Public Trust In Health Care Research Articles

The influence of waiting times and sociopolitical variables on public trust in healthcare: A cross-sectional study of the NHS in England

ObjectivesThis study aims to assess factors influencing public trust in the National Health Service (NHS) in England, focusing on the impact of waiting times in Accident & Emergency (A&E) departments and for GP-to-specialist cancer referrals. Study designA cross-sectional survey-based research design was employed, covering the period from July 2022 to July 2023. MethodsData were collected through YouGov surveys, yielding 7415 responses. Our analysis is based on 6952 of these responses which we were able to aggregate to 42 NHS Integrated Care Boards (ICBs) for A&E waiting times and 106 ICB sub-units for cancer referral times. Multiple regression analysis was conducted, with the dependent variable being trust in the NHS. ResultsWaiting times for A&E and cancer referrals did not significantly affect trust in the NHS. However, other sociopolitical factors displayed significant influence. Specifically, being a member of an ethnic minority group, or having voted Conservative in the 2019 general election were associated with lower trust scores. Other variables such as age and local unemployment rate were also significant predictors. ConclusionsOur findings suggest that waiting times for healthcare services have no effect on public trust in the NHS. Instead, trust appears to be largely shaped by sociopolitical factors. Policymakers should therefore look beyond operational efficiency when seeking to bolster trust in the healthcare system.

Evidence-based interventions to reduce maternal malnutrition in low and middle-income countries: a systematic review.

Despite remarkable strides in global efforts to reduce maternal mortality, low-and middle-income countries (LMICs) continue to grapple with a disproportionate burden of maternal mortality, with malnutrition emerging as a significant contributing factor to this enduring challenge. Shockingly, malnourished women face a mortality risk that is twice as high as their well-nourished counterparts, and a staggering 95% of maternal deaths in 2020 occurred within LMICs. The critical importance of addressing maternal malnutrition in resource-constrained settings cannot be overstated, as compelling research studies have demonstrated that such efforts could potentially save thousands of lives. However, the landscape is marred by a scarcity of evidence-based interventions (EBIs) specifically tailored for pregnant individuals aimed at combatting maternal malnutrition and reducing mortality rates. It is against this backdrop that our study endeavors to dissect the feasibility, adoption, sustainability, and cost-effectiveness of EBIs designed to combat maternal malnutrition. Our comprehensive search encompassed eight prominent databases covering the period from 2003 to 2022 in LMICs. We began our study with a comprehensive search across multiple databases, yielding a total of 149 studies. From this initial pool, we eliminated duplicate entries and the remaining studies underwent a thorough screening process resulting in the identification of 63 full-text articles that aligned with our predefined inclusion criteria. The meticulous full-text review left us with a core selection of six articles that shed light on interventions primarily centered around supplementation. They underscored a critical issue -the limited understanding of effective implementation in these countries, primarily attributed to inadequate monitoring and evaluation of interventions and insufficient training of healthcare professionals. Moreover, our findings emphasize the pivotal role of contextual factors, such as cultural nuances, public trust in healthcare, the prevalence of misinformation, and concerns regarding potential adverse effects of interventions, which profoundly influence the successful implementation of these programs. While the EBIs have shown promise in reducing maternal malnutrition, their true potential for feasibility, adoption, cost-effectiveness, and sustainability hinges on their integration into comprehensive programs addressing broader issues like food insecurity and the prevention of both communicable and non-communicable diseases.

