The public health disaster trust scale: validation of a brief measure.

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.