Development and testing of the health care system distrust scale
Development and testing of the health care system distrust scale
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DOI：
10.1111/j.1525-1497.2004.21146.x
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发表时间：
2004-01-01
影响因子：
5.7
通讯作者：
Armstrong, K
中科院分区：
文献类型：
--
作者：
Rose, A;Peters, N;Armstrong, K
背景：对卫生保健系统的不信任可能是寻求医疗保健、坚持预防性保健和治疗方案以及参与医学研究的重要障碍。目的：介绍一种测量卫生保健系统不信任程度的工具（卫生保健系统不信任程度量表）的开发和心理测量测试。方法：量表开发分为2个阶段。在第一阶段，根据卫生保健相关不信任的概念模型开发了一个试点工具。草案项目是通过与公众成员的焦点小组会议、文献回顾和专家意见创建的。草案项目在55名等待被分配到费城市政法院担任陪审员的个人中进行了试点测试。先验地，排除或修订的候选项目包括那些丢失数据5%，项目间或项目总数相关性极低或极高，或那些对量表内部一致性有负面影响的项目。在第二阶段，我们对400名准陪审员进行了调查，以评估最终量表得分的信度和效度。结果：第一阶段构建了一个10项量表，包括4项诚实、2项保密、2项胜任力和2项忠诚。第二阶段的参与者平均年龄为41岁。43%为非裔美国人，45%为白人，4%为西班牙裔。医疗保健系统不信任量表的得分范围从12到46，可能的范围从10到50。平均得分为29.4，标准差为6.33。没有一个项目的数据丢失率超过5%。内部一致性（Cronbach’s alpha）为0.75。项目总相关性从0.27到0.57不等。主成分分析显示1个一般成分占32%的方差。其中9个变量的负荷量高于0.40。正如预测的那样，非裔美国人对医疗保健系统的不信任程度高于白人，并且与对私人医生的信任呈负相关。结论：初步测试表明，我们开发了一种有效可靠的评分工具，以衡量对医疗保健系统的不信任。未来的研究需要评估医疗保健系统不信任量表在不同人群中的效度和信度。该工具可以促进对美国医疗保健系统不信任的流行程度、原因和影响的调查。
BACKGROUND: Distrust of the health care system may be a significant barrier to seeking medical care, adhering to preventive health care and treatment regimens, and participating in medical research.OBJECTIVE: To describe the development and psychometric testing of an instrument (the Health Care System Distrust Scale) to measure distrust of the health care system.METHODS: Scale development involved 2 phases. In Phase 1, a pilot instrument was developed based on a conceptual model of health care-related distrust. Draft items were created using focus group sessions with members of the general public, literature review, and expert opinion. Draft items were pilot tested with 55 individuals waiting to be assigned to jury duty at the Municipal Court of Philadelphia. A priori, candidate items for elimination or revision included those with >5% missing data, extremely low or high interitem or item-total correlations, or those having a negative effect on the scale's internal consistency. In Phase 2, we conducted a survey of 400 prospective jurors to assess the reliability and validity of the final scale scores.RESULTS: In Phase 1, a 10-item scale was constructed that included 4 items measuring honesty, 2 items measuring confidentiality, 2 items measuring competence, and 2 items measuring fidelity. The participants in Phase 2 had a mean age of 41 years. Forty-three percent were African-American, 45% white, and 4% Hispanic. Scores on the Health Care System Distrust scale ranged from 12 to 46 with a possible range from 10 to 50. The mean score was 29.4 with a standard deviation of 6.33. No item had over 5% missing data. Internal consistency (Cronbach's alpha) was 0.75. Item-total correlations ranged from 0.27 to 0.57. Principal components analysis revealed 1 general component accounting for 32% of the variance. Nine of the variables had loadings higher than 0.40. As predicted, distrust of the health care system was higher among African Americans than whites and was inversely correlated with trust in personal physicians.CONCLUSIONS: Initial testing suggests that we developed an instrument with valid and reliable scores in order to measure distrust of the health care system. Future research is needed to evaluate the validity and reliability of the Health Care System Distrust scale among diverse populations. This instrument can facilitate the investigation of the prevalence, causes, and effects of health care system distrust in the United States.