Trust In Healthcare Institutions Research Articles

Compliance with COVID-19 preventative health measures in the United Kingdom: a latent profile analysis.

Governments have adopted unprecedented measures to assist in slowing the spread of the COVID-19 pandemic, but compliance varies among individuals. This UK study uses latent profile analysis to identify four classes of individuals on factors believed to influence compliance. Those who sought health information from authoritative sources and actively sought information from multiple sources were most compliant. Profile differences in compliance and vaccination status were also primarily driven by trust in healthcare institutions over trust in government. These findings contribute to understanding compliance profiles and emphasise the importance of authoritative information and trust in healthcare systems.

The challenge of cultural changes for the reorganization of the health service

To explore the impact of cultural changes on the reorganization of health services, highlighting the importance of valuing the multidisciplinary team for Primary Health Care. This is a reflective analysis based on the discursive expression of the obstacles faced by cultural changes in the restructuring of health services in PHC with a view to the performance of the multidisciplinary team. This study had its origins in the provocations and debates promoted by the Research Group "Techno-Care Models and Health Promotion" at the School of Nursing of the University of São Paulo (EEUSP). A literature review was carried out to compile evidence and analysis related to the challenges of cultural changes in the reorganization of health services. The content was divided into two points of reflection: the figure of the doctor in the health context and the cultural obstacles in the reorganization of the health service. Resistance rooted in organizational culture, marked by traditions and norms, is a significant obstacle to the introduction of innovations in PHC. Overcoming these barriers demands a profound cultural transformation, challenging medical hegemony in favor of a collaborative and interdisciplinary approach to care. Building effective cultural competence not only overcomes resistance, but also strengthens trust in healthcare institutions, enabling successful implementation of changes tailored to the specific needs of each community.

Examining the influence of information‐related factors on vaccination intentions via confidence: Insights from adult samples in Italy and Serbia during the COVID‐19 pandemic

AbstractThe research investigates the antecedents of immunisation intentions during the COVID‐19 pandemic, including information‐related factors (conspiracy beliefs, immunisation knowledge and health communication perception) and confidence‐related factors (trust in healthcare institutions and vaccine risk perception). Data were collected online from two samples of Italian (N = 324) and Serbian (N = 486) participants. Path analyses confirmed a mediation mechanism: trust in health institutions and vaccine risk perception mediate the relationship between information‐related factors and vaccination intentions, both towards COVID‐19 and other diseases, with a few exceptions and differences between the samples. Findings show a glimpse into the inner psychological mechanisms of vaccination intentions. During times of crisis, such as pandemics, compliance toward vaccination can be fostered through the quality of information and the promotion of citizens' trust towards health institutions and vaccines.

Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada.

Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.

Prospective Attitudes towards Respiratory Syncytial Virus (RSV) Vaccination: Validation of a Survey Instrument among Young Females in Jordan Pending Vaccine Authorization.

In May 2023, the U.S. FDA advisors endorsed Pfizer's pregnancy-administered vaccine (branded ABRYSVO) to protect infants from respiratory syncytial virus (RSV) infection. Vaccination can reduce the burden of RSV-related respiratory disease, with previous studies showing its substantial medical and financial burden in Jordan. However, pregnant women may exhibit hesitancy to get vaccinated due to concerns about potential risks to themselves or their fetuses. This study aimed to assess the acceptance of the RSV vaccine among young females and identify the determinants influencing their decision using a newly constructed instrument. A survey instrument was developed and validated, comprising 26 items to measure RSV vaccine acceptance. A cross-sectional study design was employed, with data collection from a sample of females aged 18 to 45 residing in Jordan during 5-6 July 2023, using a convenient approach via an online distributed questionnaire. The final study sample comprised 315 respondents, with 67.6% who have heard of RSV before the study. If the vaccine was safe, effective, and provided freely, 70.2% showed willingness to get the RSV vaccine, 15.2% resisted, and 14.6% were hesitant. Principal component analysis identified six internally consistent sub-scales with the following suggested themes: Advice, Burden, Conspiracy, Dangers, Efficiency, and Fear, comprising 21 items collectively as assigned as the "ABCDEF" scale for RSV vaccine acceptance. RSV vaccine acceptance in this study was associated with the advice and fear constructs. The validated survey instrument successfully captured important determinants of RSV vaccine acceptance among young females. RSV vaccine promotion efforts should focus on the following: enhancing vaccine education, improving trust in healthcare institutions and providers, reducing burdens through resolving cost issues and focusing on the role of social support, addressing safety concerns, and tailoring communication strategies to effectively promote the benefits of the vaccine. These insights can inform public health policies and interventions aiming to promote RSV vaccination and mitigate the burden of RSV-related diseases among infants. Follow-up studies are recommended with pregnant women as the target group to assess their attitude towards RSV vaccination and to confirm the validity of the conceived ABCDEF survey instrument.

