ABSTRACT
Trust in physicians is the patient’s optimistic acceptance of vulnerability and the expectation that the physician will do what is best for his/her welfare. This study was undertaken to develop a conceptual understanding of the dimensions and determinants of trust in physicians in healthcare settings in resource-poor, developing countries. A cross-sectional household survey was conducted on a sample of 625 men and women from urban and rural areas in Tamil Nadu, India. The sample was selected using a multistage sampling method and a pre-tested structured questionnaire was utilised. The questionnaire covered the five dimensions of trust: perceived competence of the physician, assurance of treatment, confidence in the physician, loyalty towards him/her, and respect for him/her. Items covering four main factors that influence trust, ie shared identity, the physician’s behaviour, personal involvement of the physician and level of comfort with him/her, were included in the questionnaire. A structural equation model was constructed with the dimensions of trust on one hand and the four factors influencing trust on the other. Trust in physicians is based more on notional constructs, such as assurance of treatment (b=0.714, p<0.001) and respect for the physician (b=0.763, p<0.001),than objective assessments, such as the physician’s competence (b=0.607, p<0.001). Feeling comfortable with the physician (b=0.630, p<0.001) and the physician’s communication skills (b=0.253, p<0.001) significantly influence the level of trust. The former is correlated with the personal involvement of the physician (r=0.124, p<0.001), and so is the latter (r=0.152, p<0.001). The overall model has a good statistical fit. The factors that give rise to trust in physicians vary with the sociocultural context.
ABSTRACT
Background: The Internet is a widely used tool known to foster addictive behavior, and Internet addiction threatens to develop into a major public health issue in the near future in a rapidly developing country like India. Objective: This cross-sectional study intends to estimate prevalence, understand patterns, and evaluate risk factors for Internet addiction among college students in the city of Bengaluru, India. Materials and Methods: Out of a total of 554 data samples from eight colleges selected through multistage cluster sampling, 515 samples were analyzed. Young’s 20-item Internet Addiction Test (IAT), an inventory including demographic factors and patterns of internet use, was administered. Results: This study of college students aged 16-26 years (mean ± SD 19.2 ± 2.4 years), with marginally high female representation (56%), identified 34% [95% confidence interval (CI) 29.91-38.09%] and 8% (95%, CI 5.97-10.63%) as students with mild and moderate Internet addiction respectively. Binary logistic regression found Internet addiction to be associated with male gender [adjusted odds ratio (AOR) 1.69, 95% CI, 1.081- 2.65, P = 0.021], continuous availability online (AOR 1.724, 95% CI, 1.018-2.923, P = 0.042), using the Internet less for coursework/assignments (AOR 0.415, 95% CI, 0.263-0.655, P < 0.001), making new friendships online (AOR 1.721, 95% CI, 1.785-2.849, P = 0.034), getting into relationships online (AOR 2.283, 95% CI, 1.424-3.663, P = 0.001). Conclusion: The results highlight the vulnerability of college students to Internet addiction. The findings provide explanations on the addictive behavior of the internet users, support the inclusion of “Internet Addiction” in the DSM-VI, and open up new paths for further research.
ABSTRACT
In the developing countries, internal migrationis a survival strategy for many labourers in search of a better livelihood and opportunities. It is inevitable that many of them will leave their home towns and villages in the coming years, and that the future will see an increase in the number of migrant labourers in developing countries such as India. Migrant workers face unique health problems and it is important for the health system to prepare itself to face these. In this context, the system will need to address certain key ethical issues.