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Hopkins Center for Health Disparities Solutions Projects

Measuring Trust in Health Care: Medical Mistrust Index 2.1

Principal Investigator: Thomas A LaVeist, PhD

This is a study to examine the validity of the psychometric properties of a new measure of trust/mistrust of medical care systems. Trust is the foundation of the interrelationships that make civil society possible and the importance of trust within health care is no less critical. Patients are inherently vulnerable within medical encounters and must be trustful of the multiple institutional entities and individuals involved in their care. Patients must trust that individual health care providers are competent and will have their best interest in mind while making treatment decisions. They must trust that the pharmaceutical companies have developed effective drugs and that the regulatory agencies have adequately monitored them. And, they must trust that the health care organization and that its staff will manage their medical information with discretion and confidentially.

Research Questions

The purpose of this study is to determine the psychometric properties of a newly created measure of patient mistrust of health care—the medical mistrust index.

  1. To establish the reliability of the Medical Mistrust Index Version 2.1
  2. To establish the validity of the Medical Mistrust Index Version 2.1


This study will involve 367 male and female adult respondents from Baltimore City and County, Maryland (see the modification to the sample size attached to the original proposal). Study participants will be contacted by telephone using random-digit dialing. The interviewer will indicate that their telephone number was selected at random. During the consent process they will be told that the interview should take about 15-20 minutes and that we will call them back in about 2 weeks for an equally brief follow-up interview. The reason for the follow-up interview is so that we can establish test-retest validity, an assessment of the stability of respondent’s attitudes over time. Since we needed to call respondents twice, we decided to split the additional questions between the two interviews. This reduced the number of questions in each questionnaire and reduces respondent burden. The only identifying information to be collected will be the respondent’s name, telephone number, and address. Respondents will be compensated $20 by check sent via the mail to their address. After respondents are paid, all identifying information (name, address and telephone number) will be deleted from our files.


Although the central role of trust in the medical care setting is widely acknowledged and many articles speculate about the impacts of trust/mistrust in health services research, there is a surprising lack of empirical research on trust in medical care settings. One impediment to advancing this literature may be a lack of conceptual models to study trust and a lack of validated measures of trust that are suitable for inclusion in patient-based and community studies.


From this research not all of the 17 items were correlated and the mistrust index was reduced to scale that only includes the seven items that had the most correlation. These items are presented below with their correlation coefficients

Table 3


Correlation between waves 1 and 2

1. You’d better be cautious when dealing with health care organizations.

Corr = .500   P= .000

2. Patients have sometimes been deceived or misled by health care organizations.

Corr = .398   P= .000

5. When health care organizations make mistakes they usually cover it up.

Corr = .567   P= .000

6. Health care organizations have sometimes done harmful experiments on patients without their knowledge.

Corr = .474   P= .000

10. Health care organizations don’t always keep your information totally private.

Corr = .364   P= .000

15.  Sometimes I wonder if health care organizations really know what they are doing.

Corr = .346   P= .000

16.  Mistakes are common in health care organizations.

Corr = .451   P= .000


Corr = .697   P= .000

Click here for survey 1 (Word document).

Click here for survey 2 (Word document).