title: Mistrust of health care organizations is associated with underutilization of health services.
abstract: OBJECTIVE
  We report the validation of an instrument to measure mistrust of health care organizations and examine the relationship between mistrust and health care service underutilization.
  
  
  METHODS
  We conducted a telephone survey of a random sample of households in Baltimore City, MD. We surveyed 401 persons and followed up with 327 persons (81.5 percent) 3 weeks after the baseline interview. We conducted tests of the validity and reliability of the Medical Mistrust Index (MMI) and then conducted multivariate modeling to examine the relationship between mistrust and five measures of underutilization of health services.
  
  
  RESULTS
  Using principle components analysis, we reduced the 17-item MMI to 7 items with a single dimension. Test-retest reliability was moderately strong, ranging from Pearson correlation of 0.346-0.697. In multivariate modeling, the MMI was predictive of four of five measures of underutilization of health services: failure to take medical advice (b=1.56, p<.01), failure to keep a follow-up appointment (b=1.11, p=.01), postponing receiving needed care (b=0.939, p=.01), and failure to fill a prescription (b=1.48, p=.002). MMI was not significantly associated with failure to get needed medical care (b=0.815, p=.06).
  
  
  CONCLUSIONS
  The MMI is a robust predictor of underutilization of health services. Greater attention should be devoted to building greater trust among patients.
authors.affiliation: Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. tlaveist@jhsph.edu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: LaVeist
authors.forename: Lydia A
authors.initials: LA
authors.lastname: Isaac
authors.forename: Karen Patricia
authors.initials: KP
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D015142:Baltimore; D003695:Delivery of Health Care; D005163:Factor Analysis, Statistical; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D035502:Trust; D055815:Young Adult