Trust is not a diagnosis; it is not a treatment; it is not a drug. But it is an essential element of a successful health care encounter. AcademyHealth is managing eight studies, funded in 2018 by the Robert Wood Johnson Foundation, which focus on trust and mutual respect. In a series of blog posts, we will describe the goals of the studies and what the research teams are uncovering about the trust dynamic across a range of factors including race and gender, the use of technology, and institutional versus personal trust. We will also share insights from the teams on trust in the midst of COVID-19.

The first post in this series features a study led by Co-PIs Consuelo H. Wilkins at Meharry-Vanderbilt Alliance and Derek M. Griffith at Vanderbilt University, a team exploring how African American men understand and define trust, respect, and trustworthiness in seeking health care. The researchers recognize that trust is an important and modifiable factor that influences how people interpret health information and utilize health care. Wilkins and Griffith note that these concerns and the patterns of health outcomes that they contribute to are not distributed equally.

“When we look at patterns by race and gender, African American men have some of the worst health outcomes, some of the lowest rates of health care utilization and health satisfaction, and some of the highest rates of mistrust and distrust,” said Griffith.

COVID-19 has magnified health disparities among African American men, as well as other people of color. While vaccine and treatment development is important, advances in those areas will be limited for these communities if there is not also a focus on the development of policies to address racial disparities and structural racism. Wilkins and Griffith point out that it is critically important that policy makers recognize that one size fits all solutions rarely work.

“Policy solutions have to begin with the understanding that there are differences in what factors and how various factors influence health outcomes, particularly rates of chronic disease, and consider those factors in the design and implementation of policy,” said Griffith.

To build trust in the health care system, everyone must see themselves in the data generated by those studying the pandemic. The researchers suggest that strategies to address COVID-19’s impact need to address both race/ethnicity and gender.

“Across the globe, we have seen similar rates of contracting COVID-19 but dramatic differences in the rates of mortality between men and women,” said Wilkins. “While it is easy to try and explain these patterns by simply looking at male biology, men’s rates of chronic disease and men’s behavior, the patterns seem far more complex.”

The researchers believe that COVID-19 policy solutions should follow the WHO recommendation that potential infectious disease pandemic data should be sex-disaggregated and analyzed in conjunction with data on race/ethnicity.

As scientists look for ways to turn the tide of the pandemic, Wilkins and Griffith note the importance of learning from communities and community experts. For example, during the early days of the HIV epidemic, community-based strategies, like the Popular Opinion Leader Program, proved highly effective. The program, says Griffith, builds on the reputations, networks and strength of trusted community leaders, who change norms of behavior by training key members of a given social network to talk persuasively about ways their own behavior is consistent with the desired norms. This modeling and sharing becomes the foundation of strategies to overcome distrust and other barriers.

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