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Haenssgen MJ, Elliott EM, Phommachanh S, Souksavanh O, Okabayashi H, Kubota S. Community engagement for stakeholder and community trust in healthcare: Short-term evaluation findings from a nationwide initiative in Lao PDR. Soc Sci Med 2024; 354:117079. [PMID: 38954978 DOI: 10.1016/j.socscimed.2024.117079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/15/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Trust remains a critical concept in healthcare provision, but little is known about the ability of health policy and interventions to stimulate more trusting relationships between communities and the health system. The CONNECT (Community Network Engagement for Essential Healthcare and COVID-19 Responses Through Trust) Initiative in Lao PDR provided an opportunity to assess the community-level impact of a trust-building community engagement approach. METHODS A mixed-method process evaluation was implemented from 10/2022-12/2023 among 14 diverse case study communities in four provinces across Lao PDR. Data collection involved two rounds of census surveys (3161 observations incl. panel data from 618 individuals) including an 8-item trust scale, 50 semi-structured interviews with villagers, and 50 contextualizing key informant interviews. The two data collection rounds were implemented before and three months after village-based CONNECT activities and helped discern impacts among activity participants, indirectly exposed villagers, and unexposed villagers in a difference-in-difference analysis. RESULTS Stakeholders attested strong support for the CONNECT Initiative although community-level retention of trust-related themes from the activities was limited. Quantitative data nevertheless showed that, at endline, the 8-item trust index (from [-8 to +8]) increased by 0.95 points from 4.44 to 5.39 and all trust indicators were universally higher. Difference-in-difference analysis showed that villagers exposed to the CONNECT activities had a 1.02-index-point higher trust index compared to unexposed villagers. Trust impacts improved gradually over time and were relatively more pronounced among men and ethnic minority groups. CONCLUSIONS The CONNECT Initiative had considerable direct and systemic effects on community members' trust in their local health centers in the short term, which arose from strong stakeholder mobilization and gradual institutional learning. Relational community engagement approaches have the potential to create important synergies in health policy and broader cross-sectorial strategies, but also require contextual grounding to identify locally relevant dimensions of trust.
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Affiliation(s)
- Marco J Haenssgen
- Department of Social Science and Development, Chiang Mai University, 239 Huay Kaew Rd. T. Suthep Muang, Chiang Mai, 50200, Thailand.
| | - Elizabeth M Elliott
- World Health Organization Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines
| | - Sysavanh Phommachanh
- Institute of Research and Education Development, University of Health Sciences, Payawat Village, Sisattanak District, Vientiane Capital, Laos
| | - Ounkham Souksavanh
- World Health Organization Representative, Country Office for Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5 Ban Saphangthongtai, Sisattanak District, Vientiane Capital, Laos
| | - Hironori Okabayashi
- World Health Organization Representative, Country Office for Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5 Ban Saphangthongtai, Sisattanak District, Vientiane Capital, Laos
| | - Shogo Kubota
- World Health Organization Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines
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Weber LR. Measuring trust in one's physician: A scoping review. PLoS One 2024; 19:e0303840. [PMID: 38758829 PMCID: PMC11101118 DOI: 10.1371/journal.pone.0303840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
Trust in one's physician drives positive health practices. However, the conceptualization and subsequent operationalization of trust have become clouded due to the multitude of approaches that have resulted in several different measures with varied dimensions and indicators. The objectives of this scoping review were: 1) to discover any new developments in the measurement of trust, 2) to identify those measures of trust, whether newly created or refined in the last ten years, that have known reliability and validity, and 3) to compare those instruments' conceptualizations, dimensions, and indicators. This researcher conducted an electronic search of three databases (PubMed, SOCAB, and PsycINFO). Two reviewers screened those selected studies and identified the following six key measurement tools, of which three had shorter, more abbreviated derivatives: the Trust in Physician Scale and its modification, the Wake Forest Physician Trust Scale and its short form, the Health Care Relationship Trust Scale and its refinement, the Trust in Oncologist Scale and its shortened form, the Trust in Health Care Providers Scale, and the Trust in My Doctor Scale. Of these six distinct tools, only the Trust in Oncologist Scale was developed and validated in non-US populations. Also identified were ten dimensions of trust: fidelity, technical competence, communicative competence, interpersonal competence (i.e., caring), honesty, confidentiality, global, behavioral, fairness, and system trust/accountability. Interpersonal competence and fairness emerged as newer dimensions that deserve further study. A comparative analysis of the indicators of these trust dimensions revealed some discrepancies that deserve theoretical and psychometric attention. In addition, incorporating item-response theory to assess measurement invariance has enhanced the assessment of external validity. This review provides a resource for researchers that will lead to a more uniform understanding of trust, thereby setting the basis for future theoretical integration and measurement development.
