The Science of Trust - Building and Restoring Trust in Science and Health Information across Patient, Community and Population Settings

"Trust is shaped by multiple factors, including biology...and, most importantly, many structural factors (e.g., social, political, economic, and information systems)....Consequently, in order to advance our understanding of the precursors and consequences of trust or mistrust, concerted and multidisciplinary efforts are needed."

There is growing concern about the erosion of public trust in health information - including traditional sources of information (e.g., government, medical experts, academia) - as highlighted by the COVID-19 pandemic. The articles in this special issue of the Journal of Communication in Healthcare (JCIH) on the science of trust focus on how to build or restore trust, providing insights on promising strategies for intervention design and exploring future research directions. The contributions also share lessons learned and perspectives from professionals across multiple sectors and disciplines, including from community settings.

Recognising the necessity of addressing trust as a complex yet key determinant of health and well-being, this special issue reflects JCIH's commitment to the topic and serves as a core resource in its broader Science of Trust Initiative. Launched in 2021, the Initiative convened a multidisciplinary expert roundtable in 2022 and issued a call for papers later that year to create this special issue of JCIH.

Major themes articulated in the issue's contents include:

• The importance of creating strong community ties, engaging local communities, and leveraging existing trusted sources of health information. Indeed, across several articles, the relationship-centred approach to addressing mistrust is emphasised, which connects trust and trustworthiness by engaging communities that have been historically marginalised in community-based research efforts and intervention design.
• The need for a system-driven approach to address trust by identifying the interaction between drivers of trust/mistrust across different levels, dimensions, and groups. Lessons learned and strategies from a participatory approach to social and behaviour change in global and country-specific health settings also support the need for multisectoral engagement across intervention levels, groups, professions, and disciplines.
• The centrality of rigorous scholarship on understanding and addressing misinformation, which undermines trust in evidence-based health information and experts.
• The importance of community- and group-specific interventions. Several articles highlight the need for interventions that are attuned to the unique characteristics of the groups being engaged.

Several emerging themes for future inquiry were also identified. For example, at the interpersonal and community level, these avenues of investigation include strengthening social network analysis to identify information pathways, identifying multi-level and group-specific drivers to promote public health goals, assessing multi-level barriers associated with mistrust, grounding research efforts in community- and equity-centred approaches, and using narrative and arts-based communication methods and entertainment-education to understand pro-social behaviours, such as those that express empathy and concern for others, and their association with trust.

Contents include:

