Developing and Validating a Trust in Public Health Authorities Scale for Extreme Heat Guidelines

Abstract

In the summer of 2021, the Pacific Northwest (PNW) experienced a record-breaking “heat dome” that severely strained public health systems and disproportionately impacted vulnerable populations. While trust in public health authorities (PHAs) is known to influence disaster response and resource use, little research has examined trust in the context of extreme heat events (EHEs) guidelines. This study addresses that gap by assessing the face validity of an adapted survey tool to measure public trust in PHAs and acceptance of EHE guidelines. To adapt an existing survey, a literature review was conducted on existing EHE guidelines to develop themes and questions proposed to a discussion group. Questions were refined through a second discussion group resulting in eight finalized questions, those eight questions were combined with 12 PHA trust questions and demographic questions to create the adapted Trust in Public Health Authorities (TiPHA) questionnaire. The adapted TiPHA questionnaire was administered to six focus groups with 29 participants from Multnomah County, OR, King County, WA and Vancouver, BC to assess perceived clarity, accuracy, difficulty, length, and bias through facilitated discussion. The focus groups were professionally transcribed, and a content analysis was conducted. Overall, the adapted TiPHA questionnaire was found to be generally clear in format and question clarity, with minimal bias, and of appropriate length. However, minor revisions were needed for specific questions and questionnaire elements, including definitions for key terms. This research begins to fill the gap for trust in PHAs and their climate-related hazard guidance, which will equip PHAs to assess if trust impacts adherence to EHE guidance and thus how to best deploy EHE communications to improve health outcomes.