Patient trust in healthcare tanked during COVID-19 pandemic

New data out in JAMA Network Open outlines the negative impact the COVID-19 pandemic had on patient trust.

The study, which recounted survey results from between April 2020 and January 2024, showed a drop of 30 percentage points in self-reported patient trust levels. Factors like age, female gender, lower educational attainment, lower income, Black race and rurality were all linked to lower patient trust levels, the researchers found.

These findings come as the healthcare industry conducts a post-mortem of sorts following the pandemic. The researchers focused on patient trust for this report because of the outsized role healthcare providers play in public health and the way in which the pandemic went on to shape society.

"During the COVID-19 pandemic, medicine and public health more broadly became politicized, with the internet amplifying public figures and even physicians encouraging individuals not to trust the advice of public health experts and scientists," the investigators wrote. "As such, the pandemic may have represented a turning point in trust, with a profession previously seen as trustworthy increasingly subject to doubt."

That is, in fact, what happened.

Using data from 24 waves of surveying between April 2020 and January 2024, the researchers analyzed self-reported patient trust levels among more than 443,000 individuals over age 18. While healthcare professionals started the pandemic getting high trust ratings from patients, with 71.5% of individuals reporting trust in physicians and hospitals, those numbers quickly tanked.

By January 2024, self-reported patient trust levels were 40.1%.

This decline could have detrimental effects on the future of public health, the researchers posited. For one thing, lower patient trust was associated with a lower likelihood of flu or COVID-19 vaccination.

"Our results cannot establish causation, but in the context of prior studies documenting associations between physician trust and more positive health outcomes, they raise the possibility that the decrease in trust during the pandemic could have long-lasting public health implications," they explained.

On the other hand, higher levels of trust were linked to healthier behaviors, particularly receipt of the COVID-19 vaccine, the flu shot and the COVID-19 boosters.

To that end, healthcare should zero in on ways to reaffirm patient trust in physicians and hospitals, although they acknowledged that could be a challenging path forward.

"However, a prior Cochrane review concluded that there was a lack of evidence that any intervention meaningfully changed trust in physicians, despite a number of efforts to do so that observed generally modest effects," they said. "A better understanding of groups exhibiting particularly low trust, and the factors associated with that diminished trust, may be valuable in guiding future intervention development and deployment."

These findings are a far cry from the beginning of the pandemic, including the COVID-19 vaccine rollout, where public health experts were touting doctors as among the most trusted COVID-19 messengers.

The researchers were not able to identify a reason for the loss of patient trust, noting that low patient trust was not linked to political affiliation, nor was it fully accounted for by lack of trust in science. In other words, there was something specific about healthcare that lowered patient trust during the pandemic.

Further research will be necessary to uncover more trends among individuals whose trust levels went down during the pandemic, the researchers suggested.

Sara Heath has covered news related to patient engagement and health equity since 2015.