Baseline Interview: Medical Mistrust Survey
Revised 04/02/03
Hello, my name is ____________ and I’m from the Johns Hopkins School of Public Health.
A. We would like to speak with an adult in your household who is 18 years old or older.
If the person who answered the phone is an adult who is over 18 years of age, skip to item B.
We are doing a study of how people feel about their doctors, hospitals, and the healthcare system in general.
The goal of this study is to use this information to help hospitals and doctors serve their patients better.
Re-introduce yourself to the adult.
Hello, my name is ____________ and I’m from the Johns Hopkins School of Public Health. We are doing a
study of how people feel about their doctors, hospitals, and the healthcare system in general. The goal of
this study is to use this information to help hospitals and doctors serve their patients better.
Go to item B.
B
INTERVIEWER: GO TO CONSENT FORM AND CONSENT PATIENT.
Q1) Are you be willing to be involved in this study?
1 – yes
2 – No
If “yes” continue.
If “no” thank the respondent and end the interview.
If willing but not now, schedule appointment.
Day of week (Monday-Friday) ___________
Date (Month/Day/Year) _______________
Time (AM or PM) _______________
Verify telephone number and record here _________________
Continue for all other respondents.
SECTION A: HEALTH STATUS
Let’s begin. First, I would like to ask you about your health
A1.
In general, how would you describe your own health? Would you say that it is excellent, very good, good,
fair, or poor?
1
2
3
4
5
8
9
Excellent
Very Good
Good
Fair
Poor
Don’t Know
Refused
Have you been told by a doctor or other healthcare professional that you have any of the following health problems?
Have been
told
Have not
been told
Don’t
know
Refused
A2. High blood pressure
1
2
8
9
A3. Heart attack, or heart disease
1
2
8
9
A4. Cancer
1
2
8
9
A5. Diabetes or sugar diabetes
1
2
8
9
A6. Anxiety or depression
1
2
8
9
A7. Obesity
1
2
8
9
A8. Asthma
1
2
8
9
A9. Arthritis
1
2
8
9
A10. Any other health problems
1
2
8
9
If yes to A10.
-- A10a. Specify ________________________________________________________________________
MEDICAL MISTRUST INDEX V2.2 MEASURING MISTRUST IN HEALTHCARE
Next, I would like to ask you a few questions about how you feel about healthcare organizations. When I say
healthcare organizations, I am not asking about an individual doctor or nurse or any other person like that. I am asking
about organizations where you might get healthcare, like a hospital or a clinic, the healthcare system in general.
Please listen to the statements carefully. For each one, tell me whether you strongly disagree, disagree, agree or
strongly agree.
Read each statement
Item
B1. You’d better be cautious when dealing with healthcare
organizations.
B2. Patients have sometimes been deceived or mislead by
healthcare organizations.
B3. I trust that healthcare organizations will tell me if a
mistake is made about my treatment.
B4. Healthcare organizations often want to know more about
your business than they need to know.
B5. When healthcare organizations make mistakes they
usually cover it up.
B6. Healthcare organizations have sometimes done harmful
experiments on patients without their knowledge.
B7. The patient’s medical needs come before other
considerations at healthcare organizations.
B8.Healthcare organizations are more concerned about
making money than taking care of people.
B9. Healthcare organizations put the patient’s health first.
B10. Healthcare organizations don’t always keep your
information totally private.
B11. Patients should always follow the advice given to them
at healthcare organizations.
B12. I typically get a second opinion when I am told
something about my health.
B13. I trust that healthcare organizations check their staff’s
credentials to make sure they are hiring the best people.
B14. They know what they are doing at healthcare
organizations.
B15. Sometimes I wonder if healthcare organizations really
know what they are doing.
B16. Mistakes are common in healthcare organizations.
B17. I trust that healthcare organizations keep up with the
latest medical information.
Strongly
Disagree
1
Disagree
Agree
2
3
Strongly
Agree
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
1
2
2
3
3
4
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
SECTION C HEALTHCARE UTILIZATION (17-ITEMS)
Source: Princeton Survey Research Associates. “Survey on Disparities in Quality of Health Care: Spring
2001.” Commonwealth Fund
Now I’m going to ask you some questions about your experiences with the healthcare system.
C1. In the last 2 years, how many times did you visit a doctor, hospital or medical clinic for any reason, including
check-ups, visits to the emergency room or the hospital outpatient department?
Record Number _______________________
C2. How many of those visits were to the emergency room?
Record Number _______________________
C3. All together how many nights did you spend in a hospital over the last 2 years?
Record Number _______________________
C4. Where do you usually go when you are sick or need health care? Do you go to a doctor’s office or private clinic, a
community health center or other public clinic, a hospital outpatient department, a hospital emergency room, or
some other place? If respondent says HMO, ask where visit occurred.
1
2
3
4
5
8
9
Doctor’s office or private clinic
Community health center or other public clinic
Hospital outpatient department
Hospital emergency room
Some other place (voluntary)
Don’t know
Refused
C5. How much choice do you have in where you go for medical care? Would you say that you have a great deal,
some, very little, or no choice?
1
2
3
4
8
9
C6.
A great deal of choice
Some choice
Very little choice
No choice
Don’t know
Refused
Do you have a regular doctor or other health professional, such as a nurse or a midwife, you usually go to
when you are sick or need health care?
1
2
3
8
9
Yes
No (skip to Section G)
Has more than one regular doctor (voluntary)
Don’t know
Refused
C7.
Now thinking about the regular doctor you see more than others or whom you consider your main regular
doctor, is this person male or female?
