title: Development and testing of the Multidimensional Trust in Health Care Systems Scale.
abstract: OBJECTIVE
  To describe the development and psychometric testing of the Multidimensional Trust in Health Care Systems Scale (MTHCSS).
  
  
  METHODS
  Scale development occurred in 2 phases. In phase 1, a pilot instrument with 70 items was generated from the review of the trust literature, focus groups, and expert opinion. The 70 items were pilot tested in a sample of 256 students. Exploratory factor analysis was used to derive an orthogonal set of correlated factors. In phase 2, the final scale was administered to 301 primary care patients to assess reliability and validity. Phase 2 participants also completed validated measures of patient-centered care, health locus of control, medication nonadherence, social support, and patient satisfaction.
  
  
  RESULTS
  In phase 1, a 17-item scale (MTHCSS) was developed with 10 items measuring trust in health care providers, 4 items measuring trust in health care payers, and 3 items measuring trust in health care institutions. In phase 2, the 17-item MTHCSS had a mean score of 63.0 (SD 8.8); the provider subscale had a mean of 40.0 (SD 6.2); the payers subscale had a mean of 12.8 (SD 3.0); and the institutions subscale had a mean of 10.3 (SD 2.1). Cronbach's alpha for the MTHCSS was 0.89 and 0.92, 0.74, and 0.64 for the 3 subscales. The MTHCSS was significantly correlated with patient-centered care (r = .22 to .62), locus of control-chance (r = .42), medication nonadherence (r = -.22), social support (r = .25), and patient satisfaction (r = .67).
  
  
  CONCLUSIONS
  The MTHCSS is a valid and reliable instrument for measuring the 3 objects of trust in health care and is correlated with patient-level health outcomes.
authors.affiliation: Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC 29425, USA. egedel@musc.edu
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
authors.forename: Charles
authors.initials: C
authors.lastname: Ellis
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D006268:Health Facilities; D006282:Health Personnel; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011594:Psychometrics; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D035502:Trust / Q000523:psychology*; D014481:United States