What Influences Patient Trust in Public Health Agencies?

Public health agencies that communicated clearly, led with science, and provided protective resources were able to build patient trust more than those agencies that appeared to be politically motivated, according to a new report in Health Affairs obtained via email.

The challenge? Perceptions of how agencies communicate are certainly in the eye of the beholder. While one individual might see advice for universal masking as science-based public health communication, another might see it as politically motivated, setting the scene for the public health trust problem the US has faced since the pandemic’s onset in 2020.

“Public trust in government and other major institutions across US society has been declining for decades, and the pandemic has raised concerns about trust in public health agencies in particular,” the Harvard University researchers wrote in the study. “Opportunities for misinformation to take root in the current social and traditional media environments raise concerns that trust will decline further.”

In order for public health agencies, each at the federal, state, and local levels, to recoup their image, they will need to better understand what influences an individual’s trust.

In a February 2022 survey of around 4,200 adults, the researchers found that people’s trust differed by agency and how that agency communicated. Generally speaking, trust in any public health agencies was low.

Trust in federal entities like the Centers for Disease Control and Prevention (CDC), Surgeon General, National Institutes of Health (NIH), and the Food and Drug Administration (FDA) didn’t even reach the 50 percent mark. Trust in local and state public health agencies was even lower.

Rather, people trusted their doctors and nurses, plus the scientists researching COVID-19.

That said, trust in public health agencies at any level never quite reached zero, a finding the researchers said gives hope that these organizations can revamp their reputations. However, they will need to understand exactly what has prompted some to trust or not trust.

Overall, it didn’t quite matter whether these public health agencies actually did a good job controlling COVID-19. Individuals were instead more interested in how agencies communicated about the pandemic.

For instance, people trusted federal public health agencies if the agency communicated clearly, led with scientific fact, and provided protective resources.

But when it came to trusting state and local public health agencies, people were looking for something different. When the public perceived hard work, compassion, and direct services from state and local agencies, trust levels went up.

Across federal, state, and local public health agencies, the reasons for limited trust were similar. Respondents said any perception of political agenda or bias, private-sector influence, and too many conflicting advisories all harmed trust. Trust was also harmed if people thought agencies did not treat underserved communities, like rural areas of racial and ethnic minorities, fairly. However, this trend was less common among respondents.

Perceptions of public health are subjective, but the researchers suggested a few tips that will help federal, state, and local public health agencies increase the odds they can get public buy-in.

Foremost, the researchers highlighted that agencies will want to focus on driving science, providing resources, and building out effective and clear policies for the public. Centralizing emergency communication will be helpful here. Above all, the researchers emphasized that controlling a public health emergency is not of foremost priority to gain public trust; instead, communication is key.

Second, agencies should be mindful of what will help their organization gain trust. At the federal level, this will mean providing scientific information, but on smaller scales at the state and local level, that means meeting the moment with compassion and dedication and ensuring those efforts are perceived by the public.

Next, agencies need consistent messaging when possible. While scientific discovery may spur changes to public health best practices, ensuring consistency overall will help individuals trust that messaging is accurate. Inconsistent messaging opens the door for assumptions of political or private-sector influence.

Finally, it will be crucial for agencies to select the right messengers for building and maintaining public trust.

For one thing, public health agencies at any level should employ the voice of the healthcare provider. Countless surveys have found that clinicians are the most trusted messengers for public health messaging, and this study corroborated that. Payment incentives will help increase the odds that a provider engages in public health messaging and public service announcements.

The researchers said that community health leaders can be employed in messaging, but judiciously. Community leaders like religious or faith leaders are not necessarily trusted public health messengers, but they can help amplify messaging first outlined by a healthcare expert. After all, people trust their faith leaders for non-medical messaging, so community leaders can be a good reinforcement.

Politicians, however, aren’t effective in this area. People do not trust local politicians for healthcare information, and they do not perceive local politicians as having the public’s best interest at heart.

“Our findings suggest not only a need to enhance policies around stockpiles of protective resources, such as masks, but also a need to support a robust communication infrastructure in which public health agencies are given clear authority to disseminate science-based recommendations,” the researchers concluded.

“Public health agencies can then develop strategies, both directly and with trusted partners, for effectively engaging different segments of the public who have varying levels of trust.”