Research Article
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Trust levels in the healthcare system of the patients receiving services from tertiary care institutions in Turkey

Year 2020, Volume: 45 Issue: 3, 860 - 870, 30.09.2020
https://doi.org/10.17826/cumj.647412

Abstract

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&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. 

Thanks

We all thank Leonard E. Egede, Charles Ellis, Leyla Dinç, and Erdem Karabulut for permitting to use the Multidimensional Trust in Healthcare Scale. We are grateful to the patients who participated in the study.

References

  • 1. Hosmer LT. Trust: The connecting link between organizational theory and philosophical ethics. Acad Manage Rev. 1995;20:379-403.
  • 2. Jamison AM, Quinn SC, Freimuth VS. “You don't trust a government vaccine”: Narratives of institutional trust and influenza vaccination among African American and white adults. Social Science & Medicine. 2019.
  • 3. Rutten LJF, Hesse BW, Sauver JLS, Wilson P, Chawla N, Hartigan DB, et al. Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Adv Ther. 2016;33:1440-51.
  • 4. Ozawa S, Sripad P. How do you measure trust in the health system? A systematic review of the literature. Social Science & Medicine. 2013;91:10-4.
  • 5. Wiltshire JC, Person SD, Kiefe CI, Allison JJ. Disentangling the influence of socioeconomic status on differences between African American and white women in unmet medical needs. Am J Public Health. 2009;99:1659-65.
  • 6. Sabel CF. Studied trust: Building new forms of cooperation in a volatile economy. Hum Relat. 1993;46:1133-70.
  • 7. Ward PR. Improving access to, use of, and outcomes from public health programs: the importance of building and maintaining trust with patients/clients. Front Public Health. 2017;5:22.
  • 8. Hall MA, Dugan E, Zheng B, Mishra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79:613-39.
  • 9. Calnan MW, Sanford E. Public trust in health care: the system or the doctor? BMJ Qual Saf. 2004;13:92-7.
  • 10. Benkert R, Peters R, Tate N, Dinardo E. Trust of nurse practitioners and physicians among African Americans with hypertension. J Am Acad Nurse Pract. 2008;20:273-80.
  • 11. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003;118:358-65.
  • 12. Ozawa S, Walker DG. Trust in the context of community-based health insurance schemes in Cambodia: villagers’ trust in health insurers. Innovations in Health System Finance in Developing and Transitional Economies: Emerald Group Publishing Limited; 2009. p. 107-32.
  • 13. Karsavuran S, Kaya S, Akturan S. Trust in patient-physician communication: A survey in a general surgery policlinic. Hacettepe Sağlık İdaresi Dergisi. 2011;14.
  • 14. Yilmaz S, Akkaya VB. Measuring Trust Component in Patient-Physician Relationship in Dermatology. Turkderm. 2009;43:89.
  • 15. Ozaras G, Abaan S. Investigation of the trust status of the nurse–patient relationship. Nurs Ethics. 2018;25:628-39.
  • 16. Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavioral sciences: Psychology Press; 2014.
  • 17. Kavuncubasi S, Kisa A. Administration of Health Institutions. Anadolu University: Eskisehir; 2002.
  • 18. Egede LE, Ellis C. Development and testing of the multidimensional trust in health care systems scale. J Gen Intern Med. 2008;23:808.
  • 19. Ertong Attar G. Trust in the health system: The case of cardiology patients in Turkey. Journal of Graduate School of Social Sciences. 2018;22.
  • 20. Dinç L, Korkmaz F, Karabulut E. A validity and reliability study of the Multidimensional Trust in Health-Care Systems Scale in a Turkish patient population. Soc Indic Res. 2013;113:107-20.
  • 21. Sato Y, Aida J, Tsuboya T, Shirai K, Koyama S, Matsuyama Y, et al. Generalized and particularized trust for health between urban and rural residents in Japan: A cohort study from the JAGES project. Soc Sci Med. 2018;202:43-53.
  • 22. Stacey RE, Dempsey AR. The influence of trust in health care systems on postabortion contraceptive choice. Obstet Gynecol. 2014;123:111S.
  • 23. Gordon H, Pugach O, Berbaum M, Ford M. Examining patients’ trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure. Patient Educ Couns. 2014;97:173-9.
  • 24. Gupta C, Bell SP, Schildcrout JS, Fletcher S, Goggins KM, Kripalani S, et al. Predictors of health care system and physician distrust in hospitalized cardiac patients. J Health Commun. 2014;19:44-60.
  • 25. Çarkoğlu A, Kalaycıoğlu E. Türkiye'de ve Dünya'da vatandaşlık. Istanbul: Istanbul Policy Center, 2014.
  • 26. Dinç L, Gastmans C. Trust in nurse–patient relationships: A literature review. Nurs Ethics. 2013;20:501-16.
  • 27. Kuhlmann E. Traces of doubt and sources of trust: Health professions in an uncertain society. Curr Sociol. 2006;54:607-20.
  • 28. Rose A, Peters N, Shea JA, Armstrong K. Development and testing of the health care system distrust scale. J Gen Intern Med. 2004;19:57-63.
  • 29. Gunay G, Boylu AA, Bener O. Views of homemakers’ on social security system. Sosyal Güvenlik Dergisi. 2014;4:35-58.
  • 30. Hardie EA, Critchley CR. Public perceptions of Australia’s doctors, hospitals and health care systems. Med J Aust. 2008;189:210-4.
  • 31. Wu D, Lam TP, Lam KF, Zhou XD, Sun KS. Health reforms in China: the public’s choices for first-contact care in urban areas. Fam Pract. 2017;34:194-200.
  • 32. Gülcemal E, Keklik B. An investigation on factors affecting the confidence of patients to physicians: A research in İsparta. Mehmet Akif Ersoy University Journal of Social Sciences Institute. 2016;8:64-87.
  • 33. Hammond WP. Psychosocial correlates of medical mistrust among African American men. Am J Community Psychol. 2010;45:87-106.
  • 34. Tsai T-I, Yu W-R, Lee S-YD. Is health literacy associated with greater medical care trust? Int J Qual Health Care. 2018;30:514-9.
  • 35. Musa D, Schulz R, Harris R, Silverman M, Thomas SB. Trust in the health care system and the use of preventive health services by older black and white adults. Am J Public Health. 2009;99:1293-9.
  • 36. Gupta S, Brenner AT, Ratanawongsa N, Inadomi JM. Patient trust in physician influences colorectal cancer screening in low-income patients. Am J Prev Med. 2014;47:417-23.
  • 37. Alesina A, La Ferrara E. Who trusts others? Journal of Public Economics. 2002;85:207-34.
  • 38. O'Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Prev Med. 2004;38:777-85.
  • 39. Schwei RJ, Kadunc K, Nguyen AL, Jacobs EA. Impact of sociodemographic factors and previous interactions with the health care system on institutional trust in three racial/ethnic groups. Patient Educ Couns. 2014;96:333-8.
  • 40. Sun X, Meng H, Ye Z, Conner KO, Duan Z, Liu D. Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China. PloS one. 2019;14:e0211984.
  • 41. Befort CA, Nazir N, Engelman K, Choi W. Fatalistic cancer beliefs and information sources among rural and urban adults in the USA. J Cancer Educ. 2013;28:521-6.
  • 42. Dyer T, Owens J, Robinson P. The acceptability of healthcare: From satisfaction to trust. Community Dent Health. 2016;33:1-10.