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Affiliation(s)
- Linda R. Weber
- Department of Social and Behavioral Sciences, State University of New York Polytechnic Institute, Utica, New York, United States of America
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Haenssgen MJ, Elliott EM, Phommachanh S, Phomkong S, Kounnavong S, Kubota S. Trust in healthcare: methodological and conceptual insights from mixed-method research in Lao People's Democratic Republic. BMJ Glob Health 2024; 9:e014640. [PMID: 38754897 PMCID: PMC11097858 DOI: 10.1136/bmjgh-2023-014640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/14/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Global health foregrounds trust as a key requirement for the achievement of international health initiatives, but it remains an elusive concept that is often mobilised without consideration of its dimensions, drivers and downstream behavioural consequences. This paper aims to contribute to the conceptual development and measurement of 'patient trust in primary healthcare' from the lower middle-income country perspective of rural Lao PDR. METHODS A two-phase mixed-method research design was implemented between January 2021 and April 2023. Phase 1 involved exploratory qualitative research to understand the local expressions and dimensions of patient trust in primary healthcare, with 25 semistructured interviews and 17 focus group discussions (120 participants) in eight villages in Bokeo Province. Phase 2 involved explanatory research to assess patterns of trust systematically at scale in 14 villages across four provinces, wherein 26 cognitive interviews, 17 expert interviews and non-participant community observations informed a community census survey with 1838 participants. We analysed qualitative data through content-oriented thematic analysis and developed an 8-item trust scale on that basis. Quantitative data analysis used descriptive statistical and regression analysis. RESULTS We found that trust in primary healthcare is readily understood and intrinsically valuable in rural Lao PDR. Key dimensions included communication, respectful care, relationship, fairness, integrity, reputation, assurance of treatment and competence. The survey highlighted that reputation, competence, integrity and respectful care had the lowest trust scores. Health centre operations predicted the local expressions of trust. The behavioural consequences of trust were limited to a positive statistical association with antenatal care uptake among pregnant women but outweighed by alternative measures that also captured the availability of healthcare facilities. CONCLUSIONS Overall, the development of our quantitative trust scale offers a process model for future researchers. We conclude that interpersonal, institutional and service-related trust require more explicit recognition in health system development and integration into health policy.
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Affiliation(s)
- Marco J Haenssgen
- Department of Social Science and Development, Chiang Mai University, Chiang Mai, Thailand
| | - Elizabeth M Elliott
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | - Sylivanh Phomkong
- World Health Organization Representative Office, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Shogo Kubota
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
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Xavier SM, Malla A, Mohan G, Mustafa S, Padmavati R, Rangaswamy T, Joober R, Schmitz N, Margolese HC, Iyer SN. Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada. Soc Psychiatry Psychiatr Epidemiol 2024; 59:813-825. [PMID: 37848572 DOI: 10.1007/s00127-023-02576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. METHODS Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. RESULTS The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. CONCLUSION This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.
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Affiliation(s)
- Salomé M Xavier
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
- University of Warwick, Coventry, CV4 7AL, UK
| | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- University of Tübingen, Geschwister-Scholl-Platz 72074, Tübingen, Germany
| | - Howard C Margolese
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Zaman SB, Evans RG, Chow CK, Joshi R, Thankappan KR, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Riddell MA, Suresh O, Thomas N, Mini GK, Maulik PK, Srikanth VK, Thrift AG. Morbidity and utilisation of healthcare services among people with cardiometabolic disease in three diverse regions of rural India. Chronic Illn 2023; 19:873-888. [PMID: 36744377 PMCID: PMC10655594 DOI: 10.1177/17423953231153550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the prevalence and determinants of cardiometabolic disease (CMD), and the factors associated with healthcare utilisation, among people with CMD. METHODS Using a cross-sectional design, 11,657 participants were recruited from randomly selected villages in 3 regions located in Kerala and Andhra Pradesh from 2014 to 2016. Multivariable logistic regression was used to identify factors independently associated with CMD and healthcare utilisation (public or private). RESULTS Thirty-four per cent (n = 3629) of participants reported having ≥1 CMD, including hypertension (21.6%), diabetes (11.6%), heart disease (5.0%) or chronic kidney disease (CKD) (1.6%). The prevalence of CMD was progressively greater in regions of greater socio-economic position (SEP), ranging from 19.1% to 40.9%. Among those with CMD 41% had sought any medical advice in the last month, with only 19% utilising public health facilities. Among people with CMD, those with health insurance utilised more healthcare (age-gender adjusted odds ratio (AOR) (95% confidence interval (CI)): 1.31 (1.13, 1.51)) as did those who reported accessing private rather than public health services (1.43 (1.23, 1.66)). DISCUSSION The prevalence of CMD is high in these regions of rural India and is positively associated with indices of SEP. The utilisation of outpatient health services, particularly public services, among those with CMD is low.
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Affiliation(s)
- Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Clara K Chow
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Rohina Joshi
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- George Institute for Global Health, New Delhi, India
| | | | - Brian Oldenburg
- Non-Communicable Diseases and Implementation Science, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ajay S Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Rishi Valley Rural Health Centre, Chittoor District, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Gomathyamma K Mini
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Pallab K Maulik
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, New Delhi, India
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Xavier SM, Malla A, Mohan G, Mustafa S, Padmavati R, Rangaswamy T, Joober R, Schmitz N, Margolese HC, Iyer SN. Trust of patients and families in mental healthcare providers and institutions: A cross-cultural study in Chennai, India and Montreal, Canada. RESEARCH SQUARE 2023:rs.3.rs-2584056. [PMID: 36824772 PMCID: PMC9949234 DOI: 10.21203/rs.3.rs-2584056/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Purpose Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. Methods Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Non-parametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. Results The study included 333 patients (Montreal=165, Chennai=168) and 324 family members (Montreal=128, Chennai=168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. Conclusion This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.