Experts Offer Advice to Fight Harassment Toward Gender-Affirming Clinics

Back to table of contents Previous article ProfessionalFull AccessExperts Offer Advice to Fight Harassment Toward Gender-Affirming ClinicsKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:22 Mar 2023https://doi.org/10.1176/appi.pn.2023.05.5.25AbstractProfessionals and their institutions can implement several strategies before and after potential acts of online extremism to ensure their patients and staff are safe and experience as few disruptions in care as possible.istock/Cunaplus_M.FabaClinics and clinicians who provide gender-affirming care to youth have received an onslaught of threats and harassment in recent months, as treatment of transgender youth continues to be a hotly debated topic on social media and more states introduce bills that restrict gender-affirming care. In a JAMA Pediatrics viewpoint published last month, three clinicians whose institutions were the subject of harassment campaigns offered advice to support patients and clinicians in response to acts of online extremism, while always optimizing safety.In August 2022, social media posts falsely claimed that clinicians at Boston Children’s Hospital performed hysterectomies on minors. A month later, another social media attack claimed that gender-affirming care clinicians at Vanderbilt Children’s Hospital were chemically castrating minors, among other claims. Clinicians at both institutions faced threats, harassment, bomb threats, and hate speech.“Online extremism and the purposeful spread of misinformation for political gain undermine public trust in health care,” wrote Rishub Das, B.A., a third-year medical student at Vanderbilt University School of Medicine; Oren Ganor, M.D., M.Sc., co-director of the Center for Gender Surgery at Boston’s Children Hospital; and Brian Drolet, M.D., chief of the Division of Hand and Upper Extremity Surgery at Vanderbilt University Medical Center. “[T]he ways clinicians respond to harassment and hate speech regarding the care they provide have critical impacts on health outcomes, access to care, and patient and physician safety.”In the viewpoint, Das, Ganor, and Drolet pointed out that the polarization of health care issues, like abortion and gender-affirming care, severely limit access to health care. Yet it is essential that patients are still able to access the care they need. “We have to remember our role in society, why we became doctors, and the humanity involved in medicine,” Das told Psychiatric News. “We’re taking care of human beings who are being very vulnerable in expressing their identities to us. Sometimes they haven’t even expressed those identities to their families yet.”Das, Ganor, and Drolet described both reactive and proactive strategies that clinicians who provide gender-affirming care and their institutions can take to fight misinformation and protect both staff and patients.Reactive strategies they outlined include the following:Make a timely institutional response to misinformation-based threats. “Issuing a clear, official statement that corrects misinformation and directs people to credible sources and evidence within the first hours of a crisis has been shown to elicit greater trust from the public,” the authors wrote.Create clear channels through which clinicians and other staff can request the deletion of sensitive information (such as email addresses) from department websites to minimize harassment.Connect health care workers who receive online threats to law enforcement for guidance on protecting themselves and their families.Conduct patient appointments via telehealth if clinical spaces are at risk.“It’s really important to make sure that information patients need isn’t removed from the websites,” Das told Psychiatric News. “There’s this mentality that we need to block all the websites so these people on social media won’t find our information. But when these attacks happen, patients need us the most. Making sure that patients continue to have access to resources should remain a priority.”Das, Ganor, and Drolet also described numerous proactive strategies in the viewpoint article, including the following:Gender-affirming care clinicians should feel empowered to correct misinformation and provide expert medical advice to their peers and other individuals. Further, hospitals should protect these clinicians with internal and public statements of support.Systems should be implemented through which health care workers can report and document harassment.Professional organizations should continue to address misinformation through evidence-based recommendations and statements, particularly because these organizations can speak on behalf of health care professionals and limit identification of individual clinicians.Media relations teams should be prepared to aggregate and distribute reports of online harassment to law enforcement and report individual posts and users.Das pointed out that there is already a dearth of professionals who provide care to transgender and gender diverse patients.“The scare tactics these groups are using will further discourage clinicians from providing any kind of care to these patients,” he said. “We have to remember that respecting these patients and providing the care that is medically indicated is our duty as physicians.” ■Resources“Addressing Online Extremism—Lessons From Current Threats to Gender-Affirming Care” ISSUES NewArchived

How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links.

Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.

Обзор исследований доверия к системе здравоохранения

Purpose. Many aspects of the health care system effective functioning depend on the level of trust in it. The purpose of this work is to study and summarize the research of native and foreign scientists on the topic of trust in the health care system in order to identify the context and methodological approaches to the study of trust. Materials and methods. The author used in the review the method of systematic review of publications based on strict criteria for selecting publications of individual homogeneous original studies. The search was carried out in the bibliographic databases PubMed, Google Scholar. The author included in the review articles that mentioned trust in the health system as part of their research objectives or questions. No reports published in peer-reviewed literature were analyzed. Results and discussion. There are three positions to consider trust from: trust in the personality of a medical worker (interpersonal); institutional trust in medical organizations; trust in the health care system as a whole (systemic). Several studies have looked at trust in the context of public trust in health care. Within the health care system, there are processes of transfer of trust from an individual to an institution and back. Institutional trust has a significant impact on the formation of interpersonal trust. No causal relationship has been established about the impact of trust on treatment outcomes, and patient distrust of healthcare providers can have detrimental health consequences. The degree of trust in the health care system is different in various categories of citizens. Conclusion. The review revealed that there is no sufficiently accurate, theoretically substantiated and empirically verified definition of trust; trust studies are scattered and built around different definitions. The terms are used interchangeably between studies with the same focus and are not clearly defined and distinct. A variety of tools used to measure trust, the use of different concepts, a significant variation in the choice of the subject and object of empirical research, different methodological foundations of research make it difficult to compare and generalize research data, therefore, for further understanding, study, assessment and conduct of empirical research, a theoretical basis of trust is needed.

International variations in trust in health care systems.

