Trust as a dyadic mechanism of action: a call to explore patient-provider relationships in the twenty-first century

ABSTRACT

Background: There is general agreement that trust between patients and providers influences patient knowledge, behaviors, and adherence to provider-recommendations--with subsequent impacts on patient health-related outcomes and provider practices. There is less academic agreement on the processes by which trust is formulated and changed over time and how trust with ongoing healthcare providers can influence health-related outcomes over time.

Methods: This opinion 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 behaviors, from one another.

Results: Theoretical bases for this construct are provided as are qualitative, quantitative, and mixed measurement approaches for multiple healthcare settings.

Conclusions: A mechanistic approach to understand how trust is established through patient-provider communication and how trust informs patient health-related outcomes can contribute over time to improve communication in healthcare encounters.

KEYWORDS:

• Patient-provider communication
• mechanism of action
• mixed methods

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author note

This is an expert opinion. It does not include original data and does not involve human participants.

Ethical approval

This is an opinion piece. It does not include original data and does not involve human participants.

Additional information

Funding

Salary support was provided by the U.S. Government, though this opinion represents only authorial views and perspectives, not those of the U.S. Government.

Notes on contributors

William N. Elwood

William (Bill) Elwood, Ph.D. (he | él) is a health scientist administrator and project scientist in the National Institutes of Health’s (NIH) Office of Behavioral and Social Sciences Research (OBSSR). He facilitates NIH-wide collaborations that develop NOFOs on underlying mechanisms and processes that inform health behaviors, for example, the biopsychosocial effects of social connections or isolation on health and wellbeing, and K awards that allow mid-career researchers to gain expertise in behavioral, biomedical, or social science processes to be stronger PIs. Bill also serves on the NIH-wide Employee Mental Health and Wellbeing Action Team (MHWAT) which strives to coordinate wellbeing activities and best practices across the agency. Additional expertise includes crisis response/management, healthcare delivery, community-engaged research approaches, resilience, and program evaluation. Before joining OBSSR, Bill served at NIH’s Center for Scientific Review where he was the SRO for applications proposing community-based interventions for disease prevention and/or treatment. Prior to NIH, Bill held positions at Auburn University, University of Miami, University of Texas-Houston, and as research and development director for a large mental health and substance abuse agency in South Florida. Bill received his Ph.D. in communication and health policy from Purdue University.