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Developing and validating trust measures

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For each domain, there were between five and nine survey items for which respondents were asked to express the degree to which they agree with the statement using a 5-point scale ranging from strongly disagree (1) to strongly agree (5) with higher scores representing patient reports of relatively more collaborative goal setting.

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Measure responses depicted participation in collaborative goal setting within five domains: (1) listen and learn from each other, (2) share ideas, (3) caring relationship, (4) agree on a measurable objective, and (5) support for goal achievement.Objective Despite known benefits of patient-perceived collaborative goal setting, we have a limited ability to monitor this process in practice.We developed the Patient Measure of Collaborative Goal Setting (PM-CGS) to evaluate the use of collaborative goal setting from the patient's perspective.Thus, while Heisler's conceptualization of collaborative goal setting was considered, items developed were based primarily on findings from a previously conducted qualitative study in which we used focus groups to explore patient perceptions of collaborative goal setting in diabetes care.11 That study resulted in a conceptualization of collaborative goal setting as including five domains: (1) listen and learn from each other (ie, patients and physicians listen and learn from each other), (2) share ideas (ie, the physician shares his or her ideas and gives the patient the opportunity to share), (3) the context of a caring relationship (ie, physicians have a good bedside manner, are compassionate and sensitive to patient needs), (4) agree on a measurable objective (ie, patients agree on a measureable objective with their physician), and (5) support for goal achievement (ie, the provision of support by the physician in a number of forms: emotional, tangible, or instrumental).11 For each of these domains we developed 6–11 survey items with a 5-point Likert-type response format ranging from 1 (strongly disagree) to 5 (strongly agree). In the second phase, the initial pool of 77 items was revised and refined by incorporating input from an expert panel and by conducting cognitive interviews.The expert panel included a psychometrician, a primary care physician, a health communication specialist, and a health psychologist.Patients Initial measure development was divided into two consecutive phases.

In the first phase, we developed survey items for potential inclusion in the PM-CGS based on results from our formative research.

Research design and methods A random sample of 400 patients aged 40 years or older, receiving diabetes care from the Virginia Commonwealth University Health System between 8/2012 and 8/2013, were mailed a survey containing potential PM-CGS items (n=44) as well as measures of patient demographics, perceived self-management competence, trust in their physician, and self-management behaviors.

Confirmatory factor analysis was used to evaluate construct validity.

The questionnaire included the PM-CGS items, as well as the following previously validated measures: the Perceived Competence Scale,17 the Trust in Physician Scale,18 and the Summary of Diabetes Self-Care Activities (SDSCA) measure.19 The survey also included items specific to the patient's socio-demographic characteristics including age, race, gender, marital status, employment status, income, and level of education achieved.

The collaborative goal setting and self-management measures were treated as latent variables, each comprising five domains.

This model used a multidimensional representation of collaborative goal setting where the five first-order factors were represented by the five conceptual domains of collaborative goal setting as previously identified: (1) listen and learn from each other, (2) share ideas, (3) caring relationship, (4) agree on a measurable objective, and (5) support goal achievement.