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Bertram M, Brandt US, Hansen RK, Svendsen GT. Does higher health literacy lead to higher trust in public hospitals? Int J Equity Health 2021; 20:209. [PMID: 34530812 PMCID: PMC8447678 DOI: 10.1186/s12939-021-01528-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Does higher health literacy lead to higher trust in public hospitals? Existing literature suggests that this is the case since a positive association between the level of health literacy and the level of trust in physicians and the health care system has been shown. This study aims to challenge this assumption. Methods Based on theoretical arguments from game theory and analysis of empirical data, we argue that the association is better described as an inversely u-shaped curve, suggesting that low and high levels of health literacy lead to a lower level of trust than a medium level of health literacy does. The empirical analysis is based on a study of the Danes’ relationship to the overall health care system. More than 6000 Danes have been asked about their overall expectations of the health service, their concrete experiences and their attitudes to a number of change initiatives. Results Game theory analysis show that the combined perceived cooperation and benefit effects can explain an inversely u-shaped relationship between social groups and trust in the health care system. Based on quantitative, binary regression analyses of empirical data, the lowest degree of trust is found among patients from the lowest and highest social groups, while the highest degree of trust is found in the middle group. The main driver for this result is that while patients having low health literacy perceive that the health care system is not cooperative, patients with a high level of health literacy have high expectations about the quality, which the health care system might not be able to provide. This reduces the perceived benefit from their encounter with the health care system. Conclusion It is important that health care professionals understand that some patient groups have a higher chance of cooperation (e.g., agreeing on the choice of treatment) or defection (e.g. passing a complaint) than others. In perspective, future research should undertake further qualitative examinations of possible patient types and their demands in relation to different health care sectors, focusing specifically on the opportunities to improve the handling of different patient types.
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Affiliation(s)
- Maja Bertram
- Department of Public Health, Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
| | - Urs Steiner Brandt
- Department of Sociology, Environmental and Business Economic, University of Southern Denmark, Esbjerg, Denmark
| | - Rikke Klitten Hansen
- Department for Planning and Finances, Odense University Hospital, Odense, Denmark
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Oksavik JD, Solbjør M, Kirchhoff R, Sogstad MKR. Games of uncertainty: the participation of older patients with multimorbidity in care planning meetings - a qualitative study. BMC Geriatr 2021; 21:242. [PMID: 33849484 PMCID: PMC8045290 DOI: 10.1186/s12877-021-02184-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Active patients lie at the heart of integrated care. Although interventions to increase the participation of older patients in care planning are being implemented in several countries, there is a lack of knowledge about the interactions involved and how they are experienced by older patients with multimorbidity. We explore this issue in the context of care-planning meetings within Norwegian municipal health services. METHODS This qualitative study drew on direct observations of ten care-planning meetings and an interview with each patient right after the meeting. Following a stepwise-deductive induction approach, the analysis began inductively and then considered the interactions through the lens of game theory. RESULTS The care-planning interactions were influenced by uncertainty about the course of the disease and how to plan service delivery. In terms derived from game theory, the imaginary and unpredictable player 'Nature' generated uncertainty in the 'game' of care planning. The 'players' assessed this uncertainty differently, leading to three patterns of game. 1) In the 'game of chance', patients viewed future events as random and uncontrollable; they felt outmatched by the opponent Nature and became passive in their decision-making. 2) In the 'competitive game', participants positioned themselves on two opposing sides, one side perceiving Nature as a significant threat and the other assigning it little importance. The two sides negotiated about how to accommodate uncertainty, and the level of patient participation varied. 3) In the 'coordination game', all participants were aligned, either in viewing themselves as teammates against Nature or in ascribing little importance to it. The level of patient participation was high. CONCLUSIONS In care planning meetings, the level of patient participation may partly be associated with how the various actors appraise and respond to uncertainty. Dialogue on uncertainty in care-planning interventions could help to increase patient participation.
