Background: Patient engagement has become a priority for health care providers. This study examined primary care patients’ preferred roles in health care decision-making in an era of increased health information and how these preferences related to perceived health information literacy and trust in their physician. Methods: This research applied a multi-methods design. The first phase involved quantitative surveys in a primary care clinic (N=141); the surveys examined patients’ preferred roles, perceived health information literacy, trust in the physician, and demographic variables. The second phase involved follow-up with semi-structured interviews with a subgroup of these patients (N=11). Preferred roles were measured for two vignettes: ‘current health condition’ and ‘chest pain’. T-tests compared the perceived health information literacy and trust in physician scores between shared and passive patients. A binary logistic regression was computed to see whether trust in physician and perceived health information literacy could predict patients’ preferred roles. Thematic analysis was done for qualitative interviews. Results: The results of this research showed that most patients surveyed preferred a shared role, had a high level of perceived health information literacy, and had high levels of trust in their physician. Patients who preferred a shared role had a higher mean perceived health information literacy compared to those who preferred a passive role. Results of the binary logistic regression showed that trust in the physician was the only variable that predicted patients’ preferred roles for the chest pain and current health condition vignettes. Qualitative themes included: frequency of website use, patients’ preferred roles factors that influence them, factors that influence the patient-physician relationship, and patients’ preferred forms of communication. Conclusion: The findings of this research showed that even in this sample of highly educated patients with high levels of perceived health information literacy, most patients preferred a shared role. Almost none wanted an autonomous role. Trust in the physician was significantly associated with patients’ preferred roles in this sample of patients that had high levels of trust in their doctor.