Dependence on the health care system and trust in the context of institutional betrayal and adverse medical events

Abstract

Individuals rely on institutions (e.g., health care systems) for a range of important needs. However, when institutions fail to provide services in a safe and supportive manner, they can cause harm to individuals who depend on them for protection, resources, and other needs. This concept is known as institutional betrayal (Smith & Freyd, 2014), which refers to wrongdoings perpetrated by an institution on whom an individual is dependent on. While dependence is theorized to affect the person-institution dynamic, it has not been examined empirically. Currently, it is not known how dependence impacts the tendency to trust in the health care system. The current study examined the relationships between an individual's level of dependence and trust in the health care system when institutional betrayal and adverse medical events occur. University of Regina students (n = 201) completed a survey that assessed adverse medical events, institutional betrayal, institutional dependence, and trust in the health care system and physicians. Dependence and adverse medical events were significantly correlated with lower trust in the health care system. Institutional betrayal and adverse medical events were significantly correlated with lower trust in physicians. The relationship between dependence and trust in physicians was moderated by the severity of institutional betrayal. This study highlights the unique elements of relationships that individuals have with the institutions they rely on.