{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T13:07:51Z","timestamp":1774012071652,"version":"3.50.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Public acceptance of health messaging, recommendations, and policy is heavily dependent on the public\u2019s trust in doctors, health systems and health policy. Any erosion of public trust in these domains is thus a concern for public health as it can no longer be assumed that the public will follow official health recommendations. In response, the health policy and health services communities have emphasized a commitment to (re)building trust in healthcare. As such, measures of trust that can be used to develop and evaluate interventions to (re)build trust are highly valuable. In 2024, the Trust in Multidimensional Health System Scale (TIMHSS) was published, providing the first measure of trust in healthcare that includes doctors, the system and health policy within a single measure. This measure can effectively facilitate research on trust across diverse populations. However, it is limited in its application because results cannot be directly added together for a total trust score. Further, at 38-items, it is burdensome for respondents and analysts, particularly when being used as a repeat measure in an applied setting. The aim of the present work was to develop a shortened measure of trust in healthcare for use in applied settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Survey data were collected (<jats:italic>N<\/jats:italic> = 512; in Sept 2024) to reduce the number of items and to test if the factor structure was consistent with the original TIMHSS. Several statistical criteria were used to support item reduction (i.e., correlated errors, measurement invariance, inter-item correlations, factor loadings and communalities, item-total correlation, and skewness), as well as an exercise testing the content validity ratio (CVR). We then tested a three-factor model based on the 18 items that remained following the CVR and statistical test metrices to finalize the measure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The S-TIMHSS is an 18-item scale that allows for direct scoring of trust items for applied research. It preserves the content, convergent, and criterion validity of the original 38-item version.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>We recommend the measure be used by health policy makers and practitioners as a quality metric to inform and evaluate interventions which aim to (re)build trust in doctors, health systems and health policy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1568836","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T06:40:32Z","timestamp":1746081632000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Development and validation of the S-TIMHSS: a quality metric to inform and evaluate interventions to (re)build trust"],"prefix":"10.3389","volume":"13","author":[{"given":"Samantha B.","family":"Meyer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerrica","family":"Little","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul R.","family":"Ward","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Calnan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1080\/21515581.2022.2029742","article-title":"Public trust in governments, health care providers, and the media during pandemics: a systematic review","volume":"11","author":"Majid","year":"2021","journal-title":"J Trust Res"},{"key":"ref2","year":"2020"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e277","DOI":"10.1016\/S2589-7500(20)30084-4","article-title":"Building trust while influencing online COVID-19 content in the social media world","volume":"2","author":"Limaye","year":"2020","journal-title":"Lancet Digit Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"177","DOI":"10.5172\/hesr.451.17.2.177","article-title":"Trust in the health system: an analysis and extension of the social theories of Giddens and Luhmann","volume":"17","author":"Meyer","year":"2008","journal-title":"Health Sociol Rev"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1080\/1359432X.2020.1850520","article-title":"Making an impact in healthcare contexts: insights from a mixed-methods study of professional misconduct","volume":"30","author":"Searle","year":"2021","journal-title":"Eur J Work Organ Psy"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1007\/s40615-024-01913-5","article-title":"Examining race-based and gender-based discrimination, Trust in Providers, and mental well-being among black women","volume":"12","author":"Cuffee","year":"2024","journal-title":"J Racial Ethn Health Disparities"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e0170988","DOI":"10.1371\/journal.pone.0170988","article-title":"Trust in the health care professional and health outcome: a meta-analysis","volume":"12","author":"Birkh\u00e4uer","year":"2017","journal-title":"PLoS One"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1001\/jama.2019.1924","article-title":"Building Trust in Health Systems to eliminate health disparities","volume":"322","author":"Wesson","year":"2019","journal-title":"JAMA"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2023.2263525","article-title":"Examining factors impacting acceptance of COVID-19 countermeasures among structurally marginalised Canadians","volume":"18","author":"Ike","year":"2023","journal-title":"Glob Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e13101","DOI":"10.1111\/soc4.13101","article-title":"How do you measure trust in social institutions and health professionals? A systematic review of the literature (2012-2021)","volume":"17","author":"Aboueid","year":"2023","journal-title":"Sociol Compass"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s12939-024-02162-y","article-title":"Development and validation of the Trust in Multidimensional Healthcare Systems Scale (TIMHSS)","volume":"23","author":"Meyer","year":"2024","journal-title":"Int J