Journal of Postgraduate Medicine
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Year : 2014  |  Volume : 60  |  Issue : 2  |  Page : 222  

Authors' reply

M Baidya, V Gopichandran 
 School of Public Health, Medical College, Sri Ramaswamy Memorial University, Kattankulathur, Tamil Nadu, India

Correspondence Address:
M Baidya
School of Public Health, Medical College, Sri Ramaswamy Memorial University, Kattankulathur, Tamil Nadu

How to cite this article:
Baidya M, Gopichandran V. Authors' reply.J Postgrad Med 2014;60:222-222

How to cite this URL:
Baidya M, Gopichandran V. Authors' reply. J Postgrad Med [serial online] 2014 [cited 2022 Aug 19 ];60:222-222
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We thank Raina S for the incisive comments on our paper. He has rightly pointed out that the multistage random sampling technique that has been used here has violated the probability sampling rule in the last stage. [1] The samples were selected in a convenient manner in the last stage based on two important observations. First, there is a strong homogeneity within the cluster with respect to treatment-seeking behavior. Therefore, physician characteristics and traits leading to trust are likely to be homogeneous, thus minimizing bias. Second, a previous study from South India by the same team showed that trust in physicians and judgment of competence are usually shared among the community and largely influenced by the community, thus adding to the homogeneity of trust inside the clusters. [3] Keeping these in mind, it is unlikely that a nonprobabilistic sampling in the last stage of the multistage method would have significantly affected the trust assessment. Having said that, we do concede that more rigorous sampling procedure should be in place in future assessments of trust. Raina also raises the question as to whether healthy or ill people were selected for the study. [2] This is an important point to consider as we know well that trust is a state and not a trait. [3] Because it is a state, it is likely to be dynamic and depend on the health status of the people. While making sure that the people who responded to the study were all healthy (defined here as an absence of illness and being ambulatory), it was also ensured that they were all "patients" in the sense that they had attended a health facility for some form of health care in the past 5 years. The respondents thus were "patients" at some point in time in the past 5 years. They were not suffering from any active illness requiring treatment or admission in the hospital at the time of interview.

The third issue raised is about the classification of the respondents as those with "high" and "low" trust. [2] While classifying the respondents as such, we have made the assumption that each contributing item in the scale has the same weightage and adding them up mathematically will formatively indicate the overall trust in physicians. This is a basic tenet of the Classical Test Theory. [4],[5] However; we agree that this may have flaws because different items in the scale may reflect different levels of trust. Also an arithmetic summary of scores on all the items in the scale will give a measure that is highly dependent on the sample. These preclude the interpretation of the analysis done in this study.

The present paper merely aims to understand the various covariates of trust and satisfaction in physicians. As stated in the discussion, the study does not indicate the prevalence of trust in physicians in the community. Nor do we report the prevalence of high or low trust and we acknowledge this limitation. The use of the arbitrary classification for purposes of bivariate analysis has also been clearly indicated in the study. The "trust" score used in the study has its limitations and needs to be interpreted cautiously for above-mentioned reasons.


1Raina S. Performing multi stage random sampling in community based surveys. J Postgrad Med 2014;60:221-2.
2Baidya M, Gopichandran V, Kosalram K. Patient-physician trust among adults of rural Tamil Nadu: A community-based survey. J Postgrad Med 2014;60:21-6.
3Gopichandran V, Chetlapalli SK. Dimensions and determinants of trust in health care in resource poor settings-a qualitative exploration. PLoS One 2013;8:e69170.
4Thom DH, Hall MA, Pawlson LG. Measuring patients' trust in physicians when assessing quality of care. Health Aff (Millwood) 2004;23:124-32.
5DeVellis RF. Quantitative Issues and Approaches: Classical Test Theory (CTT) and Item Response Theory (IRT). Med Care 2006;44:S50-9.

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