Exploring individual's public trust in the NHS Test and Trace System - A pragmatic reflexive thematic analysis

Context

Digital contact tracing uses automated systems and location technology embedded on smartphone software for efficient identification of individuals exposed to COVID-19. Such systems are only effective with high compliance, yet compliance is mediated by public trust in the system. This work explored the perception of individual's trust and expectation of the broader Test and Trace system in the United Kingdom (UK) with the upcoming release of the National Health Service's (NHS) COVID-19 app as a case example.

Methods

Twelve adults underwent online semi-structured interviews in August 2020, prior to public availability of the COVID-19 app. Pragmatic reflexive thematic analysis was applied inductively to explore common themes between participants, using an organic and recursive process (Braun & Clarke, 2019).

Results

Themes highlighted features of the technology that would be perceived to be trustworthy (Theme 1), and concerns relating to i) whether users would comply with a T&T system (Theme 2) and ii) how a T&T system would handle user's personal data (Theme 3). Two further themes built on aspects of automation within a T&T system and its impact on trust (Theme 4) and how the media altered perceptions of the T&T system (Theme 5).

Conclusions

Participants outlined the need for different user requirements that could be built into the NHS COVID-19 app that would support increased adherence. Concurrently, participants raised questions surrounding personal data and privacy of their data, plus the level of automated versus manual tasks, which impacted perception of trust in the app and wider system. Additionally, themes highlighted that T&T systems do not happen within a vacuum, but within a pre-existing environment influenced by variables such as the media and perception of other's compliance to T&T.

Implications

Since it's roll-out, controversies surrounding the UK T&T system include concerns about privacy, stigma and uptake. Considering the current piece of work, which anticipated similar concerns prior to public access to COVID-19 app, engaging with the public may have been an important step in improving the perception and compliance with the app. Principles fundamental to patient and public involvement (PPI) and Responsible Research and Innovation (RRI) such as the inclusion of the public in the early development of research and aligning the outcomes of research and innovation with broader societal values and expectations would have been well-applied to this system and should be applied to future autonomous systems requiring high public uptake.

Analysis of causal relations between vaccine hesitancy for COVID-19 vaccines and ideological orientations in Brazil

This article presents a causal inference analysis of vaccine hesitancy for Coronavirus disease 2019 (COVID-19) vaccines based on socio-demographic data obtained via questionnaires applied to a sample of the Brazilian population. This data includes the respondents' political preferences, age group, education, salary range, country region, sex, believing fake news, vaccine confidence, and intention to get the COVID-19 vaccine. The research created a causal graph using these variables, seeking to answer questions about the probability of people getting vaccinated. The results of this research corroborate findings observed in the literature, also presenting unique findings: (i) The perception that the vaccine is safe is positively affected by age group and negatively by religion; (ii) The older the person, the greater the probability of considering the vaccine safe and, consequently, of getting vaccinated; (iii) The religion variable showed great importance in the model since it has a simultaneous causal effect on political preferences and the perception of vaccine safety; (iv) The data reveal that the probability of a person accepting the vaccination against COVID-19 is reduced given the fact that they believe fake news related to the vaccine. The methodology applied in this research can be replicated for populations from other countries so that it is possible to generate customized models. General causal models can be helpful for agencies dealing with vaccine hesitancy to decide which variables should be addressed to reduce this phenomenon.

Trust in public health policy in the time of the COVID-19 epidemic in Israel

The government of Israel provides universal health care through four health care organizations ("sick funds") that enjoy general public trust. In hindsight, the response of the government to the COVID-19 epidemic seems reasonable. In the first year of the epidemic, tests and vaccines were developed and other measures were taken, including social distancing, focusing on risk factors for infection and disease severity, and improving treatment. The COVID-19 mortality rate between January 2000 and June 2021 was around 750 per million inhabitants, well below the OECD average of 1300. Still, although the control measures were largely well received, the media and an ad hoc non-governmental Emergency Council for the coronavirus crisis in Israel criticized the government's response to the epidemic thereby contributing to a decline in public trust in government policy. This commentary provides an overview of the importance of trust in medical institutions and the difficulties of evaluating healthcare decisions in an attempt to justify three conclusions. First, when physicians and self-appointed experts publicly disapprove of a government policy, they should consider the trade-off between improving care and undermining public trust. Second, when evaluating a medical decision, experts should not ask, "Would I have acted differently?" but rather, "Was the decision under review completely unreasonable?" Thirdly, criticism is certainly worth listening to. However, I believe that by calling for organized resistance against the government, the publicly announced establishment of the Emergency Council for the Corona crisis blatantly crossed the line between constructive criticism and destructive mistrust.

Global matters of epidemiology and the ethical challenges of addressing the health of populations

PURPOSE

The American College of Epidemiology (ACE) held its 2022 Annual Meeting, September 8-11, with a conference theme of 'Pandemic of Misinformation: Building Trust in Epidemiology'. The ACE Ethics Committee hosted a symposium session in recognition of the global spotlight placed on epidemiology and public health due to the COVID-19 crisis. The ACE Ethics Committee invited previous Chairs of the Ethics Committee and current President of the International Epidemiological Association to present at the symposium session. This paper aims to highlight the ethical challenges presented during the symposium session.

METHODS

Three speakers with diverse backgrounds representing expertize from the fields of ethics, epidemiology, public health, clinical trials, pharmacoepidemiology, statistics, law, and public policy, covering perspectives from the U.S., Europe, and Southeast Asia were selected to present on the ethical challenges in epidemiology and public health applying a global theme. Dr. D. Weed presented on 'Causation, Epidemiology and Ethics'; Dr. C.M. Pandey presented on the 'Ethical Challenges in the Practice of Digital Epidemiology'; and Dr. J. Acquavella presented on 'Departures from Scientific Objectivity: A Cause of Eroding Trust in Epidemiology.'

