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dc.rights.licenseCC BY-NC-ND
dc.contributor.authorArakelyan, Stellaen
dc.contributor.authorJailobaeva, Kanykeyen
dc.contributor.authorDakessian, Areken
dc.contributor.authorDiaconu, Karinen
dc.contributor.authorCaperon, Lizzieen
dc.contributor.authorStrang, Alisonen
dc.contributor.authorBou-Orm, Ibrahim R.en
dc.contributor.authorWitter, Sophieen
dc.contributor.authorAger, Alastairen
dc.date.accessioned2021-10-11T12:59:00Z
dc.date.available2021-10-11T12:59:00Z
dc.date.issued2021-10-09
dc.identifierhttps://eresearch.qmu.ac.uk/bitstream/handle/20.500.12289/11518/11518.pdf
dc.identifier.citationArakelyan, S., Jailobaeva, K., Dakessian, A., Diaconu, K., Caperon, L., Strang, A., Bou-Orm, I.R., Witter, S. and Ager, A. (2021) ‘The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study’, Social Science & Medicine, 291, article no. 114473.en
dc.identifier.issn0277-9536en
dc.identifier.urihttps://doi.org/10.1016/j.socscimed.2021.114473
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/11518
dc.descriptionStella Arakelyan - ORCID: 0000-0003-0326-707X https://orcid.org/0000-0003-0326-707Xen
dc.descriptionArek Dakessian - ORCID: 0000-0001-7792-6862 https://orcid.org/0000-0001-7792-6862
dc.descriptionKarin Diaconu - ORCID: 0000-0002-5810-9725 https://orcid.org/0000-0002-5810-9725
dc.descriptionLizzie Caperon - ORCID: 0000-0001-5204-170X https://orcid.org/0000-0001-5204-170X
dc.descriptionAlison Strang - ORCID: 0000-0003-3064-5283 https://orcid.org/0000-0003-3064-5283
dc.descriptionSophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188
dc.descriptionAlastair Ager - ORCID: 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563
dc.descriptionReplaced AM with VoR 2021-10-21
dc.description.abstractNon-communicable diseases (NCDs) disproportionately affect people living in fragile contexts marked by poor governance and health systems struggling to deliver quality services for the benefit of all. This combination can lead to the erosion of trust in the health system, affecting health-seeking behaviours and the ability of individuals to sustain their health. In this cross-country multiple-case study, we analyse the role of trust in health-seeking for NCD services in fragile contexts. Our analysis triangulates multiple data sources, including semi-structured interviews (n=102) and Group Model Building workshops (n=8) with individuals affected by NCDs and health providers delivering NCD services. Data were collected in Freetown and Makeni (Sierra Leone), Beirut and Beqaa (Lebanon), and Morazán, Chalatenango and Bajo Lempa (El Salvador) between April 2018 and April 2019. We present a conceptual model depicting key dynamics and feedback loops between contextual factors, institutional, interpersonal and social trust and health-seeking pathways. Our findings signal that firstly, the way health services are delivered and experienced shapes institutional trust in health systems, interpersonal trust in health providers and future health-seeking pathways. Secondly, historical narratives about public institutions and state authorities’ responses to contextual fragility drivers impact institutional trust and utilisation of services from public health institutions. Thirdly, social trust mediates health-seeking behaviour through social bonds and links between health systems and individuals affected by NCDs. Given the repeated and sustained utilisation of health services required with these chronic diseases, (re)building and maintaining trust in public health institutions and providers is a crucial task in fragile contexts. This requires interventions at community, district and national levels, with a key focus on promoting links and mutual accountability between health systems and communities affected by NCDs.en
dc.description.sponsorshipThis research was funded by the National Institute for Health Research (NIHR) Global Health Research programme 16/136/100.en
dc.description.urihttps://doi.org/10.1016/j.socscimed.2021.114473en
dc.language.isoenen
dc.publisherElsevieren
dc.relation.ispartofSocial Science & Medicineen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectNon-communicable Diseases
dc.subjectTrust
dc.subjectHealth-seeking
dc.subjectHealth Services
dc.subjectHealth Systems
dc.subjectFragile Contexts
dc.titleThe role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative studyen
dc.typeArticleen
dcterms.accessRightspublic
dcterms.dateAccepted2021-10-07
dc.date.updated2021-10-21
dc.description.volume291
dc.description.ispublishedpub
rioxxterms.typeJournal Article/Reviewen
rioxxterms.publicationdate2021-10-09
refterms.dateFCD2021-10-11
refterms.depositExceptionpublishedGoldOAen
refterms.accessExceptionNAen
refterms.technicalExceptionNAen
refterms.panelUnspecifieden
qmu.authorArakelyan, Stellaen
qmu.authorJailobaeva, Kanykeyen
qmu.authorDakessian, Areken
qmu.authorDiaconu, Karinen
qmu.authorCaperon, Lizzieen
qmu.authorStrang, Alisonen
qmu.authorBou-Orm, Ibrahim R.en
qmu.authorWitter, Sophieen
qmu.authorAger, Alastairen
qmu.centreInstitute for Global Health and Developmenten
dc.description.statuspub
refterms.versionVoRen
refterms.dateDeposit2021-10-11


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