Trust in the Time of COVID-19

Age as a Moderator of Health Outcomes and Trust in Physicians

Objectives: Patient trust in physicians is associated with patient satisfaction with healthcare, patients engaging in follow-up care, and positive health-related outcomes. The current study investigated whether age moderated the relation between trust in physicians and four health outcome variables, including patient satisfaction, doctor visits, emergency room visits, and hospital admissions. Methods: 398 English-speaking, community-dwelling adults completed measures of physician trust and important health outcome variables via Amazon Mechanical Turk. Results: Age significantly moderated relations between trust in physicians and hospital admissions, and trust in physicians and patient satisfaction, with both positive relations becoming stronger with increasing age. Discussion: The results highlight the need for a lifespan approach to the study of physician trust and related health outcomes. They offer an avenue for increasing physician trust, engagement with the healthcare system prior to the need for hospitalization, and the reduction of healthcare costs.

Examining the Dimensionality of Trust in the Inpatient Setting: Exploratory and Confirmatory Factor Analysis

BACKGROUND

Trust in healthcare providers is associated with important outcomes, but has primarily been assessed in the outpatient setting. It is largely unknown how hospitalized patients conceptualize trust in their providers.

OBJECTIVE

To examine the dimensionality of a measure of trust in the inpatient setting.

DESIGN

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

PARTICIPANTS

Hospitalized patients (N = 1756; 76% response rate) across six hospitals in the midwestern USA. The sample was randomly split such that approximately one half was used in the EFA, and the other half in the CFA.

MAIN MEASURES

The Trust in Physician Scale, adapted for inpatient care.

KEY RESULTS

Based on the Kaiser-Guttman criterion and parallel analysis, EFAs were inconclusive, indicating that trust may be comprised of either one or two factors in this sample. In follow-up CFAs, a 2-factor model fit best based on a chi-squared difference test (Δχ² = 151.48(1), p < .001) and a Comparative Fit Index (CFI) difference test (CFI difference = .03). The overall fit for the 2-factor CFA model was good (χ² = 293.56, df = 43, p < .01; CFI = .95; RMSEA = .081 [90% confidence interval = .072-.090]; TLI = .93; SRMR = .04). Items loaded onto two factors related to cognitive (i.e., whether patients view providers as competent) and affective (i.e., whether patients view that providers care for them) dimensions of trust.

CONCLUSIONS

While measures of trust in the outpatient setting have been validated as unidimensional, in the inpatient setting, trust appears to be composed of two factors: cognitive and affective trust. This provides initial evidence that inpatient providers may need to work to ensure patients see them as both competent and caring in order to gain their trust.