RESULTS

The collective goal to improve the public's health was a mutually shared theme across the three distinct areas. We highlight the common ethical guidance and principle-based approaches that have served epidemiology and public health in framing and critical analysis of novel challenges, including autonomy, beneficence, justice, scientific integrity, duties to the profession and community, and developing and maintaining public trust; however, gaps remain in how best to address health inequalities and the novel emergence and pervasiveness of misinformation and disinformation that have impacted the health of the global community. We introduce an ethical framework of translational bioethics that places considerations of the social determinants of health at the forefront.

CONCLUSIONS

The COVID-19 pandemic required an expedited public health response and, at the same time, placed the profession of epidemiology and public health, its system, and structures, under the microscope like never before. This article illustrates that revisiting our foundations in research and practice and orienting contemporary challenges using an ethical lens can assist in identifying and furthering the health of populations globally.

What is public trust in national electronic health record systems? A scoping review of qualitative research studies from 1995 to 2021

Objective

Public trust in national electronic health record systems is essential for the successful implementation within a healthcare system. Research investigating public trust in electronic health records is limited, leading to a lack of conceptual clarity. In response, the objective of this study is to gain a clearer understanding on the conceptualizations of public trust in electronic health records, which can support the implementation of national electronic health record systems.

Methods

Guided by the PRISMA-ScR checklist, a scoping review of 27 qualitative studies on public trust in electronic health records found between January 2022 and June 2022 was conducted using an inclusive search method. In an iterative process, conceptual themes were derived describing the promoters and outcomes of public trust in electronic health records.

Results

Five major conceptual themes with 15 sub-themes were present across the literature. Comprehension, autonomy, and data protection promote public trust in electronic health record; while personal and system benefits are the outcomes once public trust in electronic health records exists. Additional findings highlight the pivotal role of healthcare actors for the public trust building process.

Conclusions

The results underscore comprehension, autonomy, and data protection as important themes that help ascertain and solidify public trust in electronic health records. As well, health system actors have the capacity to promote or hinder national electronic health record implementation, depending on their actions and how the public perceives those actions. The findings can assist researchers, policymakers, and other health system actors in attaining a better understanding of the intricacies of public trust in electronic health records.

Use of the socio-ecological model to explore trusted sources of COVID-19 information in Black and Latinx communities in Michigan

BACKGROUND

Identifying trusted sources of health information and exploring what makes these sources trustworthy is an important aspect of public health. This exploration requires embracing the cultural differences in minoritized communities, which are often treated as homogeneous. This qualitative study identifies and analyze the sources of trusted COVID-19 information among Black and Latinx communities in Michigan and assesses the rationale underlying this trust.

METHODS

Interviews were conducted with 24 Black and 16 Latinx participants (n = 40) in four Michigan counties significantly impacted by COVID-19. The socio-ecological model was applied as an analytical framework for understanding the entities considered trusted sources of information. Within each level of the model, the dimensions of trustworthiness most salient for participants were identified.

RESULTS

We found that sources of information came from all levels of the model, including interpersonal (COVID-19 survivors, church representatives, friends, relatives), organizational (employers, healthcare providers, traditional news reports), social media (hybrid source), community (members and groups), and public policy (county health department, federal and state government). Furthermore, participants determined whether they could trust information about COVID-19 by cross-referencing multiple resources. We identified competence, confidence, communication, and system trust as the dimensions of trustworthiness most often reported by participants.

CONCLUSIONS

Our research suggests public health communications should engage in cross-referencing practices, providing information from sources at all levels of interaction, cultural competency, and awareness of historical/structural inequities. These efforts would be further strengthened by attending to needs for both factual information as well as care and personal connection.

Drivers of social acceptance of natural-resource management: A comparison of the public and professionals in California

The social impacts of natural resource management are challenging to evaluate because their perceived benefits and costs vary across stakeholder groups. Nevertheless, ensuring social acceptance is essential to building public support for adaptive measures required for the sustainable management of ecosystems in a warming climate. Based on surveys with both members of the public and natural-resource professionals in California, we applied structural-equation modeling to examine how psychological factors impact individuals' attitudes toward management's capacity to reduce the impacts of disturbance events, including wildfires, smoke from wildfires, drought, water shortages, tree mortality, and utility failure. We found the members of the public more optimistic than natural-resource professionals, perceiving management capacity to be on average 3.04 points higher (of 10) and displaying higher levels of trust of the government on both the state (Δ = 11%) and federal levels (Δ = 19%). Personal experience with natural-resource events had a positive effect on perceived management in both the public (1.26) and the professional samples (5.05), whereas perceived future risk had a negative effect within both samples (professional = -0.91, public = -0.45). In addition, higher trust and perceived management effectiveness were also linked with higher perceptions of management capacity in the public sample (1.81 versus 1.24), which could affect the acceptance of management actions. Continued social acceptance in a period of increasing risk may depend on managers sharing personal experiences and risk perception when communicating with the public. The contemporary shift toward multibenefit aims is an important part of that message.

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

BACKGROUND

Policy 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.

METHODS

For 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.

RESULTS

Among 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.

CONCLUSIONS

Examining populations' perceived trust in healthcare institutions and tailoring health messages to vulnerable populations can promote public trust in healthcare systems.

