Trust In Healthcare System Research Articles

Stress and perceived discrimination among Israeli Arabs: the mediation role of threat and trust

During pandemics, minorities may experience high stress levels, which could harm their health. This study explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to guidelines, and perceived discrimination. The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect=0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (β=-0.52), which, in turn, was negatively associated with stress (β=-0.10). Furthermore, discrimination was positively associated with perceived threat (β = 0.21), which, in turn, was positively associated with stress (β = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. Our findings could assist policymakers in developing fair policies, that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving their mental and physical health.Key messages The results highlight the relationships between discrimination, trust, perceived threat and stress.To reduce minorities’ stress, it is vital to create a credible and fair atmosphere during pandemics.

Post-COVID Public Health Surveillance and Privacy Expectations in the United States: Scenario-Based Interview Study.

BackgroundSmartphone-based apps designed and deployed to mitigate the COVID-19 pandemic may become infrastructure for postpandemic public health surveillance in the United States. Through the lenses of privacy concerns and user expectations of digital pandemic mitigation techniques, we identified possible long-term sociotechnical implications of such an infrastructure.ObjectiveWe explored how people in the United States perceive the possible routinization of pandemic tracking apps for public health surveillance in general. Our interdisciplinary analysis focused on the interplay between privacy concerns, data practices of surveillance capitalism, and trust in health care providers. We conducted this analysis to achieve a richer understanding of the sociotechnical issues raised by the deployment and use of technology for pandemic mitigation.MethodsWe conducted scenario-based, semistructured interviews (n=19) with adults in the United States. The interviews focused on how people perceive the short- and long-term privacy concerns associated with a fictional smart thermometer app deployed to mitigate the “outbreak of a contagious disease.” In order to elicit future-oriented discussions, the scenario indicated that the app would continue functioning “after the disease outbreak has dissipated.” We analyzed interview transcripts using reflexive thematic analysis.ResultsIn the context of pandemic mitigation technology, including app-based tracking, people perceive a core trade-off between public health and personal privacy. People tend to rationalize this trade-off by invoking the concept of “the greater good.” The interplay between the trade-off and rationalization forms the core of sociotechnical issues that pandemic mitigation technologies raise. Participants routinely expected that data collected through apps related to public health would be shared with unknown third parties for the financial gain of the app makers. This expectation suggests a perceived alignment between an app-based infrastructure for public health surveillance and the broader economics of surveillance capitalism. Our results highlight unintended and unexpected sociotechnical impacts of routinizing app-based tracking on postpandemic life, which are rationalized by invoking a nebulous concept of the greater good.ConclusionsWhile technologies such as app-based tracking could be useful for pandemic mitigation and preparedness, the routinization of such apps as a form of public health surveillance may have broader, unintentional sociotechnical implications for individuals and the societies in which they live. Although technology has the potential to increase the efficacy of pandemic mitigation, it exists within a broader network of sociotechnical concerns. Therefore, it is necessary to consider the long-term implications of pandemic mitigation technologies beyond the immediate needs of addressing the COVID-19 pandemic. Potential negative consequences include the erosion of patient trust in health care systems and providers, grounded in concerns about privacy violations and overly broad surveillance.

Sharing Whilst Caring: Solidarity and Public Trust in a Data-Driven Healthcare System

"In the UK, the solidaristic character of the NHS makes it one of the most trusted public institutions. In recent years, the introduction of data-driven technologies in healthcare has opened up the space for collaborations with private digital companies seeking access to patient data. However, these collaborations appear to challenge the public’s trust in the healthcare system. In this paper we explore how the opening of the healthcare sector to private digital companies challenges the existing social contract and the NHS’s solidaristic character, and impacts on public trust. We start by critically discussing different examples of partnerships between the NHS and private companies that collect and use data. We then analyse the relationship between trust and solidarity, and investigate how this relationship changes in the context of digital companies entering the healthcare system. Finally, we show ways for the NHS to maintain public trust by putting in place a solidarity grounded partnership model with companies seeking to access patient data. Such a model would need to serve collective interests through, for example, securing preferential access to goods and services, providing health benefits, and monitoring data access. A solidarity grounded partnership model will help establish a social contract or licence that responds to the public’s expectations and to principles of a solidaristic healthcare system. "

