Measuring client trust in community health workers: A multi-country validation study

Area of Science:

• Global Health
• Health Systems Research
• Social Science & Medicine

Background:

• Client trust in community health workers (CHWs) is crucial for enhancing global health equity and quality.
• Existing literature lacks quantitative measures for assessing trust in CHW services.
• This study addresses the need for a validated scale to measure client trust in CHWs.

Purpose of the Study:

• To develop and validate a psychometrically sound scale for quantifying client trust in community health workers (CHWs).
• To establish a reliable and valid instrument for assessing the two key dimensions of trust: healthcare competence and respectful communication.

Main Methods:

• A consultative process adapted existing literature for the CHW context.
• Content validity and comprehension were assessed through 10 focus groups (75 community members) in Haiti and Kenya.
• A 10-item scale was developed and validated using exploratory/confirmatory factor analysis (EFA/CFA) on survey data from 1939 clients in Bangladesh, Haiti, and Kenya.

Main Results:

• The 10-item Trust in CHWs Scale demonstrated strong internal consistency reliability (Cronbach's alphas ranging from 0.86 to 0.92).
• Factor analysis identified two sub-scales: 'Health care competence' and 'Respectful communication'.
• Higher trust scores correlated positively with client empowerment, CHW familiarity, and satisfaction, independent of demographic factors.

Conclusions:

• The developed 10-item Trust in CHWs Scale is the first globally validated tool for measuring client trust.
• The scale, comprising 'Health care competence' and 'Respectful communication' sub-scales, is reliable and valid.
• This instrument can be utilized to monitor and enhance the performance of CHWs and health systems worldwide.