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ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Education and Promotion
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1568836
This article is part of the Research Topic The Erosion of Trust in the 21st Century: Origins, Implications, and Solutions View all 4 articles
Development and validation of the S-TIMHSS: A quality metric to inform and evaluate interventions to (re)build trust
Provisionally accepted- 1 University of Waterloo, Waterloo, Canada
- 2 Torrens University Australia, Adelaide, Australia
- 3 University of Amsterdam, Amsterdam, Netherlands
- 4 University of Kent, Canterbury, Kent, United Kingdom
Public acceptance of health messaging, recommendations, and policy is heavily dependent on the public's trust in doctors, health systems and health policy. Any erosion of public trust in these domains is thus a concern for public health as it can no longer be assumed that the public will follow official health recommendations. In response, the health policy and health services communities have emphasized a commitment to (re)building trust in healthcare. As such, measures of trust that can be used to develop and evaluate interventions to (re)build trust are highly valuable. In 2024, the Trust in Multidimensional Health System Scale (TIMHSS) was published, providing the first measure of trust in healthcare that includes doctors, the system and health policy within a single measure. This measure can effectively facilitate research on trust across diverse populations. However, it is limited in its application because results cannot be directly added together for a total trust score. Further, at 38-items, it is burdensome for respondents and analysts, particularly when being used as a repeat measure in an applied setting. The aim of the present work was to develop a shortened measure of trust in healthcare for use in applied settings. Survey data were collected (N=512; in Sept 2024) to reduce the number of items and to test if the factor structure was consistent with the original TIMHSS. Several statistical criteria were used to support item reduction (i.e., correlated errors, measurement invariance, inter-item correlations, factor loadings and communalities, item-total correlation, and skewness), as well as an exercise testing the content validity ratio (CVR). We then tested a three-factor model based on the 18 items that remained following the CVR and statistical test metrices to finalize the measure. The result is the S-TIMHSS, an 18-item scale that allows for direct scoring of trust items for applied research. We recommend the measure be used by health policy makers and practitioners as a quality metric to inform and evaluate interventions which aim to (re)build trust in doctors, health systems and health policy.
Keywords: healthcare, policy, doctor, Trust, Measurement, intervention, Evaluation
Received: 30 Jan 2025; Accepted: 01 Apr 2025.
Copyright: © 2025 Meyer, Little, Ward, Brown and Calnan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Samantha B Meyer, University of Waterloo, Waterloo, Canada
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