Development of the Medical Maximizer-Minimizer Scale

Objective: Medical over- and underutilization are central problems that stand in the way of delivering optimal health care. As a result, one important question is how people decide to take action, versus not, when it comes to their health. The present article proposes and validates a new measure that captures the extent to which individuals are "medical maximizers" who are predisposed to seek health care even for minor problems, versus "medical minimizers" who prefer to avoid medical intervention unless it is necessary. Method: Studies 1-3 recruited participants using Amazon's Mechanical Turk. Study 1 conducted exploratory factor analysis (EFA) to identify items relevant to the proposed construct. In Study 2 confirmatory factor analysis (CFA) was conducted on the identified items, as well as tests of internal, discriminant, and convergent validity. Study 3 examined test-retest reliability of the scale. Study 4 validated the scale in a non-Internet sample. Results: EFA identified 10 items consistent with the proposed construct, and subsequent CFA showed that the 10 items were best understood with a bifactor model that assessed a single underlying construct consistent with medical maximizing-minimizing, with 3 of the 10 items cross-loading on another independent factor. The scale was distinct from hypochondriasis, distrust in medicine, health care access, and health status, and predicted self-reported health care utilization and a variety of treatment preferences. Conclusions: Individuals have general preferences to maximize versus minimize their use of health care, and these preferences are predictive of health care utilization and treatment preferences across a range of health care contexts.