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Development of a Revised Health Care System Distrust Scale

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Abstract

Context

Growing evidence suggests that most forms of distrust are multidimensional, including domains of technical competence and value congruence. Prior measures of health care system distrust have not reflected this multidimensional structure and may be limiting research into the role of health care system distrust in health and health care in the US.

Objective

To develop a revised a scale of health care system distrust.

Design

Three phase study, including focus groups, pilot testing and a cross-sectional telephone survey.

Participants

A total of 404 individuals recruited directly from the Greater Philadelphia area or through the University of Pennsylvania Health System.

Results

Multilevel consensus coding of focus group transcripts identified 2 primary domains of competence and values with the values domain having subthemes of honesty, motives, and equity. Iterative testing of the initial 76 items led to a final scale of 9 items with a Cronbach’s alpha of 0.83. Factor analysis demonstrated a 2-factor structure, corresponding to the domains of values and competence. The values subscale (5 items) had a Cronbach’s alpha of 0.73 and the competence subscale (4 items) had a Cronbach’s alpha of 0.77. These psychometric properties were similar among African Americans and Whites.

Conclusions

A novel 9-item scale of Health Care System Distrust with high reliability allows the assessment of the 2 primary domains of distrust (values and competence) and may facilitate research in this area.

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Acknowledgments

Alex Quistberg provided valuable assistance with the Spanish-speaking focus groups. This work was supported by R01 HG02689 from the National Human Genome Research Institute and a Research Scholar Grant from the American Cancer Society.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Judy A. Shea PhD, Ellyn Micco, Lorraine T. Dean, Suzanne McMurphy PhD, J. Sanford Schwartz MD & Katrina Armstrong MD MSCE

  2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Judy A. Shea PhD, J. Sanford Schwartz MD & Katrina Armstrong MD MSCE

  3. Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    J. Sanford Schwartz MD & Katrina Armstrong MD MSCE

Authors
  1. Judy A. Shea PhD
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  2. Ellyn Micco
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  3. Lorraine T. Dean
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  4. Suzanne McMurphy PhD
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  5. J. Sanford Schwartz MD
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  6. Katrina Armstrong MD MSCE
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Corresponding author

Correspondence to Katrina Armstrong MD MSCE.

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Shea, J.A., Micco, E., Dean, L.T. et al. Development of a Revised Health Care System Distrust Scale. J GEN INTERN MED 23, 727–732 (2008). https://doi.org/10.1007/s11606-008-0575-3

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  • DOI: https://doi.org/10.1007/s11606-008-0575-3

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