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

J Gen Intern Med. 2022 Apr;37(5):1108-1114. doi: 10.1007/s11606-021-06928-w. Epub 2021 Jun 2.

Abstract

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.

Keywords: psychometrics; trust; trust in physician scale.

MeSH terms

  • Factor Analysis, Statistical
  • Humans
  • Inpatients*
  • Psychometrics
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Trust*