Academic journal article American Journal of Health Education

Development of a College Student's Mistrust of Health Care Organizations Scale

Academic journal article American Journal of Health Education

Development of a College Student's Mistrust of Health Care Organizations Scale

Article excerpt

Objective: The purpose of this study was to develop a College Student's Mistrust of Health Care Organizations (CSMHCO) scale and determine the relationship between medical mistrust with the use of a variety of health care services. Methods: A convenience sample of college students (n = 545) at 2 universities in the United States was recruited in the academic year 2010-2011. Results: Using principal components analysis we found that the scale was unidimensional, internal reliability (Cronbach's [alpha] = 0.85) was good, test-retest reliability was acceptable (r = 0.71), and readability (SMOG = 11 grade) was good. Higher mistrust of health care organizations was found to be statistically significantly associated with all 5 measures of underutilization of health services: failure to take medical advice, failure to seek needed medical care, failure to fill a prescription, postponing needed medical care, and failure to keep a follow-up appointment. This scale seems to be a satisfactory predictor of failure to obtain needed health care services. Conclusions and Translation to Health Education Practice: To help ensure appropriate use of health services by college students this scale could be used to assess levels of mistrust of health care organizations in student populations and then outreach efforts could be implemented for those students most likely to avoid needed health care services.

INTRODUCTION

There is a growing body of empirical research on health care-related mistrust that shows that mistrust is not evenly distributed across all segments of society or directed at a specific entity in the health care arena. (1-3) Most prior research on health care-related mistrust has focused on patient trust/mistrust of physicians. (2,3) The evidence indicates that the vast majority of patients trust their personal physicians. (4-6) The general mistrust of physicians but trust of one's personal physician can complicate assessment of patients' trust of physicians. Additionally, patients who do not have a personal physician but go to clinics where they may have different physicians or in cases where patients see nurse practitioners complicate such an assessment.

The theoretical and empirical research on health care-related mistrust has expanded into areas other than a focus on physicians. More recently, mistrust and patient satisfaction with primary care provided by nurse practitioners has been explored. (7) In addition, the "commercialization and privatization of US medicine" (p. 457) (8) has resulted in attempts to measure aspects of health care other than interpersonal trust between patients and clinical providers of health care. Scales have been developed to measure patients' trust in health insurers and trust in medical researchers. (9,10)

Another area of health care-related mistrust research has focused on health care organizations or the health care arena in general. In the United States, the rapid rise in health care costs has caused many to wonder whether the profit-making motive in health care has compromised the focus of health care. In addition, the preponderance of research on racial/ ethnic differences in mistrust of the health care arena have found that African Americans and Hispanics are more likely than whites to have mistrust of health care professionals and health care organizations. (11-15) Those with fewer years of formal education have also been found to have greater levels of health care provider and health systems mistrust. (15) Mistrust of the health care arena has been found to be associated with fair/poor health, reticence in obtaining cancer screening tests, failure to take medical advice, failure to keep follow-up medical appointments, less physician-patient interaction, postponing needed health care, and failure to fill a prescription. (15-19) A study in Sweden found that health system mistrust and poor self-reported health status was explained primarily by inadequate use of health care services. …

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