From Linchpin to Lever — Part 1: Measuring Trust in Public Health
From Linchpin to Lever — Part 1: Measuring Trust in Public Health


Citation (Author, Year)  Domain  Question  Response Options  Notes  Annenberg Public Policy Center (2025)​​ 9 Confidence *  In general, how confident, if at all, are you that the following are providing the public with trustworthy information about matters concerning public health? [List of agencies and named officials]  Not at all confident; Not too confident; Somewhat confident; Very confident; Not sure  Battery of national agencies (CDC, FDA, NIH) plus a personal health provider and two named federal officials; no state or local health department referent.  de Beaumont Foundation (2022)​​ 10 Importance*†  In your opinion, how important of a role, if at all, do each of the following have in creating a healthy community? [List of community agencies, including local health departments]  Very important; Somewhat important; Not too important; Not important at all; Don’t know  Battery of community agencies (hospitals, schools, fire and police departments, parks, businesses, libraries) including local health departments. Measures perceived importance of role, not trust.  Familiarity *  How familiar, if at all, would you say you are with each of the following? [List of community agencies, including local health departments]  Not specified in source reviewed  Same agency battery. Measures familiarity, not trust. Response scale not specified in source reviewed.  Favorability *  Based on what you know, do you have a favorable or unfavorable opinion of your local health official?  Not specified in source reviewed  Single referent (local health official). Measures favorability, not trust. Response scale not specified in source reviewed.  Eisenman et al. (2012)​​ 11 Competency  How confident are you that the County’s public health system can respond effectively to protect the health of the public?  Very confident; Somewhat confident; Not too confident; Not at all confident  All four items preceded by a scenario lead-in — “imagine that a terrorist or bioterrorist attack were to occur in Los Angeles County.” Response options were read aloud as part of each item. Validated 4-item scale (Public Health Disaster Trust Scale); disaster framing limits use in non-emergency contexts.  Fairness  How confident are you that the County’s public health system will respond fairly to your health needs, regardless of your race, ethnicity, income or other personal characteristics?  Honesty  How confident are you that the County’s public health system will provide honest information to the public?  Confidentiality  If there were an attack and the County’s public health system needed to collect information on you, such as race, income and citizenship, how confident are you that this information would not be used against you?  Holroyd et al. (2021)​​ 8 Beneficence  They do everything they should to protect the health of the population.  Strongly agree; Agree; Disagree; Strongly disagree  Mix of positively and negatively worded items (negative items reverse-scored). Labels are the authors’ 10ten a priori content domains; the validated scale loads on two factors — beneficence and competence.  Beneficence  They are partly responsible for the illegal drug problems in this country.  Efficiency  They use resources well.  Efficiency  They waste money on health problems.  Innovation  They keep trying the same things to help the public, even when they don’t work very well.  Innovation  They come up with new ideas to solve health problems.  Objectivity  They base recommendations on the best available science.  Competence  They ensure the public is protected against diseases.  Equity  They are more concerned about some racial and ethnic groups than other groups.  Equity  They are concerned about all people, without caring about who has more or less money.  Transparency  They accurately inform the public of both health risks and benefits of medicines.  Responsiveness  They quickly help the public with health problems.  Accuracy  They make unhelpful recommendations.  Integrity  They believe in what they recommend for the public.  KFF (2025)​​ 12 Trust *  How much do you trust [insert agency] to make the right recommendations when it comes to health issues?  A great deal; A fair amount; Not much; Not at all  Stem uses an “[insert agency]” fill-in; agencies rotated through included the CDC, FDA, and state or local health departments.  Melchinger et al. (2025)​​ 1 Confidence *  How much confidence do you have in each of these organizations? [List of public health agencies — national, state, and local]  Very little; Little; Some; Much; Very much; I don’t know  Asked across a battery including the CDC, FDA, and state and local health departments.  Shea et al. (2008)​​ 7 Competence  The health care system does its best to make patients’ health better.  Strongly disagree; Disagree; Neutral; Agree; Strongly agree  Health care system referent — items do not reference the CDC, state, or local health departments. Distrust scale: higher agreement indicates greater distrust, and positively worded items are reverse-scored. Domains are the authors’ two subscales (competence, values).  Values  The health care system covers up its mistakes.  Competence  Patients receive high quality medical care from the health care system.  Competence  The health care system makes too many mistakes.  Values  The health care system puts making money above patients’ needs.  Competence  The health care system gives excellent medical care.  Values  Patients get the same medical treatment from the health care system no matter what the patient’s race or ethnicity.  Values  The health care system lies to make money.  Values  The health care system experiments on patients without them knowing.  SteelFisher et al. (2023)​​ 2 Trust *  In terms of recommendations made to improve health in general, how much do you trust the recommendations of each of the following groups? [List of public health agencies — national, state, and local]  A great deal; Somewhat; Not very much; Not at all  Asked across a battery (CDC, state, and local health departments). Fielded February 2022 during COVID-19; the wording itself is not pandemic-specific.  SteelFisher et al. (2024)​​ 13 Trust *  In terms of recommendations made to improve health in general, how much do you trust the recommendations of each of the following groups? [CDC and state public health department]  A great deal; Somewhat; Not very much; Not at all  Wording identical to SteelFisher (2023), enabling trend comparison. Referents: the CDC and state public health departments. 

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