The effects of trust in physician on self-efficacy, adherence and diabetes outcomes

Intersectional Structural Stigma: A Qualitative Study With Persons Experiencing Homelessness in the Southwest United States

This study explored the manifestations of intersectional structural stigma and stigma-reducing strategies in the context of health among a diverse group of persons experiencing homelessness in the southwest United States. Purposive sampling was used to recruit youth (ages 12-17), young adults (ages 18-24), adults (ages 25 years old or older), women with children, veterans, and males over 60 years old who self-identified as homeless. Grounded theory was applied, and thematic analysis was conducted using data collected from seven focus groups (n = 76 participants). A model of intersectional stigma was adapted from the Health Stigma and Discrimination Framework. This adaptation depicts pathways for addressing intersectional stigmatization experienced by individuals with multiple intersecting identities across the interpersonal, organization, and community levels not explicitly addressed in the Health Stigma and Discrimination Framework. At the interpersonal level, participants indicated they experienced stigmatizing behaviors and practices by service providers due primarily to their identities related to economic or unhoused statuses, gender, age, and mental health. Facilitators of intersectional stigma were identified through organization practices and processes. Multiple stigmatized identities due to social beliefs also facilitated stigmatization at the community level. Health outcomes influenced by stigmatization were also identified. Despite the stigmatization they experienced, participants discussed stigma-reducing strategies related to community assets, medical care, and destigmatizing practices by service providers.

Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness

Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.

Unveiling Patient Trust in Physicians Across China: Insights from a Nationwide Cross-Sectional Study

Background

Trust is a major factor affecting patient-physician relationship and healthcare quality. However, there has been a lack of comprehensive study on the extent of and major factors affecting patient trust in healthcare providers of China, the world's largest developing country. The objective of this study is to elucidate the current status of outpatient trust in physicians in China and its influencing factors, providing empirical evidence to enhance doctor-patient trust and improve doctor-patient relationships.

Methods

Between December 2017 and January 2018, 28,760 patients seeking care at the outpatient departments of 136 tertiary hospitals were interviewed, where they were asked to rate their trust in physicians. We applied a multilevel logistic regression model to explore the association between patients trust and characteristics of hospitals, physicians and patient characteristics. We conducted a series of sensitivity analysis to check the robustness of our findings.

Results

Among 28,760 participants included in this study, 91.54% expressed trust in their physicians, while 7.52% showed moderate trust. Only 0.94% expressly distrusted or strongly distrusted their physicians. Outpatients of hospitals with convenient payment, volunteer guidance and enough seats available in the rest and waiting area showed higher levels of trust. Physicians who had a senior title, showed patience and protection of the patient's privacy were more likely to be trusted by their patients in the outpatient setting. Compared to their female counterparts, male outpatients showed a higher degree of trust.

Conclusion

While this study highlights an overall high level of Trust in physicians (TIP) among patients in China's tertiary hospitals, it is found to vary with patient demographic factors as well as provider's attributes. Hospitals with a more keen sense of protecting patients privacy and better meeting patients' need for efficient and caring service provision process appeared to yield a higher level of trust.

Procedural Fairness in Physician-Patient Communication: A Predictor of Health Outcomes in a Cohort of Adults with Overweight or Obesity

BACKGROUND

This study aimed to explore whether patients' perception of procedural fairness in physicians' communication was associated with willingness to follow doctor's recommendations, self-efficacy beliefs, dietary behaviors, and body mass index.

METHODS

This was a secondary analysis of baseline data from 489 primary care patients with a BMI ≥ 25 kg/m2 (43.6% Black, 40.7% Hispanic/Latino, 55.8% female, mean age = 50 years), who enrolled in a weight management study in two New York City healthcare institutions. We conducted ordinary least squares path analyses with bootstrapping to explore direct and indirect associations among procedural fairness, willingness to follow recommendations, self-efficacy, dietary behaviors, and body mass index, while controlling for age and gender.

RESULTS

Serial, multiple mediator models indicated that higher procedural fairness was associated with an increased willingness to follow recommendations which, in turn, was associated with healthier dietary behaviors and a lower BMI (indirect effect =  - .02, SE = .01; 95% CI [- .04 to - .01]). Additionally, higher procedural fairness was associated with elevated dietary self-efficacy, which was, in turn, was associated with healthier dietary behaviors and lower BMI (indirect effect =  - .01, SE = .003; 95% CI [- .02 to - .002]).

CONCLUSIONS

These findings highlight the importance of incorporating procedural fairness in physician-patient communication concerning weight management in diverse primary care patients.

Individual and Community-Level Characteristics and Adherence to Specialty Medications

Background: Understanding risk factors for nonadherence can help specialty pharmacies optimize resources to prevent nonadherence and inform risk-stratification processes. Objective: To determine which individual and community-level characteristics are associated with nonadherence to specialty medications. Methods: We analyzed a cohort of patients enrolled in a prospective randomized controlled trial having filled a specialty medication at least 4 times in the previous 12 months with a proportion of days (PDC) covered < 0.90. We collected patient age, gender, race, medication administration type, therapy start date, home address, insurance type, and online patient portal status from the electronic health record. An ordinal logistic regression model was used to assess the association of nonadherence with individual and community-level patient characteristics. Results: Most patients were female (68%), white (82%), and held commercial insurance (58%) with a median age of 53 (interquartile range [IQR] 40, 64) years. Patients were mostly from the adult rheumatology (35%), multiple sclerosis (20%) and lipid (17%) clinics. Given a 10-year increase in age, patients had lower odds of having lower PDC (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.71-0.94, P = 0.005). Patients on therapy greater than or equal to 1 year had half the odds of having lower PDC relative to patients on therapy less than 1 year (OR = 0.52, CI = 0.35 - 0.75, P < 0.001). No statistically significant associations were found between PDC and gender, race, insurance type, route of administration, clinic type, patient portal status, median income, percent receiving government assistance, or percent with no health insurance. Conclusion: Patients with younger age and shorter duration on treatment may be at-risk for lower adherence. Specialty pharmacies may benefit from targeting adherence interventions to these groups.

Health literacy and diabetic retinopathy

Health literacy (HL) is defined as a cognitive and social skill that determines the motivation and ability of individuals to understand and use information to promote and maintain proper health. Inadequate HL has been associated with worse outcomes in diabetes control, poor self-care, and higher hospitalization rates for some chronic diseases. We hypothesized that HL influences the prevalence of diabetic retinopathy (DR) among individuals with type 2 diabetes mellitus (T2DM) and that inadequate glycemic control would mediate this association. This was a cross-sectional study carried out with 288 participants of the "Brazilian Diabetes Study" cohort. Inclusion criteria were people diagnosed with T2DM aged between 40 and 70 years and ability to read and write. In the adequate HL group, DR was found in 16.5% of participants and in the inadequate HL group, it was found in 32.8% (P=0.0081). Individuals with inadequate HL had a higher risk of having DR, and this association was still statistically significant after adjusting for HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. In conclusion, HL is related to DR without the mediation of classical clinical variables.

Association of treatment satisfaction and physician trust with glycemic control among primary care patients with type 2 diabetes in Egypt

Objectives

To evaluate the association of diabetes treatment satisfaction and trust in family physicians with glycemic control among primary care patients with type 2 diabetes mellitus.

Methods

A cross-sectional study on 319 patients with type 2 diabetes mellitus from five primary healthcare centers in Egypt. Data were collected from February to August 2021 using a structured questionnaire that contained six parts: sociodemographic data, disease profile, the Diabetes Treatment Satisfaction Questionnaire (DTSQ), 8-item Morisky Medication Adherence Scale (MMAS-8), self-reported medication knowledge questionnaire (MKQ), and revised healthcare relationship trust scale (HCR). Multiple linear regression analysis was used to assess predictors of treatment satisfaction, physician trust, and HbA1c level. P values less than 0.05 were considered significant.

