Document Type : Original Article


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


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.


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