Development and validation of the Trust in Multidimensional Healthcare Systems Scale (TIMHSS).

CONTEXT: The COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1) Is responsive to the conceptual and methodological limitations of existing measures; (2) Can be used to identify systemic explanations for lower levels of trust in equity-deserving populations; (3) Can be used to design and evaluate interventions aiming to (re)build trust. METHODS: We conducted a 2021 review of existing measures of trust in healthcare, 72 qualitative interviews (Aug-Dec 2021; oversampling for equity-deserving populations), an expert review consensus process (Oct 2021), and factor analyses and validation testing based on two waves of survey data (Nov 2021, n = 694; Jan-Feb 2022, n = 740 respectively). FINDINGS: We present the Trust in Multidimensional Healthcare Systems Scale (TIMHSS); a 38-item correlated three-factor measure of trust in doctors, policies, and the system. Measurement of invariance tests suggest that the TIMHSS can also be reliably administered to diverse populations. CONCLUSIONS: This global measure of trust in healthcare can be used to measure trust over time at a population level, or used within specific subpopulations, to inform interventions to (re)build trust. It can also be used within a clinical setting to provide a stronger evidence base for associations between trust and therapeutic outcomes.

Development and validation of the Trust in Government measure (TGM).

BACKGROUND: Trust in government is associated with health behaviours and is an important consideration in population health interventions. While there is a reported decline in public trust in government across OECD countries, the tools used to measure trust are limited in their use for informing action to (re)build trust, and have limitations related to reliability and validity. To address the limitations of existing measures available to track public trust, the aim of the present work was to develop a new measure of trust in government. METHODS: Fifty-six qualitative interviews (Aug-Oct 2021; oversampling for equity-deserving populations) were conducted to design a national survey, including factor analyses and validation testing (N = 878; June 1-14th 2022) in Canada. RESULTS: The measure demonstrated strong internal consistency (α = 0.96) and test validity (CFI = 0.96, RMSEA = 0.09, SRMR = 0.03), suggesting that trust in government can be measured as a single underlying construct. It also demonstrated strong criterion validity, as measured by significant (p < 0.0001) associations of scores with vaccine hesitancy, vaccine conspiracy beliefs, COVID-19 conspiracy beliefs, trust in public health messaging about COVID-19, and trust in public health advice about COVID-19. We present the Trust in Government Measure (TGM); a 13-item unidimensional measure of trust in Federal government. CONCLUSIONS: This measure can be used within high-income countries, particularly member countries within the OECD already in support of using tools to collect, publish and compare statistics. Our measure should be used by researchers and policy makers to measure trust in government as a key indicator of societal and public health.

Clinical Predictors of Delayed Discharges in Inpatient Mental Health Settings Across Ontario.

Delayed discharges constitute an ongoing issue in psychiatric facilities. This study examined clinical predictors of 30-day delayed discharges in all designated inpatient mental health units within Ontario, Canada. Data for 76,184 inpatient episodes were obtained from 68 psychiatric facilities between 2011 and 2013. Risk factors for delayed discharges were analyzed using multivariate logistic regression. Indicators of functional, social, and cognitive impairment positively predicted delayed discharges, while symptoms of mental illness were inversely related. Policy makers and mental health care practitioners may utilize early predictors of delayed discharges to introduce treatment interventions and policies that reduce the risk of delays in mental health settings.

A Lot Can Happen in a Few Minutes: Examining Dynamic Patterns Within an Interaction to Illuminate the Interpersonal Nature of Personality Disorders.

Although problematic interpersonal tendencies have often been characterized as a traitlike excess of a particular interpersonal style, the interpersonal nature of personality disorders may have more to do with patterns of variability in interpersonal behavior and the relation of this variability to the varying behavior of interaction partners. Indeed, problematic interpersonal tendencies may often be evident as patterns within even one interaction. A useful methodology for examining moment-to-moment patterns within the course of an interaction is the computer joystick technique. To illustrate the potential of this new approach for studying problematic interpersonal patterns, the authors provide joystick-based analyses of the videoed session between Dr. Donald Meichenbaum and the client, Richard (Shostrom, 1986a). The authors show how to examine the association between concurrent levels of dominance and affiliation within a person, patterns of covariation between partners, and the moderation of such entrainment patterns. They also discuss how these indices could illuminate disordered interpersonal patterns.

ALC status in in-patient mental health settings: Evidence based on the Ontario Mental Health Reporting System.

This article examines the characteristics associated with Alternate Level of Care (ALC) status in mental health in-patient units across Ontario. Using assessment information from the Resident Assessment Instrument-Mental Health, the prevalence of ALC episodes, resource utilization associated with ALC, and demographic and diagnostic characteristics of ALC patients are examined. The effective management of ALC patients should be an important priority for all stakeholders involved in mental health services delivery in Canada.