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Wilson NA. CORR Insights®: There are Considerable Inconsistencies Among Minimum Clinically Important Differences in TKA: A Systematic Review. Clin Orthop Relat Res 2023; 481:81-83. [PMID: 36534473 PMCID: PMC9750628 DOI: 10.1097/corr.0000000000002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Nicole A Wilson
- Assistant Professor of Surgery, Pediatrics, and Biomedical Engineering, Division of Pediatric Surgery, University of Rochester, Golisano Children's Hospital, Rochester, NY, USA
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Vora K, Saiyed S, Mavalankar D, Baines LS, Jindal RM. Trust Deficit in Surgical Systems in an Urban Slum in India Under Universal Health Coverage: A Mixed Method Study. Int J Public Health 2022; 67:1604924. [PMID: 35910432 PMCID: PMC9334907 DOI: 10.3389/ijph.2022.1604924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: We carried out a mixed method study to understand why patients did not avail of surgical care in an urban slum in India. Methods: In our earlier study, we found that out of 10,330 people, 3.46% needed surgery; 42% did not avail of surgery (unmet needs). We conducted a follow-up study to understand reasons for not availing surgery, 141 in met needs, 91 in unmet needs. We administered 2 instruments, 16 in-depth interviews and 1 focused group discussion. Results: Responses from the 2 groups for “the Socio-culturally Competent Trust in Physician Scale for a Developing Country Setting” scale did not have significant difference except for, prescription of medicines, patients with unmet needs were less likely to agree (p = 0.076). Results between 2 groups regarding “Patient perceptions of quality” did not show significant difference except for doctors answering questions where a higher proportion of unmet need group agreed (p = 0.064). Similar observations were made in the in depth interviews and focus group. Conclusion: There is a need for understanding trust issues with health service delivery related to surgical care for marginalized populations.
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Affiliation(s)
- Kranti Vora
- Indian Institute of Public Health, Gandhinagar, India
| | - Shahin Saiyed
- Indian Institute of Public Health, Gandhinagar, India
| | | | - Lyndsay S. Baines
- Head of School (Health and Social Care), Anglia Ruskin University, London, United Kingdom
| | - Rahul M. Jindal
- Professor of Surgery and Global Health, Uniformed Services University, Bethesda, MD, United States
- Adjunct Indian Institute of Public Health, Gandhinagar, India
- *Correspondence: Rahul M. Jindal,
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Bhattacharjee D, Mohanty PC. Do information differentials and confidence in medical institutions influence out-of-pocket expenditure on health care in India? CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Restrepo N, Krouse HJ. COVID-19 Disparities and Vaccine Hesitancy in Black Americans: What Ethical Lessons Can Be Learned? Otolaryngol Head Neck Surg 2021; 166:1147-1160. [PMID: 34905417 DOI: 10.1177/01945998211065410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This state of the art review focuses on bioethical questions and considerations from research findings and methodological issues, including design and recruitment of participants, in studies related to COVID-19 vaccine hesitation in Black individuals. Ethical concerns identified were applied to otolaryngology with recommendations for improving health inequities within subspecialties. DATA SOURCES An internet search through PubMed, CINAHL, and socINDEX was conducted to identify articles on COVID-19 vaccine hesitation among the Black population between 2020 and 2021. REVIEW METHODS A systematic review approach was taken to search and analyze the research on this topic, which was coupled with expert analysis in identifying and classifying vital ethical considerations. CONCLUSIONS The most common COVID-19 vaccine hesitation factors were related to the development of the vaccine, mistrust toward government agencies, and misconceptions about safety and side effects. These findings raised bioethical concerns around mistrust of information, low health literacy, insufficient numbers of Black participants in medical research, and the unique positions of health professionals as trusted sources. These bioethical considerations can be applied in otolaryngology and other health-related areas to aid the public in making informed medical decisions regarding treatments, which may reduce health inequalities among Black Americans and other racial and ethnic minority groups. IMPLICATIONS FOR PRACTICE Addressing ethical questions by decreasing mistrust, tailoring information for specific populations, increasing minority representation in research, and using health professionals as primary sources for communicating health information and recommendations may improve relationships with Black communities and increase acceptance of new knowledge and therapies such as COVID-19 vaccination.
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Affiliation(s)
- Nicolas Restrepo
- Baylor College of Medicine, School of Medicine, Houston, Texas, USA
| | - Helene J Krouse
- Department of Internal Medicine, School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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Gopichandran V, Sakthivel K. Doctor-patient communication and trust in doctors during COVID 19 times-A cross sectional study in Chennai, India. PLoS One 2021; 16:e0253497. [PMID: 34161383 PMCID: PMC8221523 DOI: 10.1371/journal.pone.0253497] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The COVID 19 pandemic created a global public health crisis. Physical distancing, masks, personal protective equipment worn by the doctors created difficulties in effective doctor-patient communication. OBJECTIVES This study was conducted to assess the difficulties faced by patients in communicating with their doctors due to the COVID 19 preventive measures, and its impact on the trust on their doctors. METHODS A cross sectional study of 359 persons attending a tertiary care center in Chennai, sampled in a non-probabilistic manner selected from the outpatient department, wards, and isolation facilities, was conducted using a questionnaire containing items covering three dimensions namely difficulties faced in accessing the health facility, difficulties in doctor-patient communication and trust in the doctors. The data were collected using Google Forms and analyzed using GNU PSPP open-source statistical software version 1.4.0. RESULTS More than 60% of the participants complained of difficulty in accessing the health facility. More than 60% had difficulties in communicating with the doctors. There was a high level of trust in doctors among more than 80% of the participants. Comparison of the mean scores revealed that accessibility was a problem across ages, sexes, education and occupation groups. Communication barriers decreased with age and increased with education, but trust increased with age, but reduced with increasing education. Multivariable linear regression analysis revealed that difficulties in communication had a negative impact on trust (β = -0.63, p<0.001) and increasing education had a negative impact on trust (β = -0.42, p = 0.034). CONCLUSIONS The COVID 19 pandemic and the preventive strategies such as lock-down, physical distancing, face mask and personal protective equipment created barriers to effective doctor patient communication and led to some compromise in trust in doctors during this time.