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Affiliation(s)
- Jannike Dyb Oksavik
- Department for Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Institutt for helsevitenskap, NTNU i Ålesund, Ålesund, Norway
| | - Marit Solbjør
- Department of Public Health and Nursing, Trondheim, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Institutt for samfunnsmedisin og sykepleie, NTNU, Øya Helsehus, Mauritz Hansens gate 2, Trondheim, Norway
| | - Ralf Kirchhoff
- Department for Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Institutt for helsevitenskap, NTNU i Ålesund, Ålesund, Norway
| | - Maren Kristine Raknes Sogstad
- Department for Health Sciences, The Centre for Care Research, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU i Gjøvik, Gjøvik, Norway
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Yu J, Zhang T, Liu Z, Hatab AA, Lan J. Tripartite Data Analysis for Optimizing Telemedicine Operations: Evidence from Guizhou Province in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E375. [PMID: 31935950 PMCID: PMC6981610 DOI: 10.3390/ijerph17010375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/01/2020] [Accepted: 01/03/2020] [Indexed: 12/21/2022]
Abstract
Telemedicine is an innovative approach that helps alleviate the health disparity in developing countries and improve health service accessibility, affordability, and quality. Few studies have focused on the social and organizational issues involved in telemedicine, despite in-depth studies of and significant improvements in these technologies. This paper used evolutionary game theory to analyze behavioral strategies and their dynamic evolution in the implementation and operation of telemedicine. Further, numerical simulation was carried out to develop management strategies for promoting telemedicine as a new way of delivering health services. The results showed that: (1) When the benefits are greater than the costs, the higher medical institutions (HMIs), primary medical institutions (PMIs), and patients positively promote telemedicine with benign interactions; (2) when the costs are greater than the benefits, the stability strategy of HMIs, PMIs, and patients is, respectively, 'no efforts', 'no efforts', and 'non-acceptance'; and (3) promotion of telemedicine is influenced by the initial probability of the 'HMI efforts', 'PMI efforts', and 'patients' acceptance' strategy chosen by the three stakeholders, telemedicine costs, and the reimbursement ratio of such costs. Based on theoretical analysis, in order to verify the theoretical model, this paper introduces the case study of a telemedicine system integrated with health resources at provincial, municipal, county, and township level in Guizhou. The findings of the case study were consistent with the theoretical analysis. Therefore, the central Chinese government and local governments should pay attention to the running cost of MIs and provide financial support when the costs are greater than the benefits. At the same time, the government should raise awareness of telemedicine and increase participation by all three stakeholders. Lastly, in order to promote telemedicine effectively, it is recommended that telemedicine services are incorporated within the scope of medical insurance and the optimal reimbursement ratio is used.
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Affiliation(s)
- Jinna Yu
- Business School, Guizhou Minzu University, Guiyang 550025, China;
| | - Tingting Zhang
- School of Economics and Management, University of Science and Technology Beijing, Beijing 100083, China;
| | - Zhen Liu
- School of Business, Nanjing Normal University, Nanjing 210023, China;
| | - Assem Abu Hatab
- Department of Economics, Swedish University of Agricultural Sciences, P.O. Box 7013, SE-750 07 Uppsala, Sweden;
- Department of Economics & Rural Development, Arish University, Al-Arish 45511, North Sinai, Egypt
| | - Jing Lan
- College of Public Administration, Nanjing Agricultural University, Nanjing 210095, China
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Simulation of avascular tumor growth by agent-based game model involving phenotype-phenotype interactions. Sci Rep 2015; 5:17992. [PMID: 26648395 PMCID: PMC4673614 DOI: 10.1038/srep17992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/06/2015] [Indexed: 01/01/2023] Open
Abstract
All tumors, both benign and metastatic, undergo an avascular growth stage with nutrients supplied by the surrounding tissue. This avascular growth process is much easier to carry out in more qualitative and quantitative experiments starting from tumor spheroids in vitro with reliable reproducibility. Essentially, this tumor progression would be described as a sequence of phenotypes. Using agent-based simulation in a two-dimensional spatial lattice, we constructed a composite growth model in which the phenotypic behavior of tumor cells depends on not only the local nutrient concentration and cell count but also the game among cells. Our simulation results demonstrated that in silico tumors are qualitatively similar to those observed in tumor spheroid experiments. We also found that the payoffs in the game between two living cell phenotypes can influence the growth velocity and surface roughness of tumors at the same time. Finally, this current model is flexible and can be easily extended to discuss other situations, such as environmental heterogeneity and mutation.
