Multilevel modelling of the assessment of confidence in the healthcare system in residents of municipalities of the Arkhangelsk region and the Komi Republic

Introduction. The list of factors determining the confidence in the healthcare system, the vector and the strength of their influence are mediated by the social circumstance (place of living).

The purpose of the study is to quantify the level of confidence in the healthcare system in residents of the Arkhangelsk Region and the Komi Republic and to determine its territorial determinacy.

Materials and methods. A sociological survey was conducted in a group of one thousand seventy five residents from 20 municipalities of two northern regions. The multilevel modelling was used to confirm the hypothesis on the combined impact of factors of individual and group (municipal) levels on the confidence of citizens in healthcare system.

Results. The average “index” of confidence in the healthcare system of residents of the Arkhangelsk Region and the Komi Republic was 40.8 points (95% CI: 38.8–42.8) and 47.1 points (95% CI: 44.7–49.5), respectively (p < 0.001). The average values of the index of confidence in the healthcare system differ statistically significantly in the groups of residents in municipalities. Health Literacy is the most important determinant of the confidence in the healthcare system. Other major determinants are the respondents’ age, self-assessments of health status and well-being. Health Literacy, age and self-assessment of the well-being of Northerners living in different municipalities have a different impact on their confidence in the healthcare system.

Limitations of the study are due to the peculiarities of its design, — the lack of the possibility of verifying the respondents’ answers to the questions.

Conclusion. The confidence in the healthcare system of residents of the municipalities of the Arkhangelsk region and the Komi Republic is determined not only by their personal qualities, but also by the social (territorial) circumstance (place of living).

Compliance with ethical standards. The study was approved by the Independent Interdisciplinary Ethics Committee of the Northern State Medical University (Protocol No. 08/10-21 dated 10.27.2021). All respondents signed an informed consent to participate in the study.

Contribution of the authors:
Mordovsky E.A. — research concept and design, writing the text, statistical data processing;
Baranov A.V. — writing the text, editing;
Sannikov A.L. — collection and processing of material;
Monogarova Yu.Yu. — processing of material, editing;
Losev V.R. — collection and processing of material, compilation of the list of literature;
Shalaurova E.V. — collection and processing of material.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: April 4, 2023 / Accepted: April 27, 2023 / Published: April 29, 2024