Yang Tse-Chuan, Chen I-Chien, Noah Aggie J
Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New York, 315 Arts and Sciences Building, 1400 Washington Avenue, Albany, NY 12222,
Department of Sociology, Michigan State University, 316 Berkey Hall, East Lansing, MI 48824, USA,
Res Sociol Health Care. 2015;33:43-66. doi: 10.1108/S0275-495920150000033003.
Recently, the institutional performance model has been used to explain the increased distrust of health care system by arguing that distrust is a function of individuals' perceptions on the quality of life in neighborhood and social institutions. We examined (1) whether individuals assess two dimensions of distrust consistently, (2) if the multilevel institutional performance model explains the variation of distrust, and (3) how distrust patterns affect preventive health care behaviors.
Using data from 9,497 respondents in 914 census tracts (neighborhoods) in Philadelphia, we examined the patterns of how individuals evaluate the competence and values distrust using the Multilevel Latent Class Analysis (MLCA), and then investigated how neighborhood environment factors are associated with distrust patterns. Finally, we used regression to examine the relationships between distrust patterns and preventive health care.
The MLCA identified four distrust patterns: Believers, Doubters, Competence Skeptics, and Values Skeptics. We found that 55 % of the individuals evaluated competence and values distrust coherently, with Believers reporting low levels and Doubters having high levels of distrust. Competence and Values Skeptics assessed distrust inconsistently. Believers were the least likely to reside in socioeconomically disadvantaged and racially segregated neighborhoods than other patterns. In contrast to Doubters, Believers were more likely to use preventive health care, even after controlling for other socioeconomic factors including insurance coverage.
Our findings suggest that distrust patterns are function of neighborhood conditions and distrust patterns are associated with preventive health care. This study provides important policy implications for health care and future interventions.
最近，机构绩效模型被用于解释对医疗保健系统日益增长的不信任，认为不信任是个人对邻里和社会机构生活质量认知的一种函数。我们研究了：（1）个体是否一致地评估不信任的两个维度；（2）多层次机构绩效模型是否能解释不信任的差异；（3）不信任模式如何影响预防性医疗保健行为。
利用来自费城914个普查区（社区）的9497名受访者的数据，我们使用多层次潜在类别分析（MLCA）研究了个体如何评估能力和价值观不信任的模式，然后调查了邻里环境因素与不信任模式之间的关联。最后，我们使用回归分析来研究不信任模式与预防性医疗保健之间的关系。
MLCA识别出四种不信任模式：信仰者、怀疑者、能力怀疑者和价值观怀疑者。我们发现，55%的个体一致地评估能力和价值观不信任，信仰者报告的不信任程度较低，而怀疑者的不信任程度较高。能力和价值观怀疑者对不信任的评估不一致。与其他模式相比，信仰者居住在社会经济条件不利和种族隔离社区的可能性最小。与怀疑者不同，即使在控制了包括保险覆盖范围在内的其他社会经济因素之后，信仰者更有可能使用预防性医疗保健。
我们的研究结果表明，不信任模式是邻里条件的函数，并且不信任模式与预防性医疗保健相关。这项研究为医疗保健和未来干预措施提供了重要的政策启示。
