The roles of trust and health literacy in achieving health equity

On September 22, 2022, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Health Literacy hosted the first of three public workshops in a series titled “The Roles of Trust and Health Literacy in Achieving Health Equity.” The first workshop in the series explored how using health literacy best practices in clinical settings might impact trust in health care institutions, and how that, in turn, might positively impact health equity. The following two workshops focused on similar questions but in different contexts: rather than clinical settings, they focused on public health institutions and community settings.
 

To make progress, focus on building trust

 As our nation continues to reel from the impact of the dual crises of the COVID-19 pandemic and racial strife, we increasingly understand that trust in each other and our institutions will be essential for progress. However, data from the last several decades show a progressive erosion of trust. Absent a foundation of trust, we have watched pseudo-science and conspiracy theories gain traction on social media and other domains with real-world consequences. As we look forward to a virtual gathering next week focused on health data and policy innovation, at least three dimensions of trust are essential to addressing the health and health care challenges ahead: trust within historically disenfranchised communities to achieve equity; trust in science and scientific innovation; and trust in health care itself. 
 

Conceptualizing and measuring trust, mistrust and distrust

Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity.