Continuity of Trust: Health Systems' Role in Advancing Health Equity Beyond the COVID-19 Pandemic

Given COVID-19's disproportionate impact on populations that identify as Black, Indigenous, and People of Color (BIPOC) in the United States, researchers and advocates have recommended that health systems and institutions deepen their engagement with community-based organizations (CBOs) with longstanding relationships with these communities. However, even as CBOs leverage their earned trust to promote COVID-19 vaccination, health systems and institutions must also address underlying causes of health inequities more broadly. In this commentary, we discuss key lessons learned about trust from our participation in the U.S. Equity-First Vaccination Initiative, an effort funded by The Rockefeller Foundation to promote COVID-19 vaccination equity. The first lesson is that trust cannot be "surged" to meet the needs of the moment until it is no longer deemed important; rather, it must predate and outlast the crisis. Second, to generate long-term change, health systems cannot simply rely on CBOs to bridge the trust gap; instead, they must directly address the root causes of this gap among BIPOC populations.

Trusted Sources of Information and COVID-19 Vaccination Among Black Adults in Chicago

PURPOSE

Examine trust in sources of COVID-19 information and vaccination status.

DESIGN

Cross-sectional.

SETTING

Chicago, Illinois.

SUBJECTS

Convenience sample of 538 Black adults surveyed between September 2021 and March 2022.

MEASURES

Trust in sources of COVID-19 information, COVID-19 vaccination.

ANALYSIS

Using latent class analysis, we identified classes of trust in sources of COVID-19 information. We considered predictors of class membership using multinomial logistic regression and examined unadjusted and adjusted associations between trust class membership and COVID-19 vaccination while accounting for uncertainty in class assignment.

RESULTS

Our analytic sample (n = 522) was predominantly aged 18-34 (52%) and female (71%). Results suggested a four-class solution: (1) low trust, (2) high trust in all sources, (3) high trust in doctor and government, and (4) high trust in doctor, faith leader, and family. Unadjusted odds of vaccination were greater in the high trust in all sources (OR 2.0, 95% CI 1.2-3.2), high trust in doctor and government (OR 2.7, 95% CI 1.4-5.3), and high trust in doctor, faith leader, and family classes (OR 2.1, 95% CI 1.2, 3.9) than the low trust class. However, these associations were not significant after adjustment for sociodemographic and health status factors.

CONCLUSION

Although COVID-19 vaccination varied across trust classes, our adjusted findings do not suggest a direct association between trust and vaccination, reflecting complexities in the vaccine decision-making process.

Influenza vaccination and use of lipid lowering therapies in adults with atherosclerotic cardiovascular disease: An analysis of the Behavioral Risk Factor Surveillance System (BRFSS)

BACKGROUND

Influenza vaccination and lipid lowering therapy (LLT) are evidence-based interventions with substantial benefit for individuals with established atherosclerotic cardiovascular disease (ASCVD). However, levels of influenza immunization and LLT use are low, possibly due to pervasive fear-based misinformation uniquely targeting vaccines and LLT. Whether being unvaccinated for influenza predicts lower utilization of LLT is unknown.

OBJECTIVES

We tested the hypothesis that American adults with ASCVD who are unvaccinated for influenza have lower use of LLT even after accounting for traditional factors associated with underuse of preventive therapies.

METHODS

We pooled 2017, 2019, and 2021 survey data from the Behavioral Risk Factor Surveillance System (BRFSS), and selected respondents aged 40 to 75 years with self-reported ASCVD. We used logistic regression models adjusted for potential confounders to examine the association between influenza vaccination and self-reported LLT use. We performed a sensitivity analysis with multiple imputation to account for missing data. All analyses accounted for complex survey weighting.

RESULTS

Of 66,923 participants with ASCVD, 55% reported influenza vaccination in the last year and 76% reported using LLT. Being unvaccinated for influenza was associated with lower odds of LLT use (OR 0.54; 95% CI 0.50, 0.58; P< .001). In a multivariable regression model adjusting for demographics and comorbidities, this association remained statistically significant (aOR 0.58, 95% CI 0.52, 0.64, P < .001). After additional adjustment for preventive care engagement, health care access, and use patterns of other cardiovascular medications this association persisted (aOR 0.66; 95% CI 0.60, 0.74; P < .001). There were no significant differences across subgroups, including those with and without hyperlipidemia.

CONCLUSIONS

Unvaccinated status for influenza was independently associated with 34% lower odds of LLT use among American adults with ASCVD after adjustment for traditional factors linked to underuse of preventive therapies. This finding identifies a population with excess modifiable ASCVD risk, and supports investigation into nontraditional mechanisms driving underuse of preventive therapies, including fear-based misinformation.

Ethical Challenges of Advances in Vaccine Delivery Technologies

Strategies to address misinformation and hesitancy about vaccines, including the fear of needles, and to overcome obstacles to access, such as the refrigeration that some vaccines demand, strongly suggest the need to develop new vaccine delivery technologies. But, given widespread distrust surrounding vaccination, these new technologies must be introduced to the public with the utmost transparency, care, and community involvement. Two emerging technologies, one a skin-patch vaccine and the other a companion dye and detector, provide excellent examples of greatly improved delivery technologies for which such a careful approach should be developed in order to increase vaccine uptake. Defusing fears and conspiracy mongering must be a key part of their rollout.

Becoming Trustworthy in Treating Patients With Borderline Personality Disorder

No one doubts the importance of trust in psychotherapy, but few therapists think about the complexities of trusting relationships, and the trustworthiness that would justify trusting remains far from view. Fortunately, inasmuch as trusting and trustworthiness are inherently ethical concepts, contemporary philosophers have given trust the consideration it warrants. Integrating science and philosophy, the author reviews the broad scope and multifaceted nature of trust and trustworthiness, the social-cognitive development of trust, and the development of distrust in the context of borderline personality disorder. Without questioning therapists' character, the author makes the case for shifting the emphasis from the patient's distrust to the therapist's challenge to become trustworthy in the course of each treatment relationship and, more broadly, over the course of a professional career.

Conceptualizing Trust and Distrust as Alternative Stable States: Lessons from the Flint Water Crisis

Despite the universally recognized importance of fostering trust and avoiding distrust in governance relationships, there remains considerable debate on core questions like the relation between (dis)trust and the evaluations of the characteristics that make a governance agent appear (un)worthy of trust. In particular, it remains unclear whether levels of (dis)trust simply follow levels of (dis)trustworthiness-such that building trust is primarily a question of increasing evidence of trustworthiness and avoiding evidence of distrustworthiness, or if their dynamics are more complicated. The current paper adds novel theory for thinking about the management of trust and distrust in the governance context through the application of principles borrowed from resilience theory. Specifically, we argue that trust and distrust exist as distinct, self-reinforcing (i.e., stable) states separated by a threshold. We then theorize as to the nature of the self-reinforcing processes and use qualitative data collected from and inductively coded in collaboration with Flint residents as part of a participatory process to look for evidence of our argument in a well-documented governance failure. We conclude by explaining how this novel perspective allows for clearer insight into the experience of this and other communities and speculate as to how it may help to better position governance actors to respond to future crises.

How to deal with the past? How collective and historical trauma psychologically reverberates in Eastern Europe

Traumatic stress studies have recently addressed the issue of 'historical trauma' that well explain the impact of collective or totalitarian trauma. The example of former communist Eastern Europe shows that there are many individual and socio-psychological consequences that still have effects today. This paper summarizes concepts and findings on 'historical traumas' that describe such long-lasting effects. The focus is on the side of the victims and their family descendants and thus also on the moral heirs of the dissidents, e.g., the Russian NGO Memorial. Analogous to developments in psychotraumatology, increasing knowledge in this area can explain psychosocial pathologies but also help develop effective remedies. This includes the development of a culture of remembrance, socio-therapeutic interventions and increased sensitivity towards those patients and clients who have such a personal legacy.

Schizophrenia and Increased Distrust-Based Competitiveness in Interpersonal Interactions: A Serial Process Model

BACKGROUND AND HYPOTHESIS

Game theory paradigms, such as the Prisoner's Dilemma Game (PDG), have been used to study nonclinical paranoia, though research using clinical populations has been scarce. We test our novel theoretical model that schizophrenia leads to competitiveness in interpersonal interactions, and that this link is serially mediated by trait paranoia, state paranoia, and distrust.

STUDY DESIGN

In this quasi-experimental study, individuals with schizophrenia spectrum diagnoses with current persecutory delusions (n = 46) and a nonclinical control group (n = 43) played the PDG, and completed measures of trait paranoia, state paranoia, and distrust.

STUDY RESULTS

Individuals with schizophrenia competed more in the PDG than the control group. Supporting our theoretical model, all direct effects were significant: schizophrenia was associated with higher trait paranoia (H1); trait paranoia predicted state paranoia in the PDG (H2); state paranoia in the PDG predicted distrust of the opponent in the PDG (H3); and distrust predicted competition in the PDG (H4). The hypothesized indirect effect of schizophrenia on competition in the PDG via trait paranoia, state paranoia, and distrust was supported in a serial mediation model (H5).

CONCLUSIONS

The findings make clear theoretical and methodological contributions. We provide the first evidence for a theoretical process model by which schizophrenia leads to competitiveness in interpersonal interactions via trait paranoia, state paranoia, and distrust. Game theory paradigms, and the PDG in particular, are important for advancing theory and research on paranoia as it occurs in both clinical and nonclinical populations.

Perceptions and experiences of prostate cancer patients in a public tertiary hospital in urban South Africa

ABSTRACTProstate cancer is among the most prevalent forms of cancer worldwide and is reported to have the highest incidence, mortality, and 5-year prevalence rate of all cancers among men living in Africa. Despite this widespread burden in the African continent, little is known about the perspectives and experience of prostate cancer among African men. To further understand experiences among patients living in urban South Africa, we conducted in-depth, semi-structured qualitative interviews to examine the perceptions and experiences of 28 Black African prostate cancer patients receiving treatment at a major tertiary hospital in Johannesburg, South Africa. Our data explored four major areas of patients' experiences with prostate cancer: detection, diagnosis, treatment, and follow-up care. Our results showed that the experience of living with prostate cancer among low-income, Black South African men is a stressful and emotionally painful experience due in part to men feeling that they had insufficient knowledge about their own condition and feeling disempowered or ill-equipped to manage their cancer. These feelings were strongly associated with distrust or dissatisfaction with physicians and the health care system. Resilience factors include social support from family, friends, and religious communities, acceptance of their diagnosis, religion, and positive appraisals of their medical care.

Racial and ethnic disparities in the perception of respect from physicians among skin cancer patients in the United States

Background

Racial and ethnic minority groups are at increased risk of poor skin cancer outcomes. Successful patient-physician communication is linked to better health outcomes, but it is unknown whether disparities in perceived care exist among skin cancer patients.

Objective

To investigate whether there are racial and ethnic disparities in the perception of physicians showing respect, listening, and explaining during clinical encounters.

Methods

A cross-sectional study was conducted using data from participants with a self-reported skin cancer history from the 2008 to 2017 and 2019 Medical Expenditure Panel Survey. Race and ethnicity were self-identified.

Results

Of 5570 participants, 5263 were non-Hispanic White and 307 were racial and ethnic minority individuals. Racial and ethnic minority participants were less likely to report that their doctors show them respect, listen to, and explain to them than non-Hispanic White participants, even when adjusting for age, sex, insurance type, health status, and survey year. Among racial and ethnic minority participants, perceptions of physicians listening and explaining were strongly associated with perceived respect.

Limitations

Lack of disaggregated racial and ethnic subgroup analysis.

Conclusions

Our findings suggest racial and ethnic disparities in perceived care among skin cancer patients. Future research is warranted to determine whether such perceptions contribute to disparities in skin cancer care and/or outcomes.

Is Vaccine Hesitancy Affected by Distrust in the Healthcare System? A Study in Turkish Population

The aim of this study is to examine the effect of the perception of distrust in the healthcare system on vaccine hesitancy and to determine the association between the sociodemographic characters of the participants and their perception of distrust and their vaccine hesitancy. The population consisted of individuals who were 20 years old and above and were residing in Turkey. A total of 986 people participated in the study. The data were collected through a questionnaire that was prepared on Google Forms. As a result of the regression analysis, distrust in the healthcare system explained 20.7% of total variance in vaccine hesitancy and an increase in the perception of distrust in the healthcare system statistically increased the vaccine hesitancy. In the study, it was also determined that the participants' perceptions of distrust in the healthcare system caused statistically significant differences based on the variables of marital status, employment status, alcohol consumption, age, education level and income level. It was revealed that the participants' perceptions of vaccine hesitancy caused a statistically significant difference only based on age and the frequency of applying to the health institution.

People's Perceptions and Coping Strategies During the COVID-19 Pandemic: A Phenomenological-Longitudinal Study in Bangladesh

By emphasizing the Terror Management Theory, this study investigated the participants' perceptions, psychological experiences, coping strategies, and behavioral changes during the pandemic in Bangladesh in two phases: first, after the pandemic's immediate outbreak, and second, after 3 months of the pandemic (daily infection cases were very high). To perform the research, an empirical-phenomenological method was used. Findings indicate that at the first stage, participants' death phobia was extremely high, and poor medical facilities, religious struggles, imprudent behavior of others, concerns for family members, and a tendency to compare the socioeconomic status with other developed countries affected participants' emotions severely. Later on, participants' perceptions of the disease changed significantly. This study highlights that people's behavior varies depending on whether the thought of death is in the center or on the periphery of their attention. In both stages, religious faith and rituals played a crucial role in coping with the crisis situation.

Categorizations of Trust and Distrust in the Classifications and Social Representations of Food among Pregnant and Breastfeeding Women in Spain-Applying the Cultural Domains' Pile Sort Technique

Food is fundamental in the decision making of pregnant and breastfeeding women to care for their own health and that of their child. In this paper, we explore some common food classification systems and certain attributes assigned to these categories, represented by values of trust and distrust. This study is based on an interdisciplinary research project in which we analysed discourses and practices regarding the dietary intake of pregnant and breastfeeding women in relation to the presence of chemical substances in foods. The results presented are part of the second phase of this research where we explored the results of our analysis of the pile sort technique based on an analysis of cultural domains in order to explore the categories and semantic relations among terms regarding trust and distrust in food. This technique was applied to the 62 pregnant and breastfeeding women of Catalonia and Andalusia. These women also participated in eight focus groups that provided information and narratives enabling us to analyse the meanings of the associative subdomains obtained in the pile sorts. They classified different foods and assigned certain attributes to them according to the level of trust and mistrust, providing a social representation of food risks. The mothers expressed great concern about the quality of the food they consume and about its possible effects on their own health and on that of their child. They perceive that an adequate diet is one based on the consumption of fruits and vegetables, preferably fresh. Fish and meat generate serious concern, as their properties are considered ambivalent depending on the food's origin and mode of production. These criteria are perceived by women as relevant to their food decisions and, therefore, emic knowledge should be taken into account when developing food safety programmes and planning actions aimed at pregnant and breastfeeding women.

Distrusted disclosures: Deception drives anti-transgender but not anti-atheist prejudice

Introduction

Transgender individuals face high levels of prejudice in interpersonal relationships. However, limited experimental research has examined the role of identity disclosure on anti-transgender prejudice.

Methods

Drawing upon research on distrust and identity disclosure, two between-participants experiments (total n = 802) examined the role of intentional and unintentional identity disclosure on negative attitudes (Studies 1 & 2), perceived deception (Studies 1 & 2) and distrust (Study 2) toward two potentially concealable and historically distrusted identities (transgender and atheist). Specifically, the current studies examine the impact of a target's stigmatized identity (transgender or atheist) and method of disclosure (intentional or unintentional) on perceptions of the target, perceived deceptiveness, and distrust toward the target.

Results

Our findings demonstrated that compared to atheists, transgender targets elicited greater levels of prejudice and were viewed as more deceptive, and that this effect was amplified if the target did not intentionally reveal their identity. Study 2 demonstrated that perceived deception mediated the relationship between reveal type (i.e., intentional vs. unintentional) and prejudice toward participants who read about a transgender (but not atheist) target.

Discussion

We discuss the implications of these findings for reducing prejudice toward binary transgender individuals, particularly those who do not voluntarily disclose their identity.

Developing a peer-led intervention to promote COVID-19 testing in low-income housing settings

Background

The Housing Collaborative project at Eastern Virginia Medical School has developed a method of adapting public health guidance from public housing communities, which face tremendous health challenges in cardiometabolic health, cancer, and other major health conditions. In this paper, we describe how academic and community partners in the Housing Collaborative came together to do this work with a focus on COVID-19 testing in the context of the emerging pandemic.

Methods

The academic team used virtual community engagement methods to interact with the Housing Collaborative Community Advisory Board (HCCAB) and a separate cohort of research participants (N = 102) recruited into a study of distrust in COVID-19 guidance. We conducted a series of 44 focus group interviews with participants on related topics. Results from these interviews were discussed with the HCCAB. We used the collaborative intervention planning framework to inform adaptation of public health guidance on COVID-19 testing delivered in low-income housing settings by including all relevant perspectives.

Results

Participants reported several important barriers to COVID-19 testing related to distrust in the tests and those administering them. Distrust in housing authorities and how they might misuse positive test results seemed to further undermine decision making about COVID-19 testing. Pain associated with testing was also a concern. To address these concerns, a peer-led testing intervention was proposed by the Housing Collaborative. A second round of focus group interviews was then conducted, in which participants reported their approval of the proposed intervention.

Conclusion

Although the COVID-19 pandemic was not our initial focus, we were able to identify a number of barriers to COVID-19 testing in low-income housing settings that can be addressed with adapted public health guidance. We struck a balance between community input and scientific rigor and obtained high quality, honest feedback to inform evidence-based recommendations to guide decisions about health.

A survey on self-medication for the prevention or treatment of COVID-19 and distrust in healthcare of veterans in a primary care setting in the United States

BACKGROUND

The SARS-CoV-2 (COVID-19) pandemic brought the public overwhelming and conflicting information. Rates of trust in healthcare professionals have been declining among laypersons over the past five decades. In this setting, we sought to evaluate the use of medications, both with or without a prescription, to prevent and treat SARS-CoV-2 as well as trust in healthcare among patients in a primary care clinic.

DESIGN

We surveyed 150 veterans in primary care clinic waiting rooms at a large southwestern tertiary care Veterans Affairs hospital. This survey was performed in March-November 2021.

METHODS

The survey asked about respondents' demographics, use of medications, nutritional supplements, and other remedies for the prevention and treatment of COVID-19, perceived access to care using Agency for Healthcare Research and Quality (AHRQ) Consumer Assessment of Healthcare Providers and System (CAHPS), overall health status, and barriers to medical appointments in the last 12 months. Distrust was measured using the Revised Health Care Distrust scale. We used univariate and multivariate linear regression analyses to study predictors of distrust to healthcare.

RESULTS

Forty-two (28%) of 150 respondents reported taking an agent for the prevention of COVID-19, while 4% reported storing antibiotics for the treatment of COVID-19, if diagnosed. Medications were obtained from medical providers, US stores or markets, the Internet, home stockpiles, and other countries. Medications with potentially harmful effects taken for the prevention and treatment of COVID-19 included hydroxychloroquine, pseudoephedrine, and antibiotics. Among those surveyed, the mean (SD) on the health system distrust score was 2.2 (0.6) on a scale of 1-5, with 5 indicating higher distrust. Younger age, self-reported poor health, lack of a regular physician, and self-reported poor access to care were independently associated with distrust in healthcare.

CONCLUSION

Self-medication to prevent COVID-19 infection with unproven therapies was common among respondents, as was some level of distrust in the healthcare system. Access to care was one of the modifiable factors associated with distrust. Future studies may explore whether improving trust may moderate self-treatment behavior and storage of potentially harmful medications.

PLAIN LANGUAGE SUMMARY

Self-Medication Habits and Trust in Healthcare Among Patients in a Primary Care Setting in the United States The public has received information from many different sources on COVID-19. Trust in healthcare leadership has also been impacted. We studied self-medication habits to prevent or treat COVID-19 among a group of primary care patients in a large hospital system in the Southwest United States. We also explored these patients' trust in their healthcare system.We asked people waiting in primary care clinic waiting rooms whether they had taken any medications, nutritional supplements, or other remedies to prevent or treat COVID-19. We also asked people whether they stored medications in the event that they were diagnosed with COVID. The survey explored patients' trust in the healthcare system through a validated trust survey tool. The survey also assessed basic demographic information, health literacy, access to care, and self-reported health status. These survey answers were analyzed to see whether there was an association between trust in healthcare and other factors including self-medication habits, access to care, demographics, or perceived health.This study found that over 25% of the 150 people surveyed had taken a medication, nutritional supplement, or remedy in an attempt to prevent COVID. We found that some people were taking potentially harmful medications, including hydroxychloroquine, pseudoephedrine, and antibiotics. We found that patients' distrust score was 2.2 on a scale of 1-5 (5 is associated with higher distrust). Self-medication for the prevention or treatment of COVID was not associated with distrust; however, younger age, self-perceived lack of access to healthcare, self-perceived poor overall health, and not having a regular doctor were predictors for lower trust. This information provides a basis to further study self-medication habits as well as ways to improve trust in the healthcare system.

Misplaced Trust and Distrust: How Not to Engage with Medical Artificial Intelligence

Artificial intelligence (AI) plays a rapidly increasing role in clinical care. Many of these systems, for instance, deep learning-based applications using multilayered Artificial Neural Nets, exhibit epistemic opacity in the sense that they preclude comprehensive human understanding. In consequence, voices from industry, policymakers, and research have suggested trust as an attitude for engaging with clinical AI systems. Yet, in the philosophical and ethical literature on medical AI, the notion of trust remains fiercely debated. Trust skeptics hold that talking about trust in nonhuman agents constitutes a category error and worry about the concept being misused for ethics washing. Proponents of trust have responded to these worries from various angles, disentangling different concepts and aspects of trust in AI, potentially organized in layers or dimensions. Given the substantial disagreements across these accounts of trust and the important worries about ethics washing, we embrace a diverging strategy here. Instead of aiming for a positive definition of the elements and nature of trust in AI, we proceed ex negativo, that is we look at cases where trust or distrust are misplaced. Comparing these instances with trust expedited in doctor-patient relationships, we systematize these instances and propose a taxonomy of both misplaced trust and distrust. By inverting the perspective and focusing on negative examples, we develop an account that provides useful ethical constraints for decisions in clinical as well as regulatory contexts and that highlights how we should not engage with medical AI.

Perceived Risk of SARS-CoV-2 at the Start of the COVID-19 Pandemic and Subsequent Vaccination Attitudes in Patients With Rheumatic Diseases: A Longitudinal Analysis

OBJECTIVE

In a cohort assembled at the start of the pandemic in New York City, objectives of this longitudinal study were to ascertain whether perspectives about SARS-CoV-2 risks obtained at enrollment were associated with clinical course and vaccination intent obtained at follow-up with the advent of vaccines.

METHODS

Patients with diverse rheumatologist-diagnosed diseases taking immunosuppressive medications were interviewed in April 2020 during the height of mortality-associated COVID-19 in New York City and were asked whether they perceived greater infection risk due to rheumatic diseases/medications. Patients were interviewed again when vaccines became available and asked about flares, medication changes, disease activity during the pandemic, and current disease status. They also reported SARS-CoV-2 testing, vaccination intent, and vaccination concerns.

RESULTS

Ninety-six patients had follow-ups (January-March 2021; 83% women; mean age, 50 years). At enrollment, 53%/57% perceived much greater infection risk from autoimmune disease/medications; at follow-up, patients reported flares (63%), greater/unpredictable disease activity (40%), and more medications (44%). Current disease was excellent/very good/good (73%) and fair/poor (27%). Enrollment perspectives were not associated with follow-up status. Seventy percent had SARS-CoV-2 testing. Twenty-three percent would not/were hesitant about vaccination. In multivariable analysis, younger age, concern about effects on rheumatic disease, and distrusting vaccine information were main reasons for not intending/hesitancy to be vaccinated. Eighty-six percent did not report rheumatologists as sources of vaccine information.

CONCLUSIONS

Clinical status at follow-up and vaccination intent were not associated with perceived SARS-CoV-2 risk at the start of the pandemic. Concern about vaccine effects on rheumatic disease and distrust in vaccine information deterred patients from vaccination.

The Psychological Space of Professionals' Trust and Distrust in Socio-Technical Systems

Background

The spatial aspect of professionals' trust and distrust in socio-technical systems has not been sufficiently explored. The study of its structure, criteria for spatial distribution, and interrelationships of elements is of both scientific and practical interest.

Objective

To perform a comparative analysis of the trust and distrust experienced by professional operators in a socio-technical system of subject-subject and subject-object interactions.

Design

This work is based on A.B. Kupreychenko's methodological approach to studying trust and distrust in socio-technical systems, adapted by the authors to the railway transport system in Russia. The subjects were 86 locomotive crew members. The main focus was on their trust/distrust in the operation of the socio-technical (railway transport) system, including their workmates, managers, and themselves, as well as the technical objects they operate (locomotives), manufacturers of railway equipment, and conditions of its operation.

Results

The authors identified two relatively independent groups of indicators of trust/distrust in subject-subject and subject-object interactions. Trust in the elements of subject-subject interactions (involving workmates, managers, and the study participants themselves as specialists) was reliably higher than their trust in the elements of subject-object interactions (technical objects, manufacturers of railway equipment, and conditions of its operation). The correlations between trust and distrust in the elements of the socio-technical system were positive.

Conclusions

Trust and distrust perform the functions of integrating/differentiating elements of a socio-technical system according to their predictability in various operating conditions. The degree of trust/distrust in the system elements and their "location" in the space of trust/distrust are important when professionals make decisions in the course of performing professional actions. The results of the study can be used for designing socio-technical systems to increase the predictability of their operation in unstable conditions.

Incivility and Knowledge Hiding in Academia: Mediating Role of Interpersonal Distrust and Rumination

Workplace incivility is under investigation for the last three decades, and it holds a central position in organizational behavior literature. However, despite the extensive investigations in the past, there exists a missing link between workplace incivility and knowledge hiding in academia. This study aims to tap this missing link for which data were collected from the universities staff. Data were collected in two waves to reduce the common method biases. In the first wave, questions were asked from the respondents regarding their demographic characteristics and exposure to workplace incivility. At this stage, 400 questionnaires were floated and 355 completely filled responses were received back, while in the second wave, those respondents were approached for data collection who have completely filled questionnaires in the first wave. The time interval between the two waves was 1 month. In the second wave, questions related to distrust and knowledge hiding behavior were asked from the respondents. At this stage, 323 questionnaires were received back out of which 290 were filled and these were considered for final data analysis. Collected data were analyzed by applying structural equation modeling (SEM) through SmartPLS. Results indicated that employees tend to hide knowledge when they experience incivility at workplace. Moreover, they develop a sense of distrust in response to workplace incivility which further triggers them to hide knowledge. Limitations and future directions are also discussed.

Responding to healthcare distrust among underserved communities: Phase II

OBJECTIVE

Medical distrust is both a psychosocial construct and an underappreciated individual social determinant of health with the potential to affect oncology care and clinical trial participation. A community-based participatory research effort, called the Forward Movement Project (FMP), identified multilevel factors affecting trust for healthcare and research in an underserved urban community. In FMP Phase II, we implemented a community-responsive approach to provide lay-oriented education and address misinformation, with the goal of beginning to remediate distrust for healthcare systems and biomedical research.

METHODS

Community residents (N = 154 adults, 64% male, M = 61.5 years old, 53% annual income <$10,000, 83% African American/Black) engaged in participant-driven dialogues with oncology clinicians/clinical researchers and support services professionals. A program evaluation focused on trust for healthcare and biomedical research.

RESULTS

Participants reported positive evaluations of both the program and the cancer center clinicians and staff, who were rated as trustworthy (80% strong agreement). However, trust for healthcare systems ("Strongly agree" = 58%) and medical researchers ("Strongly agree" = 50%) following the program was moderate. Over half of the sample (52%) strongly agreed they would participate in a clinical trial compared to before joining this study.

CONCLUSION

Findings supported the user-generated program approach. The FMP is an example of a model for true community engaged research and has implications for rebuilding trust in healthcare and research.

COVID-19 Vaccine Hesitancy Among PLWH in South India: Implications for Vaccination Campaigns

BACKGROUND

The global effort to end the Severe Acute Respiratory Syndrome - Coronavirus 2 pandemic will depend on our ability to achieve a high uptake of the highly efficacious vaccines in all countries. India recently experienced an unprecedented transmission surge, likely fueled by a premature reopening, the highly transmissible delta variant, and low vaccination rates. Indian media have reported high degrees of vaccine hesitancy, which could interfere with efforts to prevent future surges, making it crucial to better understand the reasons for such reluctance in vulnerable populations, such as people living with HIV.

METHODS

We conducted telephone interviews with 438 people living with HIV who were participants in a longitudinal cohort, designed to examine and validate novel antiretroviral therapy ART adherence measures. Interviews were conducted in January and February 2021 and covered COVID-19-related questions on confidence in vaccine safety and efficacy, worries of vaccine side effects, trust in COVID-19 information from specific sources, and intent to get vaccinated.

RESULTS

Over one-third of participants (38.4%, n = 168) met our definition of "vaccine hesitant" by reporting being either unlikely to get vaccinated at all or wanting to wait. Vaccine hesitancy was associated with lack of confidence in vaccine safety, concerns about side effects and efficacy, and distrust in common sources of vaccine-related information.

DISCUSSION

These results highlight several challenges for vaccination efforts. Campaigns may benefit from using trusted sources, including antiretroviral therapy center staff, providing clear information about safety and efficacy and emphasizing the role of vaccines in preventing severe disease, hospitalizations and death, and the reduction of forward transmission to unvaccinated household members.

Handling Distrust on Risk Communication in Nigeria: A Strategy to Strengthening the COVID-19 Outbreak Response

BACKGROUND

This study aimed to assess the level of trust in the Coronavirus disease 2019 (COVID-19) risk communication efforts in Nigeria.

METHODS

We conducted a descriptive cross-sectional study among community members aged 15 years and above in Ondo State in October, 2020. Data were collected using an interviewer-administered questionnaire, and analyzed using SPSS version 22. Descriptive statistics were summarized using frequencies. Trust was ranked from "1" suggesting "Low level of trust" to "7" denoting "High level of trust". We conducted Chi-square test between respondents' level of trust in the Nigeria Centre for Disease Control (NCDC) and socio-demographic characteristics. The level of significance was set at p < 0.05.

RESULTS

Among the 691 respondents, 244 (35.3%) were aged 21 to 29 years, and 304 (51.4%) accessed COVID-19 information through the NCDC. Overall, 205 (41.8%) had high level of trust in the NCDC, and 51 (51.5%) individuals aged 30-39 years had high level of trust in the NCDC (χ2 = 17.455; p = 0.001). Also, 114 (48.5%) persons who lived with children below 18 years had high level of trust in the NCDC (χ2 = 8.266; p = 0.004).

CONCLUSION

Policy-makers should prioritize the involvement of young and educated persons in COVID-19 risk communication strategies.

The effect of momentary mood on appraisal of facial affect and distrust: an experimental approach using ambulatory assessment

Previous laboratory studies have demonstrated that an observer's current mood can influence their processing of facial stimuli, for instance, the appraisal of facial affect. The aim of the present study was to explore the association between current mood and face processing in participants' daily lives, thereby making use of naturally occurring affective states. We employed Ambulatory Assessment (AA) and included two experimental tasks to test whether current mood predicts how participants evaluate (i) the valence of emotional faces and (ii) facial trustworthiness. We hypothesised a mood-congruent processing, such that individuals would rate pictures of faces more negatively and less trustworthy, the more negative their current mood was. We recruited 42 participants who completed a 7-day AA study with six random prompts per day. At each prompt, participants provided self-reports on momentary mood and completed an emotion rating task and a hypothetical distrust game. Results show that negative momentary mood was significantly associated with higher levels of distrust, but was not significantly associated with more negative emotion ratings. We discuss the incremental value and feasibility of implementing experimental tasks in AA contexts and the opportunities this opens for assessing affective and cognitive processes in natural environments.

National Media Coverage of the Veterans Affairs Waitlist Scandal: Effects on Veterans' Distrust of the VA Health Care System

BACKGROUND

On April 23, 2014, US media outlets broadcast reports of excessive wait times and "secret" waitlists at some Veterans Affairs (VA) hospitals, precipitating legislation to increase Veterans' access to private sector health care.

OBJECTIVE

The aims were to assess changes in Veterans' distrust in the VA health care system before and after the media coverage and explore sex and racial/ethnic differences in the temporal patterns.

METHODS

Veterans completed semistructured interviews on health care satisfaction from June 2013 to January 2015, including a validated scale of health system distrust (range: 1-5). We used linear splines with knots at 90-day intervals to assess changes in distrust before and after April 23, 2014 ("day 0") in linear mixed models. To explore sex and racial/ethnic differences in temporal patterns, we stratified models by sex and tested for interactions of race/ethnicity with time.

RESULTS

For women (n=600), distrust scores (mean=2.09) increased by 0.45 in days 0-90 (P<0.01), then decreased by 0.45 in days 90-180 (P<0.01). Among men (n=575), distrust scores (mean=2.05) increased by 0.18 in days 0-90 (P=0.059). Distrust levels were significantly higher for Black versus White women (time adjusted mean difference=0.21) and for Black and Hispanic versus White men (differences=0.26 and 0.18). However, the temporal patterns did not vary by race/ethnicity for women or men (interaction P=0.85 and 0.21, respectively).

CONCLUSIONS

Health system distrust increased in women following media coverage of VA access problems and was higher in Black/Hispanic versus White Veterans at all time periods. Such perceptions could influence Veteran decisions to seek health care in the community rather than VA.

Comparing Antecedents of Chinese Consumers' Trust and Distrust

To help retailers gain consumers’ trust, many studies have investigated antecedents of consumer trust. However, distrust, a concept closely related to trust, has attracted only sporadic research attention. As a result, whether factors that increase consumer trust can eliminate consumer distrust is unclear. To deepen understanding of trust and distrust, this study applies the critical incident technique to identify and compare the antecedents of trust and distrust of Chinese consumers. The results show that the antecedents of distrust differ from those of trust, indicating different formulation mechanisms of both. Therefore, on the one hand, retailers should pay attention to increasing consumer trust, and on the other hand, they should develop marketing activities to reduce consumer distrust.

Medical education and distrust modulate the response of insular-cingulate network and ventral striatum in pain diagnosis

Healthcare providers often underestimate patients’ pain, sometimes even when aware of their reports. This could be the effect of experience reducing sensitivity to others pain, or distrust toward patients’ self-evaluations. Across multiple experiments (375 participants), we tested whether senior medical students differed from younger colleagues and lay controls in the way they assess people’s pain and take into consideration their feedback. We found that medical training affected the sensitivity to pain faces, an effect shown by the lower ratings and highlighted by a decrease in neural response of the insula and cingulate cortex. Instead, distrust toward the expressions’ authenticity affected the processing of feedbacks, by decreasing activity in the ventral striatum whenever patients’ self-reports matched participants’ evaluations, and by promoting strong reliance on the opinion of other doctors. Overall, our study underscores the multiple processes which might influence the evaluation of others’ pain at the early stages of medical career.

Limited knowledge and distrust are important social factors of out-patient' s 'inappropriate diagnosed seeking behaviour': a qualitative research in Shanghai

AIMS

This study is designed to present out-patient's 'inappropriate diagnosed seeking behaviour' in tertiary hospitals and interpret its association with some potential social factors.

METHODS

A qualitative study based on grounded theory was designed in this paper. The participates were recruited by a two-stage process. The field observation and in-depth interview were adopted for data collection. Multi-round (five rounds) sampling and continuing data analysis were adopted as well.

RESULTS

Totally 26 out-patients from three tertiary hospitals in Shanghai were involved. Four focused codes, including 'limited policy-related knowledge', 'limited health-related knowledge', 'distrust on related policy' and 'distrust on medical networks', were identified. Then, a theoretical model about the association of out-patient's 'limited knowledge' with 'distrust' and its relationship with 'inappropriate first-diagnosed seeking behaviour' in tertiary hospitals was developed.

CONCLUSION

'Inappropriate first-diagnosed seeking behaviour' of the out-patients in tertiary hospitals is closely associated with their limited knowledge and related distrust. Great effort on improving publics' knowledge and rebuilding a benign trust relationship with out-patients and the medical networks is found to be essential for guiding publics' appropriate first-diagnosed health behaviour in various levels of medical institutions.

A Leap of Faith: Is There a Formula for "Trustworthy" AI?

Trust is one of the big buzzwords in debates about the shaping of society, democracy, and emerging technologies. For example, one prominent idea put forward by the High-Level Expert Group on Artificial Intelligence appointed by the European Commission is that artificial intelligence should be trustworthy. In this essay, we explore the notion of trust and argue that both proponents and critics of trustworthy AI have flawed pictures of the nature of trust. We develop an approach to understanding trust in AI that does not conceive of trust merely as an accelerator for societal acceptance of AI technologies. Instead, we argue, trust is granted through leaps of faith. For this reason, trust remains precarious, fragile, and resistant to promotion through formulaic approaches. We also highlight the significance of distrust in societal deliberation, as it is relevant to trust in various and intricate ways. Among the fruitful aspects of distrust is that it enables individuals to forgo technology if desired, to constrain its power, and to exercise meaningful human control.

Sharing Data - Not With Us! Distrust as Decisive Obstacle for Public Authorities to Benefit From Sharing Economy

Future mobility planning to cope with ongoing environmental challenges such as air pollution has to be anchored in the work of every public authority worldwide. One recent trend that could support public authorities to meet the European Union’s sustainability targets is the creation and sharing of transport and mobility “big” data between public authorities via tools such as crowdsourcing. While the benefits of the use of big data to increase public authorities’ efficiency and effectivity and their citizens’ lives is well understood, examples from the public sector that highlight public authorities’ engagement in such sharing activities is still missing. To date relevant literature has highlighted issues around the capacity of public authorities that hinder shared activities. In this paper we want to raise distrust as a key reason for lack of engagement. Based on comprehensive data collected over the period of 4 years via several workshops and semi-structured interviews with seven public authorities in Europe, we are able to demonstrate that a major obstacle for not providing and sharing data via crowdsourcing for mutual benefit lies primarily in the hands of the public authority’s servants of the middle and high-level management. Our results show firstly, that distrust may emerge toward different referents such as the community, particular individuals, or the technology itself and thus, managerial implications have to be very specific to overcome distrust. Secondly, we show how distrust may spread from one referent to another through negative reciprocity and which, if unchecked may lead to an all-encompassing state that affects the whole sharing economy framework and inhibits potential benefits.

Development and validation of the Health Care System Distrust scale for cancer screening among Koreans

PURPOSE

The current research addresses the need for developing a Health Care System Distrust scale for cancer screening among Koreans living in the Republic of Korea. This study developed and validated a scale to measure health care system distrust and to examine the psychometric properties of the scale.

METHODS

Interviews, expert reviews, a pilot test, and a cross-sectional survey with 884 Koreans were conducted for instrument development and validation. Content validity, construct validity using exploratory and confirmatory factor analyses, convergent and discriminant validity, and reliability of the scale were examined.

RESULTS

Factor analyses demonstrated a three-factor structure (competency of tests and health care providers, quality of health care organizations, and honesty of health care organizations) of the Health Care System Distrust scale with 12 items accounting for a total of 71.47% of the variance (competency = 33.35%, quality = 21.14%, and honesty = 16.97%). Cronbach's α coefficients of the subscales were 0.72-0.92.

CONCLUSION

The newly developed Health Care System Distrust scale will aid in understanding Koreans' distrust of the health care system and their cancer screening behaviors, and will improve cancer screening utilization by transforming distrust into trust.

Trust and Distrust as Artifacts of Language: A Latent Semantic Approach to Studying Their Linguistic Correlates

Trust and distrust are crucial aspects of human interaction that determine the nature of many organizational and business contexts. Because of socialization-borne familiarity that people feel about others, trust and distrust can influence people even when they do not know each other. Allowing that some aspects of the social knowledge that is acquired through socialization is also recorded in language through word associations, i.e., linguistic correlates, this study shows that known associations of trust and distrust can be extracted from an authoritative text. Moreover, the study shows that such an analysis can even allow a statistical differentiation between trust and distrust—something that survey research has found hard to do. Specifically, measurement items of trust and related constructs that were previously used in survey research along with items reflecting distrust were projected onto a semantic space created out of psychology textbooks. The resulting distance matrix of those items was analyzed by applying covariance-based structural equation modeling. The results confirmed known trust and distrust relationship patterns and allowed measurement of distrust as a distinct construct from trust. The potential of studying trust theory through text analysis is discussed.

Understanding Multilevel Factors Related to Urban Community Trust in Healthcare and Research

Background: Community and patient engagement in the healthcare system and biomedical research are prerequisites for eliminating health disparities. We conducted a “listening tour” to enhance our understanding of multilevel factors associated with community trust. Methods: Using community-based participatory research (CBPR) methods, we conducted a phenomenological qualitative study. “Town-hall” style discussions were held at nine sites across an urban, Midwestern city. We recruited adults (N = 130) via community networks, social media, flyers, and word-of-mouth. Demographic assessments were self-administered and listening tour sessions were conducted by trained moderators. Themes were framed within the social ecological model (SEM; intrapersonal, interpersonal, institutional, community, and policy levels). Results: Participants were mostly female (68%), African American (80%), had health coverage (97%) and were diagnosed with a chronic health condition (71%). The overarching theme was sociodemographic differences in distrust, such that African Americans and deaf/hearing impaired participants perceived disparities in healthcare, a lower quality of care, and skepticism about biomedical research, relative to Whites. Conclusions: The depth of distrust for healthcare providers, systems, and researchers in underserved communities remains strong and complex. Findings highlight the need to understand the lived experiences of community members, and how distrust is maintained. Multilevel interventions to increase trust and the accrual of underrepresented populations into clinical trials are needed.

Perceptions of Close Relationship Through the Machiavellians´ Dark Glasses: Negativity, Distrust, Self-Protection Against Risk and Dissatisfaction

It is commonly known from the literature that Machiavellian individuals have negative attitudes towards people and in general towards the world´s affairs. They are distrustful of the intentions of others, and they get cautiously involved into interpersonal interactions and take risks only if that may not have any severe negative consequence. It is also a fact that there are few ventures in life that potentially involve as much insecurity and personal vulnerability as the establishment and maintenance of close relationships. In our study, we were seeking the answer to the question: do people with high levels of Machiavellianism show a generally negative, distrustful and cautious attitude in their intimate relationships, as well? What effect their pessimistic approaches have on the other consequences of the relationship (satisfaction, commitment, investment, quality of alternatives)? This question was investigated on a dyadic sample of heterosexual couples (N = 101 pairs) with Actor-Partner Interdependence Model (APIM). The results of the correlations and actor effects show that men with high levels of Machiavellianism perceive in a negative way not just people in general, but their romantic partners and relationships as well and they experience an increased level of distrust, risk, and dissatisfaction into their close relationships. Women with high levels of Machiavellianism are less negativistic and feel less discontent towards their intimate partner and relationship, but even they are unable to put their distrust and precaution aside. The results of partner effects have revealed that women's Machiavellianism undermines men's trust, while men's Machiavellianism has the effect of minimizing women's investment into their relationship.

Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis

BACKGROUND

Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women.

METHODS

Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow-up screening mammogram was compared between women who identified ≥1 barriers and those who did not.

RESULTS

Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers.

CONCLUSIONS

Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial.

Two-Faced Morality: Distrust Promotes Divergent Moral Standards for the Self Versus Others

People do not trust hypocrites, because they preach water, but drink wine. The current research shows that, ironically, when we distrust, we become moral hypocrites ourselves. We argue that experiencing distrust alerts us to the possibility that others may intent to exploit us, and that such looming exploitation differentially affects moral standards for the self versus others. Four studies ( N = 1,225) examined this possibility and its underlying motivational dynamic. Study 1 established a relationship between dispositional distrust and flexible, self-serving moral cognition. In Studies 2 and 3, participants experiencing distrust (vs. trust) endorsed more lenient moral standards for themselves than for others. Study 4 explored the role of the motivation to avoid exploitation in these effects. Specifically, participants' dispositional victim sensitivity moderated the effect of distrust on hypocrisy. Together, these findings suggest that individuals who distrust and fear to be exploited show self-serving, and hence untrustworthy, moral cognition themselves.

Trust is heritable, whereas distrust is not

Why do people distrust others in social exchange? To what degree, if at all, is distrust subject to genetic influences, and thus possibly heritable, and to what degree is it nurtured by families and immediate peers who encourage young people to be vigilant and suspicious of others? Answering these questions could provide fundamental clues about the sources of individual differences in the disposition to distrust, including how they may differ from the sources of individual differences in the disposition to trust. In this article, we report the results of a study of monozygotic and dizygotic female twins who were asked to decide either how much of a counterpart player's monetary endowment they wanted to take from their counterpart (i.e., distrust) or how much of their own monetary endowment they wanted to send to their counterpart (i.e., trust). Our results demonstrate that although the disposition to trust is explained to some extent by heritability but not by shared socialization, the disposition to distrust is explained by shared socialization but not by heritability. The sources of distrust are therefore distinct from the sources of trust in many ways.

Involvement of the Ventrolateral Prefrontal Cortex in Learning Others' Bad Reputations and Indelible Distrust

A bad reputation can persistently affect judgments of an individual even when it turns out to be invalid and ought to be disregarded. Such indelible distrust may reflect that the negative evaluation elicited by a bad reputation transfers to a person. Consequently, the person him/herself may come to activate this negative evaluation irrespective of the accuracy of the reputation. If this theoretical model is correct, an evaluation-related brain region will be activated when witnessing a person whose bad reputation one has learned about, regardless of whether the reputation is deemed valid or not. Here, we tested this neural hypothesis with functional magnetic resonance imaging (fMRI). Participants memorized faces paired with either a good or a bad reputation. Next, they viewed the faces alone and inferred whether each person was likely to cooperate, first while retrieving the reputations, and then while trying to disregard them as false. A region of the left ventrolateral prefrontal cortex (vlPFC), which may be involved in negative evaluation, was activated by faces previously paired with bad reputations, irrespective of whether participants attempted to retrieve or disregard these reputations. Furthermore, participants showing greater activity of the left ventrolateral prefrontal region in response to the faces with bad reputations were more likely to infer that these individuals would not cooperate. Thus, once associated with a bad reputation, a person may elicit evaluation-related brain responses on their own, thereby evoking distrust independently of their reputation.

Trust and distrust between patient and doctor

To trust someone is to have expectations of their behaviour; distrust often involves disappointed expectations. But healthy trust and distrust require a good understanding of which expectations are reasonable, and which are not. In this paper, I discuss the limits of trustworthiness by drawing on recent studies of trust in the context of defensive medicine, biobanking and cardiopulmonary resuscitation decisions.

Lack of Trust in the Health-Care System After Losing a Child to Suicide

BACKGROUND

Lack of trust in the health-care system after losing a child to suicide may prevent bereaved parents from seeking professional treatment when needed, thus diminishing their chances of recovery.

AIMS

This is the first large study to aim at evaluating the incidence of lack of trust in the health-care system and associated variables in suicide-bereaved parents.

METHOD

This nationwide population-based survey included 569 parents who lost a child to suicide 2-5 years earlier and a matched comparison group of 326 nonbereaved parents. Using a study-specific questionnaire, we asked bereaved and nonbereaved parents if they trusted the health-care system and measured psychological and background variables.

RESULTS

Prevalence of lack of trust in the health-care system differed between the bereaved (46.5%) and the nonbereaved parents (18.3%), giving a relative risk of 2.5 (95% CI = 2.0-3.3). After multivariable modeling, high scores of depression, living in big cities, and being single were identified as variables associated with lack of trust in suicide-bereaved parents.

CONCLUSION

Suicide-bereaved parents show lack of trust in the health-care system. We present possible effect modifiers that may be considered in professional interventions aiming at influencing suicide-bereaved parents' level of trust.

A paradoxical association of an oxytocin receptor gene polymorphism: early-life adversity and vulnerability to depression

Several prosocial behaviors may be influenced by the hormone oxytocin. In line with this perspective, the oxytocin receptor (OXTR) gene single nucleotide polymorphism (SNP), rs53576, has been associated with a broad range of social behaviors. In this regard, the G allele of the OXTR SNP has been accompanied by beneficial attributes such as increased empathy, optimism, and trust. In the current study among university students (N = 288), it was shown that early-life maltreatment was associated with depressive symptoms, and that the OXTR genotype moderated this relationship, such that under high levels of childhood maltreatment, only individuals with GG/GA genotype demonstrated increased depressive symptomatology compared to those with the AA genotype. In addition, the role of distrust in mediating the relation between childhood maltreatment and depression seemed to be more important among G allele carriers compared to individuals with the AA genotype. Thus, a breach in trust (i.e., in the case of early-life abuse or neglect) may have a more deleterious effect among G carriers, who have been characterized as more prosocial and attuned to social cues. The data suggested that G carriers of the OXTR might favor social sensitivity and thus might have been more vulnerable to the effects of early-life adversity.

Governance mechanisms in the physician-patient relationship: a literature review and conceptual framework

BACKGROUND

The physician-patient relationship is a critical component of the integrated approach to excellence in health-care delivery. Although commonly modelled within the boundaries of the agency theory and regarded as synonymous to an agent-principal interaction, there exists only a sparse understanding about the most effective ways of governing it.

OBJECTIVE

This article undertakes a selective review of the growing body of research on the governance of the physician-patient relationship to discuss the current state of the knowledge in the field and suggest promising avenues for further exploration.

FINDINGS

On the basis of an extensive analysis of the relevant literature, we identify two emerging streams of inquiry on the trust-based (i.e. trust and ethical oversight) and distrust-based (i.e. patient information-empowerment and decision-making authority) governance mechanisms of the physician-patient relationship and discuss the key findings within each stream.

DISCUSSION

To conciliate the on-going scholarly debate concerning the efficacy of trust- and distrust-based mechanisms, we draw the foundations of a conceptual framework which might serve as a guide for more integrative research endeavours on the governance of the physician-patient relationship.

Trust and distrust among Appalachian women regarding cervical cancer screening: a qualitative study

OBJECTIVE

To explore Appalachian women's perceptions of trust and distrust of healthcare providers and the medical care system as they relate to views about cervical cancer and screening.

METHODS

Thirty-six Ohio Appalachia female residents participated in community focus groups conducted by trained facilitators. Discussion topics included factors related to cervical cancer, and the issues of trust and distrust in medical care. The tape-recorded focus groups were transcribed and analyzed to identify salient themes.

RESULTS

Five themes emerged related to trust in healthcare. Patient-centered communication and encouragement from a healthcare provider led women to trust their physicians and the medical care system. In contrast, lack of patient-centered communication by providers and perceptions of poor quality of care led to distrust. Physician gender concordance also contributed to trust as women reported trust of female physicians and distrust of male physicians; trust in male physicians was reported to be increased by the presence of a female nurse.

CONCLUSIONS

Important factors associated with trust and distrust of providers and the medical care system may impact health-seeking behaviors among underserved women.

PRACTICE IMPLICATIONS

Opportunities to improve patient-centered communication around the issues of prevention and cervical cancer screening (such as providing patient-focused information about access to appropriate screening tests) could be used to improve patient care and build patients' trust.

Development of a revised Health Care System Distrust scale

CONTEXT

Growing evidence suggests that most forms of distrust are multidimensional, including domains of technical competence and value congruence. Prior measures of health care system distrust have not reflected this multidimensional structure and may be limiting research into the role of health care system distrust in health and health care in the US.

OBJECTIVE

To develop a revised a scale of health care system distrust.

DESIGN

Three phase study, including focus groups, pilot testing and a cross-sectional telephone survey.

PARTICIPANTS

A total of 404 individuals recruited directly from the Greater Philadelphia area or through the University of Pennsylvania Health System.

RESULTS

Multilevel consensus coding of focus group transcripts identified 2 primary domains of competence and values with the values domain having subthemes of honesty, motives, and equity. Iterative testing of the initial 76 items led to a final scale of 9 items with a Cronbach's alpha of 0.83. Factor analysis demonstrated a 2-factor structure, corresponding to the domains of values and competence. The values subscale (5 items) had a Cronbach's alpha of 0.73 and the competence subscale (4 items) had a Cronbach's alpha of 0.77. These psychometric properties were similar among African Americans and Whites.

CONCLUSIONS

A novel 9-item scale of Health Care System Distrust with high reliability allows the assessment of the 2 primary domains of distrust (values and competence) and may facilitate research in this area.

Understanding African Americans' views of the trustworthiness of physicians

BACKGROUND

Many scholars have written about the historical underpinnings and likely consequences of African Americans distrust in health care, yet little research has been done to understand if and how this distrust affects African Americans' current views of the trustworthiness of physicians.

OBJECTIVE

To better understand what trust and distrust in physicians means to African Americans.

DESIGN

Focus-group study, using an open-ended discussion guide.

SETTING

Large public hospital and community organization in Chicago, IL.

PATIENTS

Convenience sample of African-American adult men and women.

MEASUREMENTS

Each focus group was systematically coded using grounded theory analysis. The research team then identified themes that commonly arose across the 9 focus groups.

RESULTS

Participants indicated that trust is determined by the interpersonal and technical competence of physicians. Contributing factors to distrust in physicians include a lack of interpersonal and technical competence, perceived quest for profit and expectations of racism and experimentation during routine provision of health care. Trust appears to facilitate care-seeking behavior and promotes patient honesty and adherence. Distrust inhibits care-seeking, can result in a change in physician and may lead to nonadherence.

CONCLUSIONS

Unique factors contribute to trust and distrust in physicians among African-American patients. These factors should be considered in clinical practice to facilitate trust building and improve health care provided to African Americans.

Distrust of the health care system and self-reported health in the United States

CONTEXT

Despite theoretical concerns that health care related distrust may lead to poor health outcomes by interfering with effective health care, little is currently known about the prevalence or outcomes of distrust of the health care system in the United States.

OBJECTIVE

To investigate the association between distrust of the health care system and self-reported health status among the general population in the United States.

DESIGN

Random-digit-dialing telephone survey.

PARTICIPANTS

Nine hundred and sixty-one adult residents of the continental U.S.

PRIMARY MEASURES

Distrust of the health care system and self-reported health status.

RESULTS

Distrust of the health care system is relatively high in the United States, with between 20% and 80% of respondents reporting distrust for each item on the Health Care System Distrust scale and a median scale score of 31 (potential range from 10 to 50). Distrust of the health care system is strongly associated with self-reported fair/poor health (odds ratio [OR] 1.40%, 95% confidence interval [CI] 1.12 to 1.75 for each standard deviation increase in distrust), even after adjusting for sociodemographic characteristics, access to health care and trust in primary physicians. In contrast, low trust in one's primary physician is much lower (only 10% to 20% of respondents reported distrust for each item) and is not associated with health status.

CONCLUSIONS

Distrust of the health care system is relatively high in the general population in the United States and is strongly associated with worse self-reported health. Further studies are needed to assess the direction of this association and the mechanisms involved.