Rudisill Caroline, Linvill Katie, Chupak Anna, Costa-Font Joan, Harrison Sayward, Hung Peiyin, Li Xiaoming
Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America.
Department of Physics & Astronomy, University of Denver, Denver, Colorado, United States of America.
PLoS One. 2025 Sep 10;20(9):e0331600. doi: 10.1371/journal.pone.0331600. eCollection 2025.
This study aimed to examine how trust in institutions and changes in household finances were associated with healthcare utilization and preventive behaviors during and immediately after the COVID-19 pandemic. The COVID-19 pandemic worsened health disparities, ignited distrust in healthcare systems, and contributed to household economic shifts for many United States (US) residents. To examine these issues, we surveyed a nationally representative sample of US residents in July 2020 (n = 1,085) and May 2023 (n = 2,189). These repeated cross-sectional surveys enabled investigation of how trust in key stakeholders (e.g., federal government, the healthcare system) and household finances were linked with various types of healthcare utilization (e.g., annual preventive visits, receipt of pharmacy-based healthcare), preventive health care (e.g., influenza vaccination), and preventive behaviors (e.g., exercise, healthy eating). In 2023, the likelihoods of using some types of healthcare (annual health check and pharmacy-based healthcare) and engaging in preventive health behaviors increased relative to 2020. Improved household finances were associated with greater odds of healthy eating, exercising, and receiving annual preventive visits. Trust in the healthcare system was positively associated with all healthcare use types examined including preventive care such as influenza immunization and the individual prevention behavior of healthy eating but not exercise. Findings highlight the important role healthcare systems can have as trusted entities in potentially supporting healthcare utilization and prevention in the post-pandemic environment. Policy implications of these findings include increased efforts by payers and healthcare systems to facilitate positive health behaviors for US residents via specific strategies, such as making annual preventive health checks more accessible. At the same time, it is critical to support maintaining and building trust in healthcare systems to promote appropriate healthcare utilization.
本研究旨在探讨在新冠疫情期间及疫情刚结束后，对机构的信任以及家庭财务变化如何与医疗保健利用和预防行为相关联。新冠疫情加剧了健康差距，引发了对医疗保健系统的不信任，并导致许多美国居民家庭经济发生变化。为研究这些问题，我们在2020年7月（n = 1,085）和2023年5月（n = 2,189）对具有全国代表性的美国居民样本进行了调查。这些重复的横断面调查能够探究对关键利益相关者（如联邦政府、医疗保健系统）的信任以及家庭财务如何与各类医疗保健利用（如年度预防性就诊、基于药房的医疗保健服务）、预防性医疗保健（如流感疫苗接种）和预防行为（如锻炼、健康饮食）相关联。与2020年相比，2023年使用某些类型医疗保健服务（年度健康检查和基于药房的医疗保健服务）以及采取预防性健康行为的可能性有所增加。家庭财务状况改善与健康饮食、锻炼以及接受年度预防性就诊的几率更高相关。对医疗保健系统的信任与所考察的所有医疗保健使用类型呈正相关，包括诸如流感免疫等预防性护理以及健康饮食这一个人预防行为，但与锻炼无关。研究结果凸显了医疗保健系统作为受信任实体在疫情后环境中潜在支持医疗保健利用和预防方面可发挥的重要作用。这些研究结果的政策含义包括，支付方和医疗保健系统应加大力度，通过特定策略（如使年度预防性健康检查更易获得）促进美国居民养成积极的健康行为。与此同时，支持维持和建立对医疗保健系统的信任以促进适当的医疗保健利用至关重要。