Trust in healthcare before and during the COVID-19 pandemic

BackgroundPublic trust is often advantageous for health authorities during crises such as the COVID-19 pandemic. Norwegian health authorities used the public´s high trust to control the pandemic, resulting in relatively few casualties.MethodsWe wanted to describe and compare the Norwegian public trust in GPs, public healthcare, information and treatment in hospitals before and during the early phases of the COVID-19 pandemic. Further, we wanted to investigate the relationship between somatic or mental illness, and trust in GPs and public health information, and to develop a theoretical understanding of the relationship between trust in healthcare institutions, generalised trust and the societal situation caused by the COVID-19 pandemic. We performed two surveys, the first in December 2019; the second in May 2020, thus providing two snapshots of the Norwegian public’s trust in healthcare and healthcare actors before and during the COVID-19 pandemic.ResultsThere was statistically significant increased trust in public healthcare, in treatment at hospital and in information at hospital after the outbreak of the COVID-19 pandemic. There was a non-significant rise in trust in GPs. We found that trust in public health information was not related to mental health nor having a chronic, somatic disease.ConclusionThe findings confirm that the Norwegian public’s trust in healthcare and healthcare actors is high. The trust levels are also relatively stable, and even show an increase during the early phases of the pandemic. We suggest that there is a dynamic relationship between trust in public health information, healthcare institutions, generalised trust and a societal crisis situation such as the COVID-19 pandemic. However, the GP-patient trust seems less affected by a crisis situation, than the public´s trust in healthcare institutions. This difference may be explained by the relative stability caused by mandates of trust obtained from the patient.

Understanding and addressing populations whose prior experience has led to mistrust in healthcare

BackgroundPolicy makers need to maintain public trust in healthcare systems in order to foster citizen engagement in recommended behaviors and treatments. The importance of such commitment has been highlighted by the recent COVID-19 pandemic. Central to public trust is the extent of the accountability of health authorities held responsible for long-term effects of past treatments. This paper addresses the topic of manifestations of trust among patients damaged by radiation treatments for ringworm.MethodsFor this mixed-methods case study (quan/qual), we sampled 600 files of Israeli patients submitting claims to the National Center for Compensation of Scalp Ringworm Victims in the years 1995–2014, following damage from radiation treatments received between 1946 and 1960 in Israel and/or abroad. Qualitative data were analyzed with descriptive statistics, and correlations were analyzed with chi-square tests. Verbal data were analyzed by the use of systematic content analysis.ResultsAmong 527 patients whose files were included in the final analysis, 42% held authorities responsible. Assigning responsibility to authorities was more prevalent among claimants born in Israel than among those born and treated abroad (χ2 = 6.613, df = 1, p = 0.01), claimants reporting trauma (χ2 = 4.864, df = 1, p = 0.027), and claimants living in central cities compared with those in suburban areas (χ2 = 18.859, df = 6, p < 0.01). Men, younger claimants, patients with a psychiatric diagnosis, and patients from minority populations expressed mistrust in health regulators.ConclusionsExamining populations' perceived trust in healthcare institutions and tailoring health messages to vulnerable populations can promote public trust in healthcare systems.

Internet Health Information on Patient’s Decision-Making: Implications, Opportunities and Challenges

The accessibility of online health information has changed the decision-making process for patients concerning their health. Nevertheless, concerns persist regarding the quality and reliability of the information available on the Internet. The Internet has emerged as the dominant global source of health-related information, with a significant proportion of individuals utilizing it to retrieve information on nutrition, diseases, symptoms, and treatment options. However, the unregulated nature of online health information poses challenges in terms of assessing its credibility and accuracy. Increasingly, patients are actively engaged in healthcare decision-making, empowered by the information they acquire online. Consequently, a paradigm shift from the traditional physician-centric model to a more collaborative and patient-centered approach has occurred. Patients now have access to an expanded array of healthcare professionals and possess the ability to make informed decisions regarding their treatment and care. Nonetheless, the variability in quality of online health information and patients' limited capacity to effectively evaluate it can give rise to misunderstandings, misinformation, and an elevated propensity for self-diagnosis and self-treatment. Furthermore, patients' reliance on online information can impact the patient-physician relationship, with discrepancies between online findings and physician diagnoses leading to dissatisfaction and conflicts. Barriers obstructing effective patient-physician communication on online health information include patient's apprehension about challenging physicians, perceived resistance from physicians themselves, and difficulties in comprehending and articulating the information sourced online. Addressing these barriers and enhancing the patient-physician relationship can yield positive outcomes, including timely diagnosis, effective treatment, and shared decision-making. While Internet use brings advantages such as increased accessibility to healthcare providers and enhanced patient empowerment, it also introduces certain disadvantages. The prevalence of misinformation and disinformation on the Internet engenders risks, contributing to confusion and a lack of trust in healthcare institutions. Additionally, patients may encounter challenges in interpreting and prioritizing the information they find online, which can result in heightened anxiety and uncertainty regarding their health. This review critically examines the impact of Internet use on patient decision-making and its effect on the patient-physician relationship.

