Do your patients trust you? A sociological understanding of the implications of patient mistrust in healthcare professionals

The trust that patients invest in healthcare professionals and their advice has been shown to facilitate positive clinical outcomes, although there is evidence that patient trust in expertise, including healthcare professionals, has been declining over the years. Questions about whether or not to trust healthcare professionals have been raised recently in international media by Australian pop icon Kylie Minogue, who spoke of her alleged initial misdiagnosis with breast cancer and went on to tell women that they should ‘follow their intuition’ rather than placing unquestioning trust in doctors or medical advice. Given the power of the media in shaping public opinion, there is a potential for such stories to further impact on the already potentially friable doctor-patient relationships, with questions of trust taking centre-stage. Therefore, an understanding of the nature of trust, in addition to the reasons for the decline in patient trust, is exceedingly important for health professionals. This paper presents an overview of social theories of trust that provide a lens through which we can analyse the development of mistrust in healthcare, and identifies ways in which healthcare professionals may aim to facilitate and sustain patient trust

Reworking the sociology of trust: making a semantic distinction between trust and dependence

Trust, as a sociological construct, has become increasingly important in recent times but an agreed definition is yet to be found. A potentially useful way of ‘defining’ trust is by distinguishing it from other semantically similar concepts. Niklas Luhmann has provided semantic distinctions between trust and familiarity, and trust and confidence. The purpose of this paper is to provide empirical evidence of a further semantic distinction between trust and dependence. This distinction allows us to further define trust and also to investigate the difference between ‘trust’ and ‘dependence’

Constructing Masculinity in Women’s Retailers: An Analysis of the Effect of Gendered Market Segmentation on Consumer Behavior

While gender-based differences in consumer behavior have been previously investigated within the context of gender-neutral or unisex retailers, men’s behavior in women’s retailers remains largely unexplored. Furthermore, most studies frame the retail environment as a passive platform through which essential gender differences yield setting-specific bifurcated behavior, and do not address the role the commercial establishment and men’s shopping habits play in gender identity formation and maintenance. To address this gap, we analyzed men’s behavior in women’s retailers using interactionist and social constructionist theories of sex/gender. Data were collected through non-participatory observation at a series of large, enclosed shopping malls in South-Western Ontario, Canada and analyzed thematically. We found that men tend to actively avoid women’s retailers or commercial spaces that connote femininity, while those who enter said spaces display passivity, aloofness, or reticence. We suggest the dominant cultural milieu that constitute hegemonic masculinity— disaffiliation with femininity, an accentuation of heterosexuality, and a prioritization of homosocial engagement—nform the dialectical relationship between individual and institutional gender practice that manifests through consumption

Does prognosis and socioeconomic status impact on trust in physicians? Interviews with patients with coronary disease in South Australia

Older participants are more likely than their younger counterparts to be unquestioning of medical advice. Higher SES participants are more likely to question medical advice than lower SES participants. Also, unlike primary prevention participants, established pathology increased participants’ trust, or decreased questioning behaviour. Participants who perceived themselves at risk of a poor or uncertain outcome were unlikely to doubt medical advice. Conclusions: Blind trust in physicians remains strong in older participants, participants who perceive their prognosis to be uncertain and a proportion of lower SES participants. This is important for practitioners in terms of patient agency and points to the importance of moral and ethical practice. However, physicians also need to be aware that there are a growing proportion of patients for whom trust needs to be developed, and cannot be assumed

Identifying Vulnerable Populations Using a Social Determinants of Health Framework: Analysis of National Survey Data across Six Asia-Pacific Countries

Copyright: © 2013 Ward et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background In order to improve the health of the most vulnerable groups in society, the WHO called for research on the multiple and inter-linking factors shaping the social determinants of health (SDH). This paper analyses four key SDH (social cohesion, social inclusion, social empowerment and socioeconomic security) across six Asia-Pacific countries: Australia, Hong Kong, Japan, South Korea, Taiwan, and Thailand. Methods Population surveys were undertaken using a validated instrument in 2009-10, with sample sizes around 1000 in each country. The four SDH were analysed using multivariate binomial logistic regression to identify socio-demographic predictors in each country. Results Low socio-economic security was associated with low income in all six study countries and with poor subjective health in Japan, South Korea and Thailand and with being married or cohabiting in Australia and Hong Kong. Low social cohesion was associated with low income in all countries and with undertaking household duties in South Korea, Thailand and Taiwan. Low social inclusion was associated with low income in Australia, South Korea and Taiwan and with poor subjective health in Australia, Japan and South Korea. Older people had lower social inclusion in Taiwan (50-59 years) and Hong Kong (retired), younger people in Japan and South Korea (20-29 years in both countries) and younger and middle-aged people in Australia. Low social empowerment was associated with low income in Australia, Thailand and Taiwan, with being aged 60 years or over in Australia, Hong Kong and South Korea, and over 50 years in Thailand. Conclusions This paper provides baseline measures for identifying where and how policy should be altered to improve the SDH. Furthermore, these data can be used for future policy evaluation to identify whether changes in policy have indeed improved the SDH, particularly for marginalised and vulnerable populations

