Pilot evaluation of the Health Organization and System Trustworthiness scale: reliability and validity testing.

Area of Science:

• Health Services Research
• Psychometrics
• Public Health

Background:

• Assessing patient trust in healthcare systems is crucial for effective healthcare delivery and public health initiatives.
• Existing measures may not fully capture the multifaceted nature of trustworthiness in healthcare organizations.
• The Healthcare Organization and System Trustworthiness (HOST) scale was developed to address this gap.

Purpose of the Study:

• To evaluate the psychometric properties of the HOST scale, including its reliability, validity, and measurement invariance.
• To compare the HOST scale's performance against the Medical Mistrust Index (MMI).
• To explore the HOST scale's utility in predicting various health-related outcomes.

Main Methods:

• Exploratory and confirmatory factor analyses (EFA/CFA) were used to determine the scale's factor structure.
• Measurement invariance testing assessed scale consistency across demographic groups (gender, LGBTQ status, race/ethnicity, healthcare access).
• Concurrent validity was examined by comparing HOST scores with the MMI using Bland-Altman plots and correlating them with seven outcomes, including vaccine hesitancy and trust in government.

Main Results:

• The HOST scale exhibited a unidimensional structure with high internal consistency (α = 0.80) and strong concurrent validity with the MMI (r = 0.52).
• Scalar measurement invariance was confirmed across gender, LGBTQ status, and regular healthcare access, indicating consistent interpretation across these groups.
• The HOST scale demonstrated stronger correlations than the MMI with trust in vaccine-related entities and perceptions of government trustworthiness at all levels.

Conclusions:

• The HOST scale is a promising tool for measuring perceived trustworthiness in healthcare systems, reflecting fairness, competence, and future expectations.
• Its robust predictive validity across diverse outcomes highlights its potential utility in research and practice.
• Further validation is recommended to enhance its application in addressing health disparities and informing public health strategies.