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Anstey Watkins J, Griffiths F, Goudge J. Community health workers' efforts to build health system trust in marginalised communities: a qualitative study from South Africa. BMJ Open 2021; 11:e044065. [PMID: 34011590 PMCID: PMC8137175 DOI: 10.1136/bmjopen-2020-044065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Community health workers (CHWs) enable marginalised communities, often experiencing structural poverty, to access healthcare. Trust, important in all patient-provider relationships, is difficult to build in such communities, particularly when stigma associated with HIV/AIDS, tuberculosis and now COVID-19, is widespread. CHWs, responsible for bringing people back into care, must repair trust. In South Africa, where a national CHW programme is being rolled out, marginalised communities have high levels of unemployment, domestic violence and injury. OBJECTIVES In this complex social environment, we explored CHW workplace trust, interpersonal trust between the patient and CHW, and the institutional trust patients place in the health system. DESIGN, PARTICIPANTS, SETTING Within the observation phase of a 3-year intervention study, we conducted interviews, focus groups and observations with patients, CHWs, their supervisors and, facility managers in Sedibeng. RESULTS CHWs had low levels of workplace trust. They had recently been on strike demanding better pay, employment conditions and recognition of their work. They did not have the equipment to perform their work safely, and some colleagues did not trust, or value, their contribution. There was considerable interpersonal trust between CHWs and patients, however, CHWs' efforts were hampered by structural poverty, alcohol abuse and no identification documents among long-term migrants. Those supervisors who understood the extent of the poverty supported CHW efforts to help the community. When patients had withdrawn from care, often due to nurses' insensitive behaviour, the CHWs' attempts to repair patients' institutional trust often failed due to the vulnerabilities of the community, and lack of support from the health system. CONCLUSION Strategies are needed to build workplace trust including supportive supervision for CHWs and better working conditions, and to build interpersonal and institutional trust by ensuring sensitivity to social inequalities and the effects of structural poverty among healthcare providers. Societies need to care for everyone.
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Affiliation(s)
- Jocelyn Anstey Watkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Tiwari B, Patil P, Ankola A, Kashyap B. Assessment of trust in dentists using the dentist-trust scale in Belagavi City, Karnataka, India: A cross-sectional hospital-based study. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2021. [DOI: 10.4103/jiaphd.jiaphd_215_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Setyawan FEB, Supriyanto S, Ernawaty E, Lestari R. Understanding patient satisfaction and loyalty in public and private primary health care. J Public Health Res 2020; 9:1823. [PMID: 32728567 PMCID: PMC7376485 DOI: 10.4081/jphr.2020.1823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 11/26/2022] Open
Abstract
Background: The quality of health centers, patient satisfaction, and loyalty are three key factors that enable health care providers to improve their services and cost-effectiveness. This study, therefore, aims to determine patient satisfaction and loyalty in public and private primary health care centers. Design and Methods: Data were obtained from a cross-sectional design of 1470 self-administered questionnaires and analyzed based on mean, standard deviation, and correlation coefficients. Results: The results showed respectively a strong and moderate correlation between patient satisfaction and loyalty in private (r=0.767) and public (r=0.54) primary health care centers, respectively. In addition, in both centers patients received adequate medical services, with social aspects as the least important factors affecting patient satisfaction. Conclusions: In conclusion, primary health care practices need to recognize the needs that influence patients’ satisfaction and loyalty, to improve the quality of their services. Significance for public health Patient satisfaction affects all dimensions of healthcare services, including patient retention, which is the key factor that determines their return to the same center. The provision of high standard health services, staff motivation, and showing appreciation help to retain patients. It is important to determine the driving forces that influence patients’ choice to return for more services in order to implement effective strategies for maintaining their loyalty. This paper describes the correlation between patient satisfaction and loyalty in public and private primary health care.
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Affiliation(s)
| | | | - Ernawaty Ernawaty
- Department of Health Policy and Administration, Faculty of Public Health
| | - Retno Lestari
- Doctoral Program of Public Health, Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya.,Study Program of Nursing Science, Faculty of Medicine, University of Brawijaya, Malang, Indonesia
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COVID-19 Pandemic: a Litmus Test of Trust in the Health System. Asian Bioeth Rev 2020; 12:213-221. [PMID: 32837551 PMCID: PMC7259435 DOI: 10.1007/s41649-020-00122-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 11/06/2022] Open
Abstract
The pandemic caused by the SARS-CoV2 novel coronavirus is creating a global crisis. There is a global ambience of uncertainty and anxiety. In addition, nations have imposed strict and restrictive public health measures including lockdowns. In this heightened time of vulnerability, public cooperation to preventive measures depends on trust and confidence in the health system. Trust is the optimistic acceptance of the vulnerability in the belief that the health system has best intentions. On the other hand, confidence is assessed based on previous experiences with the health system. Trust and confidence in the health system motivate people to accept the public health interventions and cooperate with them. Building trust and confidence therefore becomes an ethical imperative. This article analyses the COVID-19 pandemic in the south Indian state of Tamil Nadu and the state’s response to this pandemic. Further, it applies the Trust-Confidence-Cooperation framework of risk management to analyse the influence of public trust and confidence on the Tamil Nadu health system in the context of the preventive strategies adopted by the state. Finally, the article proposes a six-pronged strategy to build trust and confidence in health system functions to improve cooperation to pandemic containment measures.