Results

The mean age was 59.66 years (± 7.87 years) and 55.17% were females. Multiple linear regression analysis for predicting HbA1c showed that HbA1c level was lower in patients with higher treatment satisfaction scores (β =  - 0.289, p < 0.001) and higher medication adherence scores (β =  - 0.198, p = 0.001). Treatment satisfaction scores were positively predicted by higher physician trust scores (β = 0.301, p < 0.001), increased medication adherence scores (β = 0.160, p = 0.002), and longer duration of diabetes (β = 0.226, p < 0.001). Positive predictors for physician trust included HbA1c level (β = 0.141, p = 0.012), medication knowledge (β = 0.280, p < 0.001), diabetes treatment satisfaction (β = 0.366, p < 0.001) and medication adherence (β = 0.146, p = 0.011).

Conclusion

Optimizing diabetes treatment satisfaction and physician trust could have favorable associations with medication adherence and medication knowledge with a possible improvement in glycemic control. Family physicians should incorporate patients reported outcomes alongside traditional clinical measures in evaluating diabetes management in primary care.

Adolescents' experiences of Help Overcoming Pain Early-A school based person-centred intervention for adolescents with chronic pain

To illuminate adolescents' experiences of Help Overcoming Pain Early (HOPE), a person-centred intervention delivered in a school setting by school nurses. Twenty-one adolescents with chronic pain recruited from secondary school, who had completed the HOPE intervention, were included in the interview study. The HOPE intervention was built on person-centred ethics and consisted of four meetings between school nurses and adolescents on the subject of stress and pain management. A qualitative method using content analysis with an inductive approach was employed. In the interviews, the adolescents describe how they reclaim their lives with the help of HOPE. They use different strategies and parts of the intervention to move on with their lives. A trustful relationship, as that with the school nurse, was essential to dare to change. The overarching theme summarizes in Becoming myself again and is built up by three sub-themes: Trust a pillar for growth, Making sense of my life with pain, and Putting myself into the world again. A person-centred intervention such as HOPE applied in a school context is promising for promoting confidence in adolescents with chronic pain. A trust-building process emerged, in terms of both the adolescents' trust in the healthcare staff they meet and their confidence in their own ability to handle and influence their situation, which in the long term can promote trust in themselves as a person.

Communicative Pathways Predicting Adherence in Type II Diabetic Patients: A Mediation Analysis

Type II diabetes is a chronic health condition and its successful management requires effective patient-provider communication. Responding to a call to model pathways between provider communication and patient health outcomes, this study tested four models of type II diabetic patient adherence with four mediators. Given the complex nature of type II diabetic care, patient adherence was conceptualized as wellness, screening, medication, and treatment adherence. Mediators included patient understanding, agreement, trust, and motivation. A sample of U.S. patients with type II diabetes patients who were both under the care of a medical provider and taking medication for their type II diabetes completed online surveys (n = 793). Findings indicated that the relationships between patient-centered communication and adherence outcomes were mediated by proximal outcomes. The results contribute to the understanding of patient-centered communication, adherence behaviors, and proximal outcomes of patient understanding, agreement, trust, and motivation. Findings indicate that relationships between patient-centered communication and wellness adherence is mediated by patient motivation, patient-centered communication and screening adherence is mediated by patient agreement, trust, and motivation, and patient-centered communication and treatment adherence is mediated by patient agreement, trust, and motivation. The discussion addresses theoretical and practical implications and directions for future research.

Effect of Perspective-Taking on Trust Between Doctors and Patients: A Randomized Controlled Trial

Tension between doctors and patients as a social problem has existed for a long time; thus far, there is no good solution. From the perspective of trust between doctors and patients, this research studies the relieving effect of perspective-taking interventions on the tension between doctors and patients. This study used a randomized, single-blind online experiment. 133 participants were randomly divided into an intervention group (n = 67) and control group (n = 66). Participants were asked to complete writing tasks from the doctor's perspective. Patients' trust in doctors was measured at 3 time points: before intervention, immediately after intervention, and 10 days after the intervention. Findings showed a significant interaction effect between time measurement and group. In the intervention group, a pairwise comparison of time measurements showed a significant difference between T1 and T2. Perspective-taking interventions can improve patients' trust in doctors, but this effect diminishes over time.

Rationale, design, and protocol for a hybrid type 1 effectiveness-implementation trial of a proactive smoking cessation electronic visit for scalable delivery via primary care: the E-STOP trial

BACKGROUND

Cigarette smoking remains the leading cause of preventable disease and death in the United States. Primary care offers an ideal setting to reach adults who smoke cigarettes and improve uptake of evidence-based cessation treatment. Although U.S. Preventive Services Task Force Guidelines recommend the 5As model (Ask, Advise, Assess, Assist, Arrange) in primary care, there are many barriers to its implementation. Automated, comprehensive, and proactive tools are needed to overcome barriers. Our team developed and preliminarily evaluated a proactive electronic visit (e-visit) delivered via the Electronic Health Record patient portal to facilitate evidence-based smoking cessation treatment uptake in primary care, with promising initial feasibility and efficacy. This paper describes the rationale, design, and protocol for an ongoing Hybrid Type I effectiveness-implementation trial that will simultaneously assess effectiveness of the e-visit intervention for smoking cessation as well as implementation potential across diverse primary care settings.

METHODS

The primary aim of this remote five-year study is to examine the effectiveness of the e-visit intervention vs. treatment as usual (TAU) for smoking cessation via a clinic-randomized clinical trial. Adults who smoke cigarettes are recruited across 18 primary care clinics. Clinics are stratified based on their number of primary care providers and randomized 2:1 to either e-visit or TAU. An initial baseline e-visit gathers information about patient smoking history and motivation to quit, and a clinical decision support algorithm determines the best evidence-based cessation treatment to prescribe. E-visit recommendations are evaluated by a patient's own provider, and a one-month follow-up e-visit assesses cessation progress. Main outcomes include: (1) cessation treatment utilization (medication, psychosocial cessation counseling), (2) reduction in cigarettes per day, and (3) biochemically verified 7-day point prevalence abstinence (PPA) at six-months. We hypothesize that patients randomized to the e-visit condition will have better cessation outcomes (vs. TAU). A secondary aim evaluates e-visit implementation potential at patient, provider, and organizational levels using a mixed-methods approach. Implementation outcomes include acceptability, adoption, fidelity, implementation cost, penetration, and sustainability.

DISCUSSION

This asynchronous, proactive e-visit intervention could provide substantial benefits for patients, providers, and primary care practices and has potential to widely improve reach of evidence-based cessation treatment.

TRIAL REGISTRATION

NCT05493254.

Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study

BACKGROUND

Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted.

OBJECTIVE

The aim of this study was to assess the usability of an app among people at risk of DM2.

METHODS

A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis.

RESULTS

In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app.

CONCLUSIONS

Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial.

Patients' Positions on the Degree of Trust to be Placed in Physicians

Patient-physician relationship is ideally based on mutual trust. Trust usually takes times to build but can quite instantaneously be destroyed as a result of a single action or a single misperception. This study examined the way patients conceptualize the relationship between trust in a physician and perceived competency, honesty and openness, and personal involvement in care. One hundred sixty-seven patients aged 18-85 years were presented with a set of 27 three-item realistic vignettes that described situations in which participants could find themselves if hospitalized because of illness or accident. These scenarios resulted from the complete crossing of the three factors mentioned above. Participants were asked to assess the level of trust they would feel in each case. Through cluster analysis, three positions were found. For a minority of participants, trust was either unconditionally high (4%) or always quite low (8%). For a majority (75%), however, trust depended interactively on competency and honesty, on the one hand, and involvement, on the other hand; that is, the impact of competency and honesty on trust always depended on the level of involvement in care. In particular, when involvement had a low level, trust was always quite low, irrespective of the levels of both other factors. These findings are fully consistent with the view that, for a majority of patients, trust is inherently brittle: A breach in any one of participants' expectations regarding physicians' professionalism is enough to result in a more than proportional reduction in trust level.