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

Year 2020, Volume: 45 Issue: 3, 860 - 870, 30.09.2020
https://doi.org/10.17826/cumj.647412

Abstract

Amaç: Bu çalışmada üçüncü basamak sağlık kurumlarından hizmet alan hastaların Türk sağlık sistemine duydukları güven düzeyini ve etkileyen sosyodemografik faktörleri incelemek amaçlanmıştır.
Gereç ve Yöntem: Bu tanımlayıcı çalışma, Ankara il merkezinde bulunan üçüncü basamak sağlık hizmeti sunan altı hastanenin (üç eğitim araştırma, üç üniversite hastanesi) yatan hasta birimlerinde 493 hasta üzerinde yürütülmüştür. Veriler sosyodemografik form ve Sağlık Hizmetleri Sistemi Çok Boyutlu Güven Ölçeği ile toplanmıştır.
Bulgular: Katılımcıların yaş ortalamasının 47.7±13.1, &50.1’inin kadın, %38.3’ünün lise mezunu, %58.2’sinin işsiz, %70’inin orta düzeyde gelire sahip olduğu, %64.7’sinin kırsal bölgede yaşadığı ve %63.5’inin sağlık hizmetlerinden memnun olduğu belirlenmiştir. Sağlık Hizmetleri Sistemi Çok Boyutlu Güven Ölçeği toplam puan ortalaması 61.5±8.2, sağlık profesyonellerine duyulan güven alt boyutu için 38.1±5.2, sağlık hizmetinin maliyetini karşılayan kurumlara duyulan güven alt boyutu için 12.9±3.7 ve sağlık kurumlarına duyulan güven alt boyutu için 10.6±1.9’dur. Sağlık sistemine duyulan güven ile yaş, eğitim düzeyi, çalışma durumu, gelir düzeyi, evde yaşayan bireylerin varlığı, yaşanılan yer ve sağlık hizmetinden memnuniyet düzeyi arasında anlamlı ilişki bulunmuştur.
Sonuç: Çalışmanın bulguları doğrultusunda altmış yaşından büyük, düşük eğitimli, işsiz, düşük gelirli ve kırsal bölgede yaşayanların sağlık sistemine güvenlerinin yüksek olduğu sonucuna ulaşılmıştır. Belirtilen profil özelliklerine sahip popülasyondaki bireylerin tıbbi bilgiye daha fazla ihtiyaç duydukları ve ekonomik güçlük yaşadıkları için sağlık hizmetine görece daha fazla ihtiyaç duydukları düşünülmekte; bu durum sağlık hizmetine daha fazla güvendikleri şeklinde yorumlanmaktadır. 