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Shaya B, Al Homsi N, Eid K, Haidar Z, Khalil A, Merheb K, Honein-Abou Haidar G, Akl EA. Factors associated with the public's trust in physicians in the context of the Lebanese healthcare system: a qualitative study. BMC Health Serv Res 2019; 19:525. [PMID: 31351485 PMCID: PMC6660947 DOI: 10.1186/s12913-019-4354-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/17/2019] [Indexed: 01/26/2023] Open
Abstract
Background The Lebanese public perceives the physician-patient relationship as flawed. The objectives of this study are to assess factors associated with the public’s trust in physicians in the context of the Lebanese healthcare system and to explore potential ways to enhance it. Methods We conducted a qualitative study based on a grounded theory methodology using semi-structured interviews with members of the Lebanese public (not restricted to patients). We selected participants through convenience and maximum variation sampling approaches. The constant comparative analysis resulted in a theoretical framework that describes the factors influencing trust in physicians. Results Participants trusted an experienced, up-to-date, graduate of a North American or Western European school, working in a reputable hospital, with a high level of diagnostic skills. The personal characteristics that improved trust were physicians who are ‘non-materialistic’, have a good rapport, and have sufficient encounter time with patients. Social factors that enhance trust in the physician include: being a family member, recommended by a family member, featured in mainstream media, and/or having a good reputation. Trust increased compliance, loyalty despite occasional mistakes committed, high consultation fees, and negative attitudes towards the physician’s institution. Conversely, no trust led to severed therapeutic relationship and seeking second opinions. Conclusion The level of trust of members of the Lebanese public in physicians was affected by the personal characteristics of physicians, their practice or clinical skills, their interactions with the patient, finances, in addition to a number of social factors. Moreover, the level of trust had major implications on patients’ interactions with their physicians. Electronic supplementary material The online version of this article (10.1186/s12913-019-4354-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bashir Shaya
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Nadine Al Homsi
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Kevin Eid
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Zeinab Haidar
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Ali Khalil
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Kelly Merheb
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Gladys Honein-Abou Haidar
- Hariri School of Nursing, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Elie A Akl
- Department on Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon.
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Hamidzadeh Y, Hashemiparast M, Hassankhani H, Allahverdipour H. Obstacles for Iranian rural population to participate in health education programmes: a qualitative study. Fam Med Community Health 2019; 7:e000020. [PMID: 32148691 PMCID: PMC6910725 DOI: 10.1136/fmch-2018-000020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/31/2018] [Accepted: 01/06/2019] [Indexed: 12/12/2022] Open
Abstract
Objective To explore the obstacles of community participation in rural health education programmes from the viewpoints of Iranian rural inhabitants. Design This was a qualitative study with conventional content analysis approach which was carried out March to October 2016. Setting Data collected using semistructured interviews that were digitally recorded, transcribed and analysed until data saturation. MAXQDA 10 software was used to manage the textual data. Participant Participants were twenty-two seven clients from a rural community in Ardabil, Iran who were receiving health services from health centres. Result The main obstacles to participate in health education programmes in rural settings were ‘Lack of trust to the rural health workers’, ‘Adherence to neighbourhood social networks in seeking health information’ and ‘Lack of understanding on the importance of health education’. Conclusion Rural health education programmes in Iran are encountered with a variety of obstacles. We need to enhancing mutual trust between the rural health workers and villagers, and developing community-based education programmes to promote health information seeking behaviours among villagers. The finding of this study will be a referential evidence for the qualitative improvement of local health education programmes for rural inhabitants.
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Affiliation(s)
- Yousef Hamidzadeh
- Candidate in Health Education, Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Hashemiparast
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Hadi Hassankhani
- Qualitative Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Allahverdipour
- Candidate in Health Education, Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Subramani S. The moral significance of capturing micro-inequities in hospital settings. Soc Sci Med 2018; 209:136-144. [DOI: 10.1016/j.socscimed.2018.05.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 11/24/2022]
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Mehata S, Paudel YR, Dariang M, Aryal KK, Paudel S, Mehta R, King S, Barnett S. Factors determining satisfaction among facility-based maternity clients in Nepal. BMC Pregnancy Childbirth 2017; 17:319. [PMID: 28946851 PMCID: PMC5613378 DOI: 10.1186/s12884-017-1532-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background With an increasing number of institutional deliveries, the Nepalese health system faces a challenge to ensure a quality of service provision. This paper aims to identify the determinants of client satisfaction with maternity care in Nepal using data from a nationally representative health facility survey. Methods A total of 447 exit interviews, with women who had either recently delivered or who had experienced obstetric complications, were conducted across 13 districts in Nepal (87% in hospitals, 8% in Primary Health Care Centres (PHCCs), and 5% in Sub/Health Posts(S/HPs). Client satisfaction was measured using an eight item scale that covered accessibility, interpersonal communication, physical environment, technical aspect of care and decision making. A client satisfaction index was computed using ordinal principal component analysis. A multivariate probit model was used to assess the net effect of explanatory variables on client satisfaction. Results Longer waiting times and overcrowding increased the likelihood of dissatisfaction. Having an opportunity to ask questions was positively associated with client satisfaction. Respondents from hill districts and rural areas were more likely to be satisfied in comparison to respondents from mountain, terai and urban areas. Socio-demographic factors (age, parity, caste/ethnicity, education, and ecological zone) and supply side factors (the time taken to reach a facility, type of facility, payment for services, and unknown heath worker or anyone entering the delivery room) were not statistically associated with satisfaction. Conclusions The findings suggest client satisfaction with the quality of maternity services in Nepal could be improved by reducing waiting times and overcrowding, and giving the mothers adequate time to ask questions. If clients are more satisfied they are more likely to use the facility again/recommend to a friend.