'We were the Guinea pigs': Police uncertainty enforcing coronavirus regulations in the UK

The regulations introduced under the UK's Coronavirus Act 2020 to help curb the spread of COVID-19 caused considerable confusion due to conflation between what was regarded as 'guidance' and what was 'law'. The fast-paced nature of the pandemic meant that restrictions on public liberty and increased police powers to enforce the new 'rules' led to accusations of over-zealous enforcement behaviour of some officers, including a record number of Fixed Penalty Notices (FPNs) issued. This paper explores the experiences of police officers in a range of English police forces, using 28 h of qualitative interview data at two research points in time (2020 and 2022). The extracts presented here illustrate some of the challenges that officers faced enforcing the frequently changing rules and regulations during the COVID-19 pandemic in the UK.

Public conformism with health regulation is crumbling as COVID-19 becomes a chronic threat: Repeated Cross-sectional Studies

BACKGROUND

The purpose of this study is to analyze the long terms trends in public attitudes toward the COVID-19 pandemic and compliance with self-quarantine regulations.

METHODS

Repeated cross-sectional studies looking into data collected from nationally representative samples (N = 2568) of the adult population in Israel at five points in time representing the five morbidity waves of the COVID-19 pandemic. This study examined public trust in Israeli health regulations, levels of public panic, feelings of personal worry, and compliance with health regulations, specifically self-quarantine.

RESULTS

Public trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value of nearly 75% measured in March 2020. While reported worry is steadily reducing, the perception of public panic is increasing. In earlier rounds, public compliance with self-quarantine was reported close to 100%; however, it has dropped to 38% by January 2022 when compensation is not assumed. Regression analysis suggests that trust is a major predictor of compliance with health regulations.

CONCLUSIONS

The "fifth wave" of the COVID-19 pandemic brought about an all-time low in public trust in health regulations. The Israeli public, normally a highly compliant one, is showing signs of crumbling conformity.

The Value-Free Ideal of Science: A Useful Fiction? A Review of Non-epistemic Reasons for the Research Integrity Community

Even if the "value-free ideal of science" (VFI) were an unattainable goal, one could ask: can it be a useful fiction, one that is beneficial for the research community and society? This question is particularly crucial for scholars and institutions concerned with research integrity (RI), as one cannot offer normative guidance to researchers without making some assumptions about what ideal scientific research looks like. Despite the insofar little interaction between scholars studying RI and those working on values in science, the overlap of topics and interests make collaboration between the two fields promising for understanding research and its ethics. Here, we identify-for the use of RI scholars-the non-epistemic reasons (societal, political, professional) for and against the VFI considered in the literature. All of these are concerned with the beneficial or detrimental consequences that endorsing the VFI would have on society, policy-making, or the scientific community, with some authors appealing to the same principles to argue for opposite positions. Though most of the reviewed articles do not endorse the VFI, it is generally agreed that some constraints have to be put on the use of non-epistemic values. Disagreement on the utility of the VFI lies both on the different epistemic-descriptive positions taken by different authors, and on the scarcity of relevant empirical studies. Engaging critically with the reasons here identified and more in general with the values in science debate will help the RI community decide whether the VFI should be included in future codes of conduct.

Expanding and Evaluating Public Satisfaction with Wildlife Governance: Insights from Deer Management in Indiana, USA

Wildlife agencies in North America desire to incorporate broader public interests into decision-making so they can realize the principle of governing wildlife in the public trust. Public satisfaction is a key component of good governance but evaluating satisfaction with wildlife management focuses on traditional user experiences rather than perceptions of agency performance. We draw from political science, business, and conservation social science to develop a multidimensional concept of satisfaction with wildlife management that includes agency performance, service quality, trust in the managing agency, and informational trust. We use data collected from a 2021 survey of Indiana residents to analyze the social and cognitive determinants of satisfaction with white-tailed deer (Odocoileus virginianus) management. Quantile regression models revealed that respondents' acceptability of management methods and deer-related concerns most strongly affected performance and quality components, whereas respondent characteristics mostly affected trust components of the index. Future research should associate satisfaction with key variables we did not fully capture including perceived control, psychological distance, and norms of interaction between wildlife agencies and the public. Expanding agency conceptions of public satisfaction represents a critical step toward public trust thinking and the practice of good wildlife governance in North America.

Seemingly bounded knowledge, trust, and public acceptance: How does citizen's environmental knowledge affect facility siting?

Understanding the mechanism of public perception and behavior towards environmental goods provision is essential for effective sustainable governance. This paper studies how citizens' self-reported environmental knowledge affects their trust in public service providers and subsequently their decisions about accepting the provision of a pollution management facility in their neighborhood. Utilizing unique survey data on the siting of a facility for waste incineration in Guangzhou, China, we find that the public's perceived environmental knowledge damages their trust in the operator, which lowers their acceptance of the facility siting, while damage to their trust in the government is negligible. In addition, we find that citizens' preferences for the type of information disclosed and the channels used for disclosure can affect public trust and thus acceptance of the facility siting. Therefore, policy suggestions for urban planning for sustainability are that the urban planner and policy maker can mitigate the negative consequences of bounded environmental knowledge by ensuring there is appropriate information disclosure. This study broadens our understanding of public recognition and acceptance of environmental goods provision and provides practical suggestions for sustainable development.

