Trust of vulnerable groups required for effective evaluation of health centers

Written by The Evidence Base

An international study looking at healthcare provision for socially disadvantaged people has recommended that evaluators build trust with users to ensure effective participation.

Researchers at the Ludwig Boltzmann Institute for Health Technology Assessment (LBI-HTA) in Vienna (Austria) have recommended that evaluators assessing healthcare provision for socially disadvantaged people build trust with users to keep patients “on board” for the duration of an evaluation. The study compared 19 evaluations of health centers from seven countries. 

Around 100,00 people in Austria do not have health insurance, many of whom are homeless. In 2018, a social organization that supports the homeless and people at risk of poverty in Vienna asked the LBI-HTA to review evaluation methodologies to ensure they were able to provide the best service for their users; their findings have now been published.

“Overall, we found that health centers for the socially disadvantaged are evaluated in a variety of different ways,” explained Roman Winkler, an academic at the LBI-HTA. His colleague Inanna Reinsperger added: “Due to the contrasting thematic backgrounds and aims of the various facilities, we found that a range of different evaluation methodologies are used.”

The evaluations studied comprised 12 studies in English and seven in German; a range of qualitative and qualitative methods were used, including both interviews and questionnaires. The English evaluations were found to focus more on the quality of the centers’ results compared with the German studies, which also included the centers’ internal processes in the evaluations. Criteria in the evaluations included patients’ health and satisfaction, recourse to health and social services, and sociodemographic data.

“Interestingly, only a few of the evaluations made use of health-economic indicators,” commented Winkler. “These would include data on the cost effectiveness of the services offered.”

The LBI-HTA team also offered specific recommendations based on their analysis to improve the quality of the evaluation data. A focus on building trust between evaluators and patients was most important; however, the importance of a low-threshold in evaluations and methods was also mentioned, as was involvement of patients in study design.