Development of a revised Health Care System Distrust scale

Area of Science:

• Health Services Research
• Psychometrics
• Sociology of Health

Background:

• Existing measures of health care system distrust are limited by not reflecting its multidimensional nature.
• Distrust in healthcare systems often involves both technical competence and value congruence.
• This limitation may hinder research on the role of distrust in US health and healthcare outcomes.

Purpose of the Study:

• To develop and validate a revised, multidimensional scale for assessing health care system distrust.
• The scale aims to capture distinct domains of distrust, including competence and values.

Main Methods:

• A three-phase study involving focus groups, pilot testing, and a cross-sectional telephone survey.
• Data collected from 404 participants recruited from the Greater Philadelphia area and the University of Pennsylvania Health System.
• Analysis included multilevel consensus coding and factor analysis to establish scale structure and reliability.

Main Results:

• Focus groups identified two primary domains of distrust: competence and values (with subthemes of honesty, motives, and equity).
• A 9-item scale was developed with high overall reliability (Cronbach's alpha = 0.83).
• Factor analysis confirmed a two-factor structure (values and competence) with good subscale reliability (alpha = 0.73 and 0.77, respectively), consistent across racial groups.

Conclusions:

• A novel, reliable 9-item scale for Health Care System Distrust has been developed.
• The scale effectively assesses the two primary domains of distrust: values and competence.
• This validated instrument is expected to facilitate further research on health care system distrust.