Samantha B Meyer

Trust in the health system: An analysis and extension of the social theories of Giddens and Luhmann

Abstract Social theory provides a lens through which we can analyse the role of trust in health systems. However, the majority of theoretically informed trust literature addresses ‘institutional’ or ‘interpersonal’ trust individually, failing to investigate trust as determined by a ‘web’ of mutually interacting relationships between individuals and social systems. Current theoretical assumptions are also problematic as they fail to recognise the role that social factors (such as socio-economic status, class and age) play in an individual’s willingness to trust. Through the analysis and critique of existing social theories of trust, this paper demonstrates a need for further empirical research into the multidimensionality of trusting relationships, while suggesting new directions for research in public health.

The Application of Abductive and Retroductive Inference for the Design and Analysis of Theory-Driven Sociological Research

Abductive and retroductive inference are innovative tools of analysis which enable researchers to refine and redevelop social theory. This paper describes and demonstrates how to apply these tools to strengthen sociological theory-driven empirical research outputs. To illustrate how abductive and retroductive inference work for the benefit of enhanced qualitative analysis we present the findings of a qualitative study that investigated heart disease patients’ trust in medical professionals (n=37). We outline the research process using a six-stage model developed by Danermark et al. (1997) that will guide researchers doing exploratory research in how to use abductive and retroductive inference in qualitative research design and analysis. A snapshot of the study findings are provided for illustration purposes. The reader will learn how the application of these under-utilized methodological tools provides a novel way of analyzing sociological research.

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.

Differentiating between trust and dependence of patients with coronary heart disease: furthering the sociology of trust

Sociological health research on the concept of trust has been bedevilled by its multivocalities. This article extends Luhmanns attempts to clarify a sociology of trust. Luhmann argued a semantic distinction between trust and confidence. In this article, we use empirical data on patient ‘trust’ in doctors to argue that there is also a semantic distinction between trust and dependence. We conducted 37 semi-structured interviews with patients with coronary heart disease in Adelaide, Australia in 2008 and 2009. Our findings indicate that risk, familiarity and time were critical to understand the distinction between trust and dependence. We argue that patients in situations of emergency (heightened risk) ‘depended’ on, rather than trusted, doctors, given the patients lack of familiarity with their doctors. Time was a mediating factor, as the more ‘urgent’ the situation, the more likely it was that dependence came into play, since the situation was ‘unfamiliar’. Rather than juxtaposing trust and dependence, in this article we show how dependence may coexist with trust in the health care system in times of emergency.

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 uncertainly, 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.

Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

BackgroundIn order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH) called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH) (e.g. social capital, empowerment, social inclusion). However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory.MethodsData were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted.ResultsStatistical analysis revealed that people on lower incomes (less than

Vaccine Rejecting Parents’ Engagement With Expert Systems That Inform Vaccination Programs

45000) experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion), higher levels of discrimination and less political action (lower social inclusion) and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion) and engaging in more political action (higher social empowerment). In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion).ConclusionsApplying social quality theory allows researchers and policy makers to measure and respond to the multiple sources of oppression and advantage experienced by certain population groups, and to monitor the effectiveness of interventions over time.

Elevated HIV prevalence and risk behaviours among men who have sex with men (MSM) in Vietnam: a systematic review

In attempting to provide protection to individuals and communities, childhood immunization has benefits that far outweigh disease risks. However, some parents decide not to immunize their children with some or all vaccines for reasons including lack of trust in governments, health professionals, and vaccine manufacturers. This article employs a theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of vaccine rejection in two Australian cities view the expert systems central to vaccination policy and practice. Our data show how perceptions of the profit motive generate distrust in the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical companies had a pernicious influence over the systems driving vaccination: research, health professionals, and government. Accordingly, they saw vaccine recommendations in conflict with the interests of their child and “the system” underscored by malign intent, even if individual representatives of this system were not equally tainted. This perspective was common to parents who declined all vaccines and those who accepted some. We regard the differences between these parents—and indeed the differences between vaccine decliners and those whose Western medical epistemology informs reflexive trust—as arising from the internalization of countering views, which facilitates nuance.

Interpersonal trust across six Asia-Pacific countries: testing and extending the 'high trust society' and 'low trust society' theory.

Objectives To review and analyse original studies on HIV prevalence and risk behaviours among men who have sex with men (MSM) in Vietnam. Design Systematic literature review. Comprehensive identification of material was conducted by systematic electronic searches of selected databases. Inclusion criteria included studies conducted from 2002 onwards, following a systematic review concluding in 2001 conducted by Colby, Nghia Huu and Doussantousse. Data analysis was undertaken through the application of both the Cochrane Collaboration and ePPI Centre approaches to the synthesis of qualitative and quantitative studies. Setting Vietnam. Results Sixteen studies, undertaken during 2005–2011, were identified that met the inclusion criteria. The analysis showed that HIV prevalence among MSM in Vietnam has increased significantly (eg, from 9.4% in 2006 to 20% in 2010 in Hanoi) and that protective behaviours, such as condom use and HIV testing and counselling, continue at inadequately low levels. Conclusions Increasing HIV prevalence and the lack of effective protective behaviours such as consistent condom use during anal sex among MSM in Vietnam indicate a potential for a more severe HIV epidemic in the future unless targeted and segmented comprehensive HIV prevention strategies for MSM in Vietnam are designed and programmes implemented.

Trust makers, breakers and brokers: building trust in the Australian food system.

Background Trust is regarded as a necessary component for the smooth running of society, although societal and political modernising processes have been linked to an increase in mistrust, potentially signalling social and economic problems. Fukuyama developed the notion of ‘high trust’ and ‘low trust’ societies, as a way of understanding trust within different societies. The purpose of this paper is to empirically test and extend Fukuyama’s theory utilising data on interpersonal trust in Taiwan, Hong Kong, South Korea, Japan, Australia and Thailand. This paper focuses on trust in family, neighbours, strangers, foreigners and people with a different religion. Methods Cross-sectional surveys were undertaken in 2009–10, with an overall sample of 6331. Analyses of differences in overall levels of trust between countries were undertaken using Chi square analyses. Multivariate binomial logistic regression analysis was undertaken to identify socio-demographic predictors of trust in each country. Results Our data indicate a tripartite trust model: ‘high trust’ in Australia and Hong Kong; ‘medium trust’ in Japan and Taiwan; and ‘low trust’ in South Korea and Thailand. Trust in family and neighbours were very high across all countries, although trust in people with a different religion, trust in strangers and trust in foreigners varied considerably between countries. The regression models found a consistent group of subpopulations with low trust across the countries: people on low incomes, younger people and people with poor self-rated health. The results were conflicting for gender: females had lower trust in Thailand and Hong Kong, although in Australia, males had lower trust in strangers, whereas females had lower trust in foreigners. Conclusion This paper identifies high, medium and low trust societies, in addition to high and low trusting population subgroups. Our analyses extend the seminal work of Fukuyama, providing both corroboration and refutation for his theory.