“Because the country, it seems though, has turned their back on me”: Experiences of institutional betrayal among veterans living with Gulf War Illness

People living with medically unexplained symptoms (MUS) often have poor quality of life and health outcomes. Many struggle to engage with and trust in healthcare systems. This qualitative study examined how experiences with institutions influence perceptions of medical care for MUS by applying the theoretical framework of institutional betrayal to narratives of U.S. military Veterans living with Gulf War Illness (GWI). Institutional betrayal refers to situations in which the institutions people depend upon for safety and well-being cause them harm. Experiences of institutional betrayal both during active military service and when first seeking treatment appeared to shape perceptions of healthcare in this sample. Veterans expressed the belief that the military failed to protect them from environmental exposures. Veterans' concerns regarding subsequent quality of healthcare were intrinsically linked to a belief that, despite official documentation to the contrary, the predominant paradigm of both the U.S. Department of Defense and the U.S. Department of Veterans Affairs (VA) is that GWI does not exist. Veterans reported that providers are not adequately trained on treatment of GWI and do not believe Veterans' descriptions of their illness. Veterans reported taking up self-advocacy, doing their own research on their condition, and resigning themselves to decrease engagement with VA healthcare or seek non-VA care. The study's findings suggest institutional level factors have a profound impact on perceptions of care and the patient-provider relationship. Future research and policy aimed at improving healthcare for people living with MUS should consider the concept of institutional betrayal.

Stress and perceived discrimination among the Arab population in Israel: the mediation role of the perceived COVID-19 threat and trust in the healthcare system

ABSTRACT During pandemics, minorities may experience high stress levels, which could harm their mental and physical health. However, to the best of our knowledge, this has not been examined among minorities in Israel during the COVID-19 pandemic. This study, therefore, explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population’s perceived COVID-19 threat, trust in the healthcare system, adherence to preventative guidelines, and perceived discrimination. The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines. Hierarchical regression analysis showed that age, religion, trust in the healthcare system, perceived threat, and adherence to guidelines were all significant predictors of stress [F(11,600), p < .001]. The model explained 24% of the variance in stress. Structural equation modeling (SEM) revealed that the participants’ perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect = 0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (β = −0.52), which, in turn, was negatively associated with stress (β = −0.10). Furthermore, discrimination was positively associated with perceived threat (β = 0.21), which, in turn, was positively associated with stress (β = 0.35). Discrimination is an important social determinant of health – especially during health emergencies when trust in healthcare systems and perceived threats are crucial. As such, our findings could assist policymakers in developing fair policies that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving both their mental and physical health.

Acceptance of the COVID-19 vaccine based on the health belief model: A population-based survey in Hong Kong

BackgroundVaccines for COVID-19 are anticipated to be available by 2021. Vaccine uptake rate is a crucial determinant for herd immunity. We examined factors associated with acceptance of vaccine based on (1). constructs of the Health Belief Model (HBM), (2). trust in the healthcare system, new vaccine platforms and manufacturers, and (3). self-reported health outcomes. MethodsA population-based, random telephone survey was performed during the peak of the third wave of COVID-19 outbreak (27/07/2020 to 27/08/2020) in Hong Kong. All adults aged ≥ 18 years were eligible. The survey included sociodemographic details; self-report health conditions; trust scales; and self-reported health outcomes. Multivariable regression analyses were applied to examine independent associations. The primary outcome is the acceptance of the COVID-19 vaccine. ResultsWe conducted 1200 successful telephone interviews (response rate 55%). The overall vaccine acceptance rate after adjustment for population distribution was 37.2% (95% C.I. 34.5–39.9%). The projected acceptance rates exhibited a “J-shaped” pattern with age, with higher rates among young adults (18–24 years), then increased linearly with age. Multivariable regression analyses revealed that perceived severity, perceived benefits of the vaccine, cues to action, self-reported health outcomes, and trust in healthcare system or vaccine manufacturers were positive correlates of acceptance; whilst perceived access barriers and harm were negative correlates. Remarkably, perceived susceptibility to infection carried no significant association, whereas recommendation from Government (aOR = 10.2, 95% C.I. 6.54 to 15.9, p < 0.001) was as the strongest driving factor for acceptance. Other key obstacles of acceptance included lack of confidence on newer vaccine platforms (43.4%) and manufacturers without track record (52.2%), which are of particular relevance to the current context. ConclusionsGovernmental recommendation is an important driver, whereas perceived susceptibility is not associated with acceptance of COVID-19 vaccine. These HBM constructs and independent predictors inform evidence-based formulation and implementation of vaccination strategies.

