Document Type : Original Article

Authors

1 Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

2 Gastroenterohepatology Research Center, Shiraz Transplant Research Center, Nemaze Teaching Hospital, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

3 MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background and aims: Public health policies and programs should be adapted to the level of public trust in the healthcare system, as an indicator of the public support level. Accordingly, the data about public trust level in the healthcare system is considered as a critical requirement for managing public health crises. This study aimed to rapidly assess the public trust in the healthcare system during the COVID-19 epidemic in Iran, as well as to evaluate the effect of socioeconomic status (SES) on this trust.

Methods: This cross-sectional and web-based study which was conducted in Iran during the COVID-19 epidemic included adults aged 18-60 years. A probability proportional to size multistage random sampling was applied and performed in 15 provinces of the country. Data on the main sources of information about COVID-19, trust in healthcare system, fear level of COVID-19, and demographics were collected via an electronic questionnaire. Multiple linear regression was applied, and adjusted regression coefficients and 95% confidence intervals (CIs) were estimated.

Results: A total of 5250 adults (response rate: 76%) were included in the study. The mean of reported trust scores was 50.3 ± 22.8, and that of fear scores was 72.0 ± 17.8. The highest (65%) and lowest (28%) levels of trust were observed among participants from the lowest and highest SES, respectively. Gender (male) (P = 0.006), higher levels of education (P < 0.001), higher socio-economic status (P < 0.001), and higher fear scores (P < 0.001) were independently correlated with the lower level of ⦰ trust in healthcare system.

Conclusion: It was found that the public trust in Iran’s healthcare system was not high enough at the time of the COVID-19 epidemic in the country, especially among higher social class population.

