Distrust Of Doctors Research Articles

Comparative Analysis of Self-Medication Practices with Antibiotics Among Non-Medical and Medical College Students in India

Background: Self-medication is prevalent globally, making the processes easier but raising potential hazards like antibiotic resistance. College students, influenced by social media, exhibit alarming self-medication behaviours. This cross-sectional study surveyed undergraduate students across medical, nursing, and non-health science institutions to assess the self-medication habits, knowledge and attitude of students. Methods: This descriptive cross-sectional study was conducted across various educational institutions from August 2023 to February 2024, targeting undergraduate students aged 18 and over. Using a pre-validated questionnaire, data on socio-demography, self-medication with antibiotics, and related knowledge were collected via Google Forms. The sample size was doubled to 1175 for better statistical power. Data analysis was performed using standard statistical tools. Results: Analysis of data demonstrated that a substantive proportion of students self-medicate with antibiotics. For medical students, convenience was the biggest issue and for non-medical students, it was cost-saving coupled with distrust in doctors. The most common complaint received for self-medication was throat pain. Medical students used textbooks for necessary information whereas non-medical students went to local shops for advice. Patterns differed somewhat in comparison with international studies, indicating regional differences. Strikingly, medical students predominantly relied on academic knowledge and previous experiences while using antibiotics, whereas non-medical students often obtained antibiotics from shops or the internet, making them vulnerable to misdiagnosis and inappropriate treatment. Conclusion: This highlights the importance of implementing specific interventions to reduce unsafe self-medication practices in students.

How Masculinity Impedes African American Men From Seeking Mental Health Treatment.

This study addresses the pronounced mental health disparities faced by African American men, characterized by the heightened severity of mental health conditions and their reluctance to seek mental health treatment. Persistent neglect toward the mental health of African American men perpetuates systemic inequities and heightens the stigma surrounding mental well-being within their communities. This study investigates the interaction of masculinity, distrust in doctors, and parental support on attitudes influencing African American men's reluctance to seek mental health care. A survey administered to 74 African American men revealed a negative correlation between masculinity and attitudes toward seeking mental health treatment. In contrast, no significant correlations were found between distrust in doctors and parental support on attitudes toward seeking mental health treatment. These findings were analyzed using Pearson's correlation, underscoring the urgent need to address masculine norms in mental health discourse among African American men. Implications of the findings and future directions for masculinity in African American men are discussed.

Pain and other complications of pelvic mesh: a systematic review of qualitative studies and thematic synthesis of women’s accounts

ObjectivesSynthesis of the experience of women with pain from pelvic or vaginal mesh or its removal, to identify pain-related problems and to formulate psychological aspects of pain.DesignSystematic review and thematic...

104 Perceived Barriers to the Recruitment and Retention of Underrepresented Racial and Ethnic Groups (URGs) in Clinical Research

OBJECTIVES/GOALS: The inclusion of underrepresented racial and ethnic groups (URGs) in clinical research is critical for ethical and scientific reasons. This initiative aimed to assess the perspectives, barriers, needs, and recommendations encountered by research teams when enrolling and retaining URGs in clinical research. METHODS/STUDY POPULATION: An anonymous, web-based survey comprised of quantitative and qualitative questions was administered to individuals involved in clinical research at an academic medical center. The survey assessed three main domains: 1. Research teams' perceptions and experiences with enrolling URGs in clinical research, 2. Factors that discourage URGs from participating in clinical research, and 3. Research teams’ overall willingness to support URG enrollment. Demographics were also collected. The survey was reviewed by experts in clinical research, research ethics, and diversity, equity, inclusion, and accessibility (DEIA). The assessment was piloted among research professionals and edits were made accordingly prior to official dissemination. Data were analyzed using descriptive statistics. RESULTS/ANTICIPATED RESULTS: There was a total of 63 responses. A majority of respondents have more success enrolling patients whose primary language is the same as their own and that time arranging for an interpreter has negatively impacted enrollment efforts. Approximately half of the respondents believe that the race and/or ethnicity of the potential study participant influences enrollment success. Factors discouraging URGs from participating in clinical research include unavailability for follow-up visits due to transportation issues, distrust in doctors and/or researchers, fear of unknown side effects, and unavailability of medical interpreters. Respondents report that they are not discouraged from enrolling URGs and would utilize resources related to encouraging the inclusion of URGs DISCUSSION/SIGNIFICANCE: Language appears more influential than ethnicity or race when it comes to enrolling and retaining URGs. Additionally, it appears that enrolling is a bigger challenge than retaining. Major themes that emerge with respect to retaining enrolled participants include the inability to attend follow-up visits and the lack of incentives/compensation.