The connection between COVID-19 vaccine abundance, vaccination coverage, and public trust in government across the globe

This study investigates that how the number of COVID-19 vaccines secured correlates with the vaccination coverage (full and booster) depending on whether there is trust in national government or not across 47 countries. The data are based on global figures as of Nov. 2021 and Feb. 2022 while measures for confidence in government is according to Gallup World Poll, Oct. 2021. The model includes an interaction term of the two key variables, also controls for a range of socio-economic factors and country specific variables. The results indicate a non-linear and mixed relationship between the numbers secured, the public trust, and the vaccination rate. In Feb. 2022, with confidence in government, securing number of vaccines to cover 200% of the population (or more) increased the full vaccination rate by 12.26% (95% CI: 11.70 - 12.81); where number secured was 300% (or more), the coverage increased by 7.46% (95% CI: 6.95 - 7.97). Under similar scenarios, rate of booster shots increased by 13.16% (95% CI: 12.62 - 13.70; p < 0.01) and 14.36% (95% CI: 13.86 - 14.85; p < 0.01), respectively. Where the number secured fell below 200%, confidence in government had a revers relationship with the rate of full vaccination (-2.65; 95% CI: -3.32 - -1.99), yet positive with the rate of booster shots (1.65; 95% CI: 1.18 - 2.12). These results indicate that better success can be achieved by a combination of factors including securing sufficient number of vaccines and also ensuring the public trust. Vaccine abundance, however, cannot be translated into greater success in vaccination coverage. This study highlights the importance of efficiency in acquiring vaccine resources and need for improvement in public belief in immunization programmes rather than stock piling.

The deployment of social media by political authorities and health experts to enhance public information during the COVID-19 pandemic

Social media have increasingly been used by political bodies and experts to disseminate health information to the public. However, we still know little about how the communication of these actors on social media is received by other users and how it reflects trends in public trust. We examined social media dynamics in the communication of information by major actors (n = 188) involved in COVID-19 online discussions in Switzerland. These actors are scientists (experts), policymakers (government officials, cantonal executives, and other parties), and representatives of mass media. We found little correlation between Twitter features (other users' engagement and negativity in other users' replies) and the level of public trust found in representative opinion surveys. We used topic modelling in combination with correspondence analysis, and including additional variables for actor types and the period of the public debate further enabled us to detect salient episodes related to the pandemic on social media. In particular, we found that differing roles were played by the (health) experts and political authorities in terms of both topics and influence on the specific timing of the pandemic. The results of this study provide helpful conclusions for communication among political authorities, health experts, and the public.

Learning about COVID-19: sources of information, public trust, and contact tracing during the pandemic

Objective

To assess the association between public attitudes, beliefs, and information seeking about the COVID-19 pandemic and willingness to participate in contact tracing in Michigan.

Methods

Using data from the quarterly Michigan State of the State survey conducted in May 2020 (n = 1000), we conducted multiple regression analyses to identify factors associated with willingness to participate in COVID-19 contact tracing efforts.

Results

Perceived threat of the pandemic to personal health (B = 0.59, p = <.00, Ref = No threat) and general trust in the health system (B = 0.17, p < 0.001), were the strongest positive predictors of willingness to participate in contact tracing. Concern about misinformation was also positively associated with willingness to participate in contact tracing (B = 0.30, p < 0.001; Ref = No concern). Trust in information from public health institutions was positively associated with willingness to participate in contact tracing, although these institutions were not necessarily the main sources of information about COVID-19.

Conclusion

Policy makers can enhance willingness to participate in public health efforts such as contact tracing during infectious disease outbreaks by helping the public appreciate the seriousness of the public health threat and communicating trustworthy information through accessible channels.

The association of public trust with the utilization of digital contact tracing for COVID-19 in Japan

Objectives

To examin whether public trust was associated with the utilization of COVID-19 Contact Confirming Application (COCOA) in those who self-reported a history of COVID-19.

Study design

Cross-sectional study.

Methods

Data were obtained from the Japan Society and New Tobacco Internet Survey, a nationwide online survey conducted from February to March 2021, which also assessed items related to COVID-19 and public trust. We included 453 participants with a history of COVID-19. Participants' reports of their general trust in the national government and the related policies, attitudes toward COVID-19 vaccination, and the adherence to the preventive measures against SARS-CoV-2 spread were compared between COCOA users and non-users controlling for age, sex, and socioeconomic statuses by analysis of covariance. Mediation analysis was conducted to examine whether public trust mediates the associations of certain participants' characteristics with COCOA utilization.

Results

Seventy-six percent (344/453) reported the COCOA utilization. Compared to non-users, the users were younger, more likely to be men and had a tendency to have higher education. They were more willing to get COVID-19 vaccination, adherent to public health measures against the spread of the SARS-Cov-2, and more likely to express trust in government in general and policies related to COVID-19 independent of age, sex, and the socioeconomic status. Trust in government did not mediate the associations of age and education with COCOA utilization.

Conclusions

The utilization of digital contact tracing technology for the health of public during pandemic was related to the degree of trust in the government in Japan.

Beyond Performance: Racial Prejudice and Whites' Mistrust of Government

Scholars have argued that racial policy beliefs contributed to a decline in public trust among white-Americans, but this effect waned over time as racial policies left the agenda. We theorize that beliefs about racial policies may have been integrated into whites' racial attitudes, resulting in a durable association between racial prejudice and public trust. Our analysis of eight ANES surveys (1992-2020) shows that racial prejudice, measured in terms of anti-Black stereotypes, informs white Americans' beliefs about the trustworthiness of the federal government. LDV models strengthen our contention by showing that the relationship persists after an LDV is included and it is not reciprocal.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11109-022-09774-6.

