The Influence of In-Group Membership on Trust in Health-Care Professionals in Kazakhstan.

BACKGROUND: Trust in providers is key to positive health outcomes. However, perceptions of trust in health-care professionals can vary by population. Factors beyond the immediate behaviors of health-care professionals such as group association may influence perceptions of trust. OBJECTIVE: To examine the possible association of in-group membership and levels of trust in health-care professionals in Kazakhstan. METHOD: We used an online survey including the General Trust in Physicians scale along with demographic questions and a question regarding family members as health-care professionals. Bivariate analysis was used to compare the mean differences between general levels of trust and sociodemographic characteristics. Then multivariate analysis was conducted to examine the association between having a family member who is a health-care professional and general level of trust in health-care professionals among Kazakhstani citizens. Statistical tests were 2-sided. RESULTS: A total of 497 Kazakhstani participants completed the survey. In adjusted multivariate regression, participants with family members as health-care professionals scored significantly higher on the trust scale (P < .001), and other factors such as language (P < .001) and interaction term of language and education (P< .05) were also shown to be influential in the general level of trust. CONCLUSION: Further examinations of how group membership influences reported trust levels in health-care professionals in Kazakhstan are warranted. Such studies would be beneficial if trust in health-care professionals is to be understood and improved in order to achieve more desirable health outcomes.

Patient-Centered Beliefs Among Patients and Providers in Kazakhstan.

BACKGROUND: Health services in Kazakhstan have undergone radical reforms since its independence in 1991, but levels of dissatisfaction among patients remain high. We investigated whether healthcare providers and patients at one hospital in Astana, Kazakhstan, believe the doctor-patient interaction should be doctor-centered vs patient-centered. METHODS: We conducted a cross-sectional study of the responses to various surveys of 200 patients (response rate, 74%) and 201 healthcare providers (response rate, 86%) in a general hospital in Astana, Kazakhstan. The participants completed a questionnaire containing the Patient-Practitioner Orientation Scale (PPOS) and scales assessing life and job satisfaction, job effort-job reward balance, and patient evaluation of communication. Analyses were restricted to those with valid data on the variables age, sex, and PPOS (147 providers and 150 patients). RESULTS: An overwhelming majority of doctors (80%), nurses (87%), and patients (93%) were doctor-oriented. Among patients, higher patient-oriented scores were statistically significantly associated with higher satisfaction with communication with healthcare providers (P=0.038) and with life satisfaction (P=0.009). CONCLUSION: Only a small percentage of doctors, nurses, and patients reported that their interaction should be patient-centered. This congruence between providers and patients does not explain dissatisfaction, but the finding that patient-centered patients were more satisfied suggests an area for improvement.

Situated influences on perceived barriers to health behavior change: cultural identity and context in Kazakhstan.

OBJECTIVE: The objective of this study was to identify the perceived barriers to lifestyle changes citizens of Kazakhstan suffering from cardiovascular disease and type II diabetes were experiencing. DESIGN: 14 focus groups were conducted with patients across two regions of Kazakhstan. Topics of discussion included accessing medical care, communicating with health care providers, and following doctor's recommendations. The text of the discussions were analysed for trends and themes across the different groups. RESULTS: Patients identified a series of external and internal barriers to lifestyle changes, including the environment, a dependency on health care providers, a health care system they feel powerless to change, and a low level of self-efficacy. Most notable, however, was a constructed ethnic identity whose boundaries included unhealthy behaviors, specifically diet and untimely access of health care. This identity both was blamed as a cause for the patient's condition and seen as an unchangeable barrier to health behavior change. CONCLUSION: Current provider efforts to encourage lifestyle changes to manage disease are not taking into account the broader issue of ethnic identity, namely negotiating a fragile and previously suppressed identity that mostly exists alongside other ethnicities. Therefore, maintaining distinctiveness may be a greater need than modifying health behaviors. Efforts towards healthier lifestyles for the public must include not only messages regarding health but also constructions of a Kazakh identity that allows for such lifestyles to fit within the identity framework.

Public Health and Social Desirability in Kazakhstan: Methodological Considerations.

