Laboratory for Research of Individual Differences, Department of Psychology and Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia.
Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia.
Womens Health (Lond). 2024 Jan-Dec;20:17455057241249864. doi: 10.1177/17455057241249864.
Women's role as patients is associated with power relationships embedded in society. Although trust in the health care system is a general prerequisite for positive health outcomes, practices regarding women's agency in healthcare systems in Southeastern Europe reinforce women's passivity. Most of the current psychological measures of trust have been constructed and validated in "WEIRD" (samples that are drawn from populations that are White, Educated, Industrialized, Rich, and Democratic) countries, thus having a limited application in other social contexts.
We aimed to construct an instrument for assessing women's trust in healthcare systems to describe the structure of trust: Women's Trust and Confidence in the Healthcare System scale.
Two independent samples (N = 329; N = 333) of adult women in Serbia voluntarily completed an online questionnaire. The questionnaire comprised 20 trust-related items which were selected from an extensive collection of women's experiences in the healthcare system and evaluated by experts on a 5-point Likert-type scale.
We used exploratory factor analysis of the Women's Trust and Confidence in the Healthcare System scale to analyze the structure of trust in the first sample data set and validated it with the second sample using confirmatory factor analysis. We tested concurrent validity by exploring how women's trust in the healthcare system predicts health-related behaviors (multigroup structural equation modeling). All analyses were conducted using R statistical software.
The Women's Trust and Confidence in the Healthcare System scale (Cronbach's alpha = 0.86) indicated a three-factor structure of trust in the healthcare system: trust in healthcare professionals, distrust in the public healthcare system, and confidence in healthcare system. This was validated using an independent sample. Interpersonal trust positively predicted women's desirable health behaviors, while trust in the system had a negative impact.
The Women's Trust and Confidence in the Healthcare System scale captures women's trust in a paternalistic healthcare system, is reliable, and has a stable three-factor structure. The study's findings reveal the relationship between women's trust and health-related behavior: in paternalistic environments, trust reinforces women's passivity.
女性作为患者的角色与社会中隐含的权力关系有关。尽管对医疗保健系统的信任是取得积极健康结果的一般前提，但东南欧医疗保健系统中关于女性代理的做法却强化了女性的被动性。目前大多数关于信任的心理测量工具都是在“WEIRD”（从具有白人、受过教育、工业化、富有和民主特征的人群中抽取的样本）国家构建和验证的，因此在其他社会环境中的应用有限。
我们旨在构建一种评估女性对医疗保健系统信任的工具，以描述信任的结构：女性对医疗保健系统的信任和信心量表。
塞尔维亚的两个独立成年女性样本（N=329；N=333）自愿在线完成了一份问卷。问卷包括 20 个与信任相关的项目，这些项目是从女性在医疗保健系统中的广泛经历中选择的，并由专家在 5 点李克特量表上进行评估。
我们使用探索性因子分析对女性对医疗保健系统的信任和信心量表进行分析，以分析第一个样本数据集的信任结构，并使用验证性因子分析对第二个样本进行验证。我们通过探索女性对医疗保健系统的信任如何预测与健康相关的行为来检验同时效度（多组结构方程建模）。所有分析均使用 R 统计软件进行。
女性对医疗保健系统的信任和信心量表（Cronbach's alpha=0.86）显示了医疗保健系统信任的三因素结构：对医疗保健专业人员的信任、对公共医疗保健系统的不信任以及对医疗保健系统的信心。这在使用独立样本进行验证时得到了验证。人际信任与女性理想的健康行为呈正相关，而对系统的信任则呈负相关。
女性对医疗保健系统的信任和信心量表可以捕捉女性对家长式医疗保健系统的信任，具有可靠性和稳定的三因素结构。研究结果揭示了女性信任与健康相关行为之间的关系：在家长式环境中，信任会强化女性的被动性。