Chinese healthcare system: Genesis, reforms and response to the COVID-19 pandemic

The public health system is an important institutional mechanism for reducing society’s medical burden, improving people’s well-being, and, consequently, maintaining harmony and stability in society. This article is devoted to analysis of the development of the health care system of the People’s Republic of China. In particular, the article discusses the main problems of the last four decades of the PRC health system (since 1978 when reforms and opening-up were launched in China); current reforms in this area; as well as the impact of the COVID-19 pandemic on the PRC health system. The COVID-19 pandemic has revealed serious problems in the Chinese healthcare system: lack of resources (medical personnel, healthcare facilities, beds, modern medical equipment), modest investments by the state, exorbitantly high prices for healthcare services and medicines, distrust of doctors by the population, etc. At the same time, in 2020-2021, China has shown an example of a successful fight against the dangerous virus. The Chinese strategy is based on a policy of “zero tolerance” for COVID-19. This means limiting the spread of the virus through lockdowns, providing mass testing, as well as the conversion of public spaces into COVID hospitals, and the use of high technology in health care (Big Data, mobile health, etc.) were found to be decisive measures. Due to those actions, People’s Republic of China was able to recover from virus fairly quickly and show comparatively good economic results in 2020 and 2021. The outbreak of the new strain of coronavirus occurred in China in mid-2022 and a strict lockdown was introduced in some cities and provinces. The article analyzes the reasons of criticism of the “zero tolerance” policy by the World Health Organization under such circumstances.

Formation of Public Opinion on Organ Donation in Ukraine

The main purpose of the research is to analyze public opinion on organ donation in Ukraine among the population aged 18-44. Systematization of literary sources and approaches to the issue of organ donation indicates that there is a shortage of organ donors in Ukraine. The relevance of the decision on this scientific problem is that public awareness campaigns need to develop the transplant system in Ukraine. The research methods are used: questionnaire, statistical analysis, analysis of the legal framework, and comparison. The research object is the population aged 18-44 living in the Sumy region. The paper presents the results of a study on respondents’ level of awareness and attitude toward organ donation. An online survey of young people aged 18-44 living in the Sumy region was conducted on 4-11 February 2021 to obtain opinions on organ donation. A sample is 196 people. The idea of developing organ donation in Ukraine was supported by 79.1% of respondents. Moreover, 19% of respondents have not yet decided on their attitude. Only 20.9% of respondents believe that Ukraine has highly qualified doctors and appropriate equipment, and other answers indicate a low level of trust in medicine. Most of the negative information about donations comes from television and social networks. 44.2% of respondents are not yet ready to fill in the consent for the donation of certain bodies, 48.8% – gave a positive answer, and 7% will not fill in the consent at all. In general, young people living in Sumy believe that the transplant system should be implemented in Ukraine because it is an important component of saving people, and they want to save other people’s lives. However, distrust in doctors’ qualifications and the impact of negative information on television and social networks are not yet ready to complete a donation agreement. The research empirically confirms and theoretically proves that a group of people has not defined their attitude to organ donation. It is expedient to direct awareness campaigns to them to promote organ donation in Ukraine. The research results can be helpful for organizations that promote organ donation in Ukraine.

