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Preditores da Confiança no Sistema de Saúde Português: Uma abordagem multinível
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Resumo(s)
A confiança no sistema de saúde é um elemento fundamental
para o seu funcionamento eficaz, com impacto na
implementação de políticas e na adesão dos cidadãos a
cuidados de saúde. Esta tese tem como objetivo identificar e
analisar os preditores de confiança no sistema de saúde
português, tendo em consideração as perspetivas do cidadão e
do profissional de saúde, bem como a distinção entre os
setores público e privado. Integra uma revisão sistemática de
literatura, o desenvolvimento e validação de uma escala
multidimensional da confiança nos sistemas de saúde, e
quatro estudos quantitativos. A revisão sistemática, resultou
numa taxonomia, que inclui quatro dimensões agregadas da
confiança: políticas de saúde, qualidade dos cuidados,
características sociodemográficas e psicossociais. A escala
desenvolvida demonstrou validade e fiabilidade robustas,
confirmadas por análises fatoriais exploratória e
confirmatória, permitindo a avaliação de diferentes níveis do
sistema de saúde: indivíduo, profissional de saúde,
instituições e políticas de saúde. Os resultados do estudo
exploratório revelaram diferenças significativas nos níveis de
confiança entre os profissionais e não profissionais de saúde,
tanto no setor público como no setor privado. A análise de
preditores identificou determinantes distintos: entre os
cidadãos, o foco no doente foi o principal preditor da
confiança no sistema de saúde, seguido pela perceção da
qualidade dos cuidados; entre os profissionais de saúde,
razões de ordem económica surge como principal preditor
com uma relação inversa à confiança no sistema.
Adicionalmente, observou-se um efeito moderador da
satisfação na relação entre os preditores e a confiança no
sistema de saúde. As conclusões desta tese oferecem
contribuições teóricas significativas para a compreensão da
confiança nos sistemas de saúde e apresentam implicações
práticas para gestores e decisores políticos. Os resultados
sustentam a necessidade de estratégias diferenciadas para
reforçar a confiança no sistema de saúde português, ajustadas
às especificidades do setor público e privado.
Trust in the healthcare system is a fundamental element for its effective functioning, impacting the implementation of policies and citizens' adherence to healthcare. This thesis aims to identify and analyse the predictors of trust in the Portuguese healthcare system, considering the perspectives of citizens and healthcare professionals, as well as the distinction between the public and private sectors. It includes a systematic literature review, the development and validation of a multidimensional scale of trust in health systems, and four quantitative studies. The systematic review resulted in a taxonomy that includes four aggregated dimensions of trust: health policies, quality of care, sociodemographic characteristics, and psychosocial factors. The developed scale demonstrated robust validity and reliability, confirmed by exploratory and confirmatory factor analyses, allowing the assessment of different levels of the healthcare system: individual, healthcare professional, institutions, and health policies. The results of the exploratory study revealed significant differences in trust levels between healthcare professionals and non-professionals, both in the public and private sectors. The analysis of predictors identified distinct determinants: among citizens, the focus on the patient was the main predictor of trust in the healthcare system, followed by the perception of the quality of care; among healthcare professionals, economic reasons emerged as the main predictor with an inverse relationship to trust in the system. Additionally, a moderating effect of satisfaction was observed in the relationship between the predictors and trust in the healthcare system. The conclusions of this thesis offer significant theoretical contributions to the understanding of trust in healthcare systems and present practical implications for managers and policymakers. The results support the need for differentiated strategies to reinforce trust in the Portuguese healthcare system, tailored to the specificities of the public and private sectors.
Trust in the healthcare system is a fundamental element for its effective functioning, impacting the implementation of policies and citizens' adherence to healthcare. This thesis aims to identify and analyse the predictors of trust in the Portuguese healthcare system, considering the perspectives of citizens and healthcare professionals, as well as the distinction between the public and private sectors. It includes a systematic literature review, the development and validation of a multidimensional scale of trust in health systems, and four quantitative studies. The systematic review resulted in a taxonomy that includes four aggregated dimensions of trust: health policies, quality of care, sociodemographic characteristics, and psychosocial factors. The developed scale demonstrated robust validity and reliability, confirmed by exploratory and confirmatory factor analyses, allowing the assessment of different levels of the healthcare system: individual, healthcare professional, institutions, and health policies. The results of the exploratory study revealed significant differences in trust levels between healthcare professionals and non-professionals, both in the public and private sectors. The analysis of predictors identified distinct determinants: among citizens, the focus on the patient was the main predictor of trust in the healthcare system, followed by the perception of the quality of care; among healthcare professionals, economic reasons emerged as the main predictor with an inverse relationship to trust in the system. Additionally, a moderating effect of satisfaction was observed in the relationship between the predictors and trust in the healthcare system. The conclusions of this thesis offer significant theoretical contributions to the understanding of trust in healthcare systems and present practical implications for managers and policymakers. The results support the need for differentiated strategies to reinforce trust in the Portuguese healthcare system, tailored to the specificities of the public and private sectors.
Descrição
Palavras-chave
Confiança Sistema de Saúde Preditores de Confiança Profissional de Saúde Satisfação