IntroductionPublic acceptance of health messaging, recommendations, and policy is heavily dependent on the public’s trust in doctors, health systems and health policy. Any erosion of public trust in these domains is thus a concern for public health as it can no longer be assumed that the public will follow official health recommendations. In response, the health policy and health services communities have emphasized a commitment to (re)building trust in healthcare. As such, measures of trust that can be used to develop and evaluate interventions to (re)build trust are highly valuable. In 2024, the Trust in Multidimensional Health System Scale (TIMHSS) was published, providing the first measure of trust in healthcare that includes doctors, the system and health policy within a single measure. This measure can effectively facilitate research on trust across diverse populations. However, it is limited in its application because results cannot be directly added together for a total trust score. Further, at 38-items, it is burdensome for respondents and analysts, particularly when being used as a repeat measure in an applied setting. The aim of the present work was to develop a shortened measure of trust in healthcare for use in applied settings.MethodsSurvey data were collected (N = 512; in Sept 2024) to reduce the number of items and to test if the factor structure was consistent with the original TIMHSS. Several statistical criteria were used to support item reduction (i.e., correlated errors, measurement invariance, inter-item correlations, factor loadings and communalities, item-total correlation, and skewness), as well as an exercise testing the content validity ratio (CVR). We then tested a three-factor model based on the 18 items that remained following the CVR and statistical test metrices to finalize the measure.ResultsThe S-TIMHSS is an 18-item scale that allows for direct scoring of trust items for applied research. It preserves the content, convergent, and criterion validity of the original 38-item version.DiscussionWe recommend the measure be used by health policy makers and practitioners as a quality metric to inform and evaluate interventions which aim to (re)build trust in doctors, health systems and health policy.

Antimicrobial resistance (AMR) can be considered a wicked problem because the phenomenon is characterised by multiple, interdependent factors, functioning within ostensibly intractable dynamics. Collaborative or networked governance is often seen as the most appropriate approach to address wicked problems, and there is often scepticism regarding the scalability of micro-level local solutions contributing to neglect in the literature of the role that street-level actors play. Our study focuses on AMR stewardship practices in Northern Europe (Netherlands, Sweden and England), a region which has been relatively successful in controlling antibiotic use in healthcare. We conducted purposively sampled, theoretically-informed, qualitative interviews to explore stewards' practice as policy actors - how they carried out their tasks, worked with others, and dealt with tensions in their role. Using abductive analysis, we demonstrate that participants pursued sustained engagement with antibiotic prescribers and sought creative ways of working with, rather than against, embedded professional values. They deployed deliberative and diplomatic relational practices to build trust. Street-level diplomacy offers a theoretical framework for understanding how policy actors can work in the context of wicked problems. Street-level diplomats operate, with high levels of discretion, within complex, adaptive systems utilising their relational skills to build dynamic forms of influence amongst those implementing policies that have direct impact on citizens and services users. This provides a pragmatic analytical route through the extremes of romanticised calls for 'collaboration' to solve wicked problems or critical perspectives that suggest that wicked problems are intractable.

ContextThe COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1) Is responsive to the conceptual and methodological limitations of existing measures; (2) Can be used to identify systemic explanations for lower levels of trust in equity-deserving populations; (3) Can be used to design and evaluate interventions aiming to (re)build trust.MethodsWe conducted a 2021 review of existing measures of trust in healthcare, 72 qualitative interviews (Aug-Dec 2021; oversampling for equity-deserving populations), an expert review consensus process (Oct 2021), and factor analyses and validation testing based on two waves of survey data (Nov 2021, n = 694; Jan-Feb 2022, n = 740 respectively).FindingsWe present the Trust in Multidimensional Healthcare Systems Scale (TIMHSS); a 38-item correlated three-factor measure of trust in doctors, policies, and the system. Measurement of invariance tests suggest that the TIMHSS can also be reliably administered to diverse populations.ConclusionsThis global measure of trust in healthcare can be used to measure trust over time at a population level, or used within specific subpopulations, to inform interventions to (re)build trust. It can also be used within a clinical setting to provide a stronger evidence base for associations between trust and therapeutic outcomes.