References

  • 1. Hosmer LT. Trust: The connecting link between organizational theory and philosophical ethics. Acad Manage Rev. 1995;20:379-403.
  • 2. Jamison AM, Quinn SC, Freimuth VS. “You don't trust a government vaccine”: Narratives of institutional trust and influenza vaccination among African American and white adults. Social Science & Medicine. 2019.
  • 3. Rutten LJF, Hesse BW, Sauver JLS, Wilson P, Chawla N, Hartigan DB, et al. Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Adv Ther. 2016;33:1440-51.
  • 4. Ozawa S, Sripad P. How do you measure trust in the health system? A systematic review of the literature. Social Science & Medicine. 2013;91:10-4.
  • 5. Wiltshire JC, Person SD, Kiefe CI, Allison JJ. Disentangling the influence of socioeconomic status on differences between African American and white women in unmet medical needs. Am J Public Health. 2009;99:1659-65.
  • 6. Sabel CF. Studied trust: Building new forms of cooperation in a volatile economy. Hum Relat. 1993;46:1133-70.
  • 7. Ward PR. Improving access to, use of, and outcomes from public health programs: the importance of building and maintaining trust with patients/clients. Front Public Health. 2017;5:22.
  • 8. Hall MA, Dugan E, Zheng B, Mishra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79:613-39.
  • 9. Calnan MW, Sanford E. Public trust in health care: the system or the doctor? BMJ Qual Saf. 2004;13:92-7.
  • 10. Benkert R, Peters R, Tate N, Dinardo E. Trust of nurse practitioners and physicians among African Americans with hypertension. J Am Acad Nurse Pract. 2008;20:273-80.
  • 11. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003;118:358-65.
  • 12. Ozawa S, Walker DG. Trust in the context of community-based health insurance schemes in Cambodia: villagers’ trust in health insurers. Innovations in Health System Finance in Developing and Transitional Economies: Emerald Group Publishing Limited; 2009. p. 107-32.
  • 13. Karsavuran S, Kaya S, Akturan S. Trust in patient-physician communication: A survey in a general surgery policlinic. Hacettepe Sağlık İdaresi Dergisi. 2011;14.
  • 14. Yilmaz S, Akkaya VB. Measuring Trust Component in Patient-Physician Relationship in Dermatology. Turkderm. 2009;43:89.
  • 15. Ozaras G, Abaan S. Investigation of the trust status of the nurse–patient relationship. Nurs Ethics. 2018;25:628-39.
  • 16. Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavioral sciences: Psychology Press; 2014.
  • 17. Kavuncubasi S, Kisa A. Administration of Health Institutions. Anadolu University: Eskisehir; 2002.
  • 18. Egede LE, Ellis C. Development and testing of the multidimensional trust in health care systems scale. J Gen Intern Med. 2008;23:808.
  • 19. Ertong Attar G. Trust in the health system: The case of cardiology patients in Turkey. Journal of Graduate School of Social Sciences. 2018;22.
  • 20. Dinç L, Korkmaz F, Karabulut E. A validity and reliability study of the Multidimensional Trust in Health-Care Systems Scale in a Turkish patient population. Soc Indic Res. 2013;113:107-20.
  • 21. Sato Y, Aida J, Tsuboya T, Shirai K, Koyama S, Matsuyama Y, et al. Generalized and particularized trust for health between urban and rural residents in Japan: A cohort study from the JAGES project. Soc Sci Med. 2018;202:43-53.
  • 22. Stacey RE, Dempsey AR. The influence of trust in health care systems on postabortion contraceptive choice. Obstet Gynecol. 2014;123:111S.