Forming Trust in the Medical System Through Marketing Activities of Medical Institutions of Certain Territories

The peculiarity of social development in modern life is the development of the role of knowledge and information in society, in the intensive promotion of information technology, and in the formation of new qualitative forms of information interaction between people. Systematization literary sources and approaches for solving the problem indicates that social relations between doctor and patient are built on the basis of practical mutual trust. The better the communication between them, the better the result. This has a positive effect on the patient’s satisfaction with the quality of medical care provided and, in turn, increases the reputation and loyalty to the medical institution. The object of the study is the reasons for patients’ distrust of doctors of government agencies and the medical system of Ukraine as a whole. The subject is informational and marketing activities in public medical institutions in order to increase the level of trust. The target audience is patients and managers of public medical institutions. The purpose is to provide recommendations to the management of medical institutions on information activities to build trust in the medical system. To achieve the goals used these research methods: comparative, analytical, statistical, questionnaire method. The information base of the study is the analysis of the results of research, analysis of the regulatory framework, analysis of scientific literature, materials of scientific and practical conferences, statistical reference books and Internet resources. The information base of the field quantitative research is a questionnaire survey of the population on social networks and public hospitals. In February 2021, a representative survey was conducted on the attitude of people to public medical institutions among the population of Sumy region. 203 respondents took part in this survey: 117 (58%) women and 86 (42%) men. People answered questions about the assessment of trust and the state of the medical system, the reasons for choosing a public or private institution, the criteria that are considered when choosing a family doctor and the patient’s communication channels with the doctor. Analyzing the regulatory framework for informatization in the field of medicine in Ukraine, it was found that the current problem is the poor system of organization and provision of information. According to the survey, 68.5% of the population do not trust the medical system of Ukraine and assess the state of medicine as satisfactory. But the level of trust as a whole is improving. Unfortunately, little attention is paid to information and communication policy in Ukraine. Employees of medical institutions are not interested in developing and keeping up with innovations. Only 37% of respondents use alternative methods of communication with a doctor (internet, telephone). Most respondents said that communication between doctors and patients needed to be improved. Guidelines have been developed for healthcare professionals to improve communication as based on marketing with patients and increase the information literacy of professionals. The results of the study may be useful for the management of health facilities in certain territories, for family physicians who communicate directly with patients and for other institutions and their representatives involved in the health system and are responsible for information and communication component of interaction with consumers.

Barriers to Low-Dose CT Lung Cancer Screening among Middle-Aged Chinese.

Purpose: The current study aims to explore the barriers for middle-aged Chinese to learn about and uptake low-dose computed tomography (LDCT) lung cancer screening. Methods: Data were collected via an online survey in December 2019. Final valid sample included 640 respondents, aged 40–60 years old, from 21 provinces of China. We performed multiple linear regressions to test the potential barriers to LDCT scan. Findings: Cost concerns, distrust in doctors, fears of disease, lack of knowledge, and optimistic bias are negatively associated with the intention to learn about and uptake LDCT scan. Implications: Our study contributes to understanding the negative predictors of middle-aged Chinese to get LDCT lung cancer scans. Future campaign programs should help audiences to build comprehensive understandings about lung cancer and LDCT scan. To better promote LDCT scan in China, the government should fund more trial programs continuously and public efforts should be made to rebuild the patient–doctor trust.