In this editorial we highlight the need for empirical studies into the growing use of artificial intelligence (AI) technology in healthcare and social work settings, especially studies which are theoretically informed by critical social science studies of risk and uncertainty. In setting out the importance of interpretative and critical traditions for research into such AI-oriented forms of risk work, we propose three important conceptual lines of inquiry which empirical studies might follow. First, we sketch ways in which the enactment of AI in healthcare work may be changing how risk is handled amid professional decision-making, and creating new categories of patient/service-user. Patients may be evaluated as being at lower or higher risk depending, respectively, upon their engagement or non-engagement with AI-technologies. These questions of (non-)engagement lead us to consider, second, the trust and distrust dynamics around AI-technologies, exploring the potential inequalities that can emerge as a result of (non) engagement. We then consider drivers of this technological embrace in terms of hope and magical thinking in technological-imaginaries, connecting these cultural tendencies to broader structures of ideology and political-economic interests. We conclude this editorial with a plea to social scientists to be cautious to avoid both techno-optimistic narratives and alarmist warnings regarding the implications of artificial intelligence (AI). Instead, we argue that our focus should be a theoretically informed and detailed examining of how expectations (pertaining to risk, trust, and hope) materialise in practice, particularly in the daily experiences of those who develop and enact AI technologies in care settings.

IntroductionThere is a growing acknowledgement of the salience of hope for mental health service-users, in influencing care outcomes and recovery. Understandings of the processes through which hopes are co-constructed, alongside specific conceptualisations of experiences of hoping, remain limited however.MethodsThis qualitative study explored how a range of stakeholders experienced and dealt with uncertainty within three purposively selected psychosis services in southern England. In this article we focus particularly on the co-construction of hope within participants' narratives and how this emotion work shaped experiences of hoping. In-depth interviews (n = 23) with service-users, professionals, managers and other stakeholders were analysed following a phenomenological approach.FindingsHope was spontaneously identified by participants as a fundamental mechanism through which service-users and professionals managed uncertainty when vulnerable. Professionals were influential in shaping users' hopes, both intentionally and unwittingly, while some professionals also referred to managing their own hopes and those of colleagues. Such management of expectations and emotions enabled motivation and coping amidst uncertainty, for users and professionals, but also entailed difficulties where hope was undermined, exaggerated, or involved tensions between desires and expectations.DiscussionWhereas, hope is usually reflected in the caring studies literature as distinctly positive, our findings point to a more ambivalent understanding of hope, as reflected in the accounts of both service-users and professionals where elevated hopes were described as unrealistic and harmful, to the well-being of professionals as well as of service-users. It is concluded that a greater awareness within care contexts of how hopes are co-constructed by professionals and service-users, explicitly and implicitly, can assist in improving health care and healthcare outcomes.

The importance of measuring trust in health systems has been accentuated due to its correlation with important health outcomes aimed at reducing COVID-19 transmission. A systematic review published almost a decade ago identified gaps in measures including the lack of focus on trust in systems, inconsistency regarding the dimensionality of trust and need for research to strengthen the validity of measures. Given developments in our understandings of trust since its publication, we sought to identify new scales developed, existing ones adapted in response to identified gaps, and agendas for future research. Using the PRISMA approach for systematic reviews, we conducted a search in four databases. A total of 26 articles were assessed. Twelve new scales were identified, while 14 were adapted for different settings and populations. Literature continues to focus on measuring trust in health professionals rather than systems. Various shortcomings were identified, including some articles not mentioning the dimensions included in the scale and suboptimal use of validity and reliability testing and/or reporting. Moreover, a variety of terms were used for dimensions. Future research is needed to address these gaps and consequently, to understand their correlation with health behaviors and outcomes more accurately.

