5) | 26 (13) | 21 (10.5) | 3 (1.5) |
| Casual shirt and khaki pants | 27 (13.5) | 19 (9.5) | 17 (8.5) | 22 (11) | 37 (18.5) | 36 (18) | 35 (17.5) | 7 (3.5) |
| Dress shirt and black pants | 13 (6.5) | 24 (12) | 16 (8) | 28 (14) | 48 (24) | 28 (14) | 42 (21) | 1 (0.5) |
| Casual shirt and jeans | 10 (5) | 10 (5) | 18 (9) | 16 (8) | 24 (12) | 37 (18.5) | 40 (20) | 45 (22.5) |
| Formal attire | 2 (1) | 3 (1.5) | 12 (6) | 9 (4.5) | 12 (6) | 30 (15) | 21 (10.5) | 111 (55.5) |
| Male model veterinarian | ||||||||
| Surgical scrubs | 70 (34.5) | 49 (24.1) | 30 (14.8) | 17 (8.4) | 12 (5.9) | 12 (5.9) | 4 (2) | 9 (4.4) |
| Laboratory coat and khaki pants | 34 (16.7) | 41 (20.2) | 23 (11.3) | 22 (10.8) | 14 (6.9) | 26 (12.8) | 23 (11.3) | 20 (9.9) |
| Scrub top and khaki pants | 23 (11.3) | 26 (12.8) | 44 (21.7) | 32 (15.8) | 36 (17.7) | 18 (8.9) | 12 (5.9) | 12 (5.9) |
| Scrub top and jeans | 27 (13.3) | 28 (13.8) | 29 (14.3) | 33 (16.3) | 20 (9.9) | 25 (12.3) | 31 (15.3) | 10 (4.9) |
| Casual shirt and khaki pants | 15 (7.4) | 13 (6.4) | 19 (9.4) | 27 (13.3) | 47 (23.2) | 41 (20.2) | 22 (10.8) | 19 (9.4) |
| Dress shirt and black pants | 6 (3) | 23 (11.3) | 21 (10.3) | 35 (17.2) | 25 (12.3) | 28 (13.8) | 54 (26.6) | 11 (5.4) |
| Casual shirt and jeans | 7 (3.4) | 11 (5.4) | 20 (9.9) | 20 (9.9) | 28 (13.8) | 34 (16.8) | 34 (16.7) | 49 (24.1) |
| Formal attire | 21 (10.3) | 12 (5.9) | 17 (8.4) | 17 (8.4) | 21 (10.3) | 19 (9.4) | 23 (11.3) | 73 (36) |
Laboratory coats, casual shirts, and dress shirts were all shown in white. Formal attire comprised a dress shirt and black skirt for the female model veterinarian and a dress shirt, black pants, and necktie for the male model veterinarian. Percentages shown were calculated on the basis of responses from study participants randomly assigned to rank the female (n = 200) or male (203) model veterinarian attire only. Not all respondents ranked the female or male model veterinarian attire.
See Figure 1 for attire type depictions.
When rating specific appearance-related subjects or attire items (appropriate, neutral, or inappropriate), participants most frequently rated wearing running shoes as appropriate (285/446 [64%]; Figure 2). In contrast, wearing sleeveless tops was most frequently rated as inappropriate (260/449 [58%]).
Percentages of respondents among 449 pet owners from Ontario, Canada, who rated the described appearance-related subjects or items of attire as appropriate, neutral, or not appropriate (white, gray, and black stacked bars, respectively). Not all respondents answered every question; the number of responses for each item is shown above the bar.
Citation: Journal of the American Veterinary Medical Association 256, 11; 10.2460/javma.256.11.1268
Percentages of respondents among 449 pet owners from Ontario, Canada, who rated the described appearance-related subjects or items of attire as appropriate, neutral, or not appropriate (white, gray, and black stacked bars, respectively). Not all respondents answered every question; the number of responses for each item is shown above the bar.