Understanding public trust in water managers: Findings from the Netherlands

Public trust in water managers is often considered an important precondition for the effective implementation of sustainable water-management practices. Although it is well known that general public trust in government institutions is under pressure, much less is known in the literature on water governance whether such distrust also affects general and task-specific trust of the wider public in water managers. In addition, empirical studies on the determinants of such trust seem to be scarce. To fill those gaps, this study aims to measure general and task-specific public trust in water managers in the Netherlands and to assess how a selected group of potential determinants is related to general- and task-specific trust in water managers. To this end, we employ an original survey among a representative sample of the Dutch population (N = 2262). We find that trust in water managers in the Netherlands is generally high, but that it also comes with some task-specific variations. People have more trust in the flood-protection capacities of the water managers than in the capacities to successfully manage surface-water quality, nature conservation, and drought management. Using linear regression models, we subsequently find that individual-level variations in trust in water managers are best explained by one's general level of political trust. Additionally, we also show that both risk perceptions and self-evaluations of how informed people feel themselves about water management are important factors with (curvilinear) relations with trust in water managers. Overall, we conclude that water managers are under specific conditions able to build themselves well-established reputations and relatively high trust levels based on their performances. Nevertheless, trust development is far from entirely in the hands of the water managers themselves as we also conclude that trust evaluations of water managers are not immune from negative generalized political evaluations and public perceptions on water related risks.

Governing health data across changing contexts: A focus group study of citizen's views in England, Iceland, and Sweden

BACKGROUND

The governance structures associated with health data are evolving in response to advances in digital technologies that enable new ways of capturing, using, and sharing different types of data. Increasingly, health data moves between different contexts such as from healthcare to research, or to commerce and marketing. Crossing these contextual boundaries has the potential to violate societal expectations about the appropriate use of health data and diminish public trust. Understanding citizens' views on the acceptability of and preferences for data use in different contexts is essential for developing information governance policies in these new contexts.

METHODS

Focus group design presenting data sharing scenarios in England, Iceland, and Sweden.

RESULTS

Seventy-one participants were recruited. Participants supported the need for data to help understand the observable world, improve medical research, the quality of public services, and to benefit society. However, participants consistently identified the lack of information, transparency and control as barriers to trusting organisations to use data in a way that they considered appropriate. There was considerable support for fair and transparent data sharing practices where all parties benefitted.

CONCLUSION

Data governance policy should involve all stakeholders' perspectives on an ongoing basis, to inform and implement changes to health data sharing practices that accord with stakeholder views. The Findings showed that (1) data should be used for ethical purposes even when there was commercial interest; (2) data subjects and/or public institutions that provide and share data should also receive benefits from the sharing of data; (3) third parties use of data requires greater transparency and accountability than currently exists, (4) there should be greater information provided to empower data subjects.

Current Status and Future Challenges of Biobank Research in Malaysia

The establishment of MyCohort in 2005 showed that there is a growing interest on the part of the Malaysian government in the creation of biobanks in the country. This project can be considered as the biggest and most comprehensive cohort study in Malaysia, where hundreds of thousands of human samples are stored for epidemiological and biomedical research. However, little is known about the current issues or the situation related to biobank research in Malaysia. There are pressing issues that need answers such as the governance of the national biobank as well as other privately owned biobanks in the nation, the public perspectives and perceptions regarding biobanks, and other matters such as the ethical, legal, and social issues related to biobank research. This article will highlight the status and issues related to biobank research in Malaysia and provide suggestions on future research practices that we feel need to be seriously considered. These suggestions are designed to advance and enlighten researchers' knowledge, as well as provide the public with information on issues associated to biobanking. Good governance increases public knowledge and trust, and religious acceptance of biobank research and accountability can lead to increased participation in biobank research. The direct implications of the discussion about the ethical, legal, and social issues of biobanks are pertinent for the foundation of knowledge relating to biobanks, as well as the forward gestures for future medicine for mankind.

Digital contact tracing and exposure notification: ethical guidance for trustworthy pandemic management

There is growing interest in contact tracing apps (CT apps) for pandemic management. It is crucial to consider ethical requirements before, while, and after implementing such apps. In this paper, we illustrate the complexity and multiplicity of the ethical considerations by presenting an ethical framework for a responsible design and implementation of CT apps. Using this framework as a starting point, we briefly highlight the interconnection of social and political contexts, available measures of pandemic management, and a multi-layer assessment of CT apps. We will discuss some trade-offs that arise from this perspective. We then suggest that public trust is of major importance for population uptake of contact tracing apps. Hasty, ill-prepared or badly communicated implementations of CT apps will likely undermine public trust, and as such, risk impeding general effectiveness.

Using the concept of "deserved trust" to strengthen the value and integrity of biomedical research

It is commonplace for science leaders and others to claim that the future of biomedical research rests in large part upon the public's trust. If true, it behooves the biomedical research community to understand how it avoids taking chances with that trust. This commentary, which builds upon comments of noted trust scholar Russell Hardin about how best to enjoy trust, assumes that the key to being trusted is deserving to be trusted. Thus, it proposes using "deserved trust" to identify ways that the public's trust in biomedical research could be better supported. Employing deserved trust to support the public's trust leads us to consider what it is that the biomedical research community should be trusted to do, examine the evidence about the effectiveness of current safeguards meant to assure that those things routinely get done, and identify new ways to equip individual researchers, research teams, and research institutions to assure that the public's trust in their research is deserved rather than misplaced.

