背景:全球卫生前景信任是实现国际卫生倡议的关键要求,但它仍然是一个难以捉摸的概念,通常不考虑其尺寸而动员起来,司机和下游行为后果。本文旨在从老挝人民民主共和国农村的中低收入国家的角度为“患者对初级医疗保健的信任”的概念发展和衡量做出贡献。
方法:在2021年1月至2023年4月之间实施了两相混合方法研究设计。第一阶段涉及探索性定性研究,以了解初级医疗保健中患者信任的本地表达和维度,在Bokeo省的八个村庄进行了25次半结构化访谈和17次焦点小组讨论(120名参与者)。第二阶段涉及解释性研究,以系统地评估四个省14个村庄的信任模式,其中26次认知访谈,17位专家访谈和非参与者社区观察为1838位参与者的社区人口普查提供了依据。我们通过面向内容的主题分析分析了定性数据,并在此基础上制定了8项信任量表。定量数据分析采用描述性统计和回归分析。
结果:我们发现,在老挝人民民主共和国农村地区,对初级医疗保健的信任很容易理解,并且具有内在的价值。关键维度包括通信,尊重的照顾,关系,公平,完整性,声誉,保证治疗和能力。调查强调了这一声誉,能力,诚信和尊重关怀的信任得分最低。卫生中心的运营预测了当地的信任表达。信任的行为后果仅限于与孕妇接受产前护理的积极统计关联,但也被其他措施所抵消,这些措施也抓住了医疗保健设施的可用性。
结论:总体而言,我们量化信任量表的开发为未来的研究人员提供了一个过程模型。我们得出结论,人际关系,机构和服务相关的信任需要在卫生系统发展和纳入卫生政策中得到更明确的承认。
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.