The Impact of Covid-19 on Inmate Trust in Health Care and Willingness to Seek Treatment - A Qualitative Investigation

Background and Objective: &#x0D; The coronavirus has disproportionately impacted vulnerable members of society. With the U.S. as the global leader in incarceration and the difficulties prison systems face implementing many of the mitigation strategies employed by the general population, the incarcerated population is in a uniquely vulnerable position particularly within an already strained prison healthcare system. Given the nature of prisons as total institutions, negative experiences with the virus coupled with a lack of autonomy could lead to a loss of trust in the healthcare system which has the potential to impact health-seeking behaviors. In this study, we aim to examine the effect of Covid-19 on Indiana inmates’ trust in healthcare. &#x0D; &#x0D; Project Methods: &#x0D; Data from 380 surveys distributed across Indiana’s prison system will be collected and analyzed. These results will be used to develop an interview protocol to conduct at least 25 in-depth interviews which will then be coded using NVivo to identify any emerging themes regarding their experiences with Covid-19. Prior to this, in-depth literature reviews were done on health care in prison populations and trust in healthcare. &#x0D; &#x0D; Results: &#x0D; The surveys and interview protocol will be developed in the ensuing months and thus no data has yet been collected. The literature review revealed that the quality and accessibility of care in prisons is lacking, an issue exacerbated by the pandemic. Because of the disproportionate number of preexisting issues, inmates worried about the ability of prison administrators to properly protect inmates from contracting the virus. Additionally, it was found that trust likely does have an effect on health, and that many commonalities of inmates are poor predictors for trust. &#x0D; &#x0D; Potential Impact: &#x0D; This study aims to identify potential loss of trust in healthcare systems to inform community reentry programs in developing strategies that prioritize inmate health needs and perceptions.

Türkiye'deki üçüncü basamak bakım kurumlarından hizmet alan hastaların sağlık sistemine güven düzeyleri

Purpose: This study aimed to examine trust levels in the Turkish healthcare system of the patients receiving services from tertiary care institutions and the influencing sociodemographic factors.Materials and Methods: they conducted This descriptive study in inpatient units of six tertiary care hospitals (three training&amp;amp;research hospitals, three university hospitals) located in the center of Ankara among 493 inpatients. Data was collected with a sociodemographic form and Multidimensional Trust in Healthcare Systems Scale.Results: Participants’ mean age was 47.7±13.1; 50.1% were female, 38.3% were graduated from high school, 58.2% were unemployed, 70% had moderate income, 64.7 % were dwelling in rural, and 63.5% were satisfied with the healthcare services. The mean score for the scale was 61.5±8.2, and for healthcare providers, payers, and institutions subscales were as 38.1±5.2, 12.9±3.7, and 10.6±1.9, respectively. Trust in healthcare system was found significantly associated with age, educational level, employment, income, existence of household, residency area, and satisfaction from healthcare services.Conclusion: It is noted that older than sixty-years-old, low-educated, unemployed, low-income, and rural individuals had higher trust in the healthcare system. Because their need for medical information is greater, they are experiencing economic weaknesses, and they are relatively more in need of healthcare services, which increases their trust in the system.

Trust in the Israeli Healthcare System Among Arabs, Jewish Immigrants, and Non-immigrants.

