The Process of Trusting a Healthcare System: Theory and Evidence from Italy and the United States

Trust is fundamental in the healthcare setting. For this reason, over years scholars have devoted great attention to the examination of the factors that foster patients’ trust in health professionals (Dinç & Gastmans, 2013; Kim et al., 2018; Pearson & Raeke, 2000; Thom et al., 2004). However, the importance of trust in the system of healthcare has been quite overlooked. On the theoretical side, existing conceptualizations have tended to neglect the multidimensionality of the construct and such a problem has had consequences on how the concept has been measured in empirical studies. In most of the published studies, predominantly carried out in the United States, measures of public trust in the system of healthcare are either totally lacking (Ozawa & Sripad, 2013), or limited to one or two items in a questionnaire. Furthermore, current scholarship has not adequately taken into account the social nature of public trust, omitting to consider that most of the people have little or no direct experience of the healthcare system and that their evaluations of the system’s trustworthiness could be based on information deriving from experiences of acquaintances (or unknown people) in their networks (or community). This research project aims at fulfilling these gaps. It is structured in three sub-projects. The first sub-project (SP1) intends to build a theoretical framework of public trust in the healthcare system able to overcome the weaknesses of existing models. The framework will be firmly grounded in theory on trust and will try to account for the complexity and dynamism of trust as a process. In an innovative way, it will differentiate between direct and indirect interactions with the system. Also, it will allow the multiple actors and institutions that make up the systems to exert different weight in the trust building-process, depending on the individual, emotional and contextual circumstances at stake, and on the professional or non-professional relationship that each subject has with each specific component of the system. The second sub-project (SP2) proposes to develop and validate in Italy a scale to measure public trust in the healthcare system. The scale will try to capture the multidimensionality of the studied construct and will have a focus on the institutional dimension of public trust. Finally, in the third sub-project (SP3), using a 2x2 between subject survey experiment it will be tested the extent to which and the ways in which indirect experiences shape public trust in the healthcare system. In particular, the experiment will be aimed at exploring whether and to what extent public trust in the healthcare system of individuals who are members of two racial/ethnicity groups of the U.S. population—whites and blacks, respectively, is affected by the exposure to predominantly positive (vs. predominantly negative) indirect experiences from communicators who belong to their ingroup (vs. to an outgroup).