  • 23. Gordon H, Pugach O, Berbaum M, Ford M. Examining patients’ trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure. Patient Educ Couns. 2014;97:173-9.
  • 24. Gupta C, Bell SP, Schildcrout JS, Fletcher S, Goggins KM, Kripalani S, et al. Predictors of health care system and physician distrust in hospitalized cardiac patients. J Health Commun. 2014;19:44-60.
  • 25. Çarkoğlu A, Kalaycıoğlu E. Türkiye'de ve Dünya'da vatandaşlık. Istanbul: Istanbul Policy Center, 2014.
  • 26. Dinç L, Gastmans C. Trust in nurse–patient relationships: A literature review. Nurs Ethics. 2013;20:501-16.
  • 27. Kuhlmann E. Traces of doubt and sources of trust: Health professions in an uncertain society. Curr Sociol. 2006;54:607-20.
  • 28. Rose A, Peters N, Shea JA, Armstrong K. Development and testing of the health care system distrust scale. J Gen Intern Med. 2004;19:57-63.
  • 29. Gunay G, Boylu AA, Bener O. Views of homemakers’ on social security system. Sosyal Güvenlik Dergisi. 2014;4:35-58.
  • 30. Hardie EA, Critchley CR. Public perceptions of Australia’s doctors, hospitals and health care systems. Med J Aust. 2008;189:210-4.
  • 31. Wu D, Lam TP, Lam KF, Zhou XD, Sun KS. Health reforms in China: the public’s choices for first-contact care in urban areas. Fam Pract. 2017;34:194-200.
  • 32. Gülcemal E, Keklik B. An investigation on factors affecting the confidence of patients to physicians: A research in İsparta. Mehmet Akif Ersoy University Journal of Social Sciences Institute. 2016;8:64-87.
  • 33. Hammond WP. Psychosocial correlates of medical mistrust among African American men. Am J Community Psychol. 2010;45:87-106.
  • 34. Tsai T-I, Yu W-R, Lee S-YD. Is health literacy associated with greater medical care trust? Int J Qual Health Care. 2018;30:514-9.
  • 35. Musa D, Schulz R, Harris R, Silverman M, Thomas SB. Trust in the health care system and the use of preventive health services by older black and white adults. Am J Public Health. 2009;99:1293-9.
  • 36. Gupta S, Brenner AT, Ratanawongsa N, Inadomi JM. Patient trust in physician influences colorectal cancer screening in low-income patients. Am J Prev Med. 2014;47:417-23.
  • 37. Alesina A, La Ferrara E. Who trusts others? Journal of Public Economics. 2002;85:207-34.
  • 38. O'Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Prev Med. 2004;38:777-85.
  • 39. Schwei RJ, Kadunc K, Nguyen AL, Jacobs EA. Impact of sociodemographic factors and previous interactions with the health care system on institutional trust in three racial/ethnic groups. Patient Educ Couns. 2014;96:333-8.
  • 40. Sun X, Meng H, Ye Z, Conner KO, Duan Z, Liu D. Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China. PloS one. 2019;14:e0211984.
  • 41. Befort CA, Nazir N, Engelman K, Choi W. Fatalistic cancer beliefs and information sources among rural and urban adults in the USA. J Cancer Educ. 2013;28:521-6.
  • 42. Dyer T, Owens J, Robinson P. The acceptability of healthcare: From satisfaction to trust. Community Dent Health. 2016;33:1-10.
There are 42 citations in total.

Details

Primary Language English
Subjects Primary Health Care
Journal Section Research
Authors

Dilara Usta 0000-0003-1300-0678

Fatoş Korkmaz 0000-0003-4457-8691

Publication Date September 30, 2020
Acceptance Date May 11, 2020
Published in Issue Year 2020 Volume: 45 Issue: 3

Cite

MLA Usta, Dilara and Fatoş Korkmaz. “Trust Levels in the Healthcare System of the Patients Receiving Services from Tertiary Care Institutions in Turkey”. Cukurova Medical Journal, vol. 45, no. 3, 2020, pp. 860-7, doi:10.17826/cumj.647412.