A scoping review to explore patient trust in dentistry: the definition, assessment and dental professionals' perception

Background A trusting dentist-patient relationship is pivotal in providing person-centred care. This scoping review aims to identify how trust is defined, measured and perceived by dental professionals.Methods The Joanna Briggs Institute framework was adopted. A search strategy was developed using MeSH (Medical Subject Headings) terms and key words. Medline/PubMed, Embase, PsycINFO and CINAHL were searched. Data were synthesised using thematic analysis.Findings In total, 16 studies were included that frequently used quantitative research methodology. Only four studies provided definition of trust. Many studies employed either Dental Trust Scale or Dental Beliefs Survey to measure dentist-patient trust, although others developed their own items. Limited research suggested that the dental professionals appreciated communication was paramount to building a trusting relationship with patients.Conclusion No consensus was found on the definition of trust, nor on a preferred assessment tool to measure dentist-patient trust. The limited evidence intimated that dental professionals acknowledged the importance of effective communication in building a trusting alliance with patients. The scarcity of relevant research highlights the need for more robust investigations of trust in dental care.

Development and Validation of a Multivariable Exercise Adherence Prediction Model for Patients with COPD: A Prospective Cohort Study

Purpose

Pulmonary rehabilitation (PR) is considered a cost-effective method of improving health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, increasing demand and increasing costs of supply demands for sustainable and affordable care. One of the possible solutions to keep care affordable is self-management. A challenge here is non-adherence. Understanding who are adherent and who are non-adherent could be helpful to differentiate between patients who need more or less support. Therefore, the aim of this study was to develop and validate a model to predict adherence to PR in patients with COPD.

Patients and methods

A multivariable logistic regression model for exercise adherence was developed. Eight candidate predictors, that were prespecified, were obtained in a prospective cohort study from 196 patients with COPD following PR in 53 primary physiotherapy practices in the Netherlands and Belgium, between January 2021 and August 2022. To create a parsimonious model, variable selection using backward selection was performed with a p-value of >0.05 for elimination. Model performance was assessed by discrimination, calibration and clinical utility. Internal validation was assessed by bootstrapping (n = 500).

Results

The final model included four predictors: intention, depression, MRC-score and alliance. The optimism-corrected AUC after bootstrap internal validation was 0.79 (95% CI, 0.72-0.85). Calibration plots suggested good calibration and decision curve analysis showed great net benefit in a wide range of risk thresholds.

Conclusion

The exercise adherence prediction model has potential for clinical utility to predict adherence in patients with COPD. Information from such a model can be used to manage the patient instead of managing the disease, and thereby to determine the treatment frequency for each individual patient. As a result, healthcare capacity might be better distributed, potentially reducing pressure on healthcare without compromising the effectiveness of PR for the individual patient.

A mixed methods study exploring requests for unproven COVID therapies such as ivermectin and healthcare distrust in the rural South

The COVID-19 pandemic has led to contentious discourse regarding unproven COVID-19 therapies (UCTs),(e.g. ivermectin). Despite recommendations against it, ivermectin remains, in some areas, highly demanded. The goal of this study is to understand patient and provider perspectives about UCTs (e.g., ivermectin) and how responses to requests for UCTs impact healthcare distrust. This mixed methods observational study was conducted in a rural healthcare system in the Southern United States. Adults (n = 26) with a history of COVID-19 or clinicians (n = 8) from the same system were interviewed using questionnaires assessing healthcare distrust and qualitatively interviewed exploring perceptions about UCTs. Patient themes were: 1) Importance of anecdotal stories for decision-making; 2) Use of haphazard approaches to 'research'; 3) Strong distrust of government and healthcare organizations; 4) Inherent trust in local healthcare; 5) Decision-making as weighing pros/cons; and 6) Feeling a right to try medications. High survey medians indicated high distrust with differences of 8.5 points for those who requested/used ivermectin versus those who did not (p = 0.027). Clinician themes were: 1) Frustration when patients trust social media over clinicians; 2) Acceptance of community beliefs about UCTs; 3) Distrust originating outside of the healthcare system; 4) Feeling torn about prescribing UCTs to build trust; and 5) Variable educational strategies. When clinicians are perceived as aligned with government, this may void patients' trust of clinicians. Clinicians should leverage trust in local healthcare and distance themselves from distrusted information sources. Ethical questions arise regarding appropriateness of acquiescing to patient requests for ivermectin for building trust.

Post-intervention acceptability of multicomponent intervention for management of hypertension in rural Bangladesh, Pakistan, and Sri Lanka- a qualitative study

BACKGROUND

COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multicomponent, community health-worker (CHW)-led hypertension management program, has been shown to be effective in rural communities in South Asia. This paper presents the acceptability of COBRA-BPS multicomponent intervention among the key stakeholders.

METHODS

We conducted post-implementation interviews of 87 stakeholder including 23 community health workers (CHWs), 19 physicians and 45 patients in 15 rural communities randomized to COBRA-BPS multicomponent intervention in in Bangladesh, Pakistan, and Sri Lanka. We used Theoretical Framework for Acceptability framework (TFA) with a focus on affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness and self-efficacy.

RESULTS

COBRA-BPS multicomponent intervention was acceptable to most stakeholders. Despite some concerns about workload, most CHWs were enthusiastic and felt empowered. Physicians appreciated the training sessions and felt trusted by their patients. Patients were grateful to receive the intervention and valued it. However, patients in Pakistan and Bangladesh expressed the need for supplies of free medicines from the primary health facilities, while those in Sri Lanka were concerned about supplies' irregularities. All stakeholders favoured scaling-up COBRA-BPS at a national level.

CONCLUSIONS

COBRA-BPS multicomponent intervention is acceptable to the key stakeholders in Bangladesh, Pakistan and Sri Lanka. Community engagement for national scale-up of COBRA-BPS is likely to be successful in all three countries.

Black (patients') lives matter: Exploring the role of identity-safety cues in healthcare settings among Black Americans

Two online experiments investigated whether hypothetical physicians' use of an identity-safety cue acknowledging systemic injustice (a Black Lives Matter pin) improves Black Americans' evaluations of the physician and feelings of identity-safety. Across studies, findings showed that when a White physician employed the identity-safety cue, Black Americans reported stronger perceptions of physician allyship and increased identity-safety (e.g. trust). As predicted, use of the identity-safety cue produced smaller or non-significant effects when employed by a Black physician. These benefits emerged regardless of physicians' perceived motivation for employing the cue (e.g. whether the physician was personally motivated to employ the cue or his medical practice encouraged use of the cue; Study 2). Furthermore, analyses revealed that exposure to the identity-safety cue promoted a greater sense of identity-safety for Black Americans due to increased perceptions that the physician is an ally for Black individuals. Implications of identity-safety cues for racially discordant medical interactions are discussed.

Public Trust in Artificial Intelligence Applications in Mental Health Care: Topic Modeling Analysis

Background

Mental disorders (MDs) impose heavy burdens on health care (HC) systems and affect a growing number of people worldwide. The use of mobile health (mHealth) apps empowered by artificial intelligence (AI) is increasingly being resorted to as a possible solution.

Objective

This study adopted a topic modeling (TM) approach to investigate the public trust in AI apps in mental health care (MHC) by identifying the dominant topics and themes in user reviews of the 8 most relevant mental health (MH) apps with the largest numbers of reviewers.