Citation: Journal of the American Veterinary Medical Association 256, 11; 10.2460/javma.256.11.1268
Percentages of respondents among 449 pet owners from Ontario, Canada, who rated the described appearance-related subjects or items of attire as appropriate, neutral, or not appropriate (white, gray, and black stacked bars, respectively). Not all respondents answered every question; the number of responses for each item is shown above the bar.
Citation: Journal of the American Veterinary Medical Association 256, 11; 10.2460/javma.256.11.1268
Factors associated with participants’ trust in, confidence in, and comfort with the model veterinarians
With adjustment for random effects, the final regression model for participants’ trust in the model veterinarians included gender of the veterinarian, attire worn by the model veterinarian, and education level of the participant (Table 3). The final regression model for participants’ confidence in the model veterinarians included only the attire worn by the model veterinarian (Table 4). The final regression model for participants’ comfort with the model veterinarians included gender of the veterinarian, attire worn by the model veterinarian, and education level of the participant (Table 5).
Final mixed linear regression model for participants’ trust in model veterinarians.
| Variable | Estimate (95% CI) | P value |
|---|---|---|
| Gender of model veterinarian | 0.026 | |
| Female | 4.64 (4.29–4.99) | |
| Male | 4.40 (4.04–4.77) | |
| Attire type | < 0.001 | |
| Formal attire | 4.15 (3.79–4.50)a | |
| Dress shirt and black pants | 4.40 (4.05–4.75)b | |
| Casual shirt and khaki pants | 4.27 (3.92–4.63)a,b | |
| Surgical scrubs | 5.22 (4.87–5.57) | |
| Casual shirt and jeans | 3.95 (3.60–4.30) | |
| Scrub top and jeans | 4.55 (4.20–4.91)c | |
| Scrub top and khaki pants | 4.68 (4.33–5.04)c | |
| Laboratory coat and khaki pants | 4.96 (4.61–5.32) | |
| Participants’ education level | 0.032 | |
| Less than grade 12 | 2.01 (0.05–3.96) | |
| High school | 4.93 (4.61–5.25)a,b,c,d | |
| College | 4.98 (4.76–5.19)a,e,f | |
| University | 5.11 (4.94–5.27 b,e,g,h | |
| Graduate degree | 4.92 (4.69–5.16)c,f,g,i | |
| Professional degree* | 5.20 (4.84–5.56)d,h,i |
Participants rated trust in the model veterinarians with a 7-point adjectival response format anchored at 1 (low trust) and 7 (high trust).
Within a variable, values with the same superscript letters did not differ significantly (P < 0.05).
See Table 1 for remainder of key.
Final mixed linear regression model for participants’ confidence in model veterinarians.
| Variable | Estimate (95% CI) | P value |
|---|---|---|
| Attire type | < 0.001 | |
| Formal attire | 4.63 (4.49–4.78)a | |
| Dress shirt and black pants | 4.90 (4.76–5.05)b | |
| Casual shirt and khaki pants | 4.75 (4.61–4.89)a | |
| Surgical scrubs | 5.74 (5.59–5.88) | |
| Casual shirt and jeans | 4.37 (4.23–4.51) | |
| Scrub top and jeans | 4.98 (4.83–5.12)b | |
| Scrub top and khaki pants | 5.16 (5.02–5.30) | |
| Laboratory coat and khaki pants | 5.53 (5.39–5.67) |
Participants rated confidence in the model veterinarians with a 7-point adjectival response format anchored at 1 (low confidence) and 7 (high confidence).
See Table 3 for remainder of key.