Psychological Antecedents of Vaccination (5C) Scale: Turkish Validity and Reliability Study

5C psychological antecedents of vaccination scale was developed by Betsch et al. (2018) based on prior models. The scale measures the psychological antecedents of vaccination refusal/hesitancy in five dimensions. Existing Turkish vaccination-related scales cover only a limited aspect of hesitancy/refusal. In this study, the 5C scale’s Turkish translation, validity, and reliability analyses were performed (N=1848). Confirmatory factor analysis resulted that the model was consistent with the data indicating construct validity, and Cronbach alpha values of each dimension varied between .71 and .82, indicating good reliability. Correlations of the 5C dimensions with variables that are suggested by Betsch et al. were examined to test the congruence validity. Vaccination intention was positively related to all five dimensions. Moreover, in line with theoretical expectations, the following associations were observed: confidence was positively related to trust in healthcare institutions and healthcare professionals; complacency was negatively related to perceived risk; constraint was negatively related to perceived behavioral control; calculation was positively related to information seeking; collective responsibility was positively related to COVID-19 related worry. We believe that the Turkish 5C scale will be a functional tool in monitoring vaccination in Turkey and a valuable contribution to the literature by enabling cross-cultural comparisons.

Broad Medical Uncertainty and the ethical obligation for openness

This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ (BMU) regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a ‘Corrective Response’. We then consider some objections to this position (the ‘Anti-Corrective Response’), including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing.

Evaluating models of consent in changing health research environments

While Specific Informed Consent has been the established standard for obtaining consent for medical research for many years, it does not appear suitable for large-scale biobank and health data research. Thus, alternative forms of consent have been suggested, based on a variety of ethical background assumptions. This article identifies five main ethical perspectives at stake. Even though Tiered Consent, Dynamic Consent and Meta Consent are designed to the demands of the self-determination perspective as well as the perspective of research as a public good, they are still also criticized from both perspectives. In addition, criticisms based on concerns of justice, participation and democratic deliberation, and relational concerns have been levelled at each of the models. As all of these perspectives have valid points to make, the task at hand lies in balancing these ethical perspectives. What constitutes an adequate balancing depends on contextual factors. These factors include digital infrastructure and digital literacy, data safety regulation, good scientific and clinical practice, transparent debates on ethically relevant features of research, social inequalities, anti-discrimination laws and practices, trust in health care institutions and recognition of patient preferences, and consensus on unethical research. We argue that the role of context in determining acceptable models of consent puts the ethical importance of models of consent into perspective. Since altering contextual factors can help to live up to the ethical concerns at stake in debates about models of consent, opting for such a shift of focus comes without ethical loss.

Predictors of Intention to Vaccinate Against COVID-19 in a Peruvian Sample.

Background:Vaccination against COVID-19 is considered one of the most effective strategies to control this global public health crisis. However, vaccine hesitancy is one of the main threats to mitigating the pandemic. The present study aimed to identify predictors of intention to vaccinate against COVID-19 in 3 geographical regions of Peru.Methods:An online analytical cross-sectional study was conducted. Participants were selected by non-probability convenience sampling and size was estimated using the online statistical calculator proposed by Soper. A total of 529 Peruvian nationals completed the questionnaires. Student’s t-test and Fisher’s F test (ANOVA) were used. A significance level of .05 was considered.Results:Face-to-face work (β = 2.037, P < .001), fear of COVID-19 (β = .461, P < .001), vaccine confidence (β = 2.881, P < .001) and trust in health care institutions (β = .432, P < .01) predict a higher intention to receive the vaccine. However, the variables perception of a worldwide conspiracy (β = −1.900, P < .001), and practice Protestant religion (β = −2.274, P < .001) predict negatively their acceptance.Conclusion:Several positive predictors of intention to vaccinate against COVID-19 have been identified. However, having a perception of a global conspiracy and practice Protestant religion are shown to be risk variables for vaccine acceptance. Therefore, there is a need to develop strategies to ensure high uptake and success of COVID-19 vaccination campaigns.