Medicines Advertising: Legal Practice

The article explores legal practice in the field of advertising medicines. Medicines advertising is recognized as one of the mosteffective mechanisms of medicines promotion. Factors affecting the spread of medicines advertising: the public’s attitude to advertisingas a reliable source of information about medicines, distrust of doctors and the healthcare system, and, as a consequence, the prevalenceof self-medication practices. In order to protect the interests of consumers and protect economic competition (often second prevailing),the state ensures compliance with the requirements of the legislation in the field of medicines advertising. What is important is hownational courts hear cases regarding medicines advertising.Advertising is information about a person or product, disseminated in any form and by any means and intended to generate ormaintain awareness of the consumer of the advertising and their interest in such person or product. Advertising of medicinal products,like any other advertising, must comply with: the general principles of advertising; general advertising requirements (apply to all products,regardless of their type); special advertising requirements. Specific requirements for medicines advertising are: (a) specificrequirements for the permitted and prohibited medicines advertising; (b) requirements for the content of advertising of medicines (consistingof the requirements that medicines advertising should and should not contain); (c) particularities for advertising for certain ca -tegories of persons.The mandatory content requirements for medicines advertising are almost 100% specific and evaluable, while prohibitions andrestrictions often make it impossible to assess whether this effect is present in the advertising message or how it may affect a particularconsumer. Accordingly, depending on which requirements for advertising have been violated, the public authority can assess whetherthe prohibitions and restrictions have actually been violated and consider bringing those responsible for violating advertising legislationto liability. Further, if the advertisers, producers or distributors of the advertisement do not agree with the decision of the relevant publicauthorities, they can appeal to court. Most often, the plaintiff will be the advertiser, who are the field of advertising of medicines arepharmaceutical companies, drugstores. The respondent – the relevant authority. This is how the jurisprudence in the field of medicinesadvertising is formed.Almost every case about medicines advertising is about false advertising in a form of «spreading misleading information». Caseshave been considered as to the actual dissemination of misleading information and the violation of certain special requirements for themedicines advertising. In particular, cases concerning: medicines «popularization»; «exaggeration» of medicines effect; giving theproducts features of medicines; on the use of physicians’ images in medicines advertising; medicine prices.Not all cases of «spreading misleading information» about medicines go to court. The legal practice in the field of medicinesadvertising is characterized by a certain ambiguity and depends largely on the evidence presented by the parties’ representatives. Thedecisions of the courts are based on the consideration of the circumstances of each case.

Alzheimer Disease and Related Dementia Resources: Perspectives of African American and Caucasian Family Caregivers in Northwest Louisiana.

We examined knowledge of Alzheimer's disease and related dementias (ADRD), resources, and research opportunities among older African American (AA) and Caucasian caregivers. A mixed methods design integrated qualitative (focus group) and quantitative (survey) data from Northwest Louisiana. Eight focus groups (59 adults, 92% female, 78% AA, 25% rural) revealed limited knowledge. Quantitative findings from 117 ADRD caregivers (83% female, 72% AA, 30% limited heath literacy, 27% low income) indicated participants obtained information from providers (54%), friends and relatives (32%), and the internet (37%). Barriers to care were cost (24%) and lack of family agreement (17%). Few families used adult daycare (8%) or support groups (28%). Concerns about research participation were violation of privacy (30%) and fear of patient distress (27%). Distrust of doctors was minimal (3%). Findings did not vary by race. There is a need for clear, literacy-appropriate information about ADRD, caregiver resources, and clinical trials.

Collectivization and public health system formation in rural Russia

Collectivization in the USSR, without any doubt, became one of the most difficult and tragic pages in the history of our country. Not denying the devastating results of the socialization of agriculture in the 1930s, some positive consequences, nevertheless, should be noted, especially in the public health service. In this paper the authors analyze changes in the public health service for rural residents from the late 19thcentury to the end of the 1930s. They use various types of historical sources, such as statistical data, studies of Zemstvo leaders, government officials and memoirs of contemporaries. The state policy in the public health, the availability of medical care and the provision of medical personnel, the attitude of the population towards doctors and official medicine and the sanitary and hygienic living conditions of the rural residents are examined in detail. It is concluded that the depressing situation in the public health service for the rural population in pre-revolutionary Russia, aggravated by ignorance, numerous superstitions and distrust of doctors, changed dramatically only after the establishment of the Soviet government. In the process of collectivization in rural areas, an extensive network of hospitals, medical sites, maternity hospitals and pharmacies appeared. As a result, in spite of numerous problems in rural public health, it can be argued that it was in the 1930s that general medical care became an integral part of rural life.

A market of distrust: toward a cultural sociology of unofficial exchanges between patients and doctors in China

