To Örebro University

Citizen perceptions of justice, regarding both processes and outcomes, are closely related to the perceived legitimacy of the authorities involved and are thus significant for trust. This study investigates how a withdrawn driving license due to visual field loss might affect trust in the authorities involved in withdrawal processes and outcomes: the health-care system, the Swedish Transport Agency, and the judicial system. The factors influencing trust were investigated as was whether the withdrawal experience had changed the trust in other authorities not involved in the withdrawal process. Also, the aetiology of the visual field loss and gender were investigated.

A survey study was conducted in which 402 Swedish respondents with visual field loss and a withdrawal experience participated. Variance, regression, and content analyses were conducted. The following conceptual factors were used in understanding trust: Benevolence, Openness, Integrity, Ability, and Value Congruence.

The results revealed that processes and outcomes affected the overall trust in all three authorities, although the highest trust was in the health-care system (but still low). Diagnosis, but not gender, was important for the experienced trust. Differences in levels of trust in each authority were related to the aetiology of the diagnosis. Benevolence and Ability were the trust factors most important for overall trust in the health-care system and the Swedish Transport Agency. For some respondents (46%), the negative experiences of the withdrawal had worsened their trust in other, not involved authorities, as well.

Citizens’ trust of authorities is of general importance, as it can affect trust in society as awhole. The Swedish Transport Agency is a state administrative authority responsible for drivinglicense withdrawal. If withdrawals are experienced as unfair by those affected, this might leadto decreased trust in the agency and in other actors involved. This study accordingly examineshow the experiences of people who have had their driving license for a private car withdrawndue to visual field loss might affect their distrust of the authorities, as related to outcomes andprocesses. Follow-up interviews were conducted with nine people from a previous study. Contentanalysis revealed one overarching theme, struggling for justice within a system perceived as unfair, whichcomprised four identified categories: preparedness for and understanding of the withdrawn driving license(WDL); perceptions of assessment methods, reactions and actions regarding the decision, and perceptions ofthe authorities’ performance. In sum, the vision tests on which withdrawals are based were perceivedas unfair, as they did not measure individual driving ability. Furthermore, rejections of appeals led tofeelings of hopelessness. Distrust regarding outcomes and processes related to the withdrawals wasalso fueled by experiences of deficiencies regarding, for example, performance and information.

Access to transport, and thus accessibility to desired and needed activities, is of importance for the individual's welfare and subjective well-being. In many western contexts, land use and infrastructure are configured for the benefit of cars. A withdrawn driving license (WDL) might thereby affect welfare and subjective well-being. Further, if the WDL is perceived as unfair, trust for authorities involved in the WDL process can be affected. The overall aim is to explore changes of having a WDL due to visual field loss (VFL), concerning transport-related welfare and trust in authorities. Four studies were conducted, and both qualitative and quantitative methods have been used. The results showed that the WDL had led to negative welfare consequences for the respondents, such as ended careers, limited or ceased opportunities for leisure activities, and difficulties managing daily errands. These consequences can be explained by lacking or unsatisfactory alternative transport arrangements (study I). Also, the WDL had led to worsen overall subjective wellbeing. This can, for example, be explained by the respondents' perception of unsatisfactory access to transport means, to live a life to be satisfied with (study II). The respondents perceived the vision tests on which the WDL isbased as unfair, as they do not measure individual driving ability related to traffic safety. Perceptions of outcomes and processes were fueled by experiences of deficiencies regarding, for example, performance and information, leading to a decrease in trust in the authorities involved in the process of WDL due to VFL: the Health Care (the physician being obligated to report the VFL to the Swedish Transport Agency), the Swedish Transport Agency (decisions on WDL), and the Judicial system (decisions in cases of appeals) (study III). Gender had no effect on trust for none of these authorities. Though, diagnosis (reasons for VFL) had effect, and differences in degree oftrust for each of the three authorities were seen, related to type of diagnosis. The results also showed that low trust related to WDL process can generate lower trust in authorities in general (53%) (study IV). Finally, the thesis contributes to insights of goal conflicts that driving license withdrawals can entail, dealing with issues of safety, accessibility, and justice.

Research has found strong relationships between access to transport, accessibility of activities, and subjective well-being (SWB), and society is said to be car dependent. Accordingly, this study investigates, in a Swedish context, whether and how withdrawal of a driving license for a private car due to visual field loss (VFL) affects SWB. A web survey was used for statistical comparisons of three respondent groups (n = 436): people with a driving license, people with a driving license and VFL, and people whose driving license was withdrawn due to VFL. The inclusion criterion for all participants was that they should have a diagnosis that could cause VFL. The no-license group had lower overall SWB than did respondents with driving licenses. The no-license group also perceived less access to transport means in order to live a life to be satisfied with than did the other groups. The most used transport means in the no-license group was getting a lift in a car, though this group had a strong desire to drive a car. Few respondents in the license groups wanted to use specific transport means to a greater extent, car driving being the most used transport means. Some inter-group differences were seen regarding how access to activities (measured by frequency of actual trips) affected SWB. This study found a significant negative effect of driving license withdrawal on SWB. However, the results imply that qualitative aspects other than the relationship between the frequencies of trips and activities might also affect SWB, and more research on this subject is needed.