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Wong ST, Lynam MJ, Khan KB, Scott L, Loock C. The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families. BMC Pediatr 2012; 12:158. [PMID: 23034058 PMCID: PMC3507695 DOI: 10.1186/1471-2431-12-158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 09/26/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The Responsive Interdisciplinary Child-Community Health Education and Research (RICHER) initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC) model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for 'at risk' children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1) access to health care for children and families with multiple forms of disadvantage and 2) patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach. METHODS This was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86) and thematic analyses of patient interview data (n=7) were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment. RESULTS Respondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider's interpersonal style (e.g., being treated as an equal), was very important. Even after controlling for parents' education and ethnicity, the provider's interpersonal style remained positively associated with parent-reported empowerment (p<0.01). CONCLUSIONS This model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can better meet the health and health care needs of people, especially those who are vulnerable due to multiple intersecting social determinants of health. Positive interpersonal communication from providers can play a key role in facilitating situations where individuals have an opportunity to experience success in managing their and their family's health.
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Affiliation(s)
- Sabrina T Wong
- University of British Columbia, School of Nursing and Research, 6190 Agronomy Road, #302, Vancouver, V6T 1Z3, BC, Canada
- University of British Columbia, Centre for Health Services Policy, #201-2206 East Mall, Vancouver, V6T-1Z3, BC, Canada
| | - M Judith Lynam
- University of British Columbia, School of Nursing and Research, 6190 Agronomy Road, #302, Vancouver, V6T 1Z3, BC, Canada
| | - Koushambhi B Khan
- University of British Columbia, School of Nursing and Research, 6190 Agronomy Road, #302, Vancouver, V6T 1Z3, BC, Canada
| | - Lorine Scott
- Children’s Hospital, K1-111, 4480 Oak Street, Vancouver, V6H 3V4, BC, Canada
| | - Christine Loock
- Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, V5M 3E8, BC, Canada
- Department of Paediatrics, UBC Faculty of Medicine, 4480 Oak Street, Vancouver, V6H 3V4, BC, Canada
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Djulbegovic B, Hozo I. When is it rational to participate in a clinical trial? A game theory approach incorporating trust, regret and guilt. BMC Med Res Methodol 2012; 12:85. [PMID: 22726276 PMCID: PMC3473303 DOI: 10.1186/1471-2288-12-85] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 05/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) remain an indispensable form of human experimentation as a vehicle for discovery of new treatments. However, since their inception RCTs have raised ethical concerns. The ethical tension has revolved around "duties to individuals" vs. "societal value" of RCTs. By asking current patients "to sacrifice for the benefit of future patients" we risk subjugating our duties to patients' best interest to the utilitarian goal for the good of others. This tension creates a key dilemma: when is it rational, from the perspective of the trial patients and researchers (as societal representatives of future patients), to enroll in RCTs? METHODS We employed the trust version of the prisoner's dilemma since interaction between the patient and researcher in the setting of a clinical trial is inherently based on trust. We also took into account that the patient may have regretted his/her decision to participate in the trial, while a researcher may feel guilty because he/she abused the patient's trust. RESULTS We found that under typical circumstances of clinical research, most patients can be expected not to trust researchers, and most researchers can be expected to abuse the patients' trust. The most significant factor determining trust was the success of experimental or standard treatments, respectively. The more that a researcher believes the experimental treatment will be successful, the more incentive the researcher has to abuse trust. The analysis was sensitive to the assumptions about the utilities related to success and failure of therapies that are tested in RCTs. By varying all variables in the Monte Carlo analysis we found that, on average, the researcher can be expected to honor a patient's trust 41% of the time, while the patient is inclined to trust the researcher 69% of the time. Under assumptions of our model, enrollment into RCTs represents a rational strategy that can meet both patients' and researchers' interests simultaneously 19% of the time. CONCLUSIONS There is an inherent ethical dilemma in the conduct of RCTs. The factors that hamper full co-operation between patients and researchers in the conduct of RCTs can be best addressed by: a) having more reliable estimates on the probabilities that new vs. established treatments will be successful, b) improving transparency in the clinical trial system to ensure fulfillment of "the social contract" between patients and researchers.
