PURPOSE: The current research addresses the need for developing a Health Care System Distrust scale for cancer screening among Koreans living in the Republic of Korea. This study developed and validated a scale to measure health care system distrust and to examine the psychometric properties of the scale. METHODS: Interviews, expert reviews, a pilot test, and a cross-sectional survey with 884 Koreans were conducted for instrument development and validation. Content validity, construct validity using exploratory and confirmatory factor analyses, convergent and discriminant validity, and reliability of the scale were examined. RESULTS: Factor analyses demonstrated a three-factor structure (competency of tests and health care providers, quality of health care organizations, and honesty of health care organizations) of the Health Care System Distrust scale with 12 items accounting for a total of 71.47% of the variance (competency = 33.35%, quality = 21.14%, and honesty = 16.97%). Cronbach's &#945; coefficients of the subscales were 0.72-0.92. CONCLUSION: The newly developed Health Care System Distrust scale will aid in understanding Koreans' distrust of the health care system and their cancer screening behaviors, and will improve cancer screening utilization by transforming distrust into trust.
Development and validation of the Health Care System Distrust scale for cancer screening among Koreans