Measurements of public trust in the health system: mapping the evidence

Abstract

IntroductionPublic trust in the health system is essential to control the Covid-19 pandemic. It can influence the extent to which interventions to combat a pandemic are accepted by citizens. The objective of this review was to map the evidence of measurements of the concept of public trust in the health system with a focus on health system institutions.MethodsWe performed a systematic literature search in the databases Web of Science and Embase in March 2020. Quantitative studies measuring trust on a system level with regard to healthcare were eligible if they addressed the general public and were published in English or German. We excluded studies that measured trust on an interpersonal level, in a single health profession, or a single treatment. We extracted data to map the characteristics of measurements.ResultsOf initially 7137 identified articles, 87 studies were included in the mapping. In 58 (67%) of the studies, trust was the outcome variable. Most studies (69%) measured the level of trust with single items, 27 studies (31%) used scales or indices to measure the concept of trust. Of these, 12 studies measured healthcare system trust, 7 trust in government and political institutions, 4 trust in healthcare organisations, 3 trust in health insurances, and 1 trust in health data management institutions. Most common domains of trust in the healthcare system refer to policies, quality of services, communication and provision of information, relationships with providers and their expertise, and quality of cooperation between providers. Theoretical dimensions of the concept of trust include fidelity, competency, trustworthiness, integrity and global trust.ConclusionsFew quantitative studies examine dimensions of public trust on a health system level. Future country-specific research on the concept of public trust may support the understanding of context-specific determinants for the tailoring of interventions to promote trust in health systems.Key messages Public trust is an important aspect for controlling a pandemic, as it is a precondition for accepting interventions, such as vaccination programmes.Country-specific research may promote the understanding of public trust and the tailoring of interventions to increase health system trust.