Methods

We searched Google Play for the top MH apps with the largest numbers of reviewers, from which we selected the most relevant apps. Subsequently, we extracted data from user reviews posted from January 1, 2020, to April 2, 2022. After cleaning the extracted data using the Python text processing tool spaCy, we ascertained the optimal number of topics, drawing on the coherence scores and used latent Dirichlet allocation (LDA) TM to generate the most salient topics and related terms. We then classified the ascertained topics into different theme categories by plotting them onto a 2D plane via multidimensional scaling using the pyLDAvis visualization tool. Finally, we analyzed these topics and themes qualitatively to better understand the status of public trust in AI apps in MHC.

Results

From the top 20 MH apps with the largest numbers of reviewers retrieved, we chose the 8 (40%) most relevant apps: (1) Wysa: Anxiety Therapy Chatbot; (2) Youper Therapy; (3) MindDoc: Your Companion; (4) TalkLife for Anxiety, Depression & Stress; (5) 7 Cups: Online Therapy for Mental Health & Anxiety; (6) BetterHelp-Therapy; (7) Sanvello; and (8) InnerHour. These apps provided 14.2% (n=559), 11.0% (n=431), 13.7% (n=538), 8.8% (n=356), 14.1% (n=554), 11.9% (n=468), 9.2% (n=362), and 16.9% (n=663) of the collected 3931 reviews, respectively. The 4 dominant topics were topic 4 (cheering people up; n=1069, 27%), topic 3 (calming people down; n=1029, 26%), topic 2 (helping figure out the inner world; n=963, 25%), and topic 1 (being an alternative or complement to a therapist; n=870, 22%). Based on topic coherence and intertopic distance, topics 3 and 4 were combined into theme 3 (dispelling negative emotions), while topics 2 and 1 remained 2 separate themes: theme 2 (helping figure out the inner world) and theme 1 (being an alternative or complement to a therapist), respectively. These themes and topics, though involving some dissenting voices, reflected an overall high status of trust in AI apps.

Conclusions

This is the first study to investigate the public trust in AI apps in MHC from the perspective of user reviews using the TM technique. The automatic text analysis and complementary manual interpretation of the collected data allowed us to discover the dominant topics hidden in a data set and categorize these topics into different themes to reveal an overall high degree of public trust. The dissenting voices from users, though only a few, can serve as indicators for health providers and app developers to jointly improve these apps, which will ultimately facilitate the treatment of prevalent MDs and alleviate the overburdened HC systems worldwide.

Patient experiences and preferences during treatment and recovery of Lisfranc fractures: A qualitative interview study

AIM

To determine from a patient perspective what improves the quality of care and patient satisfaction during the treatment and recovery process of Lisfranc fractures and to reveal possible points for improvement in this process.

METHODS

We performed a qualitative study based on semi-structured interviews with patients treated for a Lisfranc fracture-dislocation in the Netherlands with either open reduction and internal fixation or primary arthrodesis, until data saturation was reached, focusing on the quality of care during treatment and recovery, from a patient perspective.

RESULTS

Data saturation was reached after interviewing 10 patients. The main themes emerging from the analysis were expectation management regarding the recovery period; communication with and between health care providers; information provided during consultations; and support during the recovery period. Participants expressed a need for improved provision of information about the different treatment options, the different kinds of pain that can arise, the expected duration of the recovery period, education on strong pain killers, likelihood of a second surgery, risks of osteoarthritis, risks of the surgery itself, allied health care and patient experiences. Participants mentioned the importance of good allied health care and a preference for starting allied health care as soon as possible. Insoles and compression socks were also appreciated by various participants. Finally, multiple patients saw a positive attitude on the part of the health care providers towards the recovery period as a key factor in recovery.

CONCLUSION

This study found that patients value more tailored approaches to the pre-and post-operative care program, more guidance regarding allied health care (physiotherapy), and a broader scope of available references and information for patients, both oral (during consultations and in informative videos) and written, such as brochures or evidence-based web pages and mobile platforms, which may be offered during consultations or when being discharged from the hospital.

Count on trust: the indirect effect of trust in government on policy compliance with health behavior instructions

Trust in government is considered a prominent factor for enhancing public compliance with government policies and instructions. The Coronavirus pandemic demonstrates the crucial role public compliance with governmentally issued health guidelines has in mitigating the pandemic. However, the mechanism explaining the trust-compliance association, particularly in regard to health-behavior compliance, is unclear. This article develops a new theoretical model, the Mediated Trust Model (MTM), for explaining the relationship between trust in government and public compliance with health instructions. The model extends the classic Health Belief Model for predicting health behavior by claiming that the perceptions regarding the instructions' costs, benefits and one's ability to perform them are affected by trust in government and mediate the trust-compliance association. The MTM was tested in four cross-sectional studies performed during the first 20 months of the Coronavirus pandemic in Israel on 3732 participants, for various health instructions. Implications for public health literature, policy compliance theory and policy makers are discussed.

What is important for people with type 2 diabetes? A focus group study to identify relevant aspects for Patient-Reported Outcome Measures in diabetes care

Background

Patient-Reported Outcome Measures (PROMs) aim to evaluate the quality of care based on the perspectives of patients rather than clinical indicators. Qualitative research is needed to identify these perspectives in people with type 2 diabetes.

Objective

To identify, for the first time in Israel, aspects valuable for people with type 2 diabetes that can be relevant for PROMs in diabetes care.

Methods

A qualitative study included three focus groups totalling 19 people with type 2 diabetes. Inclusion criteria were: (1)type 2 diabetes, (2)diabetes duration of at least six months, and (3)adults aged 45–80 years. Purposive sampling enabled recruitment of heterogeneous participants. Also, two experts’ panels with healthcare providers involved in diabetes care (n = 23) were conducted to provide triangulation of information (more testimony about what is valuable for people with type 2 diabetes). Discussions were recorded, transcribed and thematically analysed.

Results

Four domains were deemed valuable for people with type 2 diabetes: (1)challenges of living with diabetes, including reduced physical function, healthy lifestyle struggles, sexual dysfunction, and financial burden, (2)mental health issues, including depression, distress, anxiety, frustration, and loneliness, (3)self-management ability, including management of lifestyle modifications and treatment, knowledge about the disease and treatment, and (4)patient-clinician relationships, including the devotion of clinicians, trust in clinicians and treatment, shared decision-making, and multidisciplinary care under one roof. Experts favour using PROMs in diabetes routine care and even acknowledged their necessity to improve the treatment process. However, only some of the domains raised by people with type 2 diabetes were identified by the experts.

Conclusions

There are content gaps between perspectives of people with type 2 diabetes and their healthcare providers. PROMs are essential in addressing issues largely not addressed in routine diabetes care. We recommend that researchers and healthcare providers, who intend to utilize PROMs for diabetes care, consider the aforementioned domains.

Association between COVID-19 vaccine hesitancy and trust in the medical profession and public health officials

One's personal physician, national and state or local public health officials, and the broader medical profession play important roles in encouraging vaccine uptake for COVID-19. However, the relationship between trust in these experts and vaccine hesitancy has been underexplored, particularly among racial/minority groups where historic medical mistrust may reduce uptake. Using an April 2021 online sample of US adults (n = 3041) that explored vaccine hesitancy, regression models estimate levels of trust in each of these types of experts and between trust in each of these experts and the odds of being COVID-19 vaccine takers vs refusers or hesitaters. Interaction terms assess how levels of trust in the medical profession by race/ethnicity are associated with vaccine hesitancy. Trust in each expert is positively associated with trust in other experts, except for trust in the medical profession. Only trust in one's own doctor was associated with trust in the medical profession, as measured by factor scores derived from a validated scale. Lower levels of trust in experts were significantly associated with being either a hesitater or a refuser compared to being a taker. Black respondents had higher odds of being either a hesitater or a refuser compared to white respondents but the interaction with trust was insignificant. For Hispanic respondents only, the odds of being a hesitater declined significantly when trust in the medical profession rose. Mistrust in the medical profession, one's doctor and national experts contributes to vaccine hesitancy. Mobilizing personal physicians to speak to their own patients may help.

