Skip to main content

Advertisement

SpringerLink
Log in

Development and Testing of the Multidimensional Trust in Health Care Systems Scale

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Objective

To describe the development and psychometric testing of the Multidimensional Trust in Health Care Systems Scale (MTHCSS).

Methods

Scale development occurred in 2 phases. In phase 1, a pilot instrument with 70 items was generated from the review of the trust literature, focus groups, and expert opinion. The 70 items were pilot tested in a sample of 256 students. Exploratory factor analysis was used to derive an orthogonal set of correlated factors. In phase 2, the final scale was administered to 301 primary care patients to assess reliability and validity. Phase 2 participants also completed validated measures of patient-centered care, health locus of control, medication nonadherence, social support, and patient satisfaction.

Results

In phase 1, a 17-item scale (MTHCSS) was developed with 10 items measuring trust in health care providers, 4 items measuring trust in health care payers, and 3 items measuring trust in health care institutions. In phase 2, the 17-item MTHCSS had a mean score of 63.0 (SD 8.8); the provider subscale had a mean of 40.0 (SD 6.2); the payers subscale had a mean of 12.8 (SD 3.0); and the institutions subscale had a mean of 10.3 (SD 2.1). Cronbach’s α for the MTHCSS was 0.89 and 0.92, 0.74, and 0.64 for the 3 subscales. The MTHCSS was significantly correlated with patient-centered care (r = .22 to .62), locus of control—chance (r = .42), medication nonadherence (r = −.22), social support (r = .25), and patient satisfaction (r = .67).

Conclusions

The MTHCSS is a valid and reliable instrument for measuring the 3 objects of trust in health care and is correlated with patient-level health outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hall MA, Dugan E, Zheng B, Mishra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79(4):613–39.

    Article  PubMed  CAS  Google Scholar 

  2. Pearson SD, Raeke LH. Patients’ trust in physicians: many theories, few measures, and little data. J Gen Intern Med. 2000;15:509–13.

    Article  PubMed  CAS  Google Scholar 

  3. Govier T. Distrust as a practical problem. J Soc Philos. 1992;23(1):52–63.

    Article  Google Scholar 

  4. Bigley GA, Pearce JL. Straining for shared meaning in organization science: problems of trust and distrust. Acad Manage Rev. 1998;23(3):405–22.

    Article  Google Scholar 

  5. Lewicki R, McAllister D, Bies R. Trust and distrust: new relationships and realities. Acad Manage Rev. 1998;23(3):438–58.

    Article  Google Scholar 

  6. Anderson LA, Dedrick RF. Development of the trust in physician scale: a measure to assess interpersonal trust in patient–physician relationships. Psychol Rep. 1990;67:1091–100.

    PubMed  CAS  Google Scholar 

  7. Thom DH, Campbell B. Patient–physician trust: an exploratory study. J Fam Pract. 1997;44:169–76.

    PubMed  CAS  Google Scholar 

  8. Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA. 1998;280:1708–14.

    Article  PubMed  CAS  Google Scholar 

  9. Mechanic D. Changing medical organization and the erosion of trust. Milbank Q. 1996;74:171–89.

    Article  PubMed  CAS  Google Scholar 

  10. Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc Sci Med. 2000;51(5):657–68.

    Article  PubMed  CAS  Google Scholar 

  11. Thom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999;375(5):10–7.

    Article  PubMed  CAS  Google Scholar 

  12. Hall MA, Zheng B, Dugan E, Camacho F, Kidd KE, Mishra A, Balkrishnan R. Measuring patients’ trust in their primary care providers. Med Care Res Rev. 2002;59(3):293–318.

    Article  PubMed  Google Scholar 

  13. Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002;162(21):2458–63.

    Article  PubMed  Google Scholar 

  14. Hall MA, Camacho F, Dugan E, Balkrishnan R. Trust in the medical profession: conceptual and measurement issues. Health Serv Res. 2002;37(5):1419–39.

    Article  PubMed  Google Scholar 

  15. Rose A, Peters N, Shea JA, Armstrong K. Development and testing of the health care system distrust scale. J Gen Intern Med. 2004;19(1):57–63.

