Restoring Trustworthiness in the Healthcare System

The COVID-19 pandemic hurt public trust in healthcare and science.

Trust is especially low among communities that experience health disparities and barriers to healthcare, according to Dr. David W. Baker of The Joint Commission in Illinois.

“Black and Latino communities faced inadequate testing, financial barriers to care, and disproportionately high rates of COVID-19 cases and deaths, further threatening their trust in physicians, the health care system, public health, and science,” Baker wrote in his article, Trust in Health Care in the Time of COVID-19.

Misinformation and a lack of trust in healthcare can spur a cycle of reduced care and ultimately contribute to worse health outcomes.

But how can trust in healthcare be restored?

Reasons for Latino Distrust in Healthcare

Several factors contribute to distrust of the healthcare system for Latinos.

These include language and cultural barriers, immigration issues, and social and economic dynamics, according to the Pew Research Center.

Misinformation is another big factor.

“Health misinformation is an urgent threat to public health. It can cause confusion, sow mistrust, and undermine public health efforts,” said U.S. Surgeon General Dr. Vivek Murthy. “My job is to help people stay safe and healthy, and without limiting the spread of health misinformation, American lives are at risk.”

Similarly, lack of representation in healthcare can also play a part in Latino distrust.

For example, although 19.1% of people in America are Latinos, only 5.7% of nurses are Latino and 6.3% of physicians are Latino.

“When Latino patients are admitted to a hospital, they encounter few Latino healthcare professionals. The pipeline of Latino healthcare workers does not reflect national population demographics,” according to a Salud America! resource.

Distrust also fuels Latinos’ historic lack of participation in clinical research.

“The lack of Latinos in clinical trials makes it harder for researchers to find treatments tailored for this group,” according to a commentary by Drs. Amelie G. Ramirez and Patricia Chalela of UT Health San Antonio that identified barriers and strategies to boost Latino representation.

The 10 Principles of Trustworthiness

Fortunately, the Association of American Medical Colleges (AAMC) Center for Health Justice developed The Principals of Trustworthiness to further guide and establish trustworthiness.

The idea is to “heal long-standing distrust of such institutions as medicine and public health among groups that have been marginalized and under-resourced,” according to the AAMC.

The 10 principles include:

  1. The community is already educated; that’s why it doesn’t trust you.
  2. You are not the only experts.
  3. Without action, your organizational pledge is only performance.
  4. An office of community engagement is insufficient.
  5. It doesn’t start or end with a community advisory board.
  6. Diversity is more than skin deep.
  7. There’s more than one gay bar, one “Black church,” and one bodega in your community.
  8. Show your work.
  9. If you’re gonna do it, take your time, do it right.
  10. The project may be over, but the work is not.

“These 10 Principles of Trustworthiness integrate local perspectives with established precepts of community engagement to guide health care, public health, and other organizations as they work to demonstrate they are worthy of trust,” according to the AAMC.

Watch a video of the principles in English or Spanish.

AAMC also created a Principles of Trustworthiness Toolkit for organizations to download and use to facilitate discussions within their communities, develop relationships with a broad coalition, and track lessons learned.

Rebuilding Trust in the Healthcare System

The Hastings Center recently published a report, Rebuilding Trust in Health Care and Science, on how public officials, physicians, and scientists can rebuild trust with patients and the public.

“Given the rapid rise in efforts to increase trust, especially in the health care industry and in research settings, our goal has been to examine the ethical permissibility of certain ways of cultivating trust, thereby adding a needed critical perspective to ongoing academic and popular discussions on the topic,” according to the report article.

The series of essays that makeup the report tackle factors including:

  • Causes of Distrust
  • Patient Perspectives
  • Organizational Analysis
  • Building Trust

The complete report and series of essays can be found here.

Latino Participation in Clinical Research

Latinos are disproportionately impacted by several health issues including Alzheimer’s disease, diabetes, and cancer.

In fact, Latino cancer cases are expected to rise 142% between 2010 and 2030.

This makes Latino participation in clinical research is important.

“Latinos in clinical trials are not only helping themselves, but they are also building a future with better treatments that can help their families and communities in the future,” said Dr. Ramirez, leader of Salud America! at UT Health San Antonio.

Dr. Ramirez is creating new ways to encourage Latinos to volunteer for cancer and Alzheimer’s clinical trials, with support from Genentech, a member of the Roche Group.

This work includes showcasing open clinical trials, uplifting the stories of Latino clinical trial participants, and conducting social media events and webinars.

Looking for a clinical trial that best fits you or someone in your family?

Search open clinical trials on the Salud America! clinical trials page.


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