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Affiliation(s)
- Suresh Mehata
- Nepal Health Sector Support Program, Ministry of Health and Population, Ramshaha Path, GPO Box: 7830, Kathmandu, 44600, Nepal.
| | - Yuba Raj Paudel
- Nepal Health Sector Support Program, Ministry of Health and Population, Ramshaha Path, GPO Box: 7830, Kathmandu, 44600, Nepal
| | - Maureen Dariang
- Nepal Health Sector Support Program, Ministry of Health and Population, Ramshaha Path, GPO Box: 7830, Kathmandu, 44600, Nepal
| | - Krishna Kumar Aryal
- Nepal Health Research Council, Ministry of Health and Population, Kathmandu, 44600, Nepal
| | - Susan Paudel
- Institute of Medicine Tribhuvan University Maharajgunj, Kathmandu, 4600, Nepal
| | - Ranju Mehta
- Institute of Medicine Tribhuvan University Maharajgunj, Kathmandu, 4600, Nepal
| | - Stuart King
- Nepal Health Sector Support Program, Ministry of Health and Population, Ramshaha Path, GPO Box: 7830, Kathmandu, 44600, Nepal
| | - Sarah Barnett
- Options Consultancy Services Limited, Devon House, 58 St Katharine's Way, London, E1W1LB, UK
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Taylor J, Neff C. Social considerations of inflammatory bowel disease in Southern Israel. BMJ Case Rep 2017; 2017:bcr-2017-219941. [PMID: 28716774 DOI: 10.1136/bcr-2017-219941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chronic diseases pose unique social challenges beyond traditional health considerations that require specific attention. In this report, we examine the case of a middle-aged woman with ulcerative colitis, living in Southern Israel. Trust between the patient and physician is shown to positively influence a variety of therapeutic outcomes and should be considered a fundamental component of successful care. In context of the military conflict between Israel and Gaza, the needs of patients with chronic diseases cannot be forgotten. The work environment is also identified as an area of particular concern, as a supportive work environment is essential in order to maintain satisfaction in the workplace and sustain a high quality of life. Out-of-pocket costs for medications are confirmed to be a significant barrier to adherence. Better understanding of patients’ financial capabilities, along with affordable therapeutic interventions, will alleviate healthcare-related financial burdens and improve health outcomes.
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Affiliation(s)
- Jonathan Taylor
- Department of Medical School for International Health, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Chase Neff
- Department of Medical School for International Health, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
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Hampshire K, Hamill H, Mariwah S, Mwanga J, Amoako-Sakyi D. The application of Signalling Theory to health-related trust problems: The example of herbal clinics in Ghana and Tanzania. Soc Sci Med 2017; 188:109-118. [PMID: 28738317 PMCID: PMC5559643 DOI: 10.1016/j.socscimed.2017.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 01/19/2023]
Abstract
In contexts where healthcare regulation is weak and levels of uncertainty high, how do patients decide whom and what to trust? In this paper, we explore the potential for using Signalling Theory (ST, a form of Behavioural Game Theory) to investigate health-related trust problems under conditions of uncertainty, using the empirical example of ‘herbal clinics’ in Ghana and Tanzania. Qualitative, ethnographic fieldwork was conducted over an eight-month period (2015–2016) in eight herbal clinics in Ghana and ten in Tanzania, including semi-structured interviews with herbalists (N = 18) and patients (N = 68), plus detailed ethnographic observations and twenty additional key informant interviews. The data were used to explore four ST-derived predictions, relating to herbalists' strategic communication (‘signalling’) of their trustworthiness to patients, and patients' interpretation of those signals. Signalling Theory is shown to provide a useful analytical framework, allowing us to go beyond the primary trust problem addressed by other researchers – cataloguing observable indicators of trustworthiness – and providing tools for tackling the trickier secondary trust problem, where the trustworthiness of those indicators must be ascertained. Signalling Theory also enables a basis for comparative work between different empirical contexts that share the underlying condition of uncertainty. Applies Signalling Theory (ST) to patient-herbalist trust in Ghana & Tanzania. Herbalists communicate trustworthiness to patients via observable ‘signals’. Patients interpret signal reliability based on perceived costs and pay-offs. In conditions of uncertainty, informational mismatches result in misplaced trust. ST allows us to go beyond description, enabling prediction and comparative work.