Nutraceuticals and dietary supplements: Disparities in usage and potential for harm

Background: The use of nutraceuticals and dietary supplements has a complex history. Aim: This work seeks to discuss the current state of nutraceuticals and dietary supplements, with a particular focus on the ambiguity of these terms, their current usage, potential harms, roles within the healthcare system, and associated disparities. Methods: This work reviews recent literature spanning the history of nutraceuticals and expands upon recommendations made by previous authors. Results: While a substantial portion of the United States population consumes these substances, their safety profiles are rarely well characterized. Taking a broad definition of these terms paints a picture of harmless use by a population that is middle-aged, educated, and white. However, focusing on specific substances reveals concerning disparities in race, ethnicity, income, physical health, and health literacy. This is of particular concern when looking at the side effects of these supplements both in isolation and due to drug-supplement interactions. Conclusions: In this work, the authors build upon the recommendations of others to propose ways in which physicians and healthcare systems can work to reduce the disproportionate harms of these substances on historically marginalized groups.

The Impact of Effective Communication on Perceptions of Patient Safety—A Prospective Study in Selected Polish Hospitals

Interpersonal communication plays a key role in the treatment process. It affects not only the patient’s satisfaction with the course of treatment, but also allows the achievement of the best outcome in the therapeutic process. The process of patient empowerment and putting them in the role of a partner in the therapeutic process makes it possible to build a relationship based on trust, kindness and empathy. The aim of the study is to show the relationship between a patient’s sense of safety and access to health information, friendly and empathetic treatment by medical staff and a relationship based on trust. The study is conducted on patients from public hospitals in Wrocław by using the author’s questionnaire. One of the five most important factors according to respondents is the sense of safety, as reported by more than half of the patients (54.4%)—this is the opinion of more than half of the patients (54.4%). The respondents assessed the quality of patient care as an average of M = 41.1/50 points. There is a strong positive correlation between the sense of security and the access to information (rho = 0.642), kind treatment (rho = 0.623), trust in medical staff (rho = 0.758) and satisfaction with hospital stay (rho = 0.758).

Diabetes Technology Experiences Among Latinx and Non-Latinx Youth with Type 1 Diabetes

BACKGROUND

Diabetes technologies, such as insulin pumps and continuous glucose monitors (CGM), have been associated with improved glycemic control and increased quality of life for young people with type 1 diabetes (T1D); however, few young people use these devices, especially those from minority ethnic groups. Current literature predominantly focuses on white patients with private insurance and does not report experiences of diverse pediatric patients with limited resources.

METHODS

To explore potential differences between Latinx and non-Latinx patients, English- and Spanish-speaking young people with T1D (n = 173, ages 11-25 years) were surveyed to assess attitudes about and barriers to diabetes technologies using the Technology Use Attitudes and Barriers to Device Use questionnaires.

RESULTS

Both English- and Spanish-speaking participants who identified as Latinx were more likely to have public insurance (P = .0001). English-speaking Latinx participants reported higher Hemoglobin A1c values (P = .003), less CGM use (P = .002), and more negative attitudes about technology (generally, P = .003; and diabetes-specific, P < .001) than either non-Latinx or Spanish-speaking Latinx participants. Barriers were encountered with equivalent frequency across groups.

CONCLUSIONS

Latinx English-speaking participants had less positive attitudes toward general and diabetes technology than Latinx Spanish-speaking and non-Latinx English-speaking peers, and differences in CGM use were associated with socioeconomic status. Additional work is needed to design and deliver diabetes interventions that are of interest to and supportive of patients from diverse ethnic and language backgrounds.

Factors Associated With Dimensions of Patients' Trust in Chiropractic Doctors in the International Medical University Healthcare Chiropractic Center: An Exploratory Study

Objective

The purpose of this study was to investigate the association between patients' sociodemographic factors (age, sex, ethnicity, and education background) and dimensions of patients' trust in chiropractic doctors in Malaysia.

Methods

This cross-sectional study was conducted in the International Medical University Healthcare Chiropractic Center with a total of 302 respondents. Self-administered questionnaires were enclosed in an envelope and passed to participants by the researchers. Descriptive statistics are presented in tables and figures. Each dimension of the patients' trust was compared against the sociodemographic factors. The variables included were sex, age, ethnicity, and education background, along with their dimensions of trust.

Results

There were 106 male respondents (35.1%) and 196 female respondents (64.9%) between 21 and 40 years of age. In all of the trust dimensions, education background was the only statistically significant variable (P < .05).

Conclusion

Several sociodemographic factors were associated highly with the trust dimensions explored. Patients' education background was the only sociodemographic factor to show a statistically significant relationship to all 10 trust dimensions. Sex, age, and ethnicity showed significant associations with some of the trust dimensions explored in this study.

Prevalence and prediction of medical distrust in a diverse medical genomic research sample

PURPOSE

Medical distrust has been identified as a persistent barrier to medical care, affecting preventative screening, treatment uptake, and treatment adherence. Despite this, little research to date has examined medical distrust in a genomic medicine context. The goal of this work was to assess the prevalence of medical distrust in a genomic medicine research study and examine patient-level demographic, access-related, and health-status characteristics that predict medical distrust.

METHODS

We assessed medical distrust in a research sample of adults (N = 967) receiving genomic sequencing to screen for hereditary risk of cancer syndromes in the United States. We used multiple predictive variable selection models to determine predictors of medical distrust followed by marginal mean analyses to characterize the relationships.

RESULTS

The prevalence of medical distrust was 32%. The final model indicated that Black and African American race/ethnicity; trans, nonbinary, or nonidentifying gender identity; high education; low income; low access to health care; and poor Short Form 12 mental health composite scores predict medical distrust.

CONCLUSION

Medical distrust may pose similar challenges to genomic sequencing, as it does in other medical contexts. The pattern of variables that predict distrust suggest that increasing access and accommodation for stigmatized and underserved communities may help overcome the negative effects of medical distrust.

Impact of beliefs about medication on the relationship between trust in physician with medication adherence after stroke

OBJECTIVE

To investigate the relationship between medication adherence, trust in physician and beliefs about medication among stroke survivors. To determine whether beliefs about medication would mediate the relationship between trust in physician and medication adherence.

METHODS

A sample of 200 patients with a diagnosis of ischemic stroke or transient ischemic attack (TIA) completed a one-time survey, including the shortened Medication Adherence Report Scale (MARS-5), Beliefs about Medicines Questionnaire (BMQ), and Trust in Physician Scale (TIPS).

RESULTS

Our study found that medication adherence was associated with trust in physician (p = 0.019) and four factors of beliefs about medication (BMQ1-Necessity: p < 0.001; BMQ2-Concerns: p = 0.024; BMQ3-Overuse: p = 0.016; BMQ4-Harm: p < 0.001). Furthermore, we found monthly income of survivors moderated the relationship between trust in physician and medication adherence (p = 0.007, CI_(95%): [-0.822, -0.132]).

CONCLUSIONS

The beliefs about medication mediating the relationship between trust in physician and medication adherence were different based on the stroke survivors' income bracket.

PRACTICE IMPLICATIONS

Interventions being developed to improve medication adherence may benefit from improving stroke survivors' trust in physician and addressing their beliefs about medication. In addition, healthcare providers are advised to take monthly income into consideration to effectively address stroke survivors' concerns regarding prescribed medications to mitigate stroke recurrence.

A Qualitative Study on the Experiences of Women With Breast Implant Illness

BACKGROUND

Breast implant illness (BII) is a term used to describe physical and psychological symptoms experienced by some women following breast implant surgery. Few studies have examined the experiences of women with BII-a poorly understood condition with no clear cause or treatment.

