Measuring Patients’ Trust in their Primary Care Providers

TLDR

Existing trust scales for physicians vary in content and have limited validation. The study aimed to develop a more robust trust measure by generating a large item pool guided by a detailed conceptual model and expert review. The authors piloted the items and validated the best-performing ones with a national sample of nine and a regional HMO sample of 99, producing a 10‑item unidimensional scale that aligns with the conceptual model and improves internal consistency, variability, and discriminability over previous scales. The new scale correlates strongly with patient satisfaction, loyalty, recommendation, and avoidance of second opinions, but less with insurer trust, managed‑care membership, and physician choice, while showing similar correlations with dispute absence, relationship length, and visit frequency.

Abstract

Existing scales to measure trust in physicians have differing content and limited testing. To improve on these measures, a large item pool (n = 78) was generated following a detailed conceptual model and expert review. After pilot testing, the best-performing items were validated with a random national sample (n = 9) and a regional sample of HMO members (n = 99). Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model.Compared with previous scales, the Wake Forest physician trust scale has a somewhat improved combination of internal consistency, variability, and discriminability. The scale is more strongly correlated with satisfaction, desire to remain with a physician, willingness to recommend to friends, and not seeking second opinions; it is less correlated with insurer trust, membership in managed care, and choice of physician; and correlations are equivalent with lack of disputes, length of relationship, and number of visits.