The ability of governments and nations to handle crises and protect the lives of citizens is heavily dependent on the public's trust in their governments and related social institutions. The aim of the present research was to understand public trust in government during a time of crisis, drawing on interview data (N = 56) collected during the COVID-19 pandemic (2021). In addition to the general public (n = 11), participants were sampled to obtain diversity as it relates to identifying as First Nations, Métis, and Inuit (n = 7), LGBT2SQ+ (n = 5), low-income (n = 8), Black Canadians (n = 7), young adult (n = 8), and newcomers to Canada (n = 10). Data were coded in consideration of social theories of trust, and specifically the nature of trust between individuals and institutions working with government in pandemic management. Canadians' trust in government was shaped by perceptions of pandemic communication, as well as decision-making and implementation of countermeasures. Data suggest that although participants did not trust government, they were accepting of measures and messages as presented through government channels, pointing to the importance of (re)building trust in government. Perhaps more importantly however, data indicate that resources should be invested in monitoring and evaluating public perception of individuals and institutions generating the evidence-base used to guide government communication and decision-making to ensure trust is maintained. Theoretically, our work adds to our understanding of the nature of trust as it relates to the association between interpersonal and institutional trust, and also the nature of trust across institutions.

Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities. Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section. The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups’ attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines’ production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination. While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge.

Background Trust in government is associated with health behaviours and is an important consideration in population health interventions. While there is a reported decline in public trust in government across OECD countries, the tools used to measure trust are limited in their use for informing action to (re)build trust, and have limitations related to reliability and validity. To address the limitations of existing measures available to track public trust, the aim of the present work was to develop a new measure of trust in government. Methods Fifty-six qualitative interviews (Aug-Oct 2021; oversampling for equity-deserving populations) were conducted to design a national survey, including factor analyses and validation testing (N = 878; June 1-14th 2022) in Canada. Results The measure demonstrated strong internal consistency (α = 0.96) and test validity (CFI = 0.96, RMSEA = 0.09, SRMR = 0.03), suggesting that trust in government can be measured as a single underlying construct. It also demonstrated strong criterion validity, as measured by significant (p < 0.0001) associations of scores with vaccine hesitancy, vaccine conspiracy beliefs, COVID-19 conspiracy beliefs, trust in public health messaging about COVID-19, and trust in public health advice about COVID-19. We present the Trust in Government Measure (TGM); a 13-item unidimensional measure of trust in Federal government. Conclusions This measure can be used within high-income countries, particularly member countries within the OECD already in support of using tools to collect, publish and compare statistics. Our measure should be used by researchers and policy makers to measure trust in government as a key indicator of societal and public health.

•The past COVID-19 pandemic has shown how important of relationships can be; Even in situations such as COVID-19, the added value of being able to be able to combine three elements of proximity (physical, narrative and moral) seems important for everyone; for patients as well as healthcare professionals.

In this chapter we apply a range of insights drawn from social science studies of hope amidst contexts of illness, and studies of hope emerging from the sociology of emotions, in critically considering social processes of hoping amidst the Covid-19 pandemic. While much of the health sciences literature on hope emphasises positive outcomes in terms of coping and motivation, we also draw upon various perspectives which denote a dark side of hoping, whereby inequalities and injustices are tolerated, or where feeling rules insidiously coordinate collective hopes in ways which serve various political-economic interests. Reflecting this ambivalence across different literatures, our examples and analyses suggest that hoping as a social process is itself inherently conflicted, dissonant and rife with tensions. As we explore the contradictions of hoping amidst a pandemic, the tensions between expectations and desire, tragedy and optimism, aspiring to act and fatalistic acceptance make apparent that emotions of hope can be neither neatly delineated nor disentangled from a ‘messy’ web of related feelings and framings. We extend our emphasis of these blurry, dissonant and messy aspects of hoping through work on ‘tragic optimism’, following Frankl, wherein wider lifeworlds or imaginaries pertaining to deeply embodied and implicit notions of self and a good life are central to maintaining hope amidst heightened vulnerability and uncertainty. We close by laying out a post-formal approach to hope, which methodologically and conceptually focusses on contradictions and dissonance in narratives of hope, whereby living hopefully always involves living awkwardly with these tensions.