1
2
8
9
C8.
What is the race or ethnicity of this person? Is this person white, black or African American, Hispanic or
Latino, Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaskan Native or some other
background?
01
02
03
04
05
06
07
08
98
99
C9.
Male
Female
Don’t know
Refused
White
Black or African American
Hispanic or Latino
Asian (such as China, Korea, Japan, etc.)
East Indian, Pakistani
Native Hawaiian or other Pacific Islander
American Indian or Alaskan Native
Other
Don’t know
Refused
And how long has this person been your doctor? Read responses
Record in Years or Months
If years _________________
If Months ________________
SECTION D: TRUST IN PHYSICIAN SCALE (11-ITEMS)
Sources:
Anderson, LA; Dedrick RF. “Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician
relationships.” Psychol Rep 1990; 67:1091
Thom, DH; Ribisl, KM; Stewart, AL; Luke, DA; The Stanford Trust Study Physicians. “Further Validation and Reliability Testing of the
Trust in Physician Scale.” Medical Care 1999; 37(5): 510-517
Now I’d like you to think about how well your doctor cares for your medical needs. For each statement that I read,
please tell me whether you totally disagree, disagree, are neutral, or if you agree or totally agree.
Read each statement
Item
D1. I doubt that my doctor really cares about me
as a person. †
D2. My doctor is usually considerate of my needs
and puts them first.
D3. I trust my doctor so much I always try to follow
his/her advice
D4. If my doctor tells me something is so, then it
must be true
D5. I sometimes distrust my doctor’s opinions and
would like a second one. †
D6. I trust my doctor’s judgments about my
medical care
D7. I feel my doctor does not do everything he/she
should about my medical care. †
D8. I trust my doctor to put my medical needs
above all other considerations when treating my
medical problems.
D9. My doctor is well qualified to manage
(diagnose and treat or make an appropriate
referral) medical problems like mine.
D10. I trust my doctor to tell me if a mistake was
made about my treatment.
D11. I sometimes worry that my doctor may not
keep the information we discuss totally private. †
Totally
Disagree
1
Disagree
Neutral
Agree
2
3
4
Totally
Agree
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
SECTION G: DEMOGRAPHICS
I have some questions about your background.
G1.
What is your gender? (OBSERVATION)
1.
2.
G2.
What is your race/ethnicity? Read responses
1
2
3
4
5
6
7
8
9
G3.
Male
Female
White
Black or African American
Hispanic or Latino
Asian
Native Hawaiian or other Pacific Islander
American Indian or Alaskan Native
Other ________________
Don’t know do not read
Refused do not read
What is your age? __________________
Now, I have a question about different kinds of health insurance, including those provided by your job of somebody
else’s job, or the government. As I read each of the following health plans, please tell me whether or not you are
currently covered by any of them. Are you covered by (read options)?
G4. Private health insurance, from your job or somebody else’s job.
G5. Medicare, a government plan that pays health care bills for people
over age 65 and people who are disabled
G6. Medicaid, also called medical assistance
G7. CHAMPUS/CHAMPVA
Yes
1
No
0
1
1
1
0
0
0
Don’t know
8
8
G8.Was there any time in the past two years when you were completely without any health plan or insurance
coverage?
1 – Yes
2 – No
G8a. Are you currently uninsured?
1 – Yes
2 – No
8
8
G9. How would you describe your current employment status?
1
2
3
4
5
6
7
8
Working outside the home full time
Working outside the home part time
Retired (skip to question G10)
Attending school (skip to question G10)
Maintaining the home (skip to question G10)
Unemployed (skip to question G10)
Disabled (skip to question G10)
Other – specify ___________ (skip to question G10)
G9a. What kind of business or industry do you work in?
____________________________________________________________
G9b. What kind of work are you doing?
OCCUPATION: ______________________________________________
(If answered G9, G9a, G9b, Go to question G11)
G10. Have you ever had a job?
1 – Yes
2 – No (GO TO QUESTION G11)
G10a. What kind of business or industry did you work in at your last job?
____________________________________________________________
G10b. What kind of work did you do?
OCCUPATION: ______________________________________________
G11. What is the highest grade or year of regular school that you have completed?
Grade
College
Graduate School
Don’t know
Refused
00
04
08
13
01
05
09
14
02
06
10
15
03
07
11
16
17
98
99
12
G12.
To get a picture of people’s financial situation, we need to know the general range of income of all people we
interview. Now, think about your household’s total income from all sources, before taxes, including wages,
salaries, and any other income. About how much did your household receive in the last year?
$_____________________
If the answer is “don’t know” or respondent refuses to answer, continue with the following. If the above
question is answered, go to question G13.
G12a.
Maybe if I give you some income ranges it would help. When I say the income range that matches your total
household income for last year, please tell me.
1
2
3
4
5
6
7
8
Less than $5,000
$5,000 - $9,999
$10,000 - $14,999
$15,000 - $24,999
$25,000 - $34,999
$35,000 - $49,999
$50,000 - $59,999
$60,000 or more
If G12a is answered, go to question G13. If not, continue with the following.
G12b.
Can you tell me if your household income was more or less than $25,000?
1
2
G12c.
Can you tell me if your household income was more or less than $50,000 in the past 12 months?
1
2
G13.
Less than $25,000 (go to question G13)
More than $25,000
Less than $50,000
More than $50,000
How much of that income did you yourself bring in?
$_____________________
We have finished with all of the questions. We will call you back in about 3 weeks to do the follow-up interview. Thank
you very much for your participation in this study. Have a great day!