The Public Health Disaster Trust Scale

CONTEXT: Trust contributes to community resilience by the critical influence it has on the community's responses to public health recommendations before, during, and after disasters. However, trust in public health is a multifactorial concept that has rarely been defined and measured empirically in public health jurisdictional risk assessment surveys. Measuring trust helps public health departments identify and ameliorate a threat to effective risk communications and increase resilience. Such a measure should be brief to be incorporated into assessments conducted by public health departments. OBJECTIVE: We report on a brief scale of public health disaster–related trust, its psychometric properties, and its validity. DESIGN: On the basis of a literature review, our conceptual model of public health disaster–related trust and previously conducted focus groups, we postulated that public health disaster–related trust includes 4 major domains: competency, honesty, fairness, and confidentiality. SETTING: A random-digit-dialed telephone survey of the Los Angeles county population, conducted in 2004-2005 in 6 languages. PARTICIPANTS: Two thousand five hundred eighty-eight adults aged 18 years and older including oversamples of African Americans and Asian Americans. MAIN OUTCOME MEASURES: Trust was measured by 4 items scored on a 4-point Likert scale. A summary score from 4 to 16 was constructed. RESULTS: Scores ranged from 4 to 16 and were normally distributed with a mean of 8.5 (SD 2.7). Cronbach α = 0.79. As hypothesized, scores were lower among racial/ethnic minority populations than whites. Also, trust was associated with lower likelihood of following public health recommendations in a hypothetical disaster and lower likelihood of household disaster preparedness. CONCLUSIONS: The Public Health Disaster Trust scale may facilitate identifying communities where trust is low and prioritizing them for inclusion in community partnership building efforts under Function 2 of the Centers for Disease Control and Prevention's Public Health Preparedness Capability 1. The scale is brief, reliable, and validated in multiple ethnic populations and languages.