An Assessment of Healthcare Relationship Trust between Patent Medicine Vendors and Residents of Hard-to-Reach Settlements in Northern Nigeria
Abstract:
A trusting relationship is required for effective communication between care providers and care seekers, and trust is a determinant of early healthcare-seeking and care outcomes. The patient-Doctor healthcare trust relationship has been widely studied in different settings. However, there is a dearth of information on whether the factors underlying healthcare relationship trust between patients and their doctors are the same as those underlying patients’ trust in other healthcare professionals (including the PPMVs). This study, therefore, aims to assess the level and determinants of healthcare relationship trust between patent medicine vendors and their clients in hard-to-reach settlements in North-western Nigeria. We adapted the revised healthcare relationship trust scale, administered by trained data collectors using android devices. The data were analysed using Stata (version 16). We used the Chi-square test to identify the correlates of the level of trust(high/low), and binary logistic regression was used to identify its determinants. Statistical significance was defined as P<0.05. Slightly above one-quarter (28.1%) of the underserved had high healthcare relationship trust in the PPMVs. Being married, male, residing in a rented or makeshift shelter in Kaduna state, with under-five child(ren) in their household, and self-reporting good health predicted a high level of healthcare relationship trust in PPMVs among the underserved who participated in this study. We concluded that the personal and household characteristics of the underserved could significantly influence their level of trust in PPMV. Therefore, to achieve the aim of improving health outcomes in deprived populations, initiatives seeking to integrate PPMVs into the formal health system in resource-constrained settings should seek to address the determinants of healthcare relationship trust in these populations as part of their rollout process.
Keywords: Communities, Hard-to-reach, Healthcare, Trust, Relationship, Workforce.
References:
[1] Adeloye
D, David RA, Olaogun AA, Adesokan AA, Gadanya M, Opele JK, Owagbemi O, Iseolorunkanmi
A. (2017). Health workforce and governance: the crisis in Nigeria. Hum Resour Health
15:32. https://doi.org/10.1186/s12960-017-0205-4.
[2] World Health
Organization. The World Health Report 2006—working together for health. Geneva:
World Health Organization; 2006.
[3] International
Labour Office (ILO).1990. International standard classification of occupations:
ISCO-88.
[4] Singh P,
Sachs JD. (2013). 1 million community health workers in sub-Saharan Africa by 2015.
Lancet 382(9889):363–5.
[5] World Health
Organization. (2007). Everybody’s business: strengthening health systems to improve
health outcomes: WHO’s a framework for action. Geneva: World Health Organization.
[6] Senkubuge
F, Modisenyane M, Bishaw T. (2014). Strengthening health systems by health sector
reforms. Glob Health Action 7: 23568.
[7] Dovlo D.
(2005). Wastage in the health workforce: some perspectives from African countries.
Hum Resour Health 3:6.
[8] Dovlo D.
(2007). Migration of nurses from sub-Saharan Africa: a review of issues and challenges.
Health Serv Res. 32 (3):1373–88.
[9] Nguyen PM,
Mirzoev T, Le TM. (2016). Contribution of health workforce to health outcomes: empirical
evidence from Vietnam. Hum Resour Health. https://doi.org/10.1186/s12960-016-0165-0.
[10] National
Population Commission - NPC/Nigeria and ICF International. Nigeria demographic and
health survey 2018. Abuja, Nigeria: NPC/Nigeria and ICF International. 2018.
[11] World Health
Organization. (2016). Nigeria. In: Global Health Workforce Alliance. Geneva: World
Health Organization.
[12] World Health
Organization. (2017). Task sharing to improve access to Family Planning /Contraception.
Summary Brief. Geneva, Switzerland. https://apps.who.int/iris/bitstream/handle/10665/259633/WHO-RHR-17.20-eng.pdf;jsessionid=9D05F66331F909F3693312AFB3D11C80?sequence=1.
[13] Wagstaff
A, Van Doorslaer E, Watanabe N. (2003). On decomposing the causes of health sector
inequalities with an application to malnutrition inequalities in Vietnam. J Econ.
112:207–23.
[14] Okoli, C.,
Hajizadeh, M., Rahman, M.M. et al. (2020). Geographical and socioeconomic inequalities
in the utilization of maternal healthcare services in Nigeria: 2003–2017. BMC Health
Serv Res 20, 849. https://doi.org/10.1186/s12913-020-05700-w.
[15] Mezmur M,
Navaneetham K, Letamo G, Bariagaber H. (2017). Socioeconomic inequalities in the
uptake of maternal healthcare services in Ethiopia. BMC Health Serv Res. 17(1):367.
