28 July, 2023

Demystifying Trust: Its Role and Impact on Public Health Interventions

Lots of sources say trust is important for people to follow public health guidelines. But how important is it really, and what exactly is trust anyway?

What is trust anyway and why do we care about it?

Trust is a deeply complex sociological construct which has proven difficult to define in the past because of its multifaceted nature. It’s made up of various aspects, for instance perceived competence of another, honesty, transparency, authenticity, reliability or believing the other party has one’s best interests in mind. You can score highly on one aspect of trust, but at the same time not another. It’s because of this complexity that trust is often quite hard to operationalise and measure.

In trust research we usually differentiate between forms of trust, including social/interpersonal trust, societal trust, scientific trust, medical trust, and institutional trust. It remains rather unclear whether trust is rational or affective. This question was explored in a systematic review by Devine and colleagues (2022) and the authors argue that trust is rational in that it responds to real world factors such as rising infection rates during the COVID-19 pandemic. On the other hand, trust does not always seem to be based on hard facts, but instead often relies on intuition and other affective determinants.

Trust is also a key component of successful communication, and it is crucial to health messaging.  It is often said to play an important role in regulating certain behaviours, for example adhering to public health recommendations. And indeed, institutional trust is an important predictor of the outcome of public health interventions. Devine and colleagues (2022) for instance found that trust has a positive influence on compliance with public health interventions when the message of the trusted source aligns with official guidelines. Conversely, trusting in figures who are promoting non-compliance can also lead to decreased compliance, which shows that trust simply acts to amplify a message – regardless of whether this has a positive or negative impact.

The role of trust in the COVID-19 pandemic

Especially during the COVID-19 pandemic, governments all over the world sought to foster trust in their populations to increase adherence to protective health behaviours such as vaccine uptake, facemask wearing or social distancing. Previous research from the COVID-19 pandemic has shown that trust is decisive in reducing vaccine hesitancy – the greater the trust of a person in the public health messenger, the more likely they were to get vaccinated.

What have we learned about health messages and trust so far?

Health information for the public needs to be consistent, transparent, and accessible (in terms of language and availability on different channels). The big question is – what can we do to build and maintain trust of the public in official health advice? The latest CERC (Crisis + emergency risk communication) report by the U.S. Centers for Disease Control and Prevention (2018) explains how trust can be strengthened through open and empathetic communication. Expressing an understanding of how people feel and what their concerns are helps in building better, more trusting relationships. Further, messaging needs to be conveyed through sources that people are most likely to trust if we want people to act on these messages. Trusted messengers vary from person to person, but include for example media outlets, governmental institutions and spokespersons, healthcare providers, religious or community leaders, and often even social media and one’s own social circle (i.e., friends and family).

Beyond trusting the source

However, trust in the messenger is not the only factor of importance. The 2018 CERC report suggests that we also need to consider the needs of our target audience – cultural components, differences in age or gender and other characteristics need to be taken into consideration. As would be expected from the broad range of factors that impact trust, different cultural groups tend to show differences in whom they trust. These groups have often very different experiences with the government, which is why they sometimes rather trust their own institutions such as non-governmental organisations, religious institutions, and political organisations. The dissemination of important public health information should therefore include these sources.

The content of a message itself can also influence trust, which in turn can affect how people behave in response to that message. Information that is conflicting, inconsistent or overloads people with information can have negative effects, including loss of trust, decreased acceptance of required measures and diminished adherence. Policymakers and those providing public health guidelines should therefore aim to keep a balance between honest, transparent communication around guidelines and excessively burdening the public. Public health messages from one source (e.g. the government) should always be in accordance with other sources (e.g. international organisations such as the WHO) to maintain consistency, and clear acknowledgement should be given where guidance differs. Health information should be provided by trustworthy health officials in a timely manner, using several channels, and recognizing uncertainty to increase and maintain trust and achieve better public health outcomes.  Acknowledging what is known and what is not, e.g. regarding risks and interventions during a public health crisis like the COVID-19 pandemic, is an important tool in building trust.

Trust and political leadership

Considering that most health information is circulated through media, it is recommended that media outlets reduce their political stances on public health information during a crisis to avoid politicising public health matters.

Meanwhile, public figures of authority should (re)build trust through leading by example when it comes to adherence to public health guidelines, or restrictions as were in place during the COVID-19 pandemic. When behaviour conflicts with advice, as was the case in, for example, the Barnard Castle or the partygate affairs, this could potentially affect behaviour in a negative way. Research suggests that changes in institutional trust in times of public health crisis can have a long-lasting impact – evidence from the Spanish flu epidemic shows the negative impact on social trust lasted for a generation. We therefore need to think of and implement strategies to keep building trust in the long run so we can be better prepared for the next public health crisis.

 

By:  Hannah Dasch @hannahkdasch