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Confidence in public institutions – a focus group study on views

Conference contribution
Authors Kristina Holmgren
Frida Rosstorp
Helena Rohdén
Published in Eur J Public Health
Volume 24
Issue suppl 2
Publication year 2014
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Neuroscience and Physiology
Department of Political Science
Language en
Keywords Public health, sick-leave, procedural justice, welfare institutions
Subject categories Public Health, Global Health, Social Medicine and Epidemiology


Background Public confidence in the Swedish Social Insurance Agency (SSIA) has declined considerably during the last years, and today this is one of the least trusted public institutions among the Swedish general public. The SSIA is the public institution which administers the health insurance, and accordingly it is important that both the people in need of the benefit and the general public have confidence in this particular institution. Thus, the aim of this study was to explore how people with experience of health insurance perceive and describe their confidence in the SSIA. Method The focus group methodology was used. It has the form of group discussions and is suitable for picking up the views and experiences of a selected group. Eight groups (n=41) were conducted and each group met on one occasion. The majority (54%) had university education, was employed (58%) and held non-manual higher socio-economic positions (32%). There was a large variation when it comes to diagnoses, although most participants were sick-listed because of mental or musculoskeletal disorders. Results Four different themes, Paradigm Shift, Legal Rights, Reception and Vulnerability, emerged. The participants described a paradigm shift, where the SSIA was politically governed to bring down sickness absence. The legal rights of the individual were disregarded, with arbitrary assessment, and transparency was lacking in the contact with the SSIA. The reception of the individual by the SSIA affected confidence, and the personal contact with the officials was particularly influential in shaping the image of the SSIA as an institution. The participants also described vulnerability in relation to the SSIA. They felt mistrusted, which left a feeling of impotence that worsened their health. Still, this could also turn into a source for finding strategies to change their situation. Experiencing vulnerability left a strong impression and affected the participants’ confidence negatively. Conclusion This study shows that the vertical confidence, i.e. the confidence between individuals and a public institution is created by a paradigm shift in politics, uncertain legal rights, reception and vulnerability of the individual.

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