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Abstract
Noncommunicable diseases (NCDs) are becoming a major public health challenge in low-income countries. Different strategies have been implemented to alleviate the burden of NCDs, but service uptake, compliance and continuing engagement with care remain suboptimal. This thesis investigated patient trust in doctors to establish whether it could form part of the NCD response in low-income African countries. To date, most studies on this issue have been conducted in high-income countries. This thesis provides much needed evidence around trust by exploring: the meaning of patient trust in doctors; what factors shape trust; and whether trust matters in hypertension care in rural Tanzania.
Semi-structured interviews were conducted in Swahili with 36 patients and eight providers. Participants were drawn from Western and traditional healing practices. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes.
The findings show that participants’ understanding of trust related to: patient expectations of a doctor before an encounter, patient satisfaction with the doctors’ actions and behaviours during encounters and their post-encounter satisfaction with health outcomes associated with the doctor’s treatment. Factors shaping trust in this rural Tanzanian context can be classified as patient, provider and health system factors. Novel factors identified were patients’ faith in medications, patients’ expectations of hypertension cure and the interplay between Western and traditional systems. Participants suggested that trust mattered in hypertension care in rural Tanzania because of its benefits in facilitating patient healthcare seeking, disclosure, adherence, return for subsequent hospital care, and reduced financial burden. Trust also matters because it benefited doctors by increasing their reputation and work morale, and benefited hospitals by improving their reputation and income. The interviews also revealed a range of potential disadvantages of trust, including increased patients’ vulnerability to malpractice, inflated self-pride among doctors and increased workload.
This thesis establishes the value of improving patient trust in doctors as a means of increasing patient healthcare service uptake, adherence and continuity with hospital care for NCD response. The thesis offers context-specific considerations, and practice and policy recommendations for developing strategies to improve patient trust in doctors in low-income African countries.