The Relationship between Institutional Betrayal and Expectations for Future Healthcare: An Experimental Study

Transgressions perpetrated by an institution against an individual that trusts or relies upon that institution is a construct known as institutional betrayal and is a burgeoning area of research in the healthcare setting. These transgressions can include either an action that is committed or an omission on behalf of the system. Healthcare institutional betrayal has been associated with lower trust in healthcare providers, greater negative expectations for healthcare, and healthcare avoidance, suggesting that past experiences with the healthcare system affect one’s ongoing and future relationship with these systems. The current study employed a between-group experimental design with participants randomly assigned to read vignettes with varying levels of healthcare institutional betrayal. Participants (N = 473) completed baseline measures of trust in healthcare providers, medical mistrust, institutional betrayal. Participants were then randomly assigned to read one of three vignettes that depicted differing levels of healthcare institutional betrayal (control, low institutional betrayal, high institutional betrayal). Following the experimental manipulation, participants completed measures of healthcare avoidance and negative expectations for future healthcare. They also completed a task which allowed for collection of implicit cognitive measures (captured by mouse-tracking software) designed to assess conflict related to seeking healthcare post institutional betrayal. As hypothesized, participants assigned to the low and high institutional betrayal conditions endorsed greater negative expectations for healthcare and lower trust in healthcare providers post-manipulation. Contrary to our hypotheses, participants randomly assigned to the low and high institutional betrayal conditions did not indicate greater healthcare avoidance as measured via self-reported healthcare avoidance or via implicit measures of healthcare avoidance. However, there was an interaction of response type (“probably yes” versus “probably no”) and condition, indicating that following institutional betrayal, there may be greater hesitation, even when choosing to seek healthcare. Overall, results indicated that institutional betrayal can cause lower levels of trust and higher levels of negative expectations of healthcare. Additionally, the results shed light on how participants make decisions to seek healthcare following the experience of institutional betrayal.