This article examines how distrust drives exchange. We propose a theoretical framework integrating the literature of trust into cultural sociology and use a case of patients giving hongbao (red envelopes containing money) to doctors in China to examine how distrust drives different forms of unofficial exchange. Based on more than two years’ ethnography, we found that hongbao exchanges between Chinese patients and doctors were, ironically, bred by the public’s generalized distrust in doctors’ moral ethics. In the absence of institutional assurance, Chinese patients drew on the cultural logic of particularism and its associated cultural repertoire to induce fidelity from their physicians. They mobilized interpersonal networks to function as assurance and presented hongbao as a return of favor to the doctors. This form of exchange is gifting-oriented. Alternatively, if there were no interpersonal networks to rely on, they proactively offered hongbao to doctors at arm’s length in an attempt to personalize the relationship to seek assurance and abate their anxieties. This form of exchange is bribery-oriented. Both forms of exchange co-existed when there was one-way generalized distrust manifested from patients to doctors. When doctors also developed generalized distrust in patients, arm’s length exchanges declined, leaving embedded exchanges as the dominant form. Our study asserts the central role of culture in constituting exchange behaviors and the importance of institutions in shaping the form of exchange. It contributes to the midrange theory of trust, generating a number of hypotheses for future research on the relationships among culture, institutions, distrust, assurance, and illicit exchange.

Breathless Rictus: Ken Currie’s Krankenhaus

This article reviews Ken Currie’s show Rictus, which ran at the Flowers Gallery on Cork Street in London from 8 November – 9 December 2017. While Currie had many paintings in the show, Krankenhaus is the eerie, unsettling, and powerful zenith of Currie’s work. It contains many of the themes on which Currie continuously ruminates (like the distrust of doctors or the fragility of the human body) but Krankenhaus also curiously focuses on the rhythms and weaknesses of breath and breathing. The painting visually touches on themes of suffocation, rupture, violence and death while also inspiring breathlessness and unease in viewers. This review focuses on Krankenhaus as the linchpin of Currie’s show and an explanation of his thoughts regarding medicine, humanity, and art.

ASSESSMENT OF HEALTH CARE QUALITY BY POPULATION OF ALMATY: A CROSS-SECTIONAL STUDY

A survey of 1 194 respondents aged 45+ living in Almaty (Kazakhstan) to assess satisfaction with the quality of medical care was conducted. Specially trained interviewers visited respondents at home and filled questionnaires, which included questions on socio-demographic characteristics, the characteristics of medical care during the past year, bad habits, self-assessment of health, trust to doctors and the respondent's opinion on quality of health care. Binary logistic regression was used to analyze the data. Adjustment was performed for socio-demographic characteristics of respondents and the peculiarities of medical care. Altogether, 55.7 % (95 % CI 52.9; 58.5) of respondents were not satisfied with the quality of medical care. In multivariable analysis dissatisfaction with the quality of health care was associated with education, income, and self-, but the most influential factor was distrust of doctors (OR = 19, 95 % CI 12; 30). Thus, measures aimed at increasing the trust in doctors, especially the development of personalized medicine, have a potential increase the degree of satisfaction of the population with the quality of medical care. This study can serve as a start point for a panel study to monitor population's satisfaction with the quality of health care.

Cultural Guides, Cultural Critics: Distrust of Doctors and Social Support during Mental Health Treatment.

Research on relationships and health often interprets culture as the passively transmitted "content" of social ties, an approach that overlooks the influence of cultural resources on relationships themselves. I propose that mental health patients seek social support partly based on cultural resources held by their network members, including members' medical knowledge and beliefs. I test hypotheses using data from the Indianapolis Network Mental Health Study, an egocentric network survey of new mental health patients ( N = 152) and their personal relationships ( N = 1,868). Results from random-intercept regressions show that patients obtain support from network members who trust doctors and who have experience with mental problems. In contrast, network members who distrust doctors disproportionately cause problems for patients. I discuss how cultural resources can categorize network members as supportive cultural guides or disruptive cultural critics. Reconsidering how culture shapes relationships clarifies the role of networks during illness management and illustrates their potentially harmful effects.