Communicating Recommendations in Public Health Emergencies: The Role of Public Health Authorities

Adherence to public health recommendations is critical for public safety and well-being. Effective and appropriate communication plays an important role in whether populations trust government and public health authorities, and the extent to which people follow public health recommendations. Poor trust in communication from public health authorities can pose significant challenges for mitigating public health emergencies and maintaining health security. This study aimed to explore the importance of trust in and understanding of communication from public health authorities in improving adherence to public health recommendations, and how that communication can be improved to develop and maintain public trust, particularly in the context of public health emergencies. To understand which factors are important for public trust in communication from public health authorities, we conducted in-depth interviews (n = 25) with a racially and demographically diverse group of individuals living in Baltimore. We found that communication source and communication transparency, such as timeliness, completeness, and clarity of information, were critical constructs of trust in communication from public health authorities. We also found that many participants misunderstood the flow of information from public health authorities to news media, and many were unaware that public health authorities provide the most reliable source of health information and recommendations during a public health emergency. To ensure adherence to public health recommendations, the public needs to trust that public health authorities are providing accurate, practical, and prudent recommendations. Drawing on these results, we provide several recommendations for developing and optimizing communication from various public health authorities.

"Who is watching the watchdog?": ethical perspectives of sharing health-related data for precision medicine in Singapore

BACKGROUND

We aimed to examine the ethical concerns Singaporeans have about sharing health-data for precision medicine (PM) and identify suggestions for governance strategies. Just as Asian genomes are under-represented in PM, the views of Asian populations about the risks and benefits of data sharing are under-represented in prior attitudinal research.

METHODS

We conducted seven focus groups with 62 participants in Singapore from May to July 2019. They were conducted in three languages (English, Mandarin and Malay) and analysed with qualitative content and thematic analysis.

RESULTS

Four key themes emerged: nuanced understandings of data security and data sensitivity; trade-offs between data protection and research benefits; trust (and distrust) in the public and private sectors; and governance and control options. Participants were aware of the inherent risks associated with data sharing for research. Participants expressed conditional support for data sharing, including genomic sequence data and information contained within electronic medical records. This support included sharing data with researchers from universities and healthcare institutions, both in Singapore and overseas. Support was conditional on the perceived social value of the research and appropriate de-identification and data security processes. Participants suggested that a data sharing oversight body would help strengthen public trust and comfort in data research for PM in Singapore.

CONCLUSION

Maintenance of public trust in data security systems and governance regimes can enhance participation in PM and data sharing for research. Contrary to themes in much prior research, participants demonstrated a sophisticated understanding of the inherent risks of data sharing, analysed trade-offs between risks and potential benefits of PM, and often adopted an international perspective.

Sharing whilst caring: solidarity and public trust in a data-driven healthcare system

BACKGROUND

In the UK, the solidaristic character of the NHS makes it one of the most trusted public institutions. In recent years, the introduction of data-driven technologies in healthcare has opened up the space for collaborations with private digital companies seeking access to patient data. However, these collaborations appear to challenge the public's trust in the.

MAIN TEXT

In this paper we explore how the opening of the healthcare sector to private digital companies challenges the existing social contract and the NHS's solidaristic character, and impacts on public trust. We start by critically discussing different examples of partnerships between the NHS and private companies that collect and use data. We then analyse the relationship between trust and solidarity, and investigate how this relationship changes in the context of digital companies entering the healthcare system. Finally, we show ways for the NHS to maintain public trust by putting in place a solidarity grounded partnership model with companies seeking to access patient data. Such a model would need to serve collective interests through, for example, securing preferential access to goods and services, providing health benefits, and monitoring data access.

CONCLUSION

A solidarity grounded partnership model will help establish a social contract or licence that responds to the public's expectations and to principles of a solidaristic healthcare system.

Containing a pandemic with public actions and public trust: the Kerala story

We study the Covid pandemic in the Indian state of Kerala, and document the state’s remarkable success in containing the pandemic’s first wave. By identifying Kerala’s initial conditions when it was hit by the pandemic, and different components of the state’s Covid policy, we conclude: While being subject to resource constraints faced by an Indian state located in a federal structure, Kerala contained its first Covid wave by preemptively formulating a comprehensive set of public actions—government actions that were supported and complemented by the state’s citizens. This was achieved by leveraging and reinforcing the citizen’s public trust in the state. Specifically, the state’s pandemic response contained supportive measures to ensure that poor lives were not pitted against rich lives; rather, the aim was to protect all lives and livelihoods.

COVID-19 Population Survey of Iran (COPSIR) study protocol: Repeated survey on knowledge, risk perception, preventive behaviors, psychological problems, essential needs, and public trust during COVID-19 epidemic

Background: The worldwide emergence and rapid expansion of COVID-19 emphasizes the need to assess the knowledge gap and to predict the disease-related behaviors and reactions during this epidemic.

Methods and design: COVID19 Population Survey of Iran (COPSIR) is a repeated cross sectional survey that will be conducted in 8 waves. In each wave, 515 Iranian adults aged 18 years or older will be randomly selected and interviewed by phone. The study waves will be performed at approximately weekly intervals. The survey tool is adapted from COSMO (COVID-19 Snapshot MOnitoring) study. This study will provide information on trends of knowledge, risk perception, preventive behaviors, psychological problems, essential needs, and public trust among Iranian adults during COVID-19 epidemic.

Discussion: The key findings of each wave will be immediately reported to the National Headquarters for Coronavirus Control to set better policies for disease control and prevention. Moreover, if a message is extracted from the results of this study that needs to be communicated to the public, it will be done through the mass media.

Institutional Conflicts of Interest in Academic Research

Financial relationships in academic research can create institutional conflicts of interest (COIs) because the financial interests of the institution or institutional officials may inappropriately influence decision-making. Strategies for dealing with institutional COIs include establishing institutional COI committees that involve the board of trustees in conflict review and management, developing policies that shield institutional decisions from inappropriate influences, and establishing private foundations that are independent of the institution to own stock and intellectual property and to provide capital to start-up companies.