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Affiliation(s)
| | | | - Simon Mariwah
- Dept of Geography and Regional Planning, University of Cape Coast, Ghana
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Palanisamy B, Kosalram K, Gopichandran V. Dimensions of social capital of families with thalassemia in an indigenous population in Tamil Nadu, India - a qualitative study. Int J Equity Health 2017; 16:109. [PMID: 28646907 PMCID: PMC5483308 DOI: 10.1186/s12939-017-0609-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/20/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Studies have shown that social capital is positively associated with health, and the association is context-based. Indigenous populations with poor access to health care largely depend on social capital for their health care needs. This study was conducted to explore the dimensions and types of social capital and its utilization by families with thalassemia for their health and well-being in an indigenous population in Tamil Nadu, India. METHODS The participants in the study were parents who had children with thalassemia, belonged to an indigenous community in Tamil Nadu, were poor and marginalized, and had poor access to health care. Different dimensions and types of social capital were examined with the help of qualitative in-depth interviews using a phenomenological approach. A total of 8 in-depth interviews were conducted and transcribed. Thematic analysis of the data was performed. RESULTS The social capital identified through the in-depth interviews consisted of various levels of family support, financial support from relatives and neighbors, the provision of information from formal and informal networks, and trust in the physician. Indigenous communities are close-knit due to their geographical remoteness and limited accessibility. Family ties were a form of social capital that encouraged bonding, and provided support and care to the children affected by thalassemia. The bonding also helped to meet the regular requirement of blood donation for the children. Relatives and neighbors were an asset that served as a bridge for the families affected, helping them in times of immediate and urgent financial need, making it easier to sustain long-term treatment and providing emotional support. There were informal networks that bridged parents belonging to indigenous and non-indigenous communities, with the latter providing the former with information to help them choose better health care at an affordable cost. The other formal links were the ties between the parents and nongovernmental organizations, such as the local thalassemia association, which connected members belonging to different areas. It was these ties that were of the greatest assistance to the families affected in coping with the disease, enabling them to sustain the treatment, and assisting them to choose and carry out the complicated bone marrow transplantation, which is the definitive treatment for this condition. CONCLUSION The bonding, bridging, and linking dimensions of social capital help communities cope with thalassemia, the more so in indigenous and marginalized communities.
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Affiliation(s)
- Bharathi Palanisamy
- Doctoral Research Scholar, School of Public Health, SRM University, Kancheepuram District, Tamil Nadu India
| | - Kalpana Kosalram
- School of Public Health, SRM University, Kancheepuram District, Tamil Nadu India
| | - Vijayaprasad Gopichandran
- Department of Community Medicine, ESIC Medical College & Postgraduate Institute of Medical Sciences and Research, KK Nagar Chennai, 600078 Tamil Nadu India
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Kalsingh MJ, Veliah G, Gopichandran V. Psychometric properties of the Trust in Physician Scale in Tamil Nadu, India. J Family Med Prim Care 2017; 6:34-38. [PMID: 29026745 PMCID: PMC5629896 DOI: 10.4103/2249-4863.214966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Trust in health care is of high intrinsic value. It also leads to positive outcomes such as better treatment adherence and disclosure of sensitive information. Therefore, there is a need to measure trust in health care objectively. AIMS To assess the psychometric properties of the Trust in Physician Scale in Tamil Nadu, India. SETTINGS AND DESIGN The study was conducted in a private tertiary hospital setting in Tamil Nadu by a cross-sectional survey design. METHODS The Trust in Physician Scale and General Trust Scale were administered to 288 participants in the waiting area of a tertiary care hospital in Tamil Nadu. STATISTICAL ANALYSIS Descriptive statistics, exploratory factor analysis, and Cronbach's alpha statistics were used to assess the validity and reliability of the scale. RESULTS The respondents were predominantly men from rural areas, older than 35 years of age, and with lesser than 8 years of schooling. The questionnaire had acceptable internal consistency with Cronbach's alpha of 0.707 (95% confidence interval 0.654-0.755). Exploratory factor analysis divided the questionnaire into four domains. Seven items loaded into factor 1 which explained dependability and competence of the physician, two items loaded on factor 2, and one each in factors 3 and 4. The latter four items had very low item to total correlations and hence did not contribute much to the questionnaire. CONCLUSIONS The Trust in Physician questionnaire needs to be modified to accurately measure the domains of trust in the context of the study area. More qualitative studies are required to understand the domains of trust in this cultural and social context.
