Distrust of the Health Care System and Self-Reported Health in the United States

CONTEXT: Despite theoretical concerns that health care related distrust may lead to poor health outcomes by interfering with effective health care, little is currently known about the prevalence or outcomes of distrust of the health care system in the United States. OBJECTIVE: To investigate the association between distrust of the health care system and self-reported health status among the general population in the United States. DESIGN: Random-digit-dialing telephone survey. PARTICIPANTS: Nine hundred and sixty-one adult residents of the continental U.S. PRIMARY MEASURES: Distrust of the health care system and self-reported health status. RESULTS: Distrust of the health care system is relatively high in the United States, with between 20% and 80% of respondents reporting distrust for each item on the Health Care System Distrust scale and a median scale score of 31 (potential range from 10 to 50). Distrust of the health care system is strongly associated with self-reported fair/poor health (odds ratio [OR] 1.40%, 95% confidence interval [CI] 1.12 to 1.75 for each standard deviation increase in distrust), even after adjusting for sociodemographic characteristics, access to health care and trust in primary physicians. In contrast, low trust in one's primary physician is much lower (only 10% to 20% of respondents reported distrust for each item) and is not associated with health status. CONCLUSIONS: Distrust of the health care system is relatively high in the general population in the United States and is strongly associated with worse self-reported health. Further studies are needed to assess the direction of this association and the mechanisms involved

Anatomie von Kommunikationsrollen. Methoden zur Identifizierung von Akteursrollen in gerichteten Netzwerken.

Die Identifizierung von generalisierbaren Akteursrollen in sozialen Systemen ist seit jeher ein zentrales Anliegen der Sozialwissenschaften. Dies gilt insbesondere für die Identifizierung von Kommunikationsrollen, um die überaus komplexen Prozesse der interpersonalen und massenmedialen Kommunikation systematisch zu beschreiben und zu verstehen. Der vorliegende Beitrag zeigt auf, welche theoretischen und methodischen Überlegungen bei der Operationalisierung von Akteursrollen in gerichteten Netzwerken zu berücksichtigen sind. Basierend auf einer netzwerkanalytischen Betrachtung werden zum einen Unzulänglichkeiten in bestehenden Operationalisierungen von Kommunikationsrollen aufgezeigt und zum anderen neue Konzepte vorgeschlagen. Die diskutierten Konzepte lassen sich zwei unterschiedlichen Ansätzen zuordnen. Einerseits können Mikrostrukturen wie dyadische und triadische Ego Rollen als Basis für die Operationalisierung verwendet werden und andererseits kann man von der Gesamtstruktur des Netzwerks ausgehen. Für den ersten Fall werden unterschiedliche Aggregationsregeln diskutiert, welche eine Anwendung in komplexeren Netzwerken ermöglichen. Beim zweiten Ansatz, der Berücksichtigung der Gesamtstruktur, werden die Eignung unterschiedlicher Zentralitätsmaße, das Konzept des Blockmodelling und die hierarchische Strukturanalyse besprochen. Zwecks Anschaulichkeit beschränkt sich dieser Beitrag auf Rollen in Kommunikationsnetzwerken. Die vorgestellten Konzepte sind jedoch auch auf andere Netzwerke übertragbar, die aus gerichteten Beziehungen bestehen. ----------------------------------------------------------- The identification of generalizable roles in social systems has been one of the most central issues in social science ever since. Particularly in the field of interpersonal communication, the notion of communication roles has been used to describe and better understand the complex processes in social groups and society. This contribution identifies the theoretical and methodological concepts that have to be considered when roles in directed networks are operationalized. Based on a network analytic approach and critically evaluating the shortcomings of some widely used models, this study aims to propose new concepts for the operationalization of communication roles. These concepts can be divided into two distinctive approaches. One possibility is to use microstructures like dyadic and triadic communication roles as basic units. For this approach, different aggregation rules are discussed which are necessary for their application in more complex networks. The second approach takes the overall structure of a network into ac-count and identifies different roles by applying centrality measures, blockmodelling or hierarchical structure analysis tools. For illustrative reasons, this study limits its focus on the operationalization of communication roles as a prominent object in social science research. The concepts presented, however, are applicable for directed graphs in general