Understanding the psychosocial determinants of Italian parents’ intentions not to vaccinate their children: an extended theory of planned behaviour model

Objective This study aimed to identify the psychosocial factors involved in Italian parents’ intentions not to vaccinate their children. For this purpose, we used an extended version of the Theory of Planned Behaviour, which included both proximal and distal factors influencing intention not to vaccinate children. Design Participants included 447 Italian parents, each completed an online questionnaire, which measured intention not to vaccinate children, attitude toward not vaccinating, subjective norms, perceived behavioural control, anticipated regret, negative attitude toward vaccines, risk perception, trust in healthcare institutions, trust in science and religious morality. Results Results showed that attitude toward not vaccinating was strongly associated with intention not to vaccinate children. Furthermore, attitude toward not vaccinating was associated with negative attitude toward vaccines, which in turn was affected by all the distal factors considered (risk perception, trust in healthcare institutions, trust in science, religious morality). Finally, negative attitude toward vaccines fully mediated the effect of the distal factors on attitude toward not vaccinating children. Conclusion These findings provide support for the validity of the proposed extended TPB model in explaining parents’ intention not to vaccinate children. Theoretical and practical implications, in terms of understanding and promoting vaccination behaviour, are discussed.

COVID-19 and the Lived Experience of People Facing it; a Quantitative Study

Aims: Due to the widespread outbreak of COVID-19, thousands of people have died, and millions of people have been infected around the world, putting communities at great risk. The present study assessed the lived experience of people infected by COVID-19. Participants & Methods: This qualitative research with a phenomenological approach was conducted in March 2020 in Boroujerd, Lorestan. Using the theoretical sampling method, 18 citizens were interviewed. Data were collected through semi-structured interviews. The Colaizzi method was used for data analysis, and Goba and Lincoln validation model was used for scientific validation of research findings. Findings: After qualitative data analysis, seven main themes were identified, including the dimensions of health and education (highlighting the role of health care providers, improving personal health, stagnation of educational activities, the need to improve media literacy), family (family-centered lifestyle, generational convergence and family cohesion), social (disruption of relationships and social interactions of individuals, increasing social trust in health care institutions, reproduction of social inequality), cultural and religious (spirituality, cultural weakness), economic (disorder and recession following disruption of business and production), sovereignty and politics (organizational integrity, bioterrorism), psychological (anxiety and social phobia). Conclusion: COVID-19 has seriously affected people's daily life and mental and social health in Boroujerd.

Risk and Resilience Factors During the COVID-19 Pandemic: A Snapshot of the Experiences of Canadian Workers Early on in the Crisis.

Research highlights several risk and resilience factors at multiple ecological levels that influence individuals’ mental health and wellbeing in their everyday lives and, more specifically, in disaster or outbreak situations. However, there is limited research on the role of these factors in the early days of the COVID-19 crisis. The present study examined if and how potential risk factors (i.e., reduction in income, job insecurity, feelings of vulnerability to contracting the virus, lack of confidence in avoiding COVID-19, compliance with preventative policies) and resilience factors (i.e., trait resilience, family functioning, social support, social participation, and trust in healthcare institutions) are associated with mental health and well-being outcomes, and whether these resilience factors buffer (i.e., moderate) the associations between risk factors and said outcomes. One to two weeks after the government recommended preventative measures, 1,122 Canadian workers completed an online questionnaire, including multiple wellbeing outcome scales in addition to measures of potential risk and resilience factors. Structural equation models were tested, highlighting that overall, the considered risk factors were associated with poorer wellbeing outcomes, except social distancing which was associated with lower levels of stress. Each of the potential resilience factors was found to have a main effect on one or more of the wellbeing outcomes. Moderation analysis indicated that in general these resilience factors did not, however, buffer the risk factors. The findings confirm that the COVID-19 crisis encompasses several stressors related to the virus as well as to its impact on one’s social, occupational, and financial situation, which put people at risk for lower wellbeing as early as one to two weeks after the crisis began. While several resilience factors emerged as positively related to wellbeing, such factors may not be enough, or sufficiently activated at that time, to buffer the effects of the numerous life changes required by COVID-19. From an ecological perspective, while mental health professionals and public health decision-makers should offer/design services directly focused on mental health and wellbeing, it is important they go beyond celebrating individuals’ inner potential for resilience, and also support individuals in activating their environmental resources during a pandemic.

