TY - JOUR T1 - Level of confidence in and endorsement of the health system among internet users in 12 low-income and middle-income countries JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2019-002205 VL - 5 IS - 8 SP - e002205 AU - Sanam Roder-DeWan AU - Anna Gage AU - Lisa R Hirschhorn AU - Nana A Y Twum-Danso AU - Jerker Liljestrand AU - Kwanele Asante-Shongwe AU - Talhiya Yahya AU - Margaret Kruk Y1 - 2020/08/01 UR - http://gh.bmj.com/content/5/8/e002205.abstract N2 - Introduction People’s confidence in and endorsement of the health system are key measures of system performance, yet are undermeasured in low-income and middle-income countries (LMICs). We explored the prevalence and predictors of these measures in 12 countries.Methods We conducted an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal and South Africa collecting demographics, ratings of quality, and confidence in and endorsement of the health system. We used multivariable logistic regression to assess the association between confidence/endorsement and self-reported quality of recent healthcare.Results Of 13 489 respondents, 62% reported a health visit in the past year. Applying population weights, 32% of these users were very confident that they could receive effective care if they were to ‘become very sick tomorrow’; 30% endorsed the health system, that is, agreed that it ‘works pretty well and only needs minor changes’. Reporting high quality in the last visit was associated with 4.48 and 2.69 greater odds of confidence (95% CI 3.64 to 5.52) and endorsement (95% CI 2.33 to 3.11). Having health insurance was positively associated with confidence and endorsement (adjusted odds ratio (AOR) 1.68, 95% CI 1.49 to 1.90 and AOR 1.34, 95% CI 1.22 to 1.48), while experiencing discrimination in healthcare was negatively associated (AOR 0.67, 95% CI 0.56 to 0.80 and AOR 0.63, 95% CI 0.53 to 0.76).Conclusion Confidence and endorsement of the health system were low across 12 LMICs. This may hinder efforts to gain support for universal health coverage. Positive patient experience was strongly associated with confidence in and endorsement of the health system. ER -