Background Adverse drug reaction (ADR) reports in pharmacovigilance databases often contain coded information and large amounts of unstructured or semi-structured information in plain text format. The unstructured format and sheer volume of these data often render them neglected. Structural topic modelling (STM) represents a potentially insightful way of harnessing these valuable data and to detect grouping or themes in spontaneous reports to aid signal detection. Purpose This was an explorative study of the potential for structural topic modelling to identify useful patterns in ADR reports involving opioid drugs in a pharmacovigilance database. Methods A dataset of ADR reports on opioid drugs reported to the Netherlands Pharmacovigilance Centre Lareb from 1991 to December 2020 was used, comprising a total of 3069 unique reports. Qualitative text analysis was combined with STM, an automated text analysis method, to examine these data. Results In reports submitted directly by patients and healthcare professionals, 11 meaningful topics were identified, whereby patient experience reports, particularly in relation to pain (relief), and the timing of intake and ADRs of tramadol and paracetamol, were the most common. Of the 12 topics identified in reports received via marketing authorization holders, patch and skin-related side effects, addiction and constipation were the most prevalent. Conclusions The STM-based analysis identified information that cannot always be captured by coding with the Medical Dictionary for Regulatory Activities (MedDRA (R)). The identified topics reflect findings in the literature on opioids.

This introduction lays out the key themes of the book and locates these within wider scholarship in the sociology of risk and uncertainty. We pay particular attention to the work of Mary Douglas whose work is not so commonly drawn upon in studies of risk and inequality. We argue, however, that various Douglasian themes, not least those pertaining to relations between centre and periphery, are very pertinent to analysing the kinds of pandemic-related social phenomena we see described in the chapters of the book. While governmentality and reflexive modernisation approaches are often rooted in assumptions pertaining to a more northern European expansive state formation, Douglas’s insights lend themselves better to the various non-North-Western contexts addressed in the book, where the state plays less of a role or has absconded responsibility. Through these themes, and in dialogue with the chapters of the book, we aim towards a more global sociology of risk and uncertainty. Indeed, this chapter stresses the value of insights from empirical examples and theoretical perspectives drawn from Southern countries, with this book being an important step towards enriching critical studies of risk and uncertainty in this manner. We close the introduction with a detailed overview of each of the chapters.

In this editorial, we introduce a special thematic collection of articles published in this current issue, and earlier in 2021, which develop a range of social science approaches to studying and theorising pandemic risk, largely focused on the COVID-19 pandemic. We structure this editorial essay in two parts. First, we consider the challenges of theorising pandemics with an attentiveness to inequality. We consider what different theoretical approaches have brought and can bring to studying risk and inequality, before developing a more in-depth consideration of the work of Mary Douglas for this purpose. We draw out key features of Douglas’s work on ‘centre and periphery’, alongside the related group dynamics and tensions which are configured by, and help reproduce, social inequalities. Second, we then develop a dialogue between these analytical sensibilities around inequality, drawn from Douglas, and various conceptualisations and findings emerging in the eight studies published on pandemics in Health, Risk and Society this year (4 in this issue, 4 appearing earlier in the year). Douglas’s work, which has often been neglected in studies of inequalities and risk, provides valuable insights into institutional dynamics of culture and power. The eight recent studies in the journal include some conducted in contexts, and by researchers, located towards the global economic and academic periphery. This diversification, beyond the usual social and governmental contexts, and alongside the growing involvement of different epistemic communities, introduces and cultivates valuable insights, for the field of risk, inequality and health more generally, and for grasping the global phenomena of the pandemic.

Existing scholarship on police decision-making notes the importance of categories and 'governing mentalities' in shaping front-line discretionary practices. Much of this work explores categories of race and ethnicity. Important questions remain regarding how micro-level practices connect to organizational dynamics and why ethnic profiling endures despite attempts to counter such practices. Drawing on critical approaches to uncertainty and risk, not least Mary Douglas's cultural theory, we analyse data drawn from an ethnographic study of police work in a large city in the Netherlands. Our analysis emphasizes the multiple lines of accountability that render officers vulnerable in different ways, officers' combining of different rationalities of decision-making and the influence of everyday rituals that cultivate and reinforce particular organizational thought styles and discretionary practices.