Alexithymia as a Predictor of Chronic Tension Headaches

Alexithymia as a violation of inter-hemispheric communication which has no visible organic brain changes is now regarded as a predictor of many chronic physical and neurological diseases, but it has not yet been regarded in connection with chronic tension headaches. The authors examined 137 people with tension-type headache (33 men, 84 women) aged 30–50 years (average age 40,75 ± 6,29) in order to clarify a link to alexithymia. The diagnosis of tension headache was conducted according to the International classification of headaches, 3rd edition (beta version). The authors used the original headache diary, Toronto alexithymia scale, Hospital anxiety and depression scale, the measurement of the space under the curve of headache. It was found that the patients with alexithymia have difficulty in describing the place of headaches (the average number of word descriptors at most 1 word), distrust of doctors, abuse of analgesics and tend to use alternative medicine methods. The intensity (p = 0.0001) and the frequency of headaches (p = 0.0028) is significantly higher in patients with alexithymia, and the more common are depression (p = 0.042) and impaired nocturnal sleep (p = 0.001). Patients with chronic tension-type headache associated with sleep disorders, adaptation and symptoms of depression should be considered as alexithymic personalities until the contrary is proved. Physicians should be aware of the fact that alexithymic patients have problems with feelings verbalization, and if patient’s complaints are vague a doctor should use questionnaires, words-descriptors, phrases-descriptors and other auxiliary verbal techniques for accurate diagnosis.

Breach of Confidentiality in Sexually Transmitted Diseases from the Perspective of Consequential and Deontological Philosophical Schools

Background and Aim: Confidentiality is recognized as a fundamental principle in medical ethics, ensuring of which in dealing with patients with sexually transmitted diseases, particularly after the discovery of AIDS, is yet questioned. Absolute keeping of the patient’s secrets may be contrary to the prevention of secondary transmission to sexual partners or to the fetus due to lack of awareness. However, unconditional breach of confidentiality may result in a public distrust in doctors and people’s not referring to them. Confidentiality can, therefore, be regarded as a fundamental principle in ethical excellence which can have some limited exceptions. The present study aimed to evaluate the breach of confidentiality in sexually transmitted diseases from the perspective of consequential and deontological philosophical schools so as to reveal the “moral virtue” in the interested area. Materials and Methods: In the present review study, using such keywords as sexually transmitted diseases, confidentiality, and partner notification – which account for a broad spectrum of medical ethics studies – in PubMed, SID, and Google Scholar databases, the relevant literature were searched and analyzed. Ethical considerations: Ethical principles were observed in searching and citing the literature. Results: Whereas the consequential perspective merely pays attention to the result of the action regardless of its ethical considerations to keep or to breach the patient’s secret, the deontological emphasizes on the observance of ethical principles. Both these schools have however been subject to new perspectives in such a way that we do not seem to observe an absolute confidentiality even in the deontological school anymore. On the other hand, consequential perspectives also do emphasize on observance of the ethical principles, in addition to considering the benefits. It is therefore recommended that in the first step, the doctors lead the patients to tell their partners by telling the truth to the patient. If the patients are not able to tell the issues to their partners, the doctors can help them with the necessary guidance and training. In case some patients are still unable to do it, the doctors, taking the patients’ permission, can do it on their behalf. Since, according to the statutory laws and ethics, doctors have no duty to warn a patients’ sexual partners, if it is more to the benefit of the patients’ sexual partners to “breach the confidentiality” than to “keep the secret”, it is ethically permissible to “breach the confidentiality”. This breach should, however, be just to the extent that is “necessary”, and it should be carried out just to the exigencies of “necessary circumstances”. This at least applies to the identifiable partners of the patients. The criteria of necessity is also identified based on the definite medical traditions. Given that searching for and identifying the sexual partners is not considered as a medical responsibility, if the sexual partners consult a doctor, s/he can share the patients’ secrets with their sexual partners according to the preceding paragraphs. When a patient is not eligible, or when it is of necessity, the doctor ought to notify the patient’s hierarch or parents. Otherwise, what is to the best benefit of the patient should be considered. Conclusion: Being evidently derived from Kant’s deontological philosophy which emphasizes on keeping the secret as an absolute principle, the modern deontological philosophical perspectives- resting on the commonly known axioms- can allow for breaching of confidentiality at least with the sexual partners of the patients with sexually transmitted diseases in order to promote good and not to harm anyone. Moreover, consequential perspectives also lead us to the breach of confidentiality if it is to the best benefit of the people. To encapsulate the perspectives on the normative ethics, it is appropriate to avoid absolute thinking so as neither to allow for absolute confidentiality of the patients with sexually transmitted diseases as the deontological perspectives do nor to consider the mere benefits of the person as the diagnostic criteria for the ethical actions. Rather, by aggregating the perspectives, while respecting the principle of confidentiality, we should take the best benefits of the community board, and on top of whom the patient’s sexual partner, into account based on what common sense discerns as axiomatic. Please cite this article as: Sheykh Talimi M, Omani Samani R. Breach of Confidentiality in Sexually Transmitted Diseases from the Perspective of Consequential and Deontological Philosophical Schools. Med Ethics J 2016; 10(37): 69-79.