[16] Ejembi CL,
Dahiru T, Aliyu AA. (2015). Contextual Factors Influencing Modern Contraceptive
Use in Nigeria: DHS Working Papers No. 120. Rockville: ICF International.
[17] Doctor HV,
Olatunji A, Findley SE, Afenyadu GY, Abdulwahab A, and Jumare A. (2012). Maternal
mortality in northern Nigeria: findings of a health and demographic surveillance
system in Zamfara State, Nigeria. Tropical Doctor. 42 (3):140-3. Epub 2012 Apr 27.,
DOI: 10.1258/td.2012.120062.
[18] Ujah IAO,
Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH and Uguru VE. (2005). Factors Contributing
to Maternal Mortality in North-Central Nigeria: A Seventeen-year Review. African
Journal of Reproductive Health. 9, (3): 27-40.
[19] Liu J, Beyeler
N, Prach LM, Sieverding M, Isiguzo C, Nwokolo E, Anyanti J. (2015). The landscape
of patent and proprietary medicine vendors in 16 states of Nigeria. Abuja: Society
for Family Health.
[20] Daini, B.O.,
Okafor, E., Baruwa, S. et al. (2021). Characterization and distribution of medicine
vendors in 2 states in Nigeria: implications for scaling health workforce and family
planning services. Hum Resour Health 19, 60 (2021). https://doi.org/10.1186/s12960-021-00602-2.
[21] Liu J, Prach
LM, Treleaven E, Hansen M, Anyanti J, Jagha T, Seaman V, Ajumobi O, Isiguzo C. (2016).
The role of drug vendors in improving basic healthcare services in Nigeria. Bull
World Health Organ. 94:267–75. https://doi.org/10.2471/BLT.15.154666.
[22] Prach LM,
Treleaven E, Isiguzo C, Liu J. Care seeking at the patent and proprietary medicine
vendors in Nigeria health systems and services in low- and middle-income settings.
BMC Health Serv Res. 2015. https://doi.org/10.1186/s12913-015-0895-z.
[23] Beyeler
N, Liu J, Sieverding M. (2015). A systematic review of the role of proprietary and
patent medicine vendors in healthcare provision in Nigeria. PLoS ONE 10(1): e0117165.
[24] Evans DB,
Hsu J, Boerma T. (2013). Universal health coverage and universal access. Bull World
Health Organ. 91:546-546A.
[25] Durowade
KA, Bolarinwa OA, Fenenga CJ, Akande TM. (2018). Operations and roles of patent
and proprietary medicine vendors in selected rural communities in Edu Local Government
Area, Kwara State, North-Central Nigeria. J Community Med Prim Health Care 30(2):75–89.
[26] Akol A,
Chin-Quee D, Wamala-Mucheri P, Namwebya JH, Mercer SJ, Stanback J. (2014). Getting
closer to people: family planning provision by drug shops in Uganda. Glob Health
Sci Pract. 2(4):472–81.
[27] Treleaven
E, Liu J, Prach LM, Isiguzo C. (2015). Management of paediatric illnesses by the
patent and proprietary medicine vendors in Nigeria. Malar J. 2015;14(1):232.
[28] Brieger
WR, Osamor PE, Salami KK, Oladepo O, Otusanya SA. (2004). Interactions between patent
medicine vendors and customers in urban and rural Nigeria. Health Policy Plan. ;19(3):177–82.
[29] Task-shifting
and task-sharing policy for essential health care services in Nigeria. Abuja: Nigeria
Federal Ministry of Health; 2014.
[30] Ishaku S,
Afolabi K, Dwyer SC, Okunade F, Uzomba C, Adebayo A, Tobey E, Jain A. Examining
and strengthening the role of patent and proprietary medicine vendors in the provision
of injectable contraception in Nigeria. Research report for evidence project. Found
at http://evidenceproject.popcouncil.org/wp-content/uploads/2018/11/Examining-and-Strengthening-the-Roles-of-PPMVs-in-Nigeria_October-2018.pdf.
[31] World Health
Organization. (2017). Infant mortality: situation and trends. In: Global Health
Observatory (GHO) data. . http://www.who.int/gho/child_health/mortality/neonatal_infant_text/en/.
[32] Stanback
J, Spieler J, Shah I, Finger WR. (2010). Community-based health workers can safely
and effectively administer injectable contraceptives: conclusions from a technical
consultation. J Contracept. 81:181–4.
[33] World Health
Organization, U.S. Agency for International Development, Family Health International
(FHI). Community-Based Health Workers Can Safely and Effectively Administer Injectable
Contraceptives: Conclusions from a Technical Consultation. Research Triangle Park
(NC): FHI; 2010.
