University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies Legacy Theses 2000 A matter of trust: Public trust in the Alberta health care system Kehoe, Susan Marie Kehoe, S. M. (2000). A matter of trust: Public trust in the Alberta health care system (Unpublished master's thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/22216 http://hdl.handle.net/1880/40781 master thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca THE UNIVERSITY OF CALGARY A Matter of Trust: Public Trust in the Alberta Health Care System by Susan Marie Kehoe A THESIS SUBMllTED TO THE FACULTY OF GRADUATE STUDlES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS DEPARTMENT OF SOCIOLOGY CALGARY, ALBERTA DECEMBER. 2000 @ Susan Marie Kehoe 2000 National Library Bibliothkque nationale 1*1 ofCanada du Canada Acquisitions and Acquisitions et Bibliographic Services services bibliographiques 395 WMmgton Skeet 395. rue Wellington Oltawa ON KlA OW OttawaON KlAON4 Canada Canada The author has granted a non- L'auteur a accorde une licence non exclusive licence allowing the exclusive pennettant a la National Li'brary of Canada to Bibliotheque nationale du Canada de reproduce, loan, distri'bute or sell reproduire, prster, distrr'bner ou copies of this thesis in microform, vendre des copies de cette these sous paper or eIectronic formats. la forme de microfichel~,de reproduction sur papier on sur format dectronique. The author retains ownership of the L'auteur conserve la propriete du copyright in this thesis. Neither the droit d'auteur qui protege cette these. thesis nor substantial extracts fiom it Ni la these ni des extraits substantiels may be printed or otherwise de celle-ci ne doivent Etre imprimes reproduced without the author's ou autrement reproduits sans son permission. autorisation. ABSTRACT Trust in the Canadian heatth care system, which is a 'source of pride' and a 'symbol of core Canadian values', has declined dramatically in Alberta since the Klein administration began its heatth care reforms in 1993. This research project examines the sociological construct of trust, specifically the nature, distribution, and determinants of the public's trust in the Alberta health care system and in its component parts. The theoretical model proposes that trust is shaped by eight dimensions - sociat demographic characteristics of the respondent, ideologies and orientations of the respondent, the respondent's feelings of efficacy and control, health care experience, perceived effectiveness of the system, media influence, value congruence between the respondent and key decision-makers, and trustworthiness of key sources of information about the health care system. This study provides a comprehensive profile of various measures of trust, and identifies, through multiple regression analysis, key determinants of that trust. Bernard Barber's three-fold conceptualization of trust - generalized trust. fiduciary trust. and confidence in competence - is also explored. The data for this study were collected using a mailed, self-administered questionnaire which was distributed to a sample of households in Calgary, Alberta between November 4 and December 10,1999. Four hundred and ninety three respondents took part in the research project. .-- Ut ACKNOWLEDGEMENTS I would like to thank my supervisor Or. J. Rick Ponting for his excellent guidance and his tremendous dedication, often above and beyond the call of duty. Thank you for giving me the encouragement to pursue my goals. I would also like to thank members of my examining committee Dr. Tom Langford and Dr. Roger Gibbins for their insightful comments and advice. A very special thanks to Marg Maclennan for volunteering her time to help distribute the questionnaire. Thankyou for your hendship and encouragement. Thanks also to the following individuals: Thomas Huang Dr. Cora Voyageur Dr. Linda Henderson Pamela Weinberger Thanks to Lana, Margaret, Jordan 8 Diane. I loved walking into the office each day and hearing the latest report on my returns. Thanks for collecting all my mail and all my messages!! Thankyou for your assistance and for your humor. Many thanks to Lynda Costello who helped make this journey a smoother one. To my respondents - thankyou for taking the time to share your invaluable insights with me. DEDICATION To Susan - for encouraging me to pursue my dreams. To my parents, Pat and Maxine Kehoe - who instilled in me a love of learning. To my aunt and uncle, Terry and Dave Markle - your generosrty and support has helped make this journey possible. TABLE OF CONTENTS Approval Page ......................................................................................... ii Abstract ................................................................................................... iii Acknowledgements .............................................................................. iv Dedication ............................................................................................... v Table of Contents .................................................................................... vi List of Tables ........................................................................................... viii List of Figures ................... .. ................................................................. xi CHAPTER ONE: INTRODUCTION ..................................................... Importance of the Study of Trust ..................................... Health Care Context in Alberta .......................................... Research Question .......................................................... CHAPTER TWO: THEORETICAL FRAMELVORK .............................. Social Holism ..................................................................... Levels of Trust - Interpersonal and Systemic .................... Theoretical Perspectives on Trust ...................................... Social Leaming Theory ............................................ Functionalist Perspectives ....................................... Trust and Credibility ................................................. Trust and Contracts ................................................. Trust and Change .................................................... Distrust .................................................................... Trust and Confidence ......................................................... Definitions of Trust ........................................................... CHAPTER THREE: LITERATURE REVIEW AND HYPOTHESES........ Measures of Trust in the Literature .................................... Literature on Trust in Institutions ....................................... Determinants of Trust ........................................................ Toward a Theory of Trust .................................................. Statement of Hypotheses ................................................... CHAPTER FOUR: METHODOLOGY .................................................. A Note on Research Design ............................................... The Sample ....................... ,. ............................................ Sources of Error ................................................................. Weighting the Sample ....................... .., ........................... The Questionnaire .............................................................. Scale Construction ............................................................. Operationalization of the Dependent Variables .................. Operationalization of the Independent Variables ................ Statistical Procedures ................... ,., ............................ vl CHAPTER FIVE: MAPPING THE CONTOURS OF TRUST ............... Confidence Compared to Other Canadian Institutions .................. Confidence in the Quality of Health Care Services ....................... Trust in the Health Care Players ................................................... Trustworthiness of Sources of Information ................................... Importance of Sources of Information in Shaping Views .............. Fiduciary Trust in the Policy Community ...................................... Confidence in the Competence of Health Care Players ............... Credibility of Health Care Players ................................................ Confidence in the Health Care System - Past vs Present ........... Optimism about the Future Quaiity of the Health Care Services .. Values and Value Congruence...................................................... Who are the trusters? Who are the distrusters? ........................... CHAPTER SIX: WHAT SHAPES TRUST? .................................. ....... Summary of Hypothesis Testing ................................................... Deterrninants of Trust .................................................................. Summary of Findings Pertaining to the Model .............................. CHAPTER SEVEN: CONCLUSION ...................................................... Contributions to the Study of Trust .................................... Conceptualization of Trust ................................................