• "Reflections and Key Learnings on the Science of Trust" [Editorial by Renata Schiavo & Wen-Ying Sylvia Chou, pages 315-319] - (See paragraphs above.)
• "A Relationship-Centered Approach to Addressing Mistrust" [Commentary by Wen-Ying Sylvia Chou & Anna Gaysynsky, pages 320-323] - discusses the importance of a relationship-centerd approach to addressing mistrust and highlights practical opportunities to focus on social relationships in health communication efforts.
• "Measuring Trust across Different Dimensions and Drivers: A Working Model" [Commentary by Renata Schiavo & Nikita Boston-Fisher, pages: 324-329] - offers a working model for measuring different dimensions of trust in research and practice.
• "Lessons Learned on Building Trust during a Global Pandemic: Looking at Future Directions" [Commentary by Naureen Naqvi & Arundhati Saikia, pages 330-333] - reflects on lessons learned regarding community-driven and multisectoral strategies to build trust in COVID-19 vaccines and other mitigation measures in communities around the world that historically experienced marginalisation or vulnerability.
• "Decentering Trust to Connect with Criminal Legal System-Involved Women in Research" [Commentary by Jordana Hemberg, Joi Wickliffe & Megha Ramaswamy, published online Sepember 1 2023, Pages: 334-338] - provides a critical examination of researcher-participant relationships in health interventions with women involved with the criminal justice system, highlighting the importance of centring the participant, creating a space where participants feel safe, and demonstrating trustworthiness on the part of the researchers.
• "On Trust and Trustworthiness: Listening to Community Leaders" [Community Voices by John Davids, Emma Maceda-Maria, Khanh Ho, Sophie Randall, Frances Feltner & Alma Manabat Parker, pages 339-343] - offers a compilation of short reflections from representatives of community-based organisations and experienced community leaders.
• "The Role of Social Media Influencers as Trusted Messengers in Tobacco Control Mass Media Campaigns" [Letter by Anh Nguyen Zarndt, Merrybelle Guo & Gem Benoza, published online August 28 2023, pages 344-346] - discusses how online influencers were engaged as trusted voices in tobacco control media campaigns, thereby leveraging pre-established trust for health message delivery.
• "Transforming Systems Mistrust and Poor Communication to Improve Behavioural Health Care Uptake among Youth on Probation" [Letter by Corianna E. Sichel & Katherine S. Elkington, published online  Sepember 7 2023, pages 347-349] - offers a systems-based approach to improving behavioural health care and addressing mistrust when working with youth on probation.
• "Trusted Sources for COVID-19 Testing and Vaccination: Lessons for Future Health Communication" [Article by Camille Kroll, Amy McQueen, Victoria De La Vega, Alexis K. Marsh, Tim Poor, Niko Verdecias, Charlene Caburnay & Matthew W. Kreuter, published online Sepember 11 2023, pages 350-357] - describes a study of people who called 2-1-1 helplines that was designed to (i) better understand where people obtain trusted COVID-19 health information and (ii) identify how public health professionals can share emergency health information in the future.
• "Covid-19 Cure Perceptions and Media Use in India" [Article by Areiba Arif & Rama Mohana R. Turaga, published online June 26 2023, pages 358-369] - explores the extent to which beliefs in cure for COVID-19 in three prominent medical traditions popular in India are associated with the exposure to and trust in various sources from which the public access information.
• "Trust as a Dyadic Mechanism of Action: A Call to Explore Patient-Provider Relationships in the Twenty-First century" [Article by William N. Elwood, pages 370-374] - draws on social constructionism and symbolic interactionism to posit the possibility that trust can emanate through the communication process, during which a patient and provider transmit and attend to words, images, and paralanguage to convey their states of being and to induce responses, usually acknowledgement, suasion, or physical behaviours, from one another.
• "Trust in Public Health Institutions Moderates the Effectiveness of COVID-19 Vaccine Discussion Groups on Facebook" [Article by Donald Koban, Lorien C. Abroms, Melissa Napolitano, Samuel Simmens & David A. Broniatowski, pages 375-384] - finds that Facebook discussion groups about the COVID-19 vaccine were more effective for people who trusted public health institutions and non-conservatives. Health communicators may need to segment health messaging and develop strategies around trust views.
• "What Generative AI Means for Trust in Health Communications" [Article by Adam G. Dunn, Ivy Shih, Julie Ayre & Heiko Spallek, pages 385-388] - draws on research about the adoption of new information technologies to focus on the ways that generative artificial intelligence (AI) tools like large language models might change how health information is produced, what health information people see, how marketing and misinformation might be mixed with evidence, and what people trust.
• "Use of the Socio-Ecological Model to Explore Trusted Sources of COVID-19 Information in Black and Latinx Communities in Michigan" [Article by Gloria Carmona, Kashmira Sawant, Reema Hamasha, Fernanda Lima Cross, Susan J. Woolford, Ayse G. Buyuktur, Sarah Burke Bailey, Zachary Rowe, Erica Marsh, Barbara Israel & Jodyn Platt, pages 389-400] - shares research suggesting that public health communications should engage in cross-referencing practices, providing information from sources at all levels of interaction, cultural competency, and awareness of historical/structural inequities. These efforts would be further strengthened by attending to needs for both factual information as well as care and personal connection.
• "Trust in Science Moderates the Effects of High/Low Threat Communication on Psychological Reactance to COVID-19-Related Public Health Messages" [Article by Nejc Plohl & Bojan Musil, pages 401-411] -  investigates the role of message characteristics (i.e., high vs. low freedom-threat messages), individuals' trust in science (i.e., high vs. low trust in science), and their interaction in determining responses to public health messages.
• "Trust and Distrust toward Online Health Information in Nurse-Patient Communication and Implications for eHealth Literacy" [Article by Cathrin Brøndbo Larsen & Heidi Gilstad, pages 412-420] - examines how issues of trust manifest in the communication between nurses and patients in clinical encounters; of particular interest are the accounts of trust and distrust toward online health information linked to patients' eHealth literacy.