On Some Possible Ramifications of the "Microplastics in Fish" Case

Cases of research misconduct in the ecological and environmental sciences appear to be relatively rare. A controversial paper published in Science in 2016 documenting the effects of microplastics on the feeding and innate behaviours of fish larvae has recently been retracted, with the authors found guilty of scientific misconduct. In addition to the expected fallout, such as individual and institutional reputational damage from a research misconduct finding, this case has two possibly wider-ranging ramifications. Firstly, there may be a presumptive notion that a strong negative effect could be more successfully published than a neutral effect. This presumption would belie the true stringency and rigor of research adopted by workers in the field. Secondly, the case may have a negative impact on the public's perception of and trust in legitimate and good science that addresses critical environmental issues, such as anthropogenic climate change.

Psychometric properties of primary health care trust questionnaire

Background

Trust has been introduced as the cornerstone of the public and health providers’ relation. Public trust in primary health care (PHC) is crucial and must be measured. The aim of this study was to develop and validate PHC trust measurement tool.

Methods

This was a psychometric study to develop PHC trust measuring tool done in Tabriz, East-Azerbaijan with participation of 600 households in 2016. Item generation was done through literature review and experts opinions. The content validity, reliability and construct validity of the PHC trust tool were assessed using several statistical methods including modified Kappa, Kendall’s Tau and intra-class correlation coefficient (ICC) as well as exploratory factor analysis (EFA). Data were analyzed using STATA 14 statistical software package.

Results

A 30-item questionnaire was developed. The Modified Kappa coefficient as an indicator of content validity assessment was 0.94. With respect to reliability assessment, a high internal consistency was observed with 0.98 Cronbach-Alpha score and the test–retest reliability for overall scale (assessed by ICC) was 0.94 (CI: 0.87–0.97). Exploratory factor analysis emerged 2 factors. Factor 1 consisted of 25 items accounting for 74.1% of the variance (eigenvalue = 22.47) followed by Factor 2 consisting of 5 items accounting for 19.2% of the variance (eigenvalue = 1.6).

Conclusion

PHC trust measuring tool could be used as a valid and reliable tool by health systems in Iran and similar contexts to investigate how they are trustful from the public viewpoint.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4340-6) contains supplementary material, which is available to authorized users.

Public trust and knowledge in the context of emerging climate-adaptive forestry policies

Effective governance of public forests depends, in part, on public support for changes in forest management, particularly those responding to changes in socio-ecological conditions driven by climate change. Trust in managing authorities and knowledge about forest management have proven influential in shaping public support for policy across different forest managemen contexts. However, little is known about the relationship between public trust and knowledge as it relates to policy support for emerging management strategies for climate adaptation in forests. We use the example of genomics-based assisted migration (within and outside of natural range) in British Columbia's (BC) forests to examine the relative roles of and interactions between trust in different forestry actors and knowledge of forestry in shaping public support for this new and potentially controversial management alternative. Our results, based on an online survey (n = 1953 BC residents), reveal low public trust in governments and the forest industry combined with low levels of public knowledge about forest management. We find that individuals who are more trusting of decision-makers and other important forestry actors hold higher levels of support for assisted migration. Higher levels of forestry knowledge are linked with support for assisted migration within native range, whereas no knowledge effect is observed for assisted migration outside of native range. We discuss the implications of these observations and provide recommendations to more fully engage with the challenges of low levels of trust and knowledge in this context.

Share and protect our health data: an evidence based approach to rare disease patients' perspectives on data sharing and data protection - quantitative survey and recommendations

Background

The needs and benefits of sharing health data to advance scientific research and improve clinical benefits have been well documented in recent years, specifically in the field of rare diseases where knowledge and expertise are limited and patient populations are geographically dispersed. Understanding what patients want and need from rare disease research and data sharing is important to ensure their participation and engagement in the process, and to ensure that these wishes and needs are embedded within research design. EURORDIS-Rare Diseases Europe regularly surveys the rare disease community to identify its perspectives and needs on a number of issues in order to represent rare disease patients and be their voice within European and International initiatives and policy developments.

Here, we present key findings from a large quantitative survey conducted with patients with rare diseases and family members as part of a continuous evidence-based advocacy process developed at EURORDIS. The aim of this survey was to explore patient and family perspectives on data sharing and data protection in research and healthcare settings and develop relevant recommendations to support shaping of future data sharing initiatives in rare disease research.

This survey, translated into 23 languages, was carried out via the Rare Barometer Programme and was designed to be accessible to a diverse population with a wide range of education backgrounds. It was widely disseminated via patient organisations worldwide to ensure that a wide range of voices and experiences were represented.

Main findings

Rare disease patients, regardless of the severity of their disease and their socio-demographic profile, are clearly supportive of data sharing to foster research and improve healthcare. However, rare disease patients’ willingness to share their data does come with specific requirements in order to respect their privacy, choices and needs for information regarding the use of their data.

Conclusions

To ensure sustainability and success of international data sharing initiatives in health and research for rare diseases, appropriate legislations need to be implemented and multi-stakeholder efforts need to be pursued to foster cultural and technological changes enabling the systematic integration of patients’ preferences regarding sharing of their own health data.

Electronic supplementary material

The online version of this article (10.1186/s13023-019-1123-4) contains supplementary material, which is available to authorized users.

Trust in times of health reform

Trust is seen as an important condition for the smooth functioning of institutions, such as the health care system. In this article we describe the trust relationships between the three main actors in the Dutch health care system: patients/insured, healthcare providers and insurers. We used data from different surveys between 2006 and 2016. 2006 was the year of the introduction of an insurance reform in the Netherlands towards regulated competition. In the triangle of trust relationships between the three actors we found strong and mutual trust relationships between patients and healthcare providers and weak trust relationships between healthcare providers and insurers as well as between insured and insurance organisations. This hampers the intended role of insurers as selective purchasers of health care on the basis of quality and price.