Previous studies have shown that minorities and immigrants have low levels of trust in healthcare systems (HCSys), which might present a barrier in access to and utilization of healthcare services. We compared the levels of trust in Israel's HCSys among the Arab minority, immigrant Jews, and non-immigrant Jew sand draw on the integrative model of organizational trust to explore factors that can explain differences in the trust level within and between the study groups. We obtained cross-sectional census data from the 2017 Social Survey of the Israel Central Bureau of Statistics. We studied levels of trust based on a survey question: "Do you have trust in the HCSys?" We used logistic regression models to compare levels of trust in HCSys among the study groups, adjusting for components of the integrative model: characteristics (sex, age, education, religiosity, and healthcare service use), abilities (private health insurance ownership), integrity (discrimination, trusting the justice system and government), and perceived risk (self-reported health). Our findings revealed that Arabs (odds ratio (OR) = 4.20, 95% confidence intervals (CI) = 4.17, 4.23) and immigrant Jews (OR = 2.54, 95% CI = 2.51, 2.58) had more trust in the HCSys compared to non-immigrant Jews, even after adjusting for all the component variables. Different components of the integrative model explained trust in each population group. Minority and immigrant groups had greater trust in the HCSys compared to the non-immigrant group. These findings may indicate different expectations with respect to patient-caregiver relations and HCSys utilization and raise questions regarding access to HCS and quality of care among minority and immigrant groups.

Strengthening health care worker engagement with early adolescence in low- and middle-income countries: an overdue area for action.

The very young adolescent population (ages 10-14) is currently under-served by health care systems, particularly in low- and middle-income countries. Although there is a substantial and growing effort to reach adolescents with the health services and commodities they need, such efforts often overlook the period of early adolescence given this population's lower vulnerability to risk-taking behaviors. However, early adolescence is a period of significant change, with the onset of puberty introducing physiological, emotional, and social changes in girls' and boys' lives. This period also represents a time of intensifying gendered norms, and the transition of youth from childhood focused health care (e.g. deworming programs, nutrition interventions) to additional mid- and older adolescent related care [e.g. human papilloma virus (HPV) vaccine, and contraceptive provision). Strengthening young adolescents' engagement with health care workers around preventative and promotive health behaviors could have profound impacts on their health and wellbeing, which in turn could have cascading effects across the course of their lives. Critically, young adolescents would gain trust in health care systems, and be more likely to return when significant health issues arise later in adolescence or adulthood. Such an effort requires sensitizing health care workers and building their capacity to respond to young adolescents' unique needs, by defining a package of actions that they are mandated to provide, training them, providing them with desk reference tools, and putting in place systems to provide supportive supervision and collaborative learning on the one hand, and encouraging caregivers to connect their pubescent-aged boys and girls with the health care system, on the other hand. This paper presents an argument for increased focus in particular on building attitudes and capacities of health care workers on engaging with early adolescents, applying Principle 3 of the Society of Adolescent Medicine's position paper entitled "Health Care Reform and Adolescents."

Consequences of Covid 19 Pandemic on Children

The Pandemic of SARS COV 2 popularly known as ‘Corona Virus19’ has affected 213 countries and territories around the world since the beginning of year 2020. All the countries have focused their attention acutely on the higher fatality rate the virus has caused among the elderly and launched a scientific enquiry on why children have emerged relatively unaffected. This pandemic has already amplified existing social fractures and inequalities and it is expected that all most all countries may take 5-10 years to return to their socio-economic status of 2019. Most importantly people are losing trust in healthcare system. As the Global tally of cases crosses 28 million cases and nearly 0.9 million deaths on 10th September 2020, with the highest daily case of 300,683 on 4 September 2020 and deaths of 8513 on 17 April 2020. However, the proportion or absolute number of cases and deaths in children is not readily available at Global, National, or even at local levels. In the beginning it was estimated that the children under 14 years contributed less than 0.5% and therefore the Children were not the face of this pandemic. The sub-national data in states reporting desegregated data in USA and India indicate that the children contribute between 0.1% to 10% in the recent weeks. The pandemic of COVID-19 initially appeared to cause only a mild illness in children and immediate health impact, or mortality rates were not alarming. A few weeks following the peak of COVID-19 epidemic in the US and the European Union, a novel systemic illness called Multisystem inflammatory syndrome in children (MIS-C) has been reported with devastating effect. Most importantly children’s risk being among its biggest victims, their lives are being changed in profound ways. What has escaped our attention is the long-term damage the cascading effect of COVID-19 is likely to cause in children through inadequate health services, broken medical supplies, interrupted access to nutritious food, immunization services, informal learning ,emotional bonding among peers, Anganwadi workers affectionate care especially when, and the parents are facing income loss due to loss of jobs and low opportunities of alternatives of earning livelihood. This paper is a review of the comprehensive consequences of Covid 19 Pandemic on Children. Materials & Methodology: This paper used the data from WHO dashboard, Ministry of Health & Family Welfare, GOI India or States National Health Mission websites or other websites, like John Hopkins’s University, CDC Atlanta, NSSO, Google and Wikipedia etc. For Indian scenario I have used the data from a recent online publication of Indian Academy of Paediatrics, American Academy of paediatrics, small study reports in daily national and local newspapers, mainly Times of India, Indian Express, The Hindu etc. Bangalore, Delhi, and Mumbai editions. Study Setting & Sampling: The review covers major states and cities setting. Being the secondary data review available data was used with no sampling.

