是什么影响了印度比哈尔邦民众对公共医疗体系的信任？一项混合方法研究。

What influences the people's trust on public healthcare system in Bihar, India? A mixed methods study.

作者信息

Kumar Atul, Palle Edukondal, Kodali Prakash Babu, Thankappan Kavumpurathu Raman

机构信息

Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India.

Department of Physical and Rehabilitation Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India.

出版信息

BMC Health Serv Res. 2025 Feb 25;25(1):309. doi: 10.1186/s12913-025-12395-4.

DOI:10.1186/s12913-025-12395-4

PMID:40001032

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11863908/

Abstract

BACKGROUND

Lack of trust in healthcare systems results in underutilization, non-adherence to medications, poor healthcare outcomes, and catastrophic health expenditure. Literature on people's trust on public health care system is limited in India. This study aims to examine the people's trust in public healthcare system in Bihar and explore the factors influencing it.

METHODS

We conducted the study employing a sequential explanatory design. A door-to-door survey of 360 adults (mean age 45 years, men 65%) selected through multi-stage random sampling from two districts of Bihar was conducted employing "public healthcare system trust scale". It was followed up with 16 in-depth interviews of purposively selected respondents with a low-level of trust. Survey data were analyzed using binary logistic regression analysis and adjusted odds ratios (AOR) were computed. Qualitative interviews were analyzed employing thematic analysis.

RESULTS

Majority of the participants (76.1%; 95% CI = 71.5-80.3) had low level of trust in public healthcare system, and 27.2% (CI = 22.8-32.0) preferred public healthcare service providers. Younger age of up to 45 years (AOR = 5.68, 95% CI = 2.61-12.37, p < 0.001), residing in East Champaran district (AOR = 7.61, 95%CI = 3.67-15.77, p < 0.001), and suffering from chronic disease (AOR = 2.47, 95% CI = 1.09-5.61, p = 0.037) were significantly more likely to report a low-level of trust in public healthcare system. Thematic analysis yielded six themes namely i) inadequacy of health services, ii) poor quality of services, iii) poor health systems process and management, iv) lack of trust building dialogue, v) previous negative experiences with public facilities and, vi) corona virus disease (COVID)-19 eroding trust on healthcare system.

CONCLUSION

People's trust on public healthcare system in Bihar is low. Public health care system in the state needs to improve focusing on adequacy, quality, health system process and management and trust building dialogue.

摘要

背景

对医疗保健系统缺乏信任会导致利用不足、不遵医嘱服药、不良的医疗保健结果以及灾难性的医疗支出。在印度，关于人们对公共医疗保健系统信任度的文献有限。本研究旨在调查比哈尔邦民众对公共医疗保健系统的信任度，并探讨影响该信任度的因素。

方法

我们采用了序列解释性设计进行这项研究。通过多阶段随机抽样从比哈尔邦的两个地区选取了360名成年人（平均年龄45岁，男性占65%）进行挨家挨户的调查，采用“公共医疗保健系统信任量表”。随后，对16名经有目的地选择的低信任度受访者进行了深入访谈。调查数据采用二元逻辑回归分析进行分析，并计算调整后的优势比（AOR）。定性访谈采用主题分析法进行分析。

结果

大多数参与者（76.1%；95%置信区间 = 71.5 - 80.3）对公共医疗保健系统的信任度较低，27.2%（置信区间 = 22.8 - 32.0）更喜欢公共医疗服务提供者。年龄在45岁及以下（AOR = 5.68，95%置信区间 = 2.61 - 12.37，p < 0.001）、居住在东恰姆帕兰区（AOR = 7.61，95%置信区间 = 3.67 - 15.77，p < 0.001）以及患有慢性病（AOR = 2.47，95%置信区间 = 1.09 - 5.61，p = 0.037）的人更有可能报告对公共医疗保健系统的信任度较低。主题分析得出六个主题，即：i）卫生服务不足，ii）服务质量差，iii）卫生系统流程和管理不善，iv）缺乏建立信任的对话，v）以前在公共设施方面的负面经历，以及vi）冠状病毒病（COVID）-19削弱了对医疗保健系统的信任。