How Trustworthiness is Assessed in Health Care: A Sensemaking Perspective

Abstract

We conceptualize trust relationships between consumers and healthcare providers. Drawing on empirical findings from our study of the care-seeking behaviour patterns of consumers in Pakistan, we examined consumer and provider sensemaking at the micro-level, situated within the macro-context of a low-income country with a poorly performing pluralistic health system. We found that consumers make assessments of received care which guide further care seeking. These assessments are based on: (1) perceived technical competences of providers above perceived interpersonal competences; and (2) the perceived intentions of the provider. These assessments updated the trust relationship with the healthcare provider. On the provider side, trust and ethical behaviour were perceived to be linked and sensegiving messages, through formal and informal cues, aimed to inform consumer sensemaking. Risk and interdependence were high, given poor access to information, financial constraints and high incidence of maternal and child mortality (critical events). We offer insights into a changing context in which providers from various domains of care negotiate a contested ground for consumer trust, at times giving rise to unethical behaviour. We contribute conceptually to the interplay between trust and ethical behaviour and empirically to the sensemaking literature as applied to a healthcare organization. © 2013 Copyright Taylor and Francis Group, LLC.