Trust is vital to every aspect of healthcare, from reducing disparities and advancing medical innovation to ensuring the best patient outcomes. As healthcare systems recover from the Covid-19 pandemic, restoring public trust is top of mind.
But the effort of solving this problem comes with its own challenge: trust is hard to define and measure. Because of this reality, there’s a risk of directing resources to efforts that may not move the needle.
Applying a behavioral lens can help. With it, we can break down and frame the problem of a lack of trust in a practical and effective way – as a collection of clearly defined and measurable behaviors that can be shifted with evidence-based approaches.
Here are ways healthcare leaders can apply a behavioral lens to build trust.
Leverage messengers that reflect patients’ identities and needs
The credibility and likability of a messenger can significantly influence an audience’s actions, a concept known as the messenger effect in behavioral science.
BIT recently participated in an interdisciplinary Community of Practice (CoP) led by the Pima County Health Department. The goal was to increase health literacy and vaccination rates among Latine people who can become pregnant.
The CoP designed interventions for community and clinical settings, including community-based workshops about navigating healthcare and tools to help patients prepare for clinical appointments. Practitioners were also trained in delivering culturally and linguistically appropriate care and in holding conversations with patients about Covid-19 vaccines and boosters.
An evaluation of the pilots found that participants’ confidence in health-seeking behaviors increased and they perceived fewer barriers to health-seeking behaviors after the interventions. Health literacy rose among participants in the clinical pilot, as did the number of people who reported needing a Covid-19 booster.
Although trust wasn’t the explicit focus of this work, the CoP knew that it was an important factor in improving health literacy and vaccination rates.
That’s why community health workers called promotoras de salud helped pilot the interventions in Spanish, the language participants were most comfortable speaking. Their role was critical. They clarified patients’ doubts, facilitated communication with practitioners, and created a more attentive experience.
Trust was also part of the reason why the CoP found ways to support specific health behaviors, such as helping patients prepare for their appointments. Being more prepared can increase self-efficacy and improve conversations with practitioners, which can build a trusting relationship over time.
Make engaging with processes and services easier
Frictions are obstacles that increase the time and effort required to do something. They often manifest as administrative burden or sludge. Small frictions can significantly impact behavior, especially for those who are already overburdened, such as those with poor health. We strongly suspect that frictions undermine trust as well.
In a recent project with the State of Nevada’s Department of Employment, Training and Rehabilitation, we helped make a complicated process easier by focusing on behavior.
Using administrative data and qualitative research, the State identified parts of the Unemployment Insurance application process where people were having the most difficulties and together, we simplified them. These changes helped people address their needs more effectively and have more positive interactions with the UI system. Each positive interaction someone has can start building trust.
With the Veterans Health Administration, we took a capacity-building approach. BIT worked with their Customer Experience Office to develop an Administrative Burden Reduction Guide and Tool to help VHA employees understand, identify and address administrative burden. Agency employees will use these tools to help improve experiences for 400,000 employees and nine million customers across the veteran healthcare system.
Building trust together
People lack trust in healthcare for many legitimate reasons, ranging from racist mistreatment to surprise insurance bills. Many have noted that system-wide change is needed to address these intersecting challenges.
A behavioral lens offers a new, complementary perspective: we can restore trust indirectly by concentrating on behaviors and outcomes that communities care about using interventions that they help build and participate in.
This can include helping people have more productive conversations through conversational receptiveness, preventing the spread of medical misinformation, conducting authentic outreach for vital health services, and helping providers make timely diagnoses.
Contact us if you’d like to explore using a behavioral lens to understand the needs of those most affected by a lack of trust in healthcare. Together, we can use this knowledge to design solutions that encourage healthier behaviors and improve outcomes for all.
