By Molly Hartzog, Health Communications Specialist IV
Trust has always been a major topic of discussion in public health, and recently, several studies reported declines in trust in the U.S. Centers for Disease Control and Prevention (CDC) in the wake of COVID-19. Since her appointment as CDC Director in the summer 2023, Dr. Mandy Cohen has noted rebuilding the public’s trust in the agency as an important part of her vision. It is irrefutable that trust is essential for public health—it’s only when we trust healthcare providers and public health agencies that we seek care and act on recommendations.
Trust derives from the Old Norse word traust, meaning “help, confidence, protection, support.” Its root “deru-” means “be firm, solid, steadfast.” The etymology points to a definition of “trust” as something that is strong, certain, and unchanging—quite the opposite of science and medicine. Science is constantly evolving and perpetually questioned. Medical practice, similarly, changes as knowledge and experience grow. Even health itself changes; the microbes that make us sick evolve, environmental and social determinants of health change, and genetic predispositions shift over generations. How do we build trust if public health, at its core, is not solid and steadfast? And why is that trust important?
Factors that influence trust in public health agencies
Results of a major public survey from Harvard revealed some of the reasons people say they trust certain public health agencies. Respondents who reported a “great deal” of trust in federal health agencies believed that the agencies:
- Follow scientifically valid research.
- Make clear, science-based recommendations.
- Provide protective resources such as tests and vaccines.
Respondents who reported lower or lowest trust in public health agencies believed that the agencies:
- Make recommendations that are politically influenced and inconsistent.
- Are influenced by private sector interests.
- Create excessive restrictions.
Strategies to Build Trust
Trust-building activites should be tailored to the unique history, values, and needs of a specific community. There is no one-size-fits-all approach. However, many current recommendations in communication can address the factors that influence trust listed above. A few of these include:
– Open communication: Health communication should include sharing current state of knowledge of a public health issue including knowns and unknowns, potentially negative information, and information that may change previous recommendations. Regular open and honest communication can show that an agency is working from a foundation of credible scientific research.
– Accessible and inclusive messages: To make messages accessible, agencies may need to consider translations, accommodations for vision impairment, health literacy levels, or technology accessibility. Inclusive communication includes using preferred terms, adopting a health equity lens, and using inclusive images. Making communication accessible and inclusive of all members of a priority community can increase the likelihood that health recommendations are understood and acted on.
– Trusted messengers: Trusted messengers, such as religious leaders or healthcare providers, can be valuable resources for creating effective and relevant messages that will resonate with a community. Collaborating with trusted messengers can demonstrate an agency is committed to the interests of a community rather than private sector or political interests.
Karna’s Approach
Karna has a strong track record for helping public health and healthcare organizations build and maintain trust. For example, we start by doing research with various populations and communities to better understand factors that influence trust. Then, we engage in message and material testing so that what we develop and distribute will resonate with the relevant communities. In addition, we provide strategic communication support to guide strategies, tactics, and dissemination channels that are best suited for each audience.
Karna has supported the CDC’s efforts to build public trust in state, local, and tribal jurisdictions regarding vaccine programs. Our staff has provided support for the Vaccinate with Confidence strategic framework including bootcamps, consults, and resource development. Vaccine Confidence Bootcamps are designed to quickly train groups to assess and address vaccine confidence challenges in communities of focus. Vaccine Confidence Consults include a facilitated discussion between confidence experts and the jurisdiction to talk through considerations, factors, and recommended strategies. Additionally, Karna recently completed a project to help build confidence in COVID-19 vaccination among pregnant individuals. Working with the American College of Obstetricians and Gynecologists (ACOG), Karna developed a 6-part training for OB-GYNs on using motivational interviewing to engage patients in empathy-first, respectful conversations regarding COVID-19 vaccination.
Public trust is essential for improving public health. However, unlike medical technologies like vaccines, trust can’t be directly disseminated and measured or tacked on as a stand-alone initiative. Trust is something an individual chooses to have in a person or organization. Public health leaders must regularly give reasons for individuals to trust them. Trust-building should be at the forefront of all work at a public health agency—from the lab, to the field, to the clinic. With time and hard work, we can work together to help restore trust in the public health industry.