USING QUALITATIVE DATA TO DEVELOP LOCALLY RELEVANT AND VALID QUANTITATIVE MEASUREMENT TOOLS: A CASE EXAMPLE OF TRUST IN ETHIOPIA

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Abstract

Purpose: To build a new measure of trust from the ground up that is valid and locally relevant. Background: Little is known about the influence of trust among health workers in low-resource settings. Trust may be particularly salient among health workers in developing countries such as Ethiopia where skilled health worker shortages have led to reliance on lower-skilled community-level health workers to provide services. Methods: Ethnographic data on the conceptualization of trust were collected through semi-structured interviews with 30 health workers in Amhara region, Ethiopia. Transcripts underwent thematic analysis to identify characteristics of trustworthiness. Respondents’ own words were used to build a 25-item trust scale which was subsequently pilot tested with 92 health workers. Cultural consensus analysis and Quadratic Assignment Procedure (QAP) assessed the level of shared cultural knowledge within and between cadres of health workers. Results: Psychometric testing of the trust scale reveals strong internal consistency. Cultural consensus analysis and QAP provide preliminary evidence for the existence of divergent models of trust among health worker cadres. Conclusions: This represents a case example of how rapid formative work can lead to the development of a scale that is both valid and locally relevant. Next steps in the research involve assessing the association between trust and teamwork, and linking trust and teamwork with delivery of health services and outcomes. Funding: Bill and Melinda Gates Foundation

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