[34] High-Impact
Practices in Family Planning (HIP). (2013). Drug Shops and Pharmacies: Sources for
family planning commodities and information. Washington, DC: USAID; 2013. Available
from http://www.fphighimpactpractices.org/briefs/drug-shops-and-pharmacies.
[35] Chace Dwyer,
S., Baruwa, S., Okafor, E. et al. (2022). How do changes in motivation to prevent
pregnancy influence contraceptive continuation? Results from a longitudinal study
with women who receive family planning services from Community Pharmacists and Patent
and Proprietary Medicine Vendors in Nigeria. Reprod Health 19, 39 (2022). https://doi.org/10.1186/s12978-022-01326-9.
[37] Makinde OA, Sule A, Ayankogbe
O, Boone D. 2018. Distribution of health facilities in Nigeria: Implications and
options for Universal Health Coverage. Int J Health Plann Manage. October, vol.33,
no.4. pp.1179-1192.Accessed 8 April 2021. DOI: 10.1002/hpm.2603. PMID: 30091473.
[38] Gilson L,
Palmer N, Schneider H. (2005). Trust and Health worker performance: exploring a
conceptual framework using South African evidence. Soc. Sci. Med., 61 (7) (2005),
pp. 1418-1429, 10.1016/j.socscimed.2004.11.062.
[39] Peters D,
Youssef FF. (2016). Public trust in the healthcare system in a developing country.
Int. J. Health Plan. Manag., 31 (2), pp. 227-241, 10.1002/hpm.2280.
[40] Thom, D.
H., Kravitz, R. L., Bell, R. A., Krupat, E., & Azari, R. (2002). Patient trust
in the physician: relationship to patient requests. Family Practice, 19, 476-483.
doi:10.1093/fampra/19.5.476.
[41] Goold, S.
D., Fessler, D., & Moyer, C. A. (2006). A measure of trust in insurers. Health
Services Research, 41, 58-78. doi:10.1111/j.1475-6773.2005.00456. x.
[42] Montori,
V. M., Gafni, A., & Charles, C. (2006). A shared treatment decision-making approach
between patients with chronic conditions and their clinicians: The case of diabetes.
Health Expectations, 9. 25-36.
[43] LoCurto
J and Berg GM. (2016). Trust in healthcare settings: Scale development, methods,
and preliminary determinants. SAGE Open Medicine 4, 1-12. DOI: 10.1177/2050312116664224.
[44] Mollborn
S., Stepanikova I., Cook KS. (2005). Delayed Care and Unmet Needs among Health Care
System Users: When Does Fiduciary Trust in a Physician Matter? Health Services Research
40(6). https://doi.org/10.1111/j.1475-6773.2005.00457.x.
[45] Piette JD,
Heisler M, Krein S, et al. (2005). The role of patient-physician trust in moderating
medication nonadherence due to cost pressures. Arch Intern Med 2005; 165(15): 1749–1755.
[46] Hooper MW.,
Mitchell C., Marshall VJ. (2019). Understanding Multilevel Factors Related to Urban
Community Trust in Healthcare and Research.Int. J. Environ. Res. Public Health 16,
3280; doi:10.3390/ijerph16183280.
[47] Gopichandran,
V., & Chetlapalli, S. K. (2013). Factors influencing trust in doctors: a community
segmentation strategy for quality improvement in healthcare. BMJ Open, 3(12), e004115.
[48] Kennedy,
BR.; Mathias CC.; Woods AK. (2007). African Americans and their distrust of the
healthcare system: Healthcare for diverse populations. Journal of Cultural Diversity
14, 56-60.
[49] William
C.C, Kimberly BS, Julie A. Wilcox, MSW (1983). Aging and Perceived Health Status,
Journal of Gerontology, Volume 38, Issue 3, May 1983, Pages 349–355, https://doi.org/10.1093/geronj/38.3.349.
[50] Wu, S.,
Wang, R., Zhao, Y., Ma, X., Wu, M., Yan, X., & He, J. (2013). The relationship
between self-rated health and objective health status: a population-based study.
BMC public health, 13(1), 1-9.
[51] Goldstein
MS., Siegel JM, and Boyer R. (1984) “Predicting changes in perceived health status.”,
American Journal of Public Health 74, no. 6 (June 1, 1984): pp. 611-614. https://doi.org/10.2105/AJPH.74.6.611.
[52] Wen, M.,
Browning, C. R., & Cagney, K. A. (2003). Poverty, affluence, and income inequality:
neighborhood economic structure and its implications for health. Social science
& medicine, 57(5), 843-860.
