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.
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.
Soc Sci Med. 2022 Apr;298:114827. doi: 10.1016/j.socscimed.2022.114827. Epub 2022 Feb 16.
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).
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.
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.
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.
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.
美国历史上和当今的种族主义和不平等现象导致许多人群对医疗保健的信任度降低。改善医疗保健信任的一个关键障碍是缺乏适用于不同人群的经过充分验证的措施。事实上，系统评价表明需要开发和测试经过更新的信任措施，这些措施应是多维的，并包含相关领域（例如公平）。
我们开发了三种信任措施：信任我的医生（T-MD）、信任一般医生（T-DiG）和信任医疗团队（T-HCT）量表。
在开发初始项目池之后，专家评审员（n=6）对每个量表的表面有效性提供了反馈。我们对便利抽样的成年人进行了认知访谈（n=21），以确保项目按预期进行解释。在 2020 年，我们通过 Qualtrics 小组（n=801）对美国成年人的便利样本进行了在线调查，以评估量表的信度和效度。
探索性和验证性因素分析表明，每个量表的二阶潜在因素模型具有可接受的模型拟合度（近似均方根误差：<0.07，比较拟合指数：≥0.98，标准化均方根残差：≤0.03）。T-MD 包含 25 个项目和六个子量表：沟通能力、保真度、系统信任、保密性、公平性和整体信任。T-DiG 和 T-HCT 各包含 29 个项目和七个子量表（T-MD 中的相同子量表加上与基于污名的歧视相关的额外子量表）。每个量表与现有的信任措施和医疗保健中的感知种族主义高度相关，并且与延迟寻求医疗保健和接受常规健康检查显著相关。
多维 T-MD、T-DiG 和 T-HCT 量表具有良好的心理测量学特性，对于评估与信任相关的干预措施或开展信任是重要构建或主要结果的研究的研究人员可能很有用。
