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Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study


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  • Mohseni, Mohabbat
  • Lindstrom, Martin
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    This paper investigates the relationship between institutional trust in the health-care system, i.e. an institutional aspect of social capital, and self-rated health, and whether the strength of this association is affected by access to health-care services. The 2004 public health survey in the Scania region of Sweden is a cross-sectional study; a total of 27,963 respondents aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. Logistic regression model was used to investigate the association between institutional trust and self-rated health. Multivariate analyses of self-rated health were performed in order to investigate the importance of possible confounders (age, country of origin, education, economic stress, generalized trust in other people, and care-seeking behaviour) on this association. A 28.7% proportion of the men and 33.2% of the women reported poor self-rated health. A total of 15.0% and 58.3% of the respondents reported "very high" and "rather high" trust in the health-care system, respectively. Almost one-third of all respondents reported low institutional trust. Respondents born outside Sweden, with low/medium education, low generalized trust and low institutional trust had significantly higher odds ratios of poor self-rated health. Multiple adjustments for age, country of origin, education, economic stress, and horizontal trust had some effect on the significant relationship between institutional trust and poor self-rated health, for both men and women, but the additional introduction of care-seeking behaviour in the model substantially reduced the odds ratios. In conclusion, low trust in the health-care system is associated with poor self-rated health. This association may be partly mediated by "not seeking health care when needed". However, this is a cross-sectional exploratory study and the causality may go in both directions.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 64 (2007)
    Issue (Month): 7 (April)
    Pages: 1373-1383

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    Handle: RePEc:eee:socmed:v:64:y:2007:i:7:p:1373-1383

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    Keywords: Social capital Institutional trust Horizontal trust Self-rated health Access to health care Care-seeking behaviour Sweden;


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    Cited by:
    1. Lindström, Martin, 2008. "Social capital, political trust and purchase of illegal liquor: A population-based study in southern Sweden," Health Policy, Elsevier, vol. 86(2-3), pages 266-275, May.
    2. Chen, Danhong & Yang, Tse-Chuan, 2014. "The pathways from perceived discrimination to self-rated health: An investigation of the roles of distrust, social capital, and health behaviors," Social Science & Medicine, Elsevier, vol. 104(C), pages 64-73.
    3. Radin, Dagmar, 2013. "Does corruption undermine trust in health care? Results from public opinion polls in Croatia," Social Science & Medicine, Elsevier, vol. 98(C), pages 46-53.
    4. Shoff, Carla & Yang, Tse-Chuan, 2012. "Untangling the associations among distrust, race, and neighborhood social environment: A social disorganization perspective," Social Science & Medicine, Elsevier, vol. 74(9), pages 1342-1352.
    5. Riumallo-Herl, Carlos Javier & Kawachi, Ichiro & Avendano, Mauricio, 2014. "Social capital, mental health and biomarkers in Chile: Assessing the effects of social capital in a middle-income country," Social Science & Medicine, Elsevier, vol. 105(C), pages 47-58.
    6. Neena Chappell & Laura Funk, 2010. "Social Capital: Does it Add to the Health Inequalities Debate?," Social Indicators Research, Springer, vol. 99(3), pages 357-373, December.
    7. Favara, Marta, 2012. ""United we stand divided we fall": maternal social participation and children's nutritional status in Peru," Policy Research Working Paper Series 6264, The World Bank.


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