OBJECTIVES

The aim of this study was to explore women's experiences of BII, including symptoms, healthcare encounters, social media, and explant surgery.

METHODS

Employing an exploratory qualitative methodology, researchers undertook semistructured interviews with 29 women who self-identified as having BII. Interviews were audio-recorded and transcribed verbatim. Data were analyzed by inductive thematic analysis.

RESULTS

Thematic analysis of the interviews identified 6 themes: (1) symptoms without explanation; (2) invalidation and invisibility; (3) making the BII connection; (4) implant toxicity; (5) explant surgery: solution to suffering?; and (6) concealed information. BII was described as distressing and debilitating across multiple domains including relationships, work, identity, and physical and mental health, and symptoms were attributed to implant toxicity and immune system rejection of foreign objects. When their experience was not validated by healthcare professionals, many looked to social media for information, support, and understanding, and saw explant as their only chance of recovery.

CONCLUSIONS

BII is disabling mentally and physically. Women with BII require support, understanding, and validation, and proactive treatment to prevent disability. With unclear pathophysiology, future research should examine how biopsychosocial approaches can be used to guide treatment, and how to best support women with BII, focusing on early detection and evidence-based education and intervention.

LEVEL OF EVIDENCE: 4

Patient-reported Experience Measures in Deprescribing for Hospitalised Older Patients: A Prospective, Multicentre, Observational Study

BACKGROUND

Hospitalisation provides an opportunity for medication review and deprescribing. Patient-reported experience measures (PREM) for deprescribing in older patients in-hospital are not well-described.

AIM

To pilot test and describe PREM for deprescribing in older patients, compare PREM by patient characteristics, and investigate patients' awareness of medication changes on hospital discharge.

METHODS

This prospective, multicentre, observational cohort study at two tertiary hospitals in Sydney, Australia, evaluated the PREM questionnaire developed by the NSW Therapeutic Advisory Group. It was completed by patients (or their next of kin) recruited from acute geriatric medicine and orthogeriatric services. Association with nine patient characteristics was analysed using the chi-square test and multivariable regression. Awareness of medication changes and test-retest reliability were analysed using descriptive statistics.

RESULTS

Overall, 201 participants completed the questionnaire, with 170 eligible for analysis; 34/170 (20%) were aware of reduction or cessation of their usual medications on discharge and reported involvement in decision making and receiving enough information to reduce or stop one or more of their usual medications (positive PREM). Independent predictors of positive PREM included respondent (next of kin), hospital (Hospital 1), language (English), and specialty (acute geriatric medicine). Overall, 92 of 155 (59.4%) patients with medication changes were aware of those changes on hospital discharge.

CONCLUSIONS

These PREMs are a feasible tool to examine older patients' experiences of deprescribing in-hospital and may be applied to evaluate interventions to improve awareness, shared decision making, and provision of information when deprescribing for older patients. This article is protected by copyright. All rights reserved.

A fuzzy trust measurement method considering patients' trust opinions in Internet plus Healthcare

With the outbreak of COVID-19, Internet plus Healthcare has developed rapidly with a number of Internet plus Healthcare platforms emerging. The problem of doctor-patient trust is a key issue restricting the development of the Internet plus Healthcare, which has aroused extensive attention of scholars. The patient's perceived trust on the Internet plus Healthcare platform has the characteristics of subjectivity, ambiguity, and high perceived risk. Therefore, existing trust calculation method becomes inapplicable because these characteristics have not been considered. In order to solve this problem, this study extracts influencing factors of patient trust on the Internet plus Healthcare platform, gives a trust calculation method based on intuitionistic fuzzy set theory, and added a risk preference coefficient in order to integrate the characteristics of patients' high perceived risk into the proposed method. This method is conducive to the platform to provide patients with more accurate doctor recommendations

Impact of physician empathy on patient outcomes: a gender analysis

BACKGROUND

Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and, to date, no study has concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions.

AIM

To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation's quality, and patients' trust in their physicians, and to determine whether this relationship is moderated by a physician's gender.

DESIGN AND SETTING

Analysis of the empathy of 61 primary care physicians in relation to 244 patient experience questionnaires in the French-speaking region of Switzerland.

METHOD

Sixty-one physicians were video-recorded with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded emotional arousal. After the consultation, patients indicated their satisfaction with, trust in, and quality of the consultation.

RESULTS

Female physicians self-rated their empathic concern higher than their male counterparts did, whereas male physicians were more vocally synchronised (in terms of frequencies of speech) to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was male.

CONCLUSION

Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes, and could be used as a cost-effective proxy for relational quality.

Relationship of patient-centered communication and cancer risk information avoidance: A social cognitive perspective

OBJECTIVE

We examined the relationship between patient-centered communication and cancer risk information avoidance and estimated the mediating role of self-efficacy in this relationship.

METHODS

Using nationally representative cross-sectional data from the U.S. Health Information National Trends Survey (N = 2033), this study aims to provide a comprehensive understanding of the relationship between patient-centered communication and cancer risk information avoidance via correlation analysis, stepwise regression models, and mediation analysis.

RESULTS

Patient-centered communication was significantly negatively associated with cancer risk information avoidance (β= -0.09, p < 0.01) after controlling for gender, income, education, and cancer risk perception. Self-efficacy fully mediated the relationship of patient-centered communication with cancer risk information avoidance.

CONCLUSION

Patient-centered communication can improve patients' self-efficacy, thereby preventing them from avoiding cancer risk information.

PRACTICE IMPLICATIONS

The negative relationship between patient-centered communication and cancer risk information avoidance substantiates that improving patient-centered communication is a promising approach to support caregivers in their activities, reduce patients' subjective cancer burden, and even improve their health. To address cancer-related issues, policymakers can consider interventions from the external environment and internal personal cognition perspectives.

The Adherence to Healthy Lifestyle Among Arab Patients With Cardiovascular Disease: Mixed-Method Review

INTRODUCTION

Cardiovascular disease (CVD) accounts for 25% to 45% of deaths among Arab people. The purpose of this review was to investigate the level, predictors, motivators, and barriers to adherence to lifestyle recommendations among Arab patients with CVD.

METHOD

A systematic search of the literature was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMCARE, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched. Studies that explored adherence to a healthy lifestyle among Arab adult patients with CVD were included.

RESULTS

Twelve studies were included. Quantitative results showed low adherence among Arab people with CVD. Qualitative synthesized results revealed that internal motivators, personal desire as well as structural drivers impact the patient's ability to adhere to a healthy lifestyle.

DISCUSSION

Multidimensional solutions that consider religion and culture and include active involvement of families are required to improve adherence.

Exploring medication self-management in community-dwelling adults with chronic medication experience: A concept mapping study

BACKGROUND

People who take medications often experience challenges including making decisions about risks versus benefits and integrating medication management with all aspects of life (e.g., social and work responsibilities). Existing medication self-management frameworks are primarily adherence-focused and lack integrating holistic perspectives.

OBJECTIVE

To explore the priorities of people with chronic medication experience (i.e., take at least 1 medication daily for at least 3 months) and what they can contribute to the understanding of medication self-management.

METHODS

Concept mapping is a participatory, mixed-methods approach with 3 stages: brainstorming, sorting/rating, and mapping. Group brainstorming discussions were held with participants who generated statements about what mattered to them regarding medications in their everyday lives. In sorting/rating, individual participants grouped statements into thematic piles and rated their importance and feasibility. During mapping, a subset of participants discussed and agreed on a visual map and named the statement clusters. Following mapping, the researchers analyzed rating results, stratified by participant characteristics (gender, age, duration of medication use, number of medications, and chronic conditions).