Final mixed linear regression model for participants’ comfort with the model veterinarians.
| Variable | Estimate (95% CI) | P value |
|---|---|---|
| Gender of model veterinarian | 0.018 | |
| Female | 4.67 (4.32–5.03) | |
| Male | 4.42 (4.06–4.78) | |
| Attire type | < 0.001 | |
| Formal attire | 3.97 (3.61–4.32) | |
| Dress shirt and black pants | 4.28 (3.92–4.64)a | |
| Casual shirt and khaki pants | 4.57 (4.22–4.93)b | |
| Surgical scrubs | 5.09 (4.74–5.45) | |
| Casual shirt and jeans | 4.31 (3.95–4.66)a | |
| Scrub top and jeans | 4.73 (4.38–5.09)c,d | |
| Scrub top and khaki pants | 4.83 (4.48–5.19)c | |
| Laboratory coat and khaki pants | 4.61 (4.25–4.96)b,d | |
| Participants’ education level | 0.042 | |
| Less than grade 12 | 2.00 (0.05–3.95) | |
| High school | 4.93 (4.61–5.25)a,b,c,d | |
| College | 5.06 (4.84–5.27)a,e,f,g | |
| University | 5.13 (4.96–5.29)b,e,h,i | |
| Graduate degree | 4.99 (4.75–5.22)c,f,h,j | |
| Professional degree* | 5.19 (4.83–5.55)d,g,i,j |
Participants rated comfort with the model veterinarians with a 7-point adjectival response format anchored at 1 (low comfort) and 7 (high comfort).
See Tables 1 and 3 for remainder of key.
Discussion
Results of the present study indicated participating pet owners perceived the attire worn by a veterinarian as important. This was consistent with findings from research in human medicine, where a physician's attire has been reported to be of general importance to patients and has been viewed to reflect the level of respect a physician has toward a patient.5 It has also been found to have a role in establishing the physician-patient relationship through a patient's first impression of a physician.3–5 Findings of the present study suggested a veterinarian's attire has a potentially important role in establishing first impressions within the unique context of the veterinarian-client relationship. It is likely important for veterinarians as well as veterinary management and veterinary personnel to consider the potential impressions attire and general appearance can have on clients.
Although participants’ education level and the model veterinarians’ gender were associated with trust in and comfort with the model veterinarians, the veterinarians’ attire, as shown in the survey of the present study, was the only variable found to be associated with all 3 outcomes of trust in, comfort with, and confidence in the model veterinarians. The ability of attire to affect perceptions of trustworthiness,6,9,10 comfort,6,8,9 and confidence4,6,8 has been identified in human medicine. In addition, physicians’ attire has been found to influence patients’ perceptions of authority,20,22 friendliness,22 and empathy9 of their health-care provider. Given that an individual's attire is a form of nonverbal communication that can influence clients’ perceptions of a veterinary professional or possibly perceptions of the veterinary practice in which they work, it may be important for veterinary management to consider the potential messages sent to clients by choices of staff attire.
Participants’ trust, comfort and confidence scores in the present study were highest when the model veterinarians were pictured in surgical scrubs. In contrast, comfort score was lowest when the model veterinarians were wearing formal attire, and trust and confidence scores were lowest when the model veterinarians were wearing a casual shirt and jeans. A similar study8 in human medicine found patients indicated being most comfortable when their physician wore scrubs. The authors of that study8 suggested that this perception might be the result of influence by popular culture in which physicians are often shown in media wearing scrubs. It is not unreasonable to expect that clients likely have prior expectations of their health-care provider's attire as a result of outside influences or the client's perceptions of the type of work the health-care provider does. Because one's attire is a form of nonverbal communication that cannot be changed at a moment's notice in the way verbal communication can be changed to accommodate or respond to an individual client,14 it may be important that individuals working in veterinary practice consider the message their overall appearance sends to clients.