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Affiliation(s)
- Benjamin Djulbegovic
- Center for Evidence-based Medicine and Health Outcome Research, Clinical Translational Science Institute and Department of Internal Medicine, University of South Florida, Tampa, FL, USA
- Departments of Hematology and Health Outcome Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- 12901 Bruce B. Downs Blvd, MDC02, Tampa, FL, 33612, USA
| | - Iztok Hozo
- Department of Mathematics, Indiana University, Gary, IN, 46408, USA
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Thom DH, Wong ST, Guzman D, Wu A, Penko J, Miaskowski C, Kushel M. Physician trust in the patient: development and validation of a new measure. Ann Fam Med 2011; 9:148-54. [PMID: 21403142 PMCID: PMC3056863 DOI: 10.1370/afm.1224] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Mutual trust is an important aspect of the patient-physician relationship with positive consequences for both parties. Previous measures have been limited to patient trust in the physician. We set out to develop and validate a measure of physician trust in the patient. METHODS We identified candidate items for the scale by content analysis of a previous qualitative study of patient-physician trust and developed and validated a scale among 61 primary care clinicians (50 physicians and 11 nonphysicians) with respect to 168 patients as part of a community-based study of prescription opioid use for chronic, nonmalignant pain in HIV-positive adults. Polychoric factor structure analysis using the Pratt D matrix was used to reduce the number of items and describe the factor structure. Construct validity was tested by comparing mean clinician trust scores for patients by clinician and patient behaviors expected to be associated with clinician trust using a generalized linear mixed model. RESULTS The final 12-item scale had high internal reliability (Cronbach α =.93) and a distinct 2-factor pattern with the Pratt matrix D. Construct validity was demonstrated with respect to clinician-reported self-behaviors including toxicology screening (P <.001), and refusal to prescribe opioids (P <.001) and with patient behaviors including reporting opioids lost or stolen (P=.008), taking opioids to get high (P <.001), and selling opioids (P<.001). CONCLUSIONS If validated in other populations, this measure of physician trust in the patient will be useful in investigating the antecedents and consequences of mutual trust, and the relationship between mutual trust and processes of care, which can help improve the delivery of clinical care.
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Affiliation(s)
- David H Thom
- Department of Family and Community Medicine, University of California, San Francisco, USA.
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Tarrant C, Dixon-Woods M, Colman AM, Stokes T. Continuity and trust in primary care: a qualitative study informed by game theory. Ann Fam Med 2010; 8:440-6. [PMID: 20843886 PMCID: PMC2939420 DOI: 10.1370/afm.1160] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The relationship between continuity of care and patient trust in primary care is not fully understood. We report an empirical investigation, informed by game theory, of patients' accounts of their trust in general practitioners (GPs). METHODS We conducted an analysis based on the constant comparative method of 20 semistructured interviews with patients about trust in GPs in the United Kingdom. RESULTS People use institutional trust, derived from expectations of medicine as an institution and doctors as professionals, as a starting point for their transactions with unfamiliar doctors. This expectation may be enough to allow patients the minimum of what they want from doctors and is often sufficient for single-episode encounters, where patients have specific goals. Repeated interactions with the same doctor can allow patients to develop more secure expectations, based on a history of other interactions and anticipation of future interactions. Secure trust can develop over time, especially if patients are convinced that the doctor has their interests at heart. CONCLUSIONS This work identifies dynamics inherent in repeated interactions that enable secure trust to develop. These findings have important implications for the design of services, which in the United Kingdom and elsewhere are increasingly focused on enhancing access rather than continuity. They suggest that patients do not see GPs as interchangeable and that the move toward organizing services around single encounters may disrupt the development of secure trust.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
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Evolutionary game theory: lessons and limitations, a cancer perspective. Br J Cancer 2009; 101:2060-1; author reply 2062-3. [PMID: 19920827 PMCID: PMC2795450 DOI: 10.1038/sj.bjc.6605444] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Tarrant C, Colman AM, Stokes T. Past experience, 'shadow of the future', and patient trust: a cross-sectional survey. Br J Gen Pract 2008; 58:780-3, i-vi. [PMID: 19000401 PMCID: PMC2573976 DOI: 10.3399/bjgp08x342615] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 05/01/2008] [Accepted: 06/19/2008] [Indexed: 10/31/2022] Open
Abstract
Recent changes to the organisation and delivery of primary care in the UK have the potential to reduce continuity of care markedly, but it is not clear how this will have an impact on patient trust. This study aims to test the associations between specific aspects of continuity in the GP-patient relationship, and patient trust, informed by the theoretical framework of behavioural game theory. A cross-sectional survey of patients in three Leicestershire general practices was conducted. Regression analysis showed that ratings of the GP's interpersonal care, past experience of cooperation, and expectation of continuing care from the GP were all independent predictors of patient trust. These findings highlight the value of longitudinal aspects of the GP-patient relationship.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Hughes D. Medicines concordance and game theory. Br J Clin Pharmacol 2008; 66:577. [PMID: 18754847 DOI: 10.1111/j.1365-2125.2008.03260.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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