Women’s Trust in the Healthcare System in Serbia: Validation of the Women’s Trust and Confidence in Healthcare System (Witch) Scale

Abstract

Trust in the healthcare system is one of the prerequisites for positive treatment outcomes. Studies continuously show positive association of trust and patients’ desirable health behaviours, such as sticking to the recommended therapy. Being a quintessential social role, the role of women as patients is associated with other relations of power embedded in society, and studies have repeatedly shown the influence of gender on healthcare-seeking behaviour. Gender stereotypes reduce women's agency in health behaviour and women are more likely to be distrusted by physicians. Furthermore, most of the current psychological measures of trust in the healthcare system have been constructed and validated in Western, educated, industrialised, rich, and democratic (WEIRD) countries, and hence have a limited application in the other social contexts, such as South-eastern Europe. In this study, we constructed a Women’s Trust and Confidence in Healthcare System (WITCH) scale and validated its structure in Serbia. Exploratory factor analysis in Sample 1 (N=329) indicated four-factor structure of trust in the healthcare system, with two dimensions that capture trust (particularised trust, generalised mistrust), the third being confidence, and the fourth that relates to behavioural outcomes of trust. In sample 2 (N=333), we validated the 3+1 factor structure using Confirmatory factor analysis. We observed that interpersonal trust predicted women’s desirable health behaviours in a positive direction, while generalised trust in the system had a negative impact. This pattern of the results indicates the complex interplay between trust in the healthcare system and health-related behaviours.

Care-seeking behavior, perceived professional healthcare support, social structural and perinatal mental health: a cross-sectional study from the perspective of Chinese mother

“…Examples include a disinterest in the person's mental health history [42], structural discrimination related to poor quality psychiatric treatment or rehabilitation measures and insu cient sharing of information on the diagnosis [43][44]. Stigmatization of treatment hinders mother's positive perception of professional medical support and the building of trust in the medical communities [45].…”

Promotive and Risk Psychological Factors of Intention to Vaccinate in Health-Care Providers, Parents, and Laypeople: To Be Safe Is to Trust?

“…But what does the experience of freedom of parents mean for HPs? Given the traditional paternalistic medical models still represented in most healthcare systems in the world, but specifically in the country of the present study (Ninković et al, 2022), "too much freedom" may signify to physicians, in such a paternalistic model, that patients might ignore their medical advice. In other words, in cases of lack of medical expertise knowledge, fewer choices lead to better choices.…”

“…Namely, regardless of the social role relative to vaccination, participants who perceive themselves, or in the case of HPs and lay people perceive parents in general, as having the ability to make a free choice, review and think clearly, and not under constraints of limited choice, have their decision to vaccinate less influenced by their negative attitudes towards vaccination. This finding points to the importance of incorporating the deliberative model of the physician-patient relationship in practice, which is not the case in Serbia where the current model of this relationship de facto takes the form of a paternalistic one (Ninković et al, 2022). Any medical decision, including the one regarding childhood vaccination, should be informed and not pressured (Iyengar & Lepper, 2000), and such a setting can apparently mitigate the negative effects of previously existing negatively valenced attitudes regarding vaccination.…”

“…It seems there is fear of wrong choices and a lack of understanding on both sides of the patient-physician relationship. The solution for a better-functioning healthcare system lies in the true adoption of deliberative medical models which foster active patient-physician communication about diagnoses, and their possible and alternative treatment directions (Ninković et al, 2022). Patients actively involved in their health are more informed, educated patients who better understand their bodies and mechanisms of possible treatments thus making better health decisions.…”

Intentional non-adherence to official medical recommendations: An irrational choice or negative experience with the healthcare system?

“…Trust in the healthcare system and healthcare professionals [49] was assessed with a total of four items with the highest loadings on the Generalized (mis)trust in the healthcare system, and Particularized (interpersonal) trust in healthcare professionals factors from the Women's trust and con dence in Healthcare System -WITCH scale, two items from each subscale (1 -Completely disagree, 5 -Completely agree).…”