What is public trust in the healthcare system? A new conceptual framework developed from qualitative data in England

The conceptual ambiguity of public trust in the healthcare system poses problems for governance and public trust measurement. Therefore, we aimed to answer: what is public trust in the healthcare system? We conducted in the context of the English NHS an analysis of online news with readership comments concerning the care.data initiative; a secondary analysis of interviews about participants' experiences and perceptions of biobanks; and an analysis of public focus groups about perceptions of the 100,000 Genomes Project. Further, we engaged with existing conceptual work and trust theory. This resulted in a full conceptual framework of public trust in the healthcare system. Public trust is established in anticipation of net benefits. Public trust legitimises the actions of the healthcare system as well as encourages the public to participate in healthcare-related activities. Further, levels of public trust are affected by spill-over effects from high or low levels of public trust in other parts of the government system. Last, many actors inside and outside the healthcare system influence public trust. Future research needs to translate this conceptual framework into policy guidelines and a measurement scale, as well as to validate the conceptual framework for healthcare systems other than the British NHS.