학술논문
Trust in healthcare: methodological and conceptual insights from mixed-method research in Lao People's Democratic Republic.
Document Type
Academic Journal
Author
Haenssgen MJ; Department of Social Science and Development, Chiang Mai University, Chiang Mai, Thailand marco.haenssgen@cmu.ac.th.; Elliott EM; World Health Organization Regional Office for the Western Pacific, Manila, Philippines.; Phommachanh S; University of Health Sciences, Vientiane, Laos.; Phomkong S; World Health Organization Representative Office, Vientiane, Lao People's Democratic Republic.; Kounnavong S; Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic.; Kubota S; World Health Organization Regional Office for the Western Pacific, Manila, Philippines.
Source
Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101685275 Publication Model: Electronic Cited Medium: Print ISSN: 2059-7908 (Print) Linking ISSN: 20597908 NLM ISO Abbreviation: BMJ Glob Health Subsets: MEDLINE
Subject
Language
English
ISSN
2059-7908
Abstract
Background: Global health foregrounds trust as a key requirement for the achievement of international health initiatives, but it remains an elusive concept that is often mobilised without consideration of its dimensions, drivers and downstream behavioural consequences. This paper aims to contribute to the conceptual development and measurement of 'patient trust in primary healthcare' from the lower middle-income country perspective of rural Lao PDR.
Methods: A two-phase mixed-method research design was implemented between January 2021 and April 2023. Phase 1 involved exploratory qualitative research to understand the local expressions and dimensions of patient trust in primary healthcare, with 25 semistructured interviews and 17 focus group discussions (120 participants) in eight villages in Bokeo Province. Phase 2 involved explanatory research to assess patterns of trust systematically at scale in 14 villages across four provinces, wherein 26 cognitive interviews, 17 expert interviews and non-participant community observations informed a community census survey with 1838 participants. We analysed qualitative data through content-oriented thematic analysis and developed an 8-item trust scale on that basis. Quantitative data analysis used descriptive statistical and regression analysis.
Results: We found that trust in primary healthcare is readily understood and intrinsically valuable in rural Lao PDR. Key dimensions included communication, respectful care, relationship, fairness, integrity, reputation, assurance of treatment and competence. The survey highlighted that reputation, competence, integrity and respectful care had the lowest trust scores. Health centre operations predicted the local expressions of trust. The behavioural consequences of trust were limited to a positive statistical association with antenatal care uptake among pregnant women but outweighed by alternative measures that also captured the availability of healthcare facilities.
Conclusions: Overall, the development of our quantitative trust scale offers a process model for future researchers. We conclude that interpersonal, institutional and service-related trust require more explicit recognition in health system development and integration into health policy.
Competing Interests: Competing interests: None declared.
(© World Health Organization 2024. Licensee BMJ.)
Methods: A two-phase mixed-method research design was implemented between January 2021 and April 2023. Phase 1 involved exploratory qualitative research to understand the local expressions and dimensions of patient trust in primary healthcare, with 25 semistructured interviews and 17 focus group discussions (120 participants) in eight villages in Bokeo Province. Phase 2 involved explanatory research to assess patterns of trust systematically at scale in 14 villages across four provinces, wherein 26 cognitive interviews, 17 expert interviews and non-participant community observations informed a community census survey with 1838 participants. We analysed qualitative data through content-oriented thematic analysis and developed an 8-item trust scale on that basis. Quantitative data analysis used descriptive statistical and regression analysis.
Results: We found that trust in primary healthcare is readily understood and intrinsically valuable in rural Lao PDR. Key dimensions included communication, respectful care, relationship, fairness, integrity, reputation, assurance of treatment and competence. The survey highlighted that reputation, competence, integrity and respectful care had the lowest trust scores. Health centre operations predicted the local expressions of trust. The behavioural consequences of trust were limited to a positive statistical association with antenatal care uptake among pregnant women but outweighed by alternative measures that also captured the availability of healthcare facilities.
Conclusions: Overall, the development of our quantitative trust scale offers a process model for future researchers. We conclude that interpersonal, institutional and service-related trust require more explicit recognition in health system development and integration into health policy.
Competing Interests: Competing interests: None declared.
(© World Health Organization 2024. Licensee BMJ.)