Measurements of public trust in the health system: mapping the evidence

Abstract

facilitating improved health outcomes for migrants. Further work is needed to evaluate this intervention. Key messages: Infectious disease screening and catch-up vaccination is not currently delivered well in primary care in high-migrant receiving European countries. Innovative digital tools could aid clinical decision-making and facilitating improved health outcomes for migrants. Background: Effective integrated care interventions for hypertension (HT) and type 2 diabetes (T2D) exist and need to be scaled-up. The 'SCale-Up diaBetes and hYpertension care' SCUBY project aims to facilitate scale-up of integrated care for HT and T2D through the implementation of contextualised scale-up road-maps in Cambodia, Slovenia and Belgium and co-creation in policy dialogues. We herewith describe the plan for the process and scale-up evaluation of the SCUBY project, including the development, adoption and implementation of the roadmaps. The specific goals of the process evaluation are to (i) analyse how the reality of scale-up adheres to the developed roadmaps and (ii) assess how the different contexts can influence the implementation process of the scale-up strategies. Methods: A comprehensive framework was developed to include context, process, scale-up and impact evaluation that is embedded in implementation and political theory. A diverse range of mostly qualitative tools-including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping-will be used to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. Key implementation outcomes include acceptability, feasibility relevance, adaptation, adoption and cost of roadmap activities. The role of context is relevant, and barriers and facilitators to scale-up will be continuously assessed. Conclusions: The SCUBY project presents a comprehensive framework to guide the evaluation of scale-up of complex interventions. We describe three contextualised roadmaps, for Belgium, Slovenia and Cambodia, each adopting their own (horizontal/diversi-fication/vertical) scale-up strategy(ies) as a basis to monitor adaptations through a co-creation process. This study protocol will be a guide for other scale-up interventions making use of knowledge translation and co-creation activities. Key messages: Process evaluation is needed to keep track of complex interventions including scale up. The SCUBY project developed an evaluation plan to comprehensively monitor the scale-up of HT and T2D care. Introduction: Public trust in the health system is essential to control the Covid-19 pandemic. It can influence the extent to which interventions to combat a pandemic are accepted by citizens. The objective of this review was to map the evidence of measurements of the concept of public trust in the health system with a focus on health system institutions. Methods: We performed a systematic literature search in the databases Web of Science and Embase in March 2020. Quantitative studies measuring trust on a system level with regard to healthcare were eligible if they addressed the general public and were published in English or German. We excluded studies that measured trust on an interpersonal level, in a single health profession, or a single treatment. We extracted data to map the characteristics of measurements. Results: Of initially 7137 identified articles, 87 studies were included in the mapping. In 58 (67%) of the studies, trust was the outcome variable. Most studies (69%) measured the level of trust with single items, 27 studies (31%) used scales or indices to measure the concept of trust. Of these, 12 studies measured healthcare system trust, 7 trust in government and political institutions, 4 trust in healthcare organisations, 3 trust in health insurances, and 1 trust in health data management institutions. Most common domains of trust in the healthcare system refer to policies, quality of services, communication and provision of information, relationships with providers and their expertise, and quality of cooperation between providers. Theoretical dimensions of the concept of trust include fidelity, compe-tency, trustworthiness, integrity and global trust. Conclusions: Few quantitative studies examine dimensions of public trust on a health system level. Future country-specific research on the concept of public trust may support the understanding of context-specific determinants for the tailoring of interventions to promote trust in health systems. Key messages: Public trust is an important aspect for controlling a pandemic, as it is a precondition for accepting interventions, such as vaccination programmes. Country-specific research may promote the understanding of public trust and the tailoring of interventions to increase health system trust.