A qualitative study of CVD management and dietary changes: problems of ‘too much’ and ‘contradictory’ information

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated

How do South Australian consumers negotiate and respond to information in the media about food and nutrition? The importance of risk, trust and uncertainty

The amount of information in the media about food and nutrition is increasing. As part of the risk society, consumers have a moral imperative to synthesize this information in order to manage their diet. This article explores how media information about food affects how consumers place trust in the food system and strategies adopted to manage conflicting nutritional information. Qualitative interviews were undertaken with 47 shoppers drawn from higher and lower socio-economic metropolitan and rural locations. There was an overriding trust in the Australian food system; however, participants talked about the impact of the large amounts of complex, confusing and often contradictory information. For some, this led to an active search for ‘truth’. For others it created uncertainty and anxiety, and for others a sense of paralysis or stasis. The findings are explored in relation to the production and consumption of risks in late modernity and the interrelationship between trust and risk

Trust in the Australian food supply: innocent until proven guilty

International research demonstrates diminishing trust in the food supply associated with food scares which undermine trust in expert advice. Even though Australia has not experienced major food scares, there is evidence of diminishing trust in the food supply. Interviews were conducted with 47 South Australian food shoppers from high (n = 17) and low (n = 16) socio-economic regions of Adelaide and from rural South Australia (n = 14) about food governance and trust in the Australian food supply. Participants display a high level of trust in the food supply associated with a perception that Australian food is safe; a lack of exposure to food risks; and trust in personal food safety practices. The media was the only factor which created distrust in the food system. Other participants express confidence in the food supply where confidence is understood as a lack of reflection. Contrary to concepts of reflexive modernisation which presume an increasing awareness of risk and placement of trust as a means of reducing uncertainty, participants adopt an ‘innocent until proven guilty’ approach displaying little knowledge or interest in knowing about food regulation, relying instead on routine food safety practices as a means of managing uncertainty

Inequities in access to healthcare: analysis of national survey data across six Asia-Pacific countries

© 2013 Meyer et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background Evidence suggests that there is a link between inequitable access to healthcare and inequitable distribution of illness. A recent World Health Organization report stated that there is a need for research and policy to address the critical role of health services in reducing inequities and preventing future inequities. The aim of this manuscript is to highlight disparities and differences in terms of the factors that distinguish between poor and good access to healthcare across six Asia-Pacific countries: Australia, Hong Kong, Japan, South Korea, Taiwan, and Thailand. Methods A population survey was undertaken in each country. This paper is a secondary analysis of these existing data. Data were collected in each country between 2009 and 2010. Four variables related to difficulties in access to healthcare (distance, appointment, waiting time, and cost) were analysed using binomial logistic regression to identify socio- and demographic predictors of inequity. Results Consistent across the findings, poor health and low income were identified as difficulties in access. Country specific indicators were also identified. For Thailand, the poorest level of access appears to be for respondents who work within the household whereas in Taiwan, part-time work is associated with difficulties in access. Within Hong Kong, results suggest that older (above 60) and retired individuals have the poorest access and within Australia, females and married individuals are the worst off. Conclusion Recognition of these inequities, from a policy perspective, is essential for health sector policy decision-making. Despite the differences in political and economic climate in the countries under analysis, our findings highlight patterns of inequity which require policy responses. Our data should be used as a means of deciding the most appropriate policy response for each country which includes, rather than excludes, socially marginalised population groups. These findings should be of interest to those involved in health policy, but also in policy more generally because as we have identified, access to health care is influenced by determinants outside of the health system

What are the important issues around food safety and nutrition? Findings from a media analysis and qualitative study of consumer trust

Confusion about, and rejection of, media messages about healthy eating have the potential to contribute to the development of chronic illness through a failure to adopt lifestyle changes. Furthermore, it may inhibit the seeking of appropriate information by people with chronic illness. Given a growing emphasis upon primary care and health literacy, health care professionals need to be aware of the messages that their patients receive