Equity Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1108\/14777260610701759","article-title":"Researching trust relations in health care: conceptual and methodological challenges--introduction","volume":"20","author":"Calnan","year":"2006","journal-title":"J Health Organ Manag"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/1468-0009.12598","article-title":"Fifty years of trust research in healthcare: a synthetic review","volume":"101","author":"Taylor","year":"2023","journal-title":"Millbank Q"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1215\/03616878-23-4-661","article-title":"The functions and limitations of trust in the provision of medical care","volume":"23","author":"Mechanic","year":"1998","journal-title":"J Health Polit Policy Law"},{"key":"ref15","volume-title":"Trust: The social virtues and the creation of prosperity","author":"Fukuyama","year":"1995"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1093\/ijpor\/edh057","article-title":"Distinguishing red and green biotechnology: cultivation effects of the elite press","volume":"17","author":"Bauer","year":"2005","journal-title":"Int J Public Opin"},{"key":"ref17","author":"Rutherford-Hemming","year":"2018"},{"key":"ref18","first-page":"5","article-title":"The problem of allowing correlated errors in structural equation modeling: concerns and considerations","volume":"3","author":"Hermida","year":"2015","journal-title":"Comput Methods Soc Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.dr.2016.06.004","article-title":"Measurement invariance conventions and reporting: the state of the art and future directions for psychological research","volume":"41","author":"Putnick","year":"2016","journal-title":"Dev Rev"},{"key":"ref20","first-page":"40","article-title":"Robust factor analysis in the presence of normality violations, missing data, and outliers: empirical questions and possible solutions the quantitative methods for psychology","author":"Zygmont","year":"2014"},{"key":"ref21","first-page":"69","article-title":"Statistics corner: a guide to appropriate use of correlation coefficient in medical research","volume":"24","author":"Mukaka","year":"2012","journal-title":"Malawi Med J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1177\/0011000006288127","article-title":"Scale development research: a content analysis and recommendations for best practices","volume":"34","author":"Worthington","year":"2006","journal-title":"Couns Psychol"},{"key":"ref23","first-page":"1","article-title":"Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis","volume":"10","author":"Costello","year":"2005","journal-title":"Pract Assess Res Eval"},{"key":"ref24","volume-title":"Discovering statistics using SPSS","author":"Field","year":"2013"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1007\/s10490-023-09871-y","article-title":"Reporting reliability, convergent and discriminant validity with structural equation modeling: a review and best-practice recommendations","volume":"41","author":"Cheung","year":"2024","journal-title":"Asia Pac J Manag"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"149","DOI":"10.3389\/fpubh.2018.00149","article-title":"Best practices for developing and validating scales for health, social, and behavioral research: a primer","volume":"6","author":"Boateng","year":"2018","journal-title":"Front Public Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct Equ Model Multidiscip J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"23","DOI":"10.23668\/psycharchives.12784","article-title":"Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures","volume":"8","author":"Schermelleh-Engel","year":"2003","journal-title":"Methods Psychol Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/00005650-199003000-00006","article-title":"Older Patients' health status and satisfaction with medical care in an HMO population","volume":"28","author":"Hall","year":"1990","journal-title":"Med Care"},{"key":"ref30","volume-title":"A language and environment for statistical computing","year":"2023"},{"key":"ref31","author":"Wei","year":"2024"},{"key":"ref32","author":"Revelle","year":"2024"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v048.i02","article-title":"Lavaan: an R package for structural equation modeling","volume":"48","author":"Rosseel","year":"2012","journal-title":"J Stat Softw"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"151","DOI":"10.32614\/RJ-2014-031","article-title":"MVN: an R package for assessing multivariate normality","volume":"6","author":"Korkmaz","year":"2014","journal-title":"R J"},{"key":"ref35","author":"Jorgensen","year":""},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the Tidyverse","volume":"4","author":"Wickham","year":"2019","journal-title":"J Open Source Softw"},{"key":"ref37","year":"2025"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e59111","DOI":"10.2196\/59111","article-title":"From theory to practice: viewpoint on economic indicators for Trust in Digital Health","volume":"27","author":"Gille","year":"2025","journal-title":"J Med Internet Res"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1093\/heapro\/daw024","article-title":"A model for (re)building consumer trust in the food system","volume":"32","author":"Wilson","year":"2016","journal-title":"Health Promot Int"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.2466\/pr0.1990.67.3f.1091","article-title":"Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships","volume":"67","author":"Anderson","year":"1990","journal-title":"Psychol Rep"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1568836\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T20:16:49Z","timestamp":1746130609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1568836\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,30]]},"references-count":40,"alternative-id":["10.3389\/fpubh.2025.1568836"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1568836","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,30]]},"article-number":"1568836"}}