RESULTS

Sixty-three participants generated 1044 statements during 8 brainstorming sessions, which the researchers synthesized into 94 statements. Fifty-four participants individually sorted and rated the statements. Most statements were rated highly on both importance and feasibility, regardless of participant characteristics. Eight participants attended the mapping session. The final map had 9 thematic clusters, which were named by participants as: 1) researching and becoming educated about medications; 2) social support; 3) effectiveness of medication; 4) self-ownership of medication; 5) ease of use; 6) convenience and accessibility; 7) information provided by healthcare provider; 8) personal interactions with healthcare provider; and 9) patient involvement and trust.

CONCLUSIONS

Results enhance existing medication management frameworks by providing a more comprehensive perspective. Understanding medication self-management requires more research that incorporates and prioritizes the perspectives of individuals who manage their medications.

The Patient's Point of View: Characterizing Patient-Level Factors Associated with Perceptions of Health Care

Purpose: We explored the association between perception of care, as measured by the Interpersonal Processes of Care (IPC) survey, and patient-level factors, including (1) Trust in physicians; (2) Perceived empathy; (3) Stereotype threat; (4) Perceived everyday discrimination; and (5) Self-Reported Health. Methods: Fifty participants from diverse racial backgrounds and education levels were surveyed. We examined the associations between the five patient-level factors and each subdomain of the IPC using multiple linear regression. We added a race interaction term to assess whether associations between IPC subdomains and predictors differed by race. We tested for correlation among factors found to be significantly associated with the IPC. Results: In adjusted analyses, trust in the physician, perceived empathy from the provider, and perceived everyday discrimination were significantly associated with most subdomains of the IPC. There was no significant race interaction. Conclusion: This exploratory study suggests that empathy, trust, and perceived everyday discrimination are significantly linked to patient perception of quality care, which are linked to clinical outcomes. Results present modifiable factors that may potentially improve patient care. Practice Implications: Increased efforts to improve clinician communication of empathy and general communication skill may have a positive effect on quality of care.

Susceptibility of falling behind current medical knowledge among health-care professionals: the extended parallel process model

Purpose

The purpose of this paper is to appraise the possible response outcomes (no response, fear control or danger control) of a fear-based message on falling behind current medical knowledge among health-care professionals (HCPs).

Design/methodology/approach

This study was conducted using a quantitative research design. A cross-sectional survey was carried out in 2,873 health-care facilities across 36 districts of Punjab. The Extended Parallel Process Model (EPPM) provided a theoretical framework for this study. The important components to EPPM such as threat, efficacy and outcomes were used to collect the data. The collected data was analyzed using Statistical Package for Social Sciences (SPSS) version 22.

Findings

HCPs perceived high susceptibility and threat of falling behind current medical knowledge. A majority of the HCPs were at the danger control process and engaged in a behavior that is recommended for adaptive behavioral changes. Clinical experience and enrollment in post-graduation programs (e.g. FCPS, MCPS) were significant factors as to HCPs’ perceived response efficacy.

Research limitations/implications

The responses were obtained using a structured questionnaire, which is always subject to respondents’ personal biases and ability to understand the question’s statement.

Practical implications

This study has important implications in terms of introducing promotional, educational and logistical interventions that could help in HCPs overcoming the fear of falling behind current medical knowledge and develop productive and adoptive information behavior thus improving patient care and outcome.

Originality/value

This is the first large-scale empirical study in Pakistan that measured the level of threat and efficacy among HCPs using the EPPM. It proposes a framework for developing long-lasting adaptive information behavioral changes that may result in informed patient care and better decision-making.

Decolonizing Care at Diagnosis: Culture, History, and Family at an Urban Inter-tribal Clinic

The decolonization framework in medical anthropology is slowly reframing tropes of cultural competency toward decolonizing health care. For decolonization of health care to occur, both colonial histories and continuing postcolonial inequities must be recognized from the first diagnostic moment. We report on qualitative research into the role of culture, history, and family experience in person-specific reactions to receipt of a diagnosis. A collaborative approach at an urban inter-tribal clinic was used to interview patients with a recent (within six months) diagnosis of diabetes or related condition. Interviews revealed ways that the Relocation Act eventuated in isolation, poverty, and diabetes among now-urban Native Americans. We discuss how patients may or may not have the ability to (re)connect with their heritage and may simultaneously perceive only recent family contexts as influential in their diabetes. We conclude by acknowledging how postcolonial harms are not captured in diagnoses but should not be left out of diagnostic discussions.

Trust in physicians among patients with head and neck cancer before and after treatment

BACKGROUND

Little is known about physician trust in patients with head and neck cancer. This study's aim is to evaluate trust pre- and post-treatment.

METHODS

A study was conducted of 50 patients with head and neck cancer at a tertiary referral center. Surveys administered before and after treatment included several validated survey tools including the Trust in Oncologist Scale Short Form.

RESULTS

There was an increase in overall trust scores (p < 0.001). Female patients (p = 0.034) and those who received chemotherapy (p = 0.001) were less trusting post-treatment. Patients with more comorbidities (p = 0.045) and progression of disease (p = 0.029) had higher final trust than those without. Patients with high initial distress scores showed a decrease in trust (p = 0.023).

CONCLUSIONS

Patients with head and neck cancer trust their surgeon more after completion of treatment, with specific characteristics having a variable impact on trust scores.

Diabetic Distress Among Diabetic Patients in the Amhara Regional State, Ethiopia

Diabetes distress is a psychological reaction to the threat of diabetes, when an individuals diagnosed with diabetes consider the coping resources they possess as insufficient to manage the illness threat, thus triggering emotional distress specific to diabetes. Research conducted in Ethiopia regarding diabetes-related distress is scant. The main purpose of this study was to assess the status of diabetic distress among diabetic patients in the hospitals of the Amhara Region. A hospital-based cross-sectional survey research approach was employed. A total of 14 hospitals was included in the study using stratified simple random sample methods. The participans of the study were 532 diabetic patients who were selected using systematic simple random sampling methods. The pertinent data were collected using diabetic distress scale-17 (DDS-17). The instrument of the study was rated, piloted, and finally validated. Both descriptive and inferential techniques were used to analyze the data. The cutoff for low, moderate, and high distress level was <2, 2-2.9, and >3, respectively. The study revealed that the participant in the study area experienced a moderate level of distress. The status of diabetic distress for the diabetic sub-scale was also determined for emotional burden, physician-related distress, regimen-related distress, and interpersonal distress, it was also found to be (2.79 ± 0.85), (3.14 ± 0.87), (3.19 ± 0.81), and (3.04 ± 0.93) respectively. The most important domain in measuring diabetic distress was regimen-related distress. Statistically, a significant difference was detected in the level of diabetic distress among diabetic patients concerning marital status, educational status, the experience of living with diabetes, and having habits of planned physical exercise. Statistically, a significant difference was not observed for age, sex, and occupational status. Diabetic distress was a solemn psychological problem among diabetic patients in the hospitals of the Amhara Region. A strong policy document is required to bind the physical treatment with psychological elements to reduce distress.

Linking Health Literacy to Self-Care in Hypertensive Patients with Physical Disabilities: A Path Analysis Using a Multi-Mediation Model

Hypertension has been identified as the most prevalent chronic disease, accounting for the majority of premature deaths in people with physical disability in South Korea. Self-care is vital in controlling high blood pressure. Health literacy has been implicated in self-care behaviors; however, the mechanisms behind this relationship remain unclear. Therefore, the present study aimed to test a hypothetical path model estimating the association between health literacy and hypertension self-care behaviors and to verify the mediating effects of access to healthcare, provider–patient interactions, hypertension knowledge, and hypertension control self-efficacy in hypertensive people with physical disability. In total, 211 hypertensive adults with physical disability completed an online survey. A path analysis using a multi-mediation model was performed using AMOS 17.0 (IBM SPSS Inc., Chicago, IL, USA), and indirect effects were estimated using phantom variables. As a result, the model fit indices were deemed excellent. Significant indirect pathways were determined from health literacy to hypertension self-care behavior via provider–patient interactions, knowledge, and self-efficacy, although no direct association was found between health literacy and self-care behaviors. The study findings supported the importance of provider–patient interactions, knowledge, and self-efficacy, which play a role in linking health literacy and self-care behavior in hypertensive patients with physical disability.