Public trust in health care systems has been measured in many countries, but there have been few studies of the intercountry variability in trust, or the degree to which such variability is because of population or structural characteristics. We used data from the health care survey conducted by the International Social Survey Program from 2011 to 2013 in 31 countries to assess whether intercountry variability was significantly greater than intracountry variability using general linear models in which country was treated as a fixed factor. We also assessed the extent to which intercountry variability was because of respondent and economic circumstances (gross national income per capita). Public trust in the health care system varied significantly across countries (P<.001), even after adjustment for 8 within-country predictors and gross national income per capita. One of the strongest predictors of trust was the respondents' most recent health care experience. Higher respondent education, urban residence, and a lower country's gross national income predicted less trust in the health care system. After countries with the 10% highest health expenditures per capita (United States) and the 10% lowest health care expenditures per capita (China and the Philippines) were removed, public trust in the health care system was positively associated with the remaining countries' health care expenditures per capita (Pearson correlation coefficient, 0.490; P=.008) and gross national income per capita (Pearson correlation coefficient, 0.495; P=.007). There is significant variation in public trust in health care across the countries studied. The intercountry differences are due, in part to economic circumstances.

Society for Academic Emergency Medicine Statement on Plagiarism.

The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine (SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications.

The influence of a local, media covered hospital incident on public trust in health care

Incidents in health care happen every now and then. Incidents are often extensively covered by the news media. In this study, we investigated the impact of an incident in a Dutch hospital on public trust in health care in the population living in the vicinity of where the incident took place and in the national population. News media coverage of the incident started in Fall 2008. We collected data in three samples, using a postal questionnaire on public trust in health care. Two samples were a cross-section of the Dutch population; one was questioned in October 2006 and the other in October 2008. The third sample, also questioned in October 2008, consisted of 1000 people living in the surrounding area of the hospital where the incident occurred. The cross-sectional sample of October 2006 was a reference group, and at that time no incidents in health care were covered in the media. In the local population, the incident had a strong impact on public trust in the hospital and among the specialists working there. Also, in the local population, the impact of the incident was generalized to trust in hospitals and specialists in general. In the national population, no impact of the incident on the public's trust was found, despite national news media coverage. Local incidents have an impact on public trust in health care in the local population. However, these incidents do not influence public trust in health care in the national population.

Trust relations in health care: developing a theoretical framework for the “new” NHS

This paper seeks to address how and why trust relations in the NHS may be changing and presents a theoretical framework for exploring them in future empirical research. This paper provides a conceptual analysis. It proposes that public and patient trust in health care in the U.K. appears to be shaped by a variety of factors. From a macro perspective, any changes in levels of public trust in health care institutions appear to derive partly from top-down policy initiatives that have altered the way in which health services are organised and partly from broader social and cultural processes. A variety of policy initiatives, including the introduction of clinical governance and the resulting use of performance management to scrutinise and change clinical activity, increasing patient choice and involvement in decision-making regarding their care, are examined for how they have changed the context for trust relations within the NHS. It is argued that these policy initiatives have produced a new context for trust relations within the NHS, shifting the inter-dependence and distribution of power between patients, clinicians, and mangers and changing their vulnerability to each other and to health care institutions. The paper presents a theoretical framework based on current policy discourses which illustrates how new forms of trust relations may be emerging in this new context of health care delivery, reflecting a change in motivations for trust from affect based to cognition based trust as patients, clinicians and managers become more active partners in trust relations. The framework suggests that trust relations in all three types of relationship in the "new" modernised NHS might, in general, be particularly characterised by an emphasis on communication, providing information and the use of "evidence" to support decisions in a reciprocal, negotiated alliance. The paper examines the drivers for change in trust in health care relations in the U.K. and develops a theoretical framework for the emergence of new trust relations that can be subsequently explored through empirical research.

Public trust in health care: a performance indicator?

If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight-year period, from 1997 to 2004. The study expected to find a decrease in public trust, with a low point in 2002. Since 1997, public trust in health care was measured through postal questionnaires to the "health care consumer panel". This panel consists of approximately 1500 households and forms a representative sample of the Dutch population. Trust in health care and trust in hospitals did not show any significant trend. Trust in medical specialists displayed an upward trend. Trust in future health care, trust in five out of six dimensions of health care and trust in general practitioners actually did show a decrease. However, only for trust in macro level policies and trust in professional expertise this trend continued. For the remaining trust objects, after 1999 or 2000, an upward trend set in. No support was found for our overall assumption. Explanations for the fact that trust did increase after 1999 or 2000 are difficult to find. On the basis of these findings the study questions whether the measure of public trust is sensitive enough to provide information on the performance of the health care system. The aim of this research is to study public trust in health care on its abilities to be used as a performance indicator for health care systems.