    Article  PubMed  Google Scholar 

  16. Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The group-based medical mistrust scale: psychometric properties and association with breast cancer screening. Prev Med. 2004;38(2):209–18.

    Article  PubMed  Google Scholar 

  17. Goold SD, Fessler D, Moyer CA. A measure of trust in insurers. Health Serv Res. 2006;41(1):58–78.

    Article  PubMed  Google Scholar 

  18. Zheng B, Hall MA, Dugan E, Kidd KE, Levine D. Development of a scale to measure patients’ trust in health insurers. Health Serv Res. 2002;37(1):187–202.

    PubMed  Google Scholar 

  19. Dugan E, Trachtenberg F, Hall MA. Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Serv Res. 2005;5:64.

    Article  PubMed  Google Scholar 

  20. Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9(10):1156–63.

    Article  PubMed  CAS  Google Scholar 

  21. LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57(Suppl 1):146–61.

    Article  PubMed  Google Scholar 

  22. Cort MA. Cultural mistrust and use of hospice care: challenges and remedies. J Palliat Med. 2004;7(1):63–71.

    Article  PubMed  Google Scholar 

  23. Alston RJ. Racial identity and cultural mistrust among African-American recipients of rehabilitation services: an exploratory study. Int J Rehabil Res. 2003;26(4):289–95.

    Article  PubMed  CAS  Google Scholar 

  24. Moseley KL, Freed GL, Bullard CM, Goold SD. Measuring African-American parents’ cultural mistrust while in a healthcare setting: a pilot study. J Natl Med Assoc. 2007;99(1):15–21.

    PubMed  Google Scholar 

  25. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003;118(4):358–65.

    PubMed  Google Scholar 

  26. Laveist TA, Nuru-Jeter A. Is doctor–patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43(3):296–306.

    Article  PubMed  Google Scholar 

  27. Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, Ford DE. Race, gender, and partnership in the patient–physician relationship. JAMA. 1999;282(6):583–9.

    Article  PubMed  CAS  Google Scholar 

  28. Statistical Package for the Social Sciences (SPSS 14.0). Chicago, IL: SPSS; 2006.

  29. Nunnally JC, Bernstein I. Psychometric Theory. 3 ed. New York: McGraw-Hill; 1994.

    Google Scholar 

  30. Cleary PD, Edgman-Levitan S, Roberts M, Moloney TW, McMullen W, Walker JD, Delbanco TL. Patients evaluate their hospital care: a national survey. Health Aff. 1991;10:254–67.

    Article  CAS  Google Scholar 

  31. Cleary PD, Edgman-Levitan S, McMullen W, Delbanco TL. The relationship between reported problems and patient summary evaluations of hospital care. Qual Rev Bull. 1992;18:53–9.

    CAS  Google Scholar 

  32. Edgman-Levitan S, Cleary PD. What information do consumers want and need? Health Affairs. 1996;15(4):42–56.

    Article  PubMed  CAS  Google Scholar 

  33. Wallston KA, Wallson BS, DeVellis R. Development of the multidimensional health locus of control (MHLC) scales. Health Educ Mongr. 1978;6:160–70.

    CAS  Google Scholar 

  34. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.

    Article  PubMed  CAS  Google Scholar 

  35. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We are grateful to the following summer undergraduate research students who assisted with data collection for the different phases of the project over the past 3 years: Douglas Gleaton, Melodie Harrison, Antoinette Bennett, Ashley Hambright, Sylvia Smith, and Brittany Smalls.

Conflict of interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA

    Leonard E. Egede MD MS

  2. Charleston VA TREP, Ralph H. Johnson VA Medical Center, Charleston, SC, USA

    Leonard E. Egede MD MS

  3. Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA

    Charles Ellis PhD

Authors
  1. Leonard E. Egede MD MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles Ellis PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leonard E. Egede MD MS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Egede, L.E., Ellis, C. Development and Testing of the Multidimensional Trust in Health Care Systems Scale. J GEN INTERN MED 23, 808–815 (2008). https://doi.org/10.1007/s11606-008-0613-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0613-1

Key Words

Search

Navigation