Jennifer Richmond1, Marcella H Boynton2, Sachiko Ozawa3, Kathryn E Muessig4, Samuel Cykert5, Kurt M Ribisl6. 1. Vanderbilt University Medical Center, Department of Medicine, Division of Genetic Medicine, 2525 West End Ave, 7th Floor Suite, Nashville, TN, 37203, USA; University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA. Electronic address: jennifer.richmond@vumc.org. 2. University of North Carolina School of Medicine, North Carolina Translational & Clinical Sciences Institute (NC TraCS), 160 N. Medical Drive, Chapel Hill, NC, 27599, USA; University of North Carolina School of Medicine, Division of General Medicine and Clinical Epidemiology, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA. 3. University of North Carolina, Eshelman School of Pharmacy, Division of Practice Advancement and Clinical Education, CB #7574, Beard Hall 115G, Chapel Hill, NC, 27599, USA. 4. University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA. 5. University of North Carolina School of Medicine, Division of General Medicine and Clinical Epidemiology, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA. 6. University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
Abstract
RATIONALE: Historic and present-day racism and inequity in the United States (U.S.) have resulted in diminished trust in health care among many populations. A key barrier to improving trust in health care is a dearth of well-validated measures appropriate for diverse populations. Indeed, systematic reviews indicate a need to develop and test updated trust measures that are multidimensional and inclusive of relevant domains (e.g., fairness). OBJECTIVE: We developed three trust measures: the Trust in My Doctor (T-MD), Trust in Doctors in General (T-DiG), and Trust in the Health Care Team (T-HCT) scales. METHODS: After developing an initial item pool, expert reviewers (n = 6) provided feedback on the face validity of each scale. We conducted cognitive interviews (n = 21) with a convenience sample of adults to ensure items were interpreted as intended. In 2020, we administered an online survey to a convenience sample of U.S. adults recruited through the Qualtrics Panel (n = 801) to assess scale reliability and validity. RESULTS: Exploratory and confirmatory factor analyses indicated acceptable model fit for second order latent factor models for each scale (root mean square error of approximation: <0.07, comparative fit index: ≥0.98, and standardized root mean square residual: ≤0.03). The T-MD contained 25 items and six subscales: communication competency, fidelity, systems trust, confidentiality, fairness, and global trust. The T-DiG and T-HCT each contained 29 items and seven subscales (the same subscales in the T-MD plus an additional subscale related to stigma-based discrimination). Each scale was strongly correlated with existing trust measures and perceived racism in health care and was significantly associated with delayed health care seeking and receipt of a routine health exam. CONCLUSIONS: The multidimensional T-MD, T-DiG, and T-HCT scales have sound psychometric properties and may be useful for researchers evaluating trust-related interventions or conducting studies where trust is an important construct or main outcome.
RATIONALE: Historic and present-day racism and inequity in the United States (U.S.) have resulted in diminished trust in health care among many populations. A key barrier to improving trust in health care is a dearth of well-validated measures appropriate for diverse populations. Indeed, systematic reviews indicate a need to develop and test updated trust measures that are multidimensional and inclusive of relevant domains (e.g., fairness). OBJECTIVE: We developed three trust measures: the Trust in My Doctor (T-MD), Trust in Doctors in General (T-DiG), and Trust in the Health Care Team (T-HCT) scales. METHODS: After developing an initial item pool, expert reviewers (n = 6) provided feedback on the face validity of each scale. We conducted cognitive interviews (n = 21) with a convenience sample of adults to ensure items were interpreted as intended. In 2020, we administered an online survey to a convenience sample of U.S. adults recruited through the Qualtrics Panel (n = 801) to assess scale reliability and validity. RESULTS: Exploratory and confirmatory factor analyses indicated acceptable model fit for second order latent factor models for each scale (root mean square error of approximation: <0.07, comparative fit index: ≥0.98, and standardized root mean square residual: ≤0.03). The T-MD contained 25 items and six subscales: communication competency, fidelity, systems trust, confidentiality, fairness, and global trust. The T-DiG and T-HCT each contained 29 items and seven subscales (the same subscales in the T-MD plus an additional subscale related to stigma-based discrimination). Each scale was strongly correlated with existing trust measures and perceived racism in health care and was significantly associated with delayed health care seeking and receipt of a routine health exam. CONCLUSIONS: The multidimensional T-MD, T-DiG, and T-HCT scales have sound psychometric properties and may be useful for researchers evaluating trust-related interventions or conducting studies where trust is an important construct or main outcome.