Risky encounters with doctors? Medical diversity and health-related strategies of the inhabitants of Bishkek, Kyrgyzstan

ABSTRACTThis paper introduces the notion of ‘risky encounters’, referring to the way in which contacts with doctors are commonly perceived by the inhabitants of Bishkek, the capital city of Kyrgyzstan. The author's research conducted between 2011 and 2013 revealed that most people were extremely critical of biomedical personnel, despite positive assessments of healthcare reforms expressed by experts. Owing to the prevailing distrust of doctors, their interventions are often considered risky to one's health, which strongly influences people's health-related strategies in the context of medical diversity. This perception of risk is deeply embedded in feelings of uncertainty and anxiety, which should be viewed from the more general perspective of the political, economic and social uncertainties resulting from the difficulties of the period of post-Soviet transformation. It is evident that medical diversity in Bishkek provides people in need with many non-biomedical treatment options, and a distrust of doctors significantly contributes to the popularity of complementary medicine. Economic constraints and local concepts of health, illness and efficacy are among the many other factors that play a role in therapeutic choices. However, the current paper focuses on risk, uncertainty and trust, as emotions that are central to an understanding of the health-related strategies and tactics used by the inhabitants of present-day Bishkek.

Why informally employed Chinese women do not go to the doctor.

Informal employment, in which workers have no security of employment and receive few or no health insurance benefits, has risen sharply in urban China in the last decade. The percentage of women in informal employment in China is higher than in the formal employment sector; 'feminization' has thus become a key feature of informal employment in China. A feminized informal labor sector has far-reaching effects on the status of women's health and on women's health-seeking behavior. To better understand this behavior, especially barriers to health seeking, we conducted 34 interviews informally employed women in Guangzhou, China. For comparative purposes, we also interviewed 22 men in the informal labor sector. Findings reveal that compared with men, women have more serious health problems but report seeking medical attention less frequently. Financial constraints, distrust of doctors and medical expenses, unfriendly treatment environments and traditional attitudes about health and illness among women were the main barriers to health seeking. Implications for health promotion are discussed.

Improving our messages about research participation: a community-engaged approach to increasing clinical trial literacy

We are all aware that recruiting individuals for clinical trials (CTs) is not an easy task and it can be even more challenging to recruit within underserved populations. Numerous barriers to participation have been reported including individuals’ limited awareness and knowledge about CTs, misperceptions and fear of research and distrust of doctors and researchers [1–4]. We argue in this report that the way we as researchers and scientists communicate about CTs and research participation in general is also a significant barrier to recruitment, enrollment and participation [5]. There is tremendous potential to improve our messaging about research, which, in turn, can improve the ‘clinical trial literacy’ of those most in need of these studies and whose participation could help advance science. Providers tend to overestimate patients’ health literacy skills and the clarity of their own communication [6]. Results from the 2012 Program for the International Assessment of Adult Competencies, for example, demonstrated that the US average literacy score was 270 or at Level 2 (Level 5 or scores between 376 and 500 demonstrate highest proficiency) [7]. Respondents who self-reported ‘poor’ health often scored at or below Level 1 in literacy (38%), numeracy (52%) and problem solving (81%). Poor health-related literacy is associated with negative health outcomes [8]. Use of jargon-free language (at a ∼Grade 5–6 level) is strongly recommended for all healthrelated content [8,9]. At the national level, the US President signed the Plain Writing Act into law in 2010 requiring federal agencies to use ‘communication that the public can understand and use’ [10]. So why not apply principles of plain language communication to our messages about research participation? In this paper, we present our approach to researching CT communication needs and message strategies. We encourage other teams to consider similar methods to guide their CT messaging.