Abelson Julia, Miller Fiona A, Giacomini Mita
Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Canada.
Health Policy. 2009 Jun;91(1):63-70. doi: 10.1016/j.healthpol.2008.11.006. Epub 2008 Dec 31.
We used a qualitative empirical study of Canadians' values toward their health system to develop more meaningful conceptualizations of trust and health systems that can inform the pursuit of more trustworthy health systems.
We convened nine focus groups in three Canadian cities in 2002 and 2004 in conjunction with a national public opinion telephone survey of Canadians' attitudes and values toward their health system. Health system trust emerged as a significant theme in focus group discussions and was investigated using a modified grounded theory approach.
Respondents construct cleavages and alliances to position themselves in relation to different features of the trusted health system. The health system and Canadian Medicare are identified sources of trust just as are individual health care providers. Core to the trust relationship is the experience of vulnerability which provides the impetus for placing trust (in providers, governments and health systems) or seeds distrust, mistrust and resilience in the same.
We offer a more robust conceptualization of what it means to trust a health system. Policy maker efforts to intervene to restore lost trust could usefully be informed by these findings.
我们对加拿大人对其医疗体系的价值观进行了定性实证研究，以形成对信任和医疗体系更有意义的概念化理解，从而为追求更值得信赖的医疗体系提供参考。
2002年和2004年，我们在加拿大的三个城市召集了九个焦点小组，并结合一项关于加拿大人对其医疗体系态度和价值观的全国性民意电话调查。医疗体系信任在焦点小组讨论中成为一个重要主题，并采用改良的扎根理论方法进行了调查。
受访者构建了分歧和联盟，以便在与可信赖医疗体系的不同特征相关的方面定位自己。医疗体系和加拿大医疗保险被视为信任的来源，个体医疗服务提供者也是如此。信任关系的核心是脆弱性体验，这种体验为信任（提供者、政府和医疗体系）提供了动力，或在其中播下不信任、猜疑和恢复力的种子。
我们对信任医疗体系的含义提出了更全面的概念化理解。这些研究结果可为政策制定者为恢复失去的信任而进行的干预努力提供有益参考。