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Affiliation(s)
- Maria Jusler Kalsingh
- Department of Biostatistics, National Institute of Malaria Research, Chennai, Tamil Nadu, India
| | - Geetha Veliah
- Division of Health Communication and Promotion, School of Public Health, SRM University, Chennai, Tamil Nadu, India
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Gopichandran V, Wouters E, Chetlapalli SK. Development and validation of a socioculturally competent trust in physician scale for a developing country setting. BMJ Open 2015; 5:e007305. [PMID: 25941182 PMCID: PMC4420938 DOI: 10.1136/bmjopen-2014-007305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
UNLABELLED Trust in physicians is the unwritten covenant between the patient and the physician that the physician will do what is in the best interest of the patient. This forms the undercurrent of all healthcare relationships. Several scales exist for assessment of trust in physicians in developed healthcare settings, but to our knowledge none of these have been developed in a developing country context. OBJECTIVES To develop and validate a new trust in physician scale for a developing country setting. METHODS Dimensions of trust in physicians, which were identified in a previous qualitative study in the same setting, were used to develop a scale. This scale was administered among 616 adults selected from urban and rural areas of Tamil Nadu, south India, using a multistage sampling cross sectional survey method. The individual items were analysed using a classical test approach as well as item response theory. Cronbach's α was calculated and the item to total correlation of each item was assessed. After testing for unidimensionality and absence of local dependence, a 2 parameter logistic Semajima's graded response model was fit and item characteristics assessed. RESULTS Competence, assurance of treatment, respect for the physician and loyalty to the physician were important dimensions of trust. A total of 31 items were developed using these dimensions. Of these, 22 were selected for final analysis. The Cronbach's α was 0.928. The item to total correlations were acceptable for all the 22 items. The item response analysis revealed good item characteristic curves and item information for all the items. Based on the item parameters and item information, a final 12 item scale was developed. The scale performs optimally in the low to moderate trust range. CONCLUSIONS The final 12 item trust in physician scale has a good construct validity and internal consistency.
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Affiliation(s)
| | - Edwin Wouters
- Centre for Longitudinal & Life Course Studies, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Riva S, Monti M, Iannello P, Pravettoni G, Schulz PJ, Antonietti A. A preliminary mixed-method investigation of trust and hidden signals in medical consultations. PLoS One 2014; 9:e90941. [PMID: 24618683 PMCID: PMC3949702 DOI: 10.1371/journal.pone.0090941] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 02/05/2014] [Indexed: 12/02/2022] Open
Abstract
Background Several factors influence patients' trust, and trust influences the doctor-patient relationship. Recent literature has investigated the quality of the personal relationship and its dynamics by considering the role of communication and the elements that influence trust giving in the frame of general practitioner (GP) consultations. Objective We analysed certain aspects of the interaction between patients and GPs to understand trust formation and maintenance by focusing on communication channels. The impact of socio-demographic variables in trust relationships was also evaluated. Method A cross-sectional design using concurrent mixed qualitative and quantitative research methods was employed. One hundred adults were involved in a semi-structured interview composed of both qualitative and quantitative items for descriptive and exploratory purposes. The study was conducted in six community-based departments adjacent to primary care clinics in Trento, Italy. Results The findings revealed that patients trusted their GP to a high extent by relying on simple signals that were based on the quality of the one-to-one communication and on behavioural and relational patterns. Patients inferred the ability of their GP by adopting simple heuristics based mainly on the so-called social “honest signals” rather than on content-dependent features. Furthermore, socio-demographic variables affected trust: less literate and elderly people tended to trust more. Conclusions This study is unique in attempting to explore the role of simple signals in trust relationships within medical consultation: people shape trust and give meaning to their relationships through a powerful channel of communication that orbits not around words but around social relations. The findings have implications for both clinicians and researchers. For doctors, these results suggest a way of thinking about encounters with patients. For researchers, the findings underline the importance of analysing some new key factors around trust for future investigations in medical practice and education.
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Affiliation(s)
- Silvia Riva
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland
- * E-mail:
| | - Marco Monti
- IBM Italia, Milan, Italy
- Università Vita e Salute San Raffaele, Milan, Italy
- Department for Adaptive Behaviour and Cognition, Max Planck Institute for Human Development, Berlin, Germany
| | - Paola Iannello
- Department of Psychology, Università Cattolica del S. Cuore, Milan, Italy
| | - Gabriella Pravettoni
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Psycho-Oncology Unit, Istituto Europeo Oncologico (IEO), Milan, Italy
| | - Peter J. Schulz
- Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland
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Gopichandran V, Chetlapalli SK. Factors influencing trust in doctors: a community segmentation strategy for quality improvement in healthcare. BMJ Open 2013; 3:e004115. [PMID: 24302512 PMCID: PMC3855707 DOI: 10.1136/bmjopen-2013-004115] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Trust is a forward-looking covenant between the patient and the doctor where the patient optimistically accepts his/her vulnerability. Trust is known to improve the clinical outcomes. OBJECTIVES To explore the factors that determine patients' trust in doctors and to segment the community based on factors which drive their trust. SETTING Resource-poor urban and rural settings in Tamil Nadu, a state in southern India. PARTICIPANTS A questionnaire was administered to a sample of 625 adult community-dwelling respondents from four districts of Tamil Nadu, India, chosen by multistage sampling strategy. OUTCOME MEASURES The outcomes were to understand the main domains of factors influencing trust in doctors and to segment the community based on which of these domains predominantly influenced their trust. RESULTS Factor analysis revealed five main categories, namely, comfort with the doctor, doctor with personal involvement with the patient, behaviourally competent doctor, doctor with a simple appearance and culturally competent doctor, which explained 49.3% of the total variance. Using k-means cluster analysis the respondents were segmented into four groups, namely, those who have 'comfort-based trust', 'emotionally assessed trust', who were predominantly older and belonging to lower socioeconomic status, those who had 'personal trust', who were younger people from higher socioeconomic strata of the community and the group who had 'objectively assessed trust', who were younger women. CONCLUSIONS Trust in doctors seems to be influenced by the doctor's behaviuor, perceived comfort levels, personal involvement with the patient, and to a lesser extent by cultural competence and doctor's physical appearance. On the basis of these dimensions, the community can be segmented into distinct groups, and trust building can happen in a strategic manner which may lead to improvement in perceived quality of care.
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