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This scale has 10 items: 4 measuring honesty, 2 measuring confidentiality, and the other 2 domains being fidelity and competence.This scale also has good psychometric properties.19 The Primary Care Assessment Survey (PCAS) by Safran is another tool covering seven important domains of healthcare. It has a very high reliability of all the seven domains.6 Leisen and Hyman developed Patient Trust in their Physician Scale in 2001.Six tools to measure trust in the healthcare setting have been described in a review by Goudge and Gilson.These are, Trust in Primary Care Physician Scale by Hall in the Netherlands. Three of these tools have been developed in Wake Forest University, North Carolina.15 Egede and Ellis developed a Multidimensional Trust in Health Care System Scale that simultaneously measures trust in physician, trust in institutions and trust in insurer or payer.

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A qualitative exploration of trust in healthcare undertaken from India showed that the important dimensions of trust are perceived competence, assurance of treatment, loyalty and respect.22 Of these, only competence is a dimension that has been identified before.This forms the undercurrent of all healthcare relationships.Several scales exist for assessment of trust in physicians in developed healthcare settings, but to our knowledge none of these have been developed in a developing country context.Patient trust in the physician has been defined as a collection of expectations that patients have from their doctor.1 Certain other researchers have defined patient trust as a feeling of reassurance or confidence in the doctor.2 Another interesting definition of trust, which is apt for the healthcare setting, is “an unwritten agreement between two or more parties for each party to perform a set of agreed upon activities without fear of change from any party.” 3Trust in physicians is of inherent value in healthcare.Ample research has demonstrated the positive association between trust and individual health outcomes; it is implicit and integral to healthcare relationships.4 Several studies have indicated that greater trust is associated with greater adherence to treatment and better self management of chronic illnesses such as diabetes.5–8 Patients who have greater trust in physicians show better follow-up and continuity of care.9 Strong patient-physician relationships of trust have been shown to be associated with greater self efficacy of patients.10 Trust in physicians is also associated with open disclosure even of sensitive information, which helps in care.5 A patient's self-rated health status is also better when there is better trust.11 However, it has to be mentioned that while trust is associated with several of these outcomes, a strong causal inference cannot be made.However, trust is a difficult construct to measure.To the best of our knowledge, scales that have been developed to measure trust have emerged from the developed world.Though trust researchers recognise the importance of a dispositional component to forming trusting relationships in the workplace, there has been comparatively little research on propensity to trust in the literature.We review the literature, discuss prior measures of propensity to trust, and integrate them to develop a propensity to trust scale.This 17 item scale has good psychometric properties and also correlated well with patient centred care, patient satisfaction, adherence to medication and social support.16 Dugan, Trachtenberg and Hall developed an abridged trust scale that simultaneously measures trust in physician, health insurer and the medical profession. The scale has good psychometric properties.17 Goold 18 developed a scale to measure trust in the health insurer.This tool is a patient centred measure of trust in insurers.


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