Measuring Health-Related Trust in Diverse Populations

Funder: NIH – National Institute of Child Health and Human Development
Principal Investigator: Elizabeth A. Jacobs, MD, MPP/Collaborative Research Unit of Stroger Hospital of Cook County and Rush University Medical Center.

Dr. Jacobs is a clinician-researcher and Associate Professor of Medicine at The John H. Stroger, Jr. Hospital of Cook County and Rush University Medical Center. For the past 10 years she has pursued a research career investigating minority disparities in health care. Her research has focused of the impact language barriers and efforts to reduce them, on the cost and quality of care for patients with limited-English proficiency (LEP), access to and cultural specificity of medical care delivered to minority patients, health literacy, and the role that trust in health care plays in African American and Hispanics patients health care decisions. She has spent the last 5 years developing valid and accurate cross-cultural measurement instruments of institutional trust in health care. Her research has been supported by grants from the National Cancer Institute, The Robert Wood Johnson Foundation, The California Endowment, The Russell Sage Foundation and the Office of Minority Health.

Project Summary:
Investigations across numerous disciplines have identified respondent culture as a potential source of systematic measurement variability in survey research. This measurement bias can lead to a number of problems including errors in hypothesis testing, flawed population forecasts and policy planning and implementation, and misguided research on disparities. This is a particular problem in the measurement of trust in health care because minority populations in the United States have had and continue to have dramatically different experiences of health care than non-Hispanic whites; yet most instruments to measure trust in health care have been developed and validated for use with predominantly non-Hispanic white populations. The purpose of the proposed research is to improve the cross-cultural measurement of trust in physicians and health care institutions across the three largest racial/ethnic groups in the United States: African Americans, Mexican Hispanics, and non-Hispanic whites.

The primary objective is to produce instruments to measure trust in health care that are culturally relevant and that provide reliable, comparable measurements across these three different racial/ethnic groups. We propose to meet this objective by using qualitative and quantitative methods to: (1) maximize the measurement equivalence of three overlapping, culturally specific measures of institutional trust in health care developed for African Americans and adapted for use with Hispanics and non-Hispanic whites and (2) to adapt current measures of interpersonal trust in physicians to better measure this construct in these three racial/ethnic groups. In addition, we will use these two, improved measures to describe the predictors of trust in health care among African Americans, Mexican Hispanics, and non-Hispanic whites and to explore group differences in levels of health-related trust and how those differences might be explained by between group differences in predictors of health-related trust.

Contact Information:
Elizabeth A. Jacobs, MD, MPP
Tel: 312-864-7311
email: Elizabeth_Jacobs@rush.edu