Public trust and media influence on anxiety and depression levels among skilled workers during the COVID-19 outbreak in Serbia

Background/Aim. Along with the great impact of 2019 coronavirus disease (COVID-19) on physical health, social functioning, and economy, this public health emergency has significant impact on mental health of people as well. The aim of this study was to assess the impact of outbreak-related information and public trust in the health system and preventive measures during the COVID-19 outbreak in Serbia in 2020 on levels of anxiety and depression in education, army and healthcare professionals. Methods. An anonymous questionnaire was disseminated to skilled professionals working in fields of education, army, and healthcare. The questionnaire included the Beck Anxiety Inventory, Zung Self-Rating Depression Scale, as well as the section assessing the perceived disturbance by the outbreak-related information and the trust of participants in healthcare system and preventive measures proposed by the crisis team. Results. Out of 110 subjects enrolled in this study (mean age 35.25 ? 9.23 years), 59.1% were women. Among healthcare workers, the frequency of perceiving outbreak-related information available in public media as disturbing, as well as the average level of anxiety, were higher compared to the group of army professionals (p &lt; 0.05). Women also perceived outbreak-related information available in public media as disturbing in a higher percentage compared to men (p &lt; 0.01), and had higher levels of anxiety (p = 0.01) and depression (p &lt; 0.05). The lack of public trust was associated with higher levels of depression, and the perception of outbreak-related information as disturbing with higher levels of both anxiety and depression. Conclusion. Significant perception of outbreak-related information as disturbing among healthcare workers, as well as the lack of trust in healthcare system and preventive measures proposed by the crisis team are important factors influencing the mental state. This finding has the guiding purpose for competent institutions to make efforts to increase public trust, as one of the important preventive measures, in order to preserve and improve the mental well-being of the population in outbreak conditions.

Trust in health care systems Arab minority, Jewish immigrant and non-immigrant

Abstract Background The objective of this study was to examine the level of trust towards Israel’s health care services (HCS) among Palestinian-Arab minority, Jewish immigrant, and non-immigrant Jewish citizens. Previous studies have shown that minorities and immigrants have less trust in health care system (HCSys), which might represent a barrier in access to, and utilization of HCS. Methods We obtained cross-sectional nationwide census data from the 2017 Social Survey of the Israel Central Bureau of Statistics. We studied levels of trust in the HCSys based on a survey question: ’Do you have trust in the healthcare system?” We conducted logistic regression analysis within and between the study groups to compare levels of trust, after adjustment for different relevant covariates in different models. Results Compared to non-immigrant Jews, Arabs had higher trust in the HCS (odds ratio (OR)=3.08, 95% confidence intervals (CI)=3.06,3.10) and compared to non-immigrant Jews, immigrant Jews had more trust (OR = 1.96, 95% CI = 1.94,1.98), even after adjusting for gender, age, education level, religiosity level, perceived discrimination, self-rated health status, HCS use, and having private health insurance. The variables that predicted trust in the HCSys were different in each ethnic group. Conclusions Contrary to our hypothesis and to previous research, Arab and immigrant Jewish respondents in our study had greater trust in the HCS compared to non-immigrant Jews. This might relate to different expectations among our study groupsof the patient-caregiver relations which might affect the access to and utilization of HCS and finally might affect the quality of care. Key messages Exceptionally, in Israel, the Arab minority and Jewish immigrants have more trust in the health care system compared with non-immigrant Jews. More research is needed to understand how trust among minority groups relates to the patterns of utilization of HCS and raises question regarding the quality of care.

