ABSTRACT
Abstract Introduction Patient-physician relationship is associated with ART adherence and medical follow-up in people living with HIV (PLWH). Patient's trust in their doctor is a key component of patient-physician relationship, so adequate and reliable instruments to measure this component are important to evaluate its impact on health outcomes. Objective To evaluate the psychometric properties of a translated and adapted version of Trust in Physician Scale (TPS) in Mexican PLWH. Method A cross-sectional study was carried out in PLWH. Scale was translated to Spanish and culturally adapted. Sociodemographic and TPS data were collected online due to COVID-19 pandemic. Exploratory (EFA) and confirmatory (CFA) factor analysis were carried out in two different samples. Results Data from 215 participants was used to EFA. Five items were eliminated due to low correlation with total scale. Final Cronbach's alpha was .93. A single-factor structure explained 68.8% of the variance. CFA in a sample of 140 participants confirmed adequate fit indices (χ2[7] = 13.015 p = .072, CFI = .997, RMSEA = .057, SMRS = .0015). Discussion and conclusion The final scale was unifactorial and it is made up of six items instead of 11. It seems to be a valid and reliable scale to measure patient's trust in doctors in Mexican PLWH. Further studies are recommended to provide evidence of convergent validity to the instrument.
Resumen Introducción La relación médico-paciente está asociada a la adherencia al tratamiento antirretroviral y al seguimiento médico en las personas que viven con VIH (PVVS). La confianza de los pacientes en sus médicos es un componente clave de la relación médico-paciente, por lo que es importante disponer de instrumentos adecuados y fiables para medir este componente y evaluar su impacto en los resultados de salud. Objetivo Evaluar las propiedades psicométricas de una versión traducida y adaptada de la Trust in Physician Scale (TPS) en PVVS mexicanas. Método Se realizó un estudio transversal en adultos con VIH. La escala fue traducida al español y adaptada culturalmente. Los datos sociodemográficos y de la TPS se recogieron en línea debido a la pandemia de COVID-19. Se realizaron análisis factoriales exploratorios (AFE) y confirmatorios (AFC) en dos muestras diferentes. Resultados Se utilizaron los datos de 215 participantes para el AFE. Se eliminaron cinco ítems debido a la baja correlación con la escala total. El alfa de Cronbach final fue de .93. Una estructura unifactorial explicó el 68.8% de la varianza. El AFC en una muestra de 140 participantes confirmó la adecuación del modelo mostrando índices de ajuste adecuados (χ2[7] = 13.015 p = .072, CFI = .997, RMSEA =.057, SMRS = .0015). Discusión y conclusión La escala final fue unifactorial y se compuso de seis ítems en lugar de 11. Parece ser una escala válida y fiable para medir la confianza del paciente en los médicos en PVVS mexicanas. Se recomiendan más estudios para buscar evidencia de validez convergente del instrumento.
ABSTRACT
In today's digital world, people with type 1 and 2 diabetes turn to peers on social media to access and share information. Some studies have addressed how such information is discussed in clinical consultations, but conceptual nuances are needed to account for the different ways information is discussed. In this article, we draw on semi-structured interviews with 19 clinicians and 25 people with diabetes to examine how diabetes-related information from social media is discussed in Danish outpatient clinical consultations. The data were collected from September 2020 to January 2021. We conceptualise how these discussions fall on a continuum of (dis)engagement with social media information represented by three metaphorical concepts: parallel world, border zone, and trading zone. On one end, social media resembles a parallel world disconnected from clinical consultations: people with diabetes do not bring up social media information and clinicians do not invite them to discuss it. The middle of the continuum is represented by a border zone in which people with diabetes present social media information and clinicians' reactions can either push back, maintaining social media as a parallel world, or support the formation of a trading zone. On the other end, clinical consultations resemble a trading zone: clinicians are open to social media information, invite people with diabetes to discuss it and acknowledge the value of social media. Furthermore, these discussions are often characterised by negotiation in which different perspectives are exchanged. We discuss the benefits and challenges of moving from the parallel world to the trading zone, arguing that discussions about social media information may help clinicians learn what people with diabetes gain from online peer interactions and enable them to offer their expertise to support people with diabetes as they navigate a complex world of online information.