Impact of community engagement on public acceptance towards waste-to-energy incineration projects: Empirical evidence from China

As one of the most popular methods for the treatment of municipal solid waste (MSW), waste-to-energy (WTE) incineration offers effective solutions to deal with the MSW surge and globe energy issues. Nevertheless, the construction of WTE facilities faces considerable and strong opposition from local communities due to the perceived potential risks. The present study aims to understand whether, and how, community engagement improves local residents' public acceptance towards waste-to-energy (WTE) incineration facilities using a questionnaire survey conducted with nearby residents of two selected WTE incineration plants located in Zhejiang province, China. The results of data analysis using Structural Equation Modeling (SEM) reveal that firstly, a lower level of public acceptance exists among local residents of over the age of 35, of lower education levels, living within 3 km from the WTE Plant and from WTE incineration Plants which are under construction. Secondly, the public trust of local government and other authorities was positively associated with the public acceptance of the WTE incineration project, both directly and indirectly based on perceived risk. Thirdly, community engagement can effectively enhance public trust in local government and other authorities related to the WTE incineration project. The findings contribute to the literature on MSW treatment policy-making and potentially hazardous facility siting, by exploring the determinants of public acceptance towards WTE incineration projects.

Examining the Social Benefits Principle in Research with Human Participants

The idea that research with human participants should benefit society has become firmly entrenched in various regulations, policies, and guidelines, but there has been little in-depth analysis of this ethical principle in the bioethics literature. In this paper, I distinguish between strong and weak versions and the social benefits principle and examine six arguments for it. I argue that while it is always ethically desirable for research with human subjects to offer important benefits to society (or the public), the reasonable expectation of substantial public benefit should be a necessary condition for regarding research as ethical only when (a) it imposes more than minimal risks on non-consenting subjects; or (b) it is supported by public resources.

Investigating Public trust in Expert Knowledge: Narrative, Ethics, and Engagement

"Public Trust in Expert Knowledge: Narrative, Ethics, and Engagement" examines the social, cultural, and ethical ramifications of changing public trust in the expert biomedical knowledge systems of emergent and complex global societies. This symposium was conceived as an interdisciplinary project, drawing on bioethics, the social sciences, and the medical humanities. We settled on public trust as a topic for our work together because its problematization cuts across our fields and substantive research interests. For us, trust is simultaneously a matter of ethics, social relations, and the cultural organization of meaning. We share a commitment to narrative inquiry across our fields of expertise in the bioethics of transformative health technologies, public communications on health threats, and narrative medicine. The contributions to this symposium have applied, in different ways and with different effects, this interdisciplinary mode of inquiry, supplying new reflections on public trust, expertise, and biomedical knowledge.

Public Trust in Health Information Sharing: A Measure of System Trust

OBJECTIVE

To measure public trust in a health information sharing in a broadly defined health system (system trust), inclusive of health care, public health, and research; to identify individual characteristics that predict system trust; and to consider these findings in the context of national health initiatives (e.g., learning health systems and precision medicine) that will expand the scope of data sharing.

DATA SOURCES

Survey data (n = 1,011) were collected in February 2014.

STUDY DESIGN

We constructed a composite index of four dimensions of system trust-competency, fidelity, integrity, and trustworthiness. The index was used in linear regression evaluating demographic and psychosocial predictors of system trust.

DATA COLLECTION

Data were collected by GfK Custom using a nationally representative sample and analyzed in Stata 13.0.

PRINCIPAL FINDINGS

Our findings suggest the public's trust may not meet the needs of health systems as they enter an era of expanded data sharing. We found that a majority of the U.S. public does not trust the organizations that have health information and share it (i.e., the health system) in one or more dimensions. Together, demographic and psychosocial factors accounted for ~18 percent of the observed variability in system trust. Future research should consider additional predictors of system trust such as knowledge, attitudes, and beliefs to inform policies and practices for health data sharing.

WILDLIFE HEALTH AND PUBLIC TRUST RESPONSIBILITIES FOR WILDLIFE RESOURCES

A significant development in wildlife management is the mounting concern of wildlife professionals and the public about wildlife health and diseases. Concurrently, the wildlife profession is reexamining implications of managing wildlife populations as a public trust and the concomitant obligation to ensure the quality (i.e., health) and sustainability of wildlife. It is an opportune time to emphasize the importance of wildlife health, specifically to advocate for comprehensive and consistent integration of wildlife health in wildlife management. We summarize application of public trust ideas in wildlife population management in the US. We argue that wildlife health is essential to fulfilling public trust administration responsibilities with respect to wildlife, due to the central responsibility of trustees for ensuring the well-being of wildlife species (i.e., the core resources of the trust). Because both health of wildlife and risk perceptions regarding threats posed by wildlife disease to humans and domestic animals are issues of growing concern, managing wildlife disease and risk communication vis-à-vis wildlife health is critical to wildlife trust administration. We conclude that wildlife health professionals play a critical role in protecting the wildlife trust and that current conditions provide opportunities for important contributions by wildlife health professionals in wildlife management.

Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012

Vaccine "hesitancy" is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine. The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy. A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤ 7 years of age], used multivariate analyses, and were published between January 2007 and November 2012. Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific - varying across time, place and vaccines.

Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012

Vaccine "hesitancy" is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine. The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy. A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤ 7 years of age], used multivariate analyses, and were published between January 2007 and November 2012. Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific - varying across time, place and vaccines.