Non-Adherence Tree Analysis (NATA)-An adherence improvement framework: A COVID-19 case study

Poor medication adherence is a global phenomenon that has received a significant amount of research attention yet remains largely unsolved. Medication non-adherence can blur drug efficacy results in clinical trials, lead to substantial financial losses, increase the risk of relapse and hospitalisation, or lead to death. The most common methods of measuring adherence are post-treatment measures; that is, adherence is usually measured after the treatment has begun. What the authors are proposing in this multidisciplinary study is a new technique for predicting the factors that are likely to cause non-adherence before or during medication treatment, illustrated in the context of potential non-adherence to COVID-19 antiviral medication. Fault Tree Analysis (FTA), allows system analysts to determine how combinations of simple faults of a system can propagate to cause a total system failure. Monte Carlo simulation is a mathematical algorithm that depends heavily on repeated random sampling to predict the behaviour of a system. In this study, the authors propose a new technique called Non-Adherence Tree Analysis (NATA), based on the FTA and Monte Carlo simulation techniques, to improve adherence. Firstly, the non-adherence factors of a medication treatment lifecycle are translated into what is referred to as a Non-Adherence Tree (NAT). Secondly, the NAT is coded into a format that is translated into the GoldSim software for performing dynamic system modelling and analysis using Monte Carlo. Finally, the GoldSim model is simulated and analysed to predict the behaviour of the NAT. NATA is dynamic and able to learn from emerging datasets to improve the accuracy of future predictions. It produces a framework for improving adherence by analysing social and non-social adherence barriers. Novel terminologies and mathematical expressions have been developed and applied to real-world scenarios. The results of the application of NATA using data from six previous studies in relation to antiviral medication demonstrate a predictive model which suggests that the biggest factor that could contribute to non-adherence to a COVID-19 antiviral treatment is a therapy-related factor (the side effects of the medication). This is closely followed by a condition-related factor (asymptomatic nature of the disease) then patient-related factors (forgetfulness and other causes). From the results, it appears that side effects, asymptomatic factors and forgetfulness contribute 32.44%, 22.67% and 18.22% respectively to discontinuation of medication treatment of COVID-19 antiviral medication treatment. With this information, clinicians can implement relevant interventions and measures and allocate resources appropriately to minimise non-adherence.

Creating a compassion system to achieve efficiency and quality in health care delivery

Purpose

Health care delivery is experiencing a multi-faceted epidemic of suffering among patients and care providers. Compassion is defined as noticing, feeling and responding to suffering. However, compassion is typically seen as an individual rather than a more systemic response to suffering and cannot match the scale of the problem as a result. The authors develop a model of a compassion system and details its antecedents (leader behaviors and a compassionate human resource (HR) bundle), its climate or the extent that the organization values, supports and rewards expression of compassion and the behaviors and practices through which it is enacted (standardization and customization) and its effects on efficiently reducing suffering and delivering high quality care.

Design/methodology/approach

This paper uses a conceptual approach that synthesizes the literature in health services, HR management, organizational behavior and service operations to develop a new conceptual model.

Findings

The paper makes three key contributions. First, the authors theorize the central importance of compassion and a collective commitment to compassion (compassion system) to reducing pervasive patient and care provider suffering in health care. Second, the authors develop a model of an organizational compassion system that details its antecedents of leader behaviors and values as well as a compassionate HR bundle. Third, the authors theorize how compassion climate enhances collective employee well-being and increases standardization and customization behaviors that reduce suffering through more efficient and higher quality care, respectively.

Originality/value

This paper develops a novel model of how health care organizations can simultaneously achieve efficiency and quality through a compassion system. Specific leader behaviors and practices that enable compassion climate and the processes through which it achieves efficiency and quality are detailed. Future directions for how other service organizations can replicate a compassion system are discussed.

Common sense model of self-regulation for understanding adherence and quality of life in type 2 diabetes with structural equation modeling

OBJECTIVES

The objective of the present study was to test the Common Sense Model of self-regulation (CSM) for its relevance for improving adherence and quality of life in type 2 diabetes.

METHODS

A sample of 253 patients with type 2 diabetes was recruited. They completed questionnaires about their perceptions regarding diabetes, coping strategies, therapeutic adherence and quality of life. Their HbA1c levels were also collected. Structural equation modeling (SEM) was used to check the adequacy of our theoretical model (CSM) with the patient data.

RESULTS

The final model indicated that perceptions were directly and indirectly related to health outcomes through coping strategies and adequately matched the data (χ² / df = 561/ 220 = 2.55; RMSEA = 0.08; PCFI = 0.66; PGFI = 0.70). Moreover, the model appeared to be identical for both types of treatment (oral and injectable).

CONCLUSIONS

Illness perceptions and coping strategies, or, more specifically, how patients accept disease and think they are able to manage it, significantly affect therapeutic adherence and quality of life in type 2 diabetes.

PRACTICE IMPLICATIONS

These results pave the way for developing psychological treatments aimed at improving patient acceptance and internal resources (e.g. use of autobiographical memory, Acceptance and Commitment Therapy).

Rebuild doctor-patient trust in medical service delivery in China

Doctor–patient trust is not strong in China, but studies examining this factor remain insufficient. The present study aimed to explore the effect of doctor–patient communication, medical service quality, and service satisfaction on patient trust in doctors. Five hundred sixty-four patients with tuberculosis participated in this cross-sectional study in Dalian, China. They completed questionnaires assessing socio-demographic characteristics, doctor–patient communication, medical service quality, service satisfaction and patient trust in medical staff. A structural equation model was applied to examine the hypotheses, and all the study hypotheses were supported: (1) doctor–patient communication, medical service quality and service satisfaction were positively associated with building doctor–patient trust; (2) service quality positively mediated the relationship between doctor–patient communication and trust; (3) medical service satisfaction positively mediated the relationship between doctor–patient communication and trust; (4) medical service satisfaction positively mediated the relationship between medical service quality and doctor–patient trust; and (5) medical service quality and service satisfaction were the positively sequential mediators between communication and doctor–patient trust. Based on these findings, improvements in doctor–patient communication, medical service quality, and service satisfaction are the important issues contributing to the rebuilding of doctor–patient trust in medical service delivery.

COVID-19 and psychological distress in Norway: The role of trust in the healthcare system

Aim:

The study aims to examine groups at risk for psychological distress in connection with the COVID-19 outbreak, and the role of trust in the healthcare system as a possible moderator.

Methods:

Data were collected from a large sample of the Norwegian population (n = 4008) through the Norwegian Citizen Panel (NCP). A linear regression was conducted to examine the effects of COVID-19 related risk factors on psychological distress, using the 10-item Hopkins Symptom Checklist (HSCL-10). Finally, we conducted a moderation analysis to examine the interaction of trust in the healthcare system and COVID-19 related risk factors.

Results:

A linear regression showed that female gender, younger age, lower level of education, being infected with COVID-19, being medically vulnerable, working in the healthcare system, being in voluntary quarantine and having an immigrant background predicted mean HSCL-10 scores. The moderation analysis revealed that people in the medically vulnerable group, those below 61, and those in quarantine reported higher psychological distress when they also had lower trust in the healthcare system.

Conclusions:

Findings indicate important groups to take into consideration in mental healthcare strategies and policies. However, most participants in the current study reported psychological distress levels that were below the clinical cut-off, suggesting that the majority may have coped relatively well in the early stages of the pandemic.