Keywords

1. Gilles I, Bangerter A, Clémence A, Green EG, Krings F, Staerklé C, et al. Trust in medical organizations predicts pandemic (H1N1) 2009 vaccination behavior and perceived efficacy of protection measures in the Swiss public. Eur J Epidemiol. 2011;26(3):203-10. doi: 10.1007/s10654-011-9577-2. 
2. Böl GF. Risk communication in times of crisis: pitfalls and challenges in ensuring preparedness instead of hysterics. EMBO Rep. 2016;17(1):1-9. doi: 10.15252/embr.201541678. 
3. Gille F, Smith S, Mays N. Why public trust in health care systems matters and deserves greater research attention. J Health Serv Res Policy. 2015;20(1):62-4. doi: 10.1177/1355819614543161. 
4. Lee K. How the Hong Kong government lost the public trust in SARS: insights for government communication in a health crisis. Public Relat Rev. 2009;35(1):74-6. doi: 10.1016/j. pubrev.2008.06.003. 
5. Holmes BJ, Henrich N, Hancock S, Lestou V. Communicating with the public during health crises: experts’ experiences and opinions. J Risk Res. 2009;12(6):793-807. doi: 10.1080/13669870802648486. 
6. Gesser-Edelsburg A, Mordini E, James JJ, Greco D, Green MS. Risk communication recommendations and implementation during emerging infectious diseases: a case study of the 2009 H1N1 influenza pandemic. Disaster Med Public Health Prep. 2014;8(2):158-69. doi: 10.1017/dmp.2014.27. 
7. Bangerter A, Krings F, Mouton A, Gilles I, Green EG, Clémence A. Longitudinal investigation of public trust in institutions relative to the 2009 H1N1 pandemic in Switzerland. PLoS One. 2012;7(11):e49806. doi: 10.1371/journal.pone.0049806. 
8. Birman KP. The surprising power of epidemic communication. In: Schiper A, Shvartsman AA, Weatherspoon H, Zhao BY, eds. Future Directions in Distributed Computing: Research and Position Papers. Berlin, Heidelberg: Springer; 2003. p. 97-102. doi: 10.1007/3-540-37795-6_18. 
9. Gille F, Smith S, Mays N. Towards a broader conceptualisation of ‘public trust’ in the health care system. Soc Theory Health. 2017;15(1):25-43. doi: 10.1057/s41285-016-0017-y. 
10. Gille F, Smith S, Mays N. What is public trust in the healthcare system? a new conceptual framework developed from qualitative data in England. Soc Theory Health. 2021;19(1):1- 20. doi: 10.1057/s41285-020-00129-x. 
11. Chanley VA, Rudolph TJ, Rahn WM. The origins and consequences of public trust in government: a time series analysis. Public Opin Q. 2000;64(3):239-56. doi: 10.1086/317987.
12. van der Schee E, Braun B, Calnan M, Schnee M, Groenewegen PP. Public trust in health care: a comparison of Germany, The Netherlands, and England and Wales. Health Policy. 2007;81(1):56-67. doi: 10.1016/j.healthpol.2006.04.004. 
13. Larson HJ, Heymann DL. Public health response to influenza A(H1N1) as an opportunity to build public trust. JAMA. 2010;303(3):271-2. doi: 10.1001/jama.2009.2023. 
14. Vaughan E, Tinker T. Effective health risk communication about pandemic influenza for vulnerable populations. Am J Public Health. 2009;99 Suppl 2:S324-32. doi: 10.2105/ ajph.2009.162537. 
15. Farzadfar F, Murray CJ, Gakidou E, Bossert T, Namdaritabar H, Alikhani S, et al. Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study. Lancet. 2012;379(9810):47-54. doi: 10.1016/s0140- 6736(11)61349-4. 
16. Molavi Vardanjani H, Bagheri Lankarani K, Hassani AH. What was the starting date of the COVID-19 epidemic in Iran? rumors against management of public health emergencies. Iran J Public Health. 2020;49(12):2431-2. doi: 10.18502/ijph. v49i12.4836. 
17. Molavi Vardanjani H, Heydari ST, Dowran B, Pasalar M. A cross-sectional study of Persian medicine and the COVID-19 pandemic in Iran: rumors and recommendations. Integr Med Res. 2020;9(3):100482. doi: 10.1016/j.imr.2020.100482. 
18. Gandomkar A, Poustchi H, Moini M, Moghadami M, Imanieh H, Fattahi MR, et al. Pars cohort study of non-communicable diseases in Iran: protocol and preliminary results. Int J Public Health. 2017;62(3):397-406. doi: 10.1007/s00038-016-0848- 2. 
19. Zhao D, Zhao H, Cleary PD. Understanding the determinants of public trust in the health care system in China: an analysis of a cross-sectional survey. J Health Serv Res Policy. 2019;24(1):37- 43. doi: 10.1177/1355819618799113. 
20. Tabrizi JS, Saadati M, Sadeghi-Bazargani H, Abedi L, Alibabayee R. Iranian public trust in health services: evidence from Tabriz, Islamic Republic of Iran. East Mediterr Health J. 2017;22(10):713-8. doi: 10.26719/2016.22.10.713. 
21. Calnan MW, Sanford E. Public trust in health care: the system or the doctor? Qual Saf Health Care. 2004;13(2):92-7. doi: 10.1136/qshc.2003.009001. 
22. Straten GF, Friele RD, Groenewegen PP. Public trust in Dutch health care. Soc Sci Med. 2002;55(2):227-34. doi: 10.1016/ s0277-9536(01)00163-0. 
23. Jovell A, Blendon RJ, Navarro MD, Fleischfresser C, Benson JM, Desroches CM, et al. Public trust in the Spanish health-care system. Health Expect. 2007;10(4):350-7. doi: 10.1111/j.1369- 7625.2007.00466.x. 
24. Legido-Quigley H, Asgari N, Teo YY, Leung GM, Oshitani H, Fukuda K, et al. Are high-performing health systems resilient against the COVID-19 epidemic? Lancet. 2020;395(10227):848- 50. doi: 10.1016/s0140-6736(20)30551-1. 
25. Bangerter A. Investigating and rebuilding public trust in preparation for the next pandemic. Eur Psychol. 2014;19(1):1- 3. doi: 10.1027/1016-9040/a000173. 
26. Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. Lancet Infect Dis. 2019;19(5):529-36. doi: 10.1016/s1473- 3099(19)30063-5. 
27. Menon KU, Goh KT. Transparency and trust: risk communications and the Singapore experience in managing SARS. J Commun Manag. 2005;9(4):375-83. doi: 10.1108/13632540510621614. 
28. Fung IC, Tse ZT, Chan BS, Fu KW. Middle East respiratory syndrome in the Republic of Korea: transparency and communication are key. Western Pac Surveill Response J. 2015;6(3):1-2. doi: 10.5365/wpsar.2015.6.2.011. 
29. Rockers PC, Kruk ME, Laugesen MJ. Perceptions of the health system and public trust in government in low- and middle-income countries: evidence from the World Health Surveys. J Health Polit Policy Law. 2012;37(3):405-37. doi: 10.1215/03616878-1573076.