Public confidence in Ireland's Health Service Executive, Mid-West region: Findings from a 2024 regional survey

Abstract

Background: Public confidence is a cornerstone of effective healthcare delivery and the legitimacy of healthcare reform. In Ireland's Health Service Executive (HSE) Mid-West (MW), Regional Health Area (RHA) E, ongoing concerns about access to care at University Hospital Limerick (UHL) and the wider responsiveness of the system highlight the need for a deeper understanding of public trust in this region.

Methods: This study conducted an online cross-sectional survey of 358 participants from RHA E using convenience sampling and fully anonymised data. It assessed Emergency Department (ED) utilisation and developed a novel Overall Confidence Index (OCI), capturing five dimensions of healthcare trust across 15 Likert-scale items. Statistical analyses included Ordinal Logistic Regression (OLR), linear regression, and factor analysis to identify confidence predictors. Although respondents from Clare were over-represented, post-hoc weighting made little difference to the results.

Results: 80.78% of respondents expressed dissatisfaction. Confidence was significantly lower among older adults ([Formula: see text], [Formula: see text]), among people living with a chronic illness ([Formula: see text], [Formula: see text]), and among Clare residents compared with those in Limerick ([Formula: see text], [Formula: see text]). ED usage showed a negative trend but was not statistically significant ([Formula: see text]). Factor analysis pointed to two underlying dimensions of confidence: "Trust in Care Quality" and "Systemic Transparency".

Conclusions: In this region, trust is influenced more by broader system and population factors than by individual service use. The OCI provides a useful way to track changes in public trust over time. To rebuild confidence, reforms should focus on fair access across regions, better support for people with chronic illness, and greater transparency in how the system is run. Future studies should use a quota-based, mixed-methods design to enhance representativeness and inform Sláintecare aligned health policy.

Keywords: Health Service Executive (HSE); Ireland; Public confidence; Public health perception; Regional Health Area (RHA) E Mid-West (MW); Survey.