[53] Carr G.S, (2021). Negotiating
Trust: A Grounded Theory Study of Interpersonal Relationships Between Persons Living
With HIV/AIDS and Their Primary Health Care Providers. Journal of the Association
of Nurses in AIDS Care, 12(2); 35-43. Accessed from: https://doi.org/10.1016/S1055-3290(06)60132-5.
[54] Olaisen RH., Schluchter MD.,
Flocke SA., Smyth KA., Koroukian SM., Stange KC. 2020. Assessing the Longitudinal
Impact of Physician-Patient Relationship on Functional Health. The Annals of Family Medicine, 18 (5) 422-429; DOI: https://doi.org/10.1370/afm.2554.
[56] National
Bureau of Statistics. (2020). Nigerian Living Standards Survey. Accessed from: https://nigerianstat.gov.ng/elibrary/read/1123.
[57] Davies AR.,
and Ware JE. (1981). Measuring Health Perceptions in the Health Insurance Experiment.
The Rand Publication Series. Available: https://www.rand.org/content/dam/rand/pubs/reports/2007/R2711.pdf.
[60] Hooper MW.,
Mitchell C., Marshall VJ. (2019). Understanding Multilevel Factors Related to Urban
Community Trust in Healthcare and Research. Int. J. Environ. Res. Public Health
16, 3280; doi:10.3390/ijerph16183280.
[62] Baroundi
M., Goicolea I., Hurtig A., San-Sebastian M. (2021.). Social Factors Associated
with Trust in the Health System in Northern Sweden: A Cross-Sectional Study Research
Square [Preprint}. https://doi.org/10.21203/rs.3.rs-701308/v1.
[63] Doescher
MP, Saver BG, Franks P, et al (2000). Racial and ethnic disparities in perceptions
of physician style and trust. Arch Fam Med. 9: 1156–1163.
[64] LaVeist
TA, Nickerson KJ, Bowie JV. (2000). Attitudes about racism, medical mistrust, and
satisfaction with care among African American and white cardiac patients. Med Care
Res Rev MCRR. 57 Suppl 1:146–161.
[65] Katz, Emma
M.S., “Age as a Moderator of Health Outcomes and Trust in Physicians and the Healthcare
System” (2022). Graduate Theses, Dissertations, and Problem Reports. 8331. https://researchrepository.wvu.edu/etd/8331.
[66] Balkrishnan,
R., Dugan, E., Camacho, F. T., & Hall, M. A. (2003). Trust and satisfaction
with physicians, insurers, and the medical profession. Medical Care. 41.1058-1064.
doi: 10.1097/01.MLR.0000083743.15238.9F.
[67] Freburger,
J. K., Callahan, L. F., Currey, S. S., & Anderson, L. A. (2003) Use of the Trust
in Physician Scale in patients with rheumatic disease: Psychometric properties and
correlates of trust in the rheumatologist. Arthritis Care & Research, 49. 51-58.
doi:10.1002/art.10925.
[68] Keating,
N. L., Gandhi, T. K., Orav, E. J., Bates, D. W., & Ayanian, J. Z. (2004). Patient
characteristics and experiences associated with trust in specialist physicians.
Archives of Internal Medicine, 164, 1015-1020. doi:10.1001/archinte.164.9.1015.
[69] Tam, W.
(2012). Health care reform and patients’ trust in physicians in urban Beijing. The
China Quarterly, 211. 827-843.
[70] Russell
S. (2005). Treatment-seeking behavior in urban Sri Lanka: trusting the State, trusting
private providers. Soc Sci Med 61(7): 1396–1407.
[71] O’Malley,
A. S., Sheppard, V. B., Schwartz, M., & Mandelblatt, J. (2004). The role of
trust in use of preventive services among low-income African American women. Preventive
Medicine, 38, 777-785. doi: 10.1016/j.ypmed.2004.01.018.
[72] LoCurto J, Berg GM. (2016).
Trust in healthcare settings: Scale development, methods, and preliminary determinants.
SAGE Open Med, Sep 1;4:2050312116664224. DOI: 10.1177/2050312116664224. PMID: 27635245;
PMCID: PMC5011396.Doescher MP, Saver BG, Franks P, et al. (2000). Racial
and ethnic disparities in perceptions of physician style and trust. Arch Fam Med.
9:1156–1163.
[73] Baroundi
M., Goicolea I., Hurtig A., San-Sebastian M. (2021.). Social Factors Associated
with Trust in the Health System in Northern Sweden: A Cross-Sectional Study Research
Square [Preprint}. https://doi.org/10.21203/rs.3.rs-701308/v1.