In the present study, trust and confidence scores were also high when the model veterinarians were pictured wearing a white laboratory coat and khaki pants. Similar results have been described in the medical literature, where patients reported greater trust6,9,10 and confidence4,6,8,11 in physicians pictured wearing laboratory coats. In a recent veterinary study,19 most clients reported that wearing a white laboratory coat was not a necessity, yet the preferred attire types chosen during the study by the same participants were styles that included white laboratory coats. As a result, the authors proposed that a white-coat appearance may play a larger subconscious role in clients’ feelings of trust and confidence than clients may realize. Therefore, it may be important for veterinarians to recognize that their attire may influence their Aesculapian authority, which is an intrinsic power medical professionals hold over a client as a result of their medical position.23 It is important at all times for veterinarians to be aware of their Aesculapian authority to avoid any potential unconscious or unintended abuse of their position.23
It is also important to be aware that a study24 conducted in a human hospital found white laboratory coats of health-care workers were contaminated with pathogenic and resistant bacteria. Interestingly, most of the health-care workers in the study perceived their white coat to be dirty, with two-thirds not having washed their coat within the previous week. Given the context and environment in which veterinarians and veterinary personnel work, including exposure to blood, urine, feces, and other materials, it is important for veterinary personnel to consider that their attire can be a vector for patient-to-patient transmission of pathogens. Theoretically, a laboratory coat is a piece of attire that veterinarians or staff can easily replace to limit the transfer of materials or disease from one animal to another. It would behoove veterinary practices and personnel who use laboratory coats to ensure they change and clean coats frequently to reduce potential patient-to-patient transmission of pathogens.
Many people are aware of the so-called white-coat effect or white-coat hypertension, which has been described for human patients25 and for dogs and cats.26,27 However, it is important to recognize that this effect is not directly related to a health-care provider's attire, but is associated with the patient being in a medical environment and in the presence of a health-care provider.25 This should not deter veterinary professionals from wearing a white laboratory coat, and the findings of the present study suggested clients are likely to be more trusting of and to have greater confidence in a veterinarian who wears a white laboratory coat. In human medicine, patients have also reported a greater tendency to attend follow-up appointments and to have increased compliance with recommendations from physicians who dress professionally, which includes wearing a laboratory coat.6 Taken together with results of the present study, this suggests that members of a practice should be aware and reflect on the influence that their attire may have not only on clients’ first impressions and client relationships, but potentially on the outcomes of veterinary care.
Participants in the present study assigned scores that indicated greater trust in and comfort with the female versus the male model veterinarian. Previous research in veterinary medicine has found clients were more likely to release medical and social information regarding their pet to a female veterinarian.28 In addition, findings from human medicine suggest that human medical patients appear less intimidated by female physicians, expect female physicians to be more interested in their emotions, and experience a more patient-centered visit with a female physician than with a male physician.29 On the basis of findings in the present study and other investigations, research into further understanding the role of gender in veterinarian-client professional relationships is likely warranted.
Participants who had professional degrees assigned the greatest trust and comfort scores, whereas those with less than grade 12 education reported the lowest scores. The existing medical literature has not identified client or patient education as a factor in the trust or confidence these individuals have in a health-care provider. Findings of the present study suggested that additional factors, possibly a client's level of education, may influence a client's perception of the veterinarian. This is an area worthy of future research.
Most participants in our study (317/445 [71.2%]) agreed or strongly agreed that name tags should be part of a veterinarian's attire. Of interest, the number of participants who strongly agreed that name tags should be part of a veterinarian's attire (149/449 [31.2%]) was subjectively greater than the number of participants who strongly agreed that a veterinarian's attire is important (72/445 [16.2%]). Multiple investigations across health-care settings have shown that patients view name tags to be important for physicians,4 nurses,30 dentists,20 and psychiatrists.3 In a study30 of patients in a behavioral health unit, participants indicated that name tags were more important than the type of attire nurses wore. Further, the study participants preferred name tags that identified the positions or roles of the individuals wearing them. The provision and wearing of name tags by veterinary personnel is an important consideration for veterinary practice management, as name tags play an important role in identifying hospital personnel and can potentially reduce the identity confusion that can exist, given that personnel with various roles may interact with a client in a veterinary practice.
Although results of the study reported here raised the importance of veterinary attire for consideration, it is unlikely that all clients have the same views on veterinarians’ attire. Research has found that the preferences of physician attire may vary depending on severity of illness,31 time of day,31 situation,32 or environment.32 A recent study18 in veterinary medicine found that clients had no preference of emergency veterinarians’ attire. The authors suggested that 1 possible cause for this finding may be that the urgency of an emergency situation is likely to carry greater importance than the attire of the veterinarian. These findings support that clients’ preferences are often not associated with only 1 variable and that clients’ perceptions can be influenced by various factors. It is important to note that, in the present study, participants were specifically asked to consider the model veterinarian's attire in the context of visiting with their pet for a regular appointment. Given that client perceptions of attire may apply for all staff, the authors consider that establishing general practice-level guidelines or policies with regard to staff attire is likely an important consideration for veterinary practices to help meet a diverse array of client expectations. However, it is important to note that the present study only explored clients’ perceptions of veterinarians’ attire and that clients’ perceptions of other staff members’ attire may differ.
