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BMJ Open. 2013 May 2;3(5). pii: e002640. doi: 10.1136/bmjopen-2013-002640.

Comparison of health confidence in rural, suburban and urban areas in the UK and the USA: a secondary analysis.

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Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA.



Confidence in healthcare may influence the patients' utilisation of healthcare resources and perceptions of healthcare quality. We sought to determine whether self-reported confidence in healthcare differed between the UK and the USA, as well as by rurality or urbanicity.


A secondary analysis of a subset of survey questions regarding self-reported confidence in healthcare from the 2010 Commonwealth Fund International Health Policy Survey.


Telephone survey of participants from the UK and the USA.


Our final analysis included 1511 UK residents (688 rural, 446 suburban, 372 urban, 5 uncategorised) and 2501 US residents (536 rural, 1294 suburban, 671 urban).


Questions assessed respondents' confidence in the effectiveness and affordability of the treatment. We compared survey outcomes from these questions between, and within, the two regions and among, and within, residence types (rural, suburban and urban).


Significant differences were found in self-reported confidence in healthcare between the UK and US, among residence types, and between the two regions within residence types. Reported levels were higher in the UK. Within regions, significant differences by residence type were found for the US, but not the UK. Within the US, suburban respondents had the highest self-reported confidence in healthcare.


Significant differences exist between the UK and US in confidence in healthcare. In the US, but not in the UK, self-reported confidence is related to residence type. Within countries, significant differences by residence type were found for the US, but not the UK. Our findings warrant the examination of causes for relative confidence levels in healthcare between regions and among US residence types.


Health Services Administration & Management; Public Health

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