A model exploring the relationship between betrayal trauma and health: The roles of mental health, attachment, trust in healthcare systems, and nonadherence to treatment.

Prior research suggests that there is a relationship between traumatic experiences and poor health. When considered through the lens of betrayal trauma (i.e., the perpetrator and the victim have a close interpersonal relationship), traumatic experiences predict greater posttraumatic difficulty and higher levels of depression. Betrayal trauma has been associated with poorer interpersonal relationships and less trust in individuals and systems that may be important for a person's wellbeing, such as health care systems. In turn, trauma survivors are less likely to adhere to medical treatment, which may ultimately affect their overall health. The current study examined the complex relationship between experiences of betrayal trauma and poor health, while accounting for demographics, mental health symptoms, trust in physicians and the medical system, attachment style, and nonadherence to medical treatment. A demographically representative sample of 312 Canadian participants was surveyed online. Participants completed measures that assessed symptoms of mental health (PTSD, depression), trauma, attachment style, trust, and nonadherence to medical treatment. Hierarchical regression models were used to examine the relationship between betrayal trauma and health. Betrayal trauma significantly predicted nonadherence to treatment, while trust in physicians was explained by trauma, attachment style, and mental health symptoms. All of these factors significantly explained poor health status. Results suggest the importance of implementing trauma-informed care in health care systems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Multi-organ Transplantation Center in Romania: a story of persuasion for a controverted issue

Abstract Many countries built their own models of transplantation, collaborating to exchange knowledge and donor organs for effectively help their patients in need. Despite great clinical research on transplantation, literature regarding its management is scarce. Transplantation is quite a controverted issue in Romania, without a culture of donation, within a poor healthcare system. Yet, first attempts were in early 20th century, and modern transplantation started since 1995. There was always a shortage of organs, but after recent press scandals, people became more reluctant to donate, therefore transplantations went down, dramatically impacting patients.Our objective is to emphasize opportunity, need and sustainability for developing a multi-organ transplantation center in Romania, of regional importance, in order to better serve our patient needs in an effective and efficient manner. This research used descriptive analysis, secondary data compilation and review, legislative diagram, case study. Currently there are 68 transplantation centers accredited in Romania with 13,702 transplants accomplished (organs, tissues, cells), at a rate of 19.3/million, covering 19.4 millions of people living just 75.5 years in average (EU=80.2). But 5,400 Romanian patients wait for a transplant, while 550 died waiting... After modernization and building a great surgical center and team, Clinical Hospital St. Maria of 300 beds started complex surgery and successful liver transplantation in 2014, continued with lung transplant in 2018 – Romanian premiere, after many struggles. Next step is a modern multi-organ transplantation center. Vision, persuasion and effective leadership are crucial. Romanian potential for overspecialized surgery is greater than actual practice. Experience indicates that multi-organ transplantation centers are more effective and efficient than separated ones, by concentrating the best specialists, technology, knowledge and resources available for harvest, transplant and care, thus improving health outcomes (donors, successful transplants, lives saved, quality of life), prestige, retention of excellent professionals, and trust in healthcare system, at lower costs than in developed countries.

Understanding the determinants of public trust in the health care system in China: an analysis of a cross-sectional survey.

Despite increasing research attention on public trust in health care systems, empirical evidence on this topic in the developing world is limited and inconclusive. This paper examines the level and determinants of public trust in the health care system in China. We used data from a survey conducted with a sample of 5347 adults in all Chinese provincial areas between January and February 2016. Trust in the health care system was assessed with a question used by the 2011-2013 International Social Survey Programme (ISSP) to assess public trust in the health care systems of 29 industrialized countries and regions ('In general, how much confidence do you have in the health care system in your country?'). Only 28% of respondents reported that they had a great deal or complete trust in China's health care system. Respondents who reported to have more trust in other people in society, more trust in the local government and who were more satisfied with their most recent health care system experience and their health insurance were significantly more likely to trust the country's health care system. Furthermore, respondents who reported a higher level of happiness, better health status and positive attitudes towards social equity were more likely to trust the health care system in China. Our findings suggest that low public trust in China's health care system is a potential problem. Improving health care experiences may be the most practical and effective way of improving trust in the health care system in China.