Unproven stem cell therapies: is it my right to try?

Nowadays one of the most critical aspects of innovative cell-based therapies is the unregulated industry, as it is becoming a competitor of the regulated system. Many private clinics, worldwide, advertise and offer cell-based interventions treatments directly to the consumer and this poses a risk to both vulnerable patients and health systems. Several countries have implemented Compassionate Use Programmes (CUP) that provide patients with medicines that have not yet completed the approval pathway, in the event that no reasonable alternative exists. Recently, in the public discourse, compassionate use has been increasingly associated with a patient's right to try. Thus, the aim of this study was to assess public knowledge of the clinical trials process with specific reference to innovative stem cell treatments, and trust in the institutions responsible for regulatory activities. We also asked people about their "right" to use unregulated therapies. We developed an ad hoc questionnaire on three main areas of concern and administered it to 300 people in the patient waiting room at an Italian university hospital. Our findings suggest that people have a good knowledge of the clinical trials process and trust in healthcare institutions. Nonetheless, one person in two believes it is a right to use unregulated therapies. We stress the need, in the age of cellular therapies, for a commitment to support vulnerable patients and to strengthen awareness among the public about the substantial boundary that differentiates experimental therapies from unproven therapies. There should not be a "right to try" something that is unsafe but rather approved treatments and in line with good clinical practice. The trend, which emerged on this issue from our study, is quite different, confirming the urgent need to improve health information so that it is as complete as possible.

Public Reporting of Percutaneous Coronary Intervention Outcomes

ImportanceMore than 20 years have passed since public reporting of percutaneous coronary intervention (PCI) outcomes first began in New York State, but reporting remains a polarizing issue.ObservationsAdvocates of public reporting point to the strong incentive that public disclosure of outcomes data provides for institutions and clinicians to improve clinical care and to the importance of enabling patients to make informed choices about their care. Critics highlight the methodological challenges that impede fair and accurate assessments of care quality as well as reporting’s unintended consequences. Public reporting of PCI outcomes has only been implemented in 5 states, but reporting efforts for multiple conditions and procedures are now proliferating nationally, propelled by the notion that transparency improves the quality of health care and fosters trust in health care institutions. Careful evaluation of the evidence to date for PCI in particular, however, suggests that enthusiasm for such efforts should be tempered.Conclusions and RelevancePublic reporting has not achieved its primary objectives. Policy makers should consider variations of reporting that might strengthen care quality, empower patients, and mitigate undesirable repercussions.

Racial centrality may be linked to mistrust in healthcare institutions for African Americans.

Evidence suggests that racial identity is an important component to African Americans' self-concepts and therefore may be relevant to patients' trust in healthcare, yet little is known as to how racial identity may influence trust or mistrust. African American adults (N = 220) in the greater Portland, Oregon, area provided survey reports of healthcare-related attitudes and experiences. Those who reported higher racial centrality had lower trust in healthcare institutions. Based on these findings, clinicians employing patient-centered care approaches should recognize racial identity as an important component to patients' experiences when they seek to deliver equitable care to African American patients.

The impact of distrust in clinics on hospital utilisation in China 2012-13

Background Public trust in health-care providers is key to an efficient and equitable health system. China’s health reforms are thought to have caused a collapse of trust in health-care institutions, but actual levels of distrust and their implications for health-care utilisation are unknown. Methods We investigated levels of distrust in clinics and hospitals and their impact on hospital utilisation in urban and rural China. A nationally representative survey (n = 3,680, …

Race, Relationships, and Trust in Providers among Black Patients with HIV/AIDS

A trustful patient-provider relationship is a strong predictor of positive outcomes, including treatment adherence and viral suppression, among patients with HIV/AIDS. Understanding factors that inform this relationship is especially relevant for Black patients, who bear a disproportionate burden of HIV morbidity and mortality, and may face challenges associated with seeing providers of a racial/ethnic background that is different from their own. Using data collected through the Enhancing Communication and HIV Outcomes (ECHO) study, we build upon extant research by examining patient and provider characteristics that may influence Black patients' trust in their provider. ECHO data were collected from four ambulatory care sites in Baltimore, Detroit, New York and Portland, Oregon (N=435). Regression analysis results indicate that trust in health care institutions and cultural similarity between patient and provider are strongly associated with patients' trust in their provider. Lower perceived social status, being currently employed, and having an older provider were also related to greater patient-provide trust. These findings can inform interventions to improve trust and reduce disparities in HIV care and outcomes that stem from mistrust among Black patients.