Participants involved in the present study were recruited in person from local dog parks and through social media with snowball sampling methods. Although the recruitment methods were not found to have a significant association with the outcomes examined, this approach to participant recruitment limited the generalizability of the findings and should be considered carefully when interpreting the results. The present study also included a larger proportion of female than male participants, which is not uncommon in web-based survey research,33 but likely resulted in an underrepresentation of male clients’ opinions on veterinarians’ attire.
Following the design of other studies4,6,8,9,15–17 performed to investigate potential influences of attire in various health-care settings, single-item measures of trust, confidence, and comfort were used for the present study, and this may have limited the reliability of these results. However, the use of a similar design and approach to those used in previous studies allowed us to make comparisons between our results and the results of those investigations. Similar to findings in other health-care settings,4,6,8–10 our study found that model veterinarians’ wearing a white laboratory coat had a positive association with participants’ ratings of confidence and trust in the model veterinarians. This consistency in findings among health-care settings supported the construct validity of our study. To further support the reliability and validity of findings from the present study, further research into the effects of veterinarians’ attire on clients’ ratings of trust, confidence, and comfort is warranted.
The geographic focus on recruitment from cities in our study likely resulted in an underrepresentation of clients living in more suburban or rural areas. A larger proportion of dog owners than owners of other pets participated in the study, likely the result of focusing a portion of recruitment efforts on individuals at dog parks. In addition, participants’ ethnicity was not collected as part of the study and could not be taken into consideration during analysis. Future research in this area should consider the ethnicity of participants and veterinarians and the impact these factors may have on a clients’ ratings of trust in, confidence in, and comfort with a veterinarian. In addition, perceptions of only 1 male Caucasian and 1 female Caucasian model veterinarian were surveyed; with other male or female model veterinarians, or with more examples of male and female model veterinarians including different ethnic backgrounds and ages, results may differ. Further, the pieces of attire pictured were not identical between the male and female models in all photos, which may have influenced participants’ responses to the photographs to some degree and may have led participants to respond to the male and female model veterinarians differently, which possibly influenced the findings related to the model veterinarians’ gender.
The present study highlighted that a client's confidence in, trust in, and comfort with a veterinarian may be influenced by the veterinarian's attire. Veterinarians may use these findings to reflect on their own attire and the impression their attire may have on their clients. Recognizing that attire may also potentially affect staff-client relationships, it may benefit veterinary practices to consider the development of baseline practice-level guidelines with regard to staff attire. Whether at the practice or individual level, it is important to realize that attire may impact relationships with clients, but that different contexts or other factors may influence the specific impact that attire has on these relationships.
Acknowledgments
No third-party funding was obtained in connection with this study. Dr. Coe regularly receives honoraria and research funding from various organizations and commercial companies. The authors declare there were no conflicts of interest.
The authors thank Helen Toner and Caroline Graefin von Waldburg-Zeil for their research assistance and William Sears for statistical support.
Footnotes
Canon EOS 60D, Canon USA, Melville, NY.
PhotoScape, version 3.5, Mooii Tech Co Ltd, Seoul, Korea.
Gimp GNU Image Manipulation Program, version 2.6.11. The Gimp Team. Available at: www.GIMP.org. Accessed Jun 28, 2011.
Qualtrics Survey Software, version June 2015, Qualtrics, Provo, Utah.
A copy of the survey questions is available upon request from the corresponding author.
Facebook. Available at: www.facebook.com. Accessed Jun 4, 2015.
SAS Studio, version 3.71, Basic Edition, SAS Institute Inc, Cary, NC.
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