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.

Trust in health care and vaccine hesitancy

Health care systems can positively influence our personal decision-making and health-related behavior only if we trust them. I propose a conceptual analysis of the trust relation between the public and a healthcare system, drawing from healthcare studies and philosophical proposals. In my account, the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also modified by the vulnerability of the public on healthcare matters, and by the system’s credibility. I apply my proposed analysis of public trust in health care systems to the phenomenon of vaccine hesitancy, a tendency to question vaccine policies, and to seek alternative vaccine schedules or to refuse vaccination. Understanding the role of trust and its components can be key to understanding the phenomenon.

Trust and Reputation Management in Healthcare Systems: Taxonomy, Requirements and Open Issues

Trust is a salient feature in the context of health care, which is characterized by uncertainty and an element of risk. It is a fundamental requirement for the acceptance and adoption of new services related to health care. Soft trust, based on social control mechanisms, has yielded to evidence-based trust management, where the level of trust is explicitly computed by a trust engine termed the trust and reputation system (TRS). In e-health, soft trust can be used for access control, for assessing the quality of data represented in electronic health records , to address privacy and security requirements of healthcare systems, and to compute the credibility of an entity in the presence of unknown, possibly harmful entities. Despite the importance of soft trust in healthcare, related literature that explore soft trust issues, associated challenges and requirements are largely missing. To address this deficiency, the main contributions of this paper include: (i) taxonomy related to the soft trust in healthcare systems; (ii) reference model for measuring the performance and features of TRSs; and (iii) future areas of research related to the soft trust in healthcare.

Strengthening the Free Healthcare Initiative through a pharmacy and supply chain intervention: Partners in Health's experience in rural Sierra Leone

Abstract Background To improve high maternal and under-5 mortality—among the worst globally—Sierra Leone's Ministry of Health and Sanitation (MOHS) enacted the Free Healthcare Initiative in 2010. Under this initiative, pregnant and lactating women and children aged younger than 5 years receive medical treatment and essential medicines free of charge at public facilities. However, the availability of medicines remains inconsistent, which results in patients paying for medicines and an undermining of the quality of care and trust in the health-care system. These gaps between services and medicines promised under the Free Healthcare Initiative and actual resources delivered worsened during the 2013–15 Ebola epidemic, which strained an already weak health-care system. Here, we describe an approach to strengthen pharmacy and supply chain systems to improve access to essential medicines at a district hospital in Sierra Leone. Methods In 2015, Partners In Health undertook a gap analysis to understand the barriers to drug availability for patients eligible for the Free Healthcare Initiative at Koidu Government Hospital (KGH). A multidisciplinary task force identified priorities and created a partnership with the MOHS. Partners In Health's Director of Pharmacy led meetings with hospital management, shadowed clinical staff, and performed an inventory of drugs and medical supplies. Findings The gap analysis revealed challenges in the areas of human resources, infrastructure, storage, and information systems. The results led to the following interventions: decentralisation of medication distribution from hospital to ward level; the hiring of four pharmacy technicians; expansion of central warehousing; and implementation of electronic reporting tools to improve consumption data. MOHS pharmacy staff were mentored to improve feedback mechanisms between central and district levels. Between November, 2015, and August, 2016, these changes resulted in nearly 100% availability of essential drugs—with 80% provided via the strengthened MOHS system—and elimination of out-of-pocket expenses for patients. Additionally, trust in the public health-care system has improved: compared with a 2012 and 2013 pre-Ebola baseline at KGH, paediatric and maternity admissions have increased by 47%, with a 95% increase in hospital-based deliveries. Interpretation The success of the Free Healthcare Initiative is rooted in its shared ownership with the MOHS and the integration of central-level and district-level information systems. The approach described here could be used to guide new interventions to strengthen pharmacy supply chains elsewhere in Sierra Leone and other low-resource settings. Funding Partners In Health, Sierra Leone.