Public trust in health care: A comparison of Germany, The Netherlands, and England and Wales

This article describes public trust in health care in three European countries. Public trust is a generalised attitude, influenced by people's experiences in contacts with representatives of institutions, in its turn influencing how people enter these contacts. In general, people in Germany have less trust in health care, while people in England and Wales have the highest trust levels. Cultural differences between the three countries could be an important source of differences. That makes public trust a less straightforward candidate for use as indicator of the future oriented dimension of user views in an international, comparative performance framework.

How acceptable are innovative health-care technologies? A survey of public beliefs and attitudes in England and Wales

There has been a continuing debate about the extent to which the public finds health-care technological innovation acceptable. The public's ambivalence about scientific medicine may have been exacerbated, more recently, by developments such as the introduction of the ‘new genetics’ with their associated ethical and social implications and the claims that public trust in health care and practitioners and, more widely, in society has been eroded. The aim of this paper is to examine public attitudes to a range of innovative health-care technologies to see whether (i) certain technologies are perceived as particularly problematic, and (ii) attitudes to new health-care technologies are associated more broadly with beliefs about science, trust in health care and social trust, and perceptions of the benefits and risks of complementary and alternative medicine versus orthodox (technological) medicine. These questions are examined through a statistical analysis of data collected in a national, postal survey of the adult population ( n=1187) in England and Wales. The results showed public ambivalence about new health-care technologies, although genetic technologies, as a whole, were not seen to be problematic and their acceptability depended on their ability to control serious diseases. However, there was a level of consistency in attitude across the different technologies. Those consistently against new health-care technologies were also more likely to be suspicious of science, and doubtful about the benefits of other established, orthodox technologies (screening; medications) and to have less trust in health and health-care practitioners.

Public trust in health care: the system or the doctor?

<b>Objectives:</b> To examine how the public assess trust in health care in England and Wales. <b>Design:</b> Postal structured questionnaire in cross sectional survey. <b>Setting:</b> Random sample of people on the electoral register in England and Wales. <b>Subjects:</b> People aged 18 and over. <b>Main outcome measures:</b> General levels of trust and confidence in health care. <b>Results:</b> The response rate was 48% (n = 1187). The mean level of confidence (trust) in the healthcare system was 6.0 out of a score of 10. Levels of distrust appeared relatively high with at least 356 (30%) respondents reporting little or very little trust for 28 of 32 specific aspects of health care. The highest levels of distrust were found in relation to how the health service was run and financed, particularly waiting times and the implication of cost cutting for patients. Statistical analysis by univariable linear regression of the specific determinants of generic assessments of public trust (confidence) suggested that the key aspects were patient centred care and levels of professional expertise. Being covered by private health insurance was also a key determinant of levels of public trust. <b>Conclusion:</b> Public assessment of trust tends to address the views of care at the micro level. Policy makers concerned with the erosion of public trust need to target aspects associated with patient centred care and professional expertise.

Let it be sexual: how health care transmission of AIDS in Africa was ignored.

The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988. We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures.

Public trust in Dutch health care

This article describes the development of a valid and reliable instrument to measure different dimensions of public trust in health care in the Netherlands. This instrument is needed because the concept was not well developed, or operationalized in earlier research. The new instrument will be used in a research project to monitor trust and to predict behaviour of people such as consulting “alternative practitioners”. The idea for the research was suggested by economic research into public trust. In the study, a phased design was used to overcome the operationalization problem. In the first phase, a qualitative study was conducted; and, in the second, a quantitative study. In the first phase, more than 100 people were interviewed to gain insight into the issues they associated with trust. Eight categories of issues that were derived from the interviews were assumed to be possible dimensions of trust. On the basis of these eight categories and the interviews, a questionnaire was developed that was used in the second phase. In this phase, the questionnaire was sent to 1500 members of a consumer panel; the response was 70 percent. The analysis reveals that six of the eight possible dimensions appear in factor analysis. These dimensions are trust in: the patient-focus of health care providers; macro policies level will have no consequences for patients; expertise of health care providers; quality of care; information supply and communication by care providers and the quality of cooperation. The reliability of most scales is higher than 0.8. The validity of the dimensions is assessed by determining the correlation between the scales on the one hand, and people's experience and a general mark they would assign on the other. We conclude that public trust is a multi-dimensional concept, including not only issues that relate to the patient-doctor relationship, but also issues that relate to health care institutions. The instrument appears to be reliable and valid.

Restoring public trust in healthcare

Restoring public trust in healthcare