BACKGROUND: As the Republic of Kazakhstan undertakes new public health efforts to promote healthy lifestyles among its citizens, the local perceptions of health and health behaviors need to be examined and understood from the sociocultural and historical perspectives. The primary aim of this study is to examine the association between perception of control on one's health and engagement in good and bad health behaviors. METHODS: Students enrolled in a health communication course surveyed 310 citizens of Kazakhstan on their perceptions of control over their own health and multiple health behaviors (i.e. smoking status, physical activity, etc.). Twenty-seven students were divided into groups and approached every third passerby as a potential participant during common shopping hours in nine popular marketplaces in Astana, Kazakhstan. Perception of control on one's health was measured using a validated measure of health control: the multidimensional health locus of control scale (MHLC), developed by Wallston and colleagues. The MHLC measures three separate loci of control: internal, chance, and powerful others. RESULTS: Participants perceived themselves as having highest control over their health (MHLC subscale internal: 29.70±0.64), powerful others had second highest control (MHLC subscale power others: 23.72±0.77), and chance had the lowest but still some control on their health (MHLC subscale chance: 20.82±0.85). Most participants rated their current health as very good (18.1%), good (45.0%), or moderate (32.3%). Approximately 23.4% of participants were smokers, and 22.2% consumed alcohol. Physical activity averaged 3.63 days in the past week, and fruit and vegetable consumption averaged 2 servings of each per day. Tobacco and the powerful others subscale were significantly negatively correlated (r=-0.17, p<0.05). CONCLUSIONS: Participant reports regarding personal health behaviors and lifestyle did not reflect the national reports regarding lifestyle behaviors. The relationship between powerful others subscale and tobacco smoking indicate that using healthcare providers may open up avenues to lowering tobacco use through patient education; however, social desirability is a notable concern for public health interventions. More importantly, the surveys uncovered future questions for conducting public health research with the general public, including issues of trust in the healthcare system and social desirability bias. Additional factors such as distrust in healthcare and government also may play a role in the public's participation in social scientific research. The students who conducted the surveys reported a general skepticism from the public ranging from unfamiliarity with survey research to explicit distrust in the intentions and purpose of the research itself.

Culture and maternity care in Kazakhstan: what new mothers expected.

Maternity care in the developing nation of Kazakhstan has been characterized as low in quality, with mothers having low levels of health knowledge. Some nongovernmental organizations have been offering childbirth preparation courses to address the lack of knowledge and encourage participation and decision making among expecting mothers. The participants of this study, however, report that information is more for preparation than for decision making, and that the relational aspects of their care, namely, emotional support and trust, are most important. This emphasis reflects the cultural and historical influences that need to be considered when adopting foreign models of care and health education.

Evaluation of communication between physicians and patients in Astana City Hospital №1.

INTRODUCTION: Communication between patients and health care providers is important for the effective functioning of health care systems. Miscommunication often stems from discrepancies in expectations of both healthcare professionals and patients due to cultural and historical influences. We investigated the degree to which health care providers (doctors and nurses) and patients in Kazakhstan believe that interaction between doctors and patients should be doctor- or patient-oriented. MATERIAL AND METHODS: We conducted a cross-sectional study of 163 patients and 176 health care providers (71 doctors and 105 nurses) in a general hospital in Astana, Kazakhstan. The subjects completed a structured questionnaire containing the Patient-Practitioner Orientation Scale (PPOS), and scales assessing life and job satisfaction, effort-reward balance of healthcare professionals, and the patients' perceptions of communication practices. RESULTS: An overwhelming majority of doctors (81.7%), nurses (88.1%), and patients (92.3%) were doctor-oriented. Among health care providers, PPOS was not associated with age, sex, life and job satisfaction, or effort-reward imbalance. Among patients, PPOS was not associated with age, sex, or specialty of health care provider. However, higher PPOS among patients (indicating preference for patient-oriented interaction) was associated with higher satisfaction with communication with health care providers and, less strongly, with their life satisfaction. CONCLUSION: The main finding of this study is the very small proportion of doctors, nurses and patients who believe that interaction should be patient-oriented. These results highlight the necessity of improvement of communication among health care providers towards patient-oriented approach in order to decrease miscommunication with patients. The fact that most patients prefer doctor-oriented interaction may reflect historical stereotypes; educational/information interventions among patients may also be needed.