Measuring Trust among Frontline Health Workers in Rural Ethiopia

• Published in: Human organization Vol. 72; no. 3; pp. 230 - 241
• Main Authors: Dynes, Michelle M., Hadley, Craig, Stephenson, Rob, Sibley, Lynn M.
• Format: Journal Article
• Language: English
• Published: Oklahoma City Society for Applied Anthropology 01-10-2013; Taylor & Francis Ltd
• Subjects: Behavior; Cadres; Collaboration; Communication; Community health care; Competence; Cooperation; Ethiopia; Executives; Health; Health care; Health services; Intervention; Knowledge sharing; Maternal & child health; Patient satisfaction; Primary care; Public health; Respondents; Rural Areas; Studies; Teamwork; Trust; Trust and Assessment in Public Health Interventions; Workers; South Africa; Ethiopia
• ISSN: 0018-7259; 1938-3525
• DOI: 10.17730/humo.72.3.y2kk32w73442w6q1

Research on trust, and its influence on teamwork, among health workers in low-resource settings has been understudied. We, therefore, undertook a formative study of trust among three diverse cadres of frontline health workers in Amhara region, Ethiopia. We aimed to develop a comprehensive description of trust in this setting and generate a tool to measure levels of trust within and between cadres. In-depth interviews with 30 frontline workers uncovered a core set of items that seem to define trust in this setting (character/ability/communication), including novel conceptualizations (oneness). Twenty-five items developed from formative data were pilot tested with 92 health workers. The final 10-item scale exhibited strong internal consistency across cadres (alpha>0.83). In support of criterion validity, the scale was positively associated with the sense-of-team scale (p<0.001) and accounted for greater variance in health workers' sense-of-team (Adj.R²=0.67) than did a composite of single trust items (Adj.R²=0.28). For contrasting group validity, respondents had greater within-group agreement compared to between-group agreement on trust items and displayed higher competence in answering questions about their own cadre. Results demonstrate that the Rural Health Worker Trust Scale can be validly and reliably used to measure trust among diverse cadres. The scale may be used to develop and evaluate trust-building interventions that aim to encourage and sustain collaboration among heterogeneous frontline workers.