Earning trust is hard; winning it back is even harder. Here’s how to do it.
Cary Funk is the senior advisor for public engagement with science at the Aspen Institute Science & Society Program.
Jylana L. Sheats is a clinical associate professor of social, behavioral, and population sciences in the Tulane University Celia Scott Weatherhead School of Public Health and Tropical Medicine and the associate director at the Aspen Institute Science & Society Program.
Change moves at the speed of trust.” So says businessman and author Stephen Covey in his book, The Speed of Trust. Those of us who seek solutions to complex social problems reflect on that phrase a lot. As a society, we cannot realize the fruits of the scientific enterprise without a basic level of public trust in scientists and their research.
Trust in science is especially crucial during moments of crisis. People who reject scientific findings often ignore actions and advice that could vastly improve their lives—and sometimes even save them. At least five of those killed in Hurricane Helene in September stayed put because they didn’t believe official warnings about the deadliness of the storm, according to Florida officials. In the first 15 months of the COVID-19 pandemic, one study estimates, at least 232,000 people in the United States died because they did not get vaccinated.
The Aspen Institute’s Science & Society Program has brought together experts from a wide array of fields and institutions to discuss tactics for strengthening trust—specifically, for fostering broad-based agreement that scientific research contributes valuable evidence and understanding that are relevant to society’s needs. The advice that has emerged from those discussions is often framed around three broad concepts: involve local leaders, know your community, and improve the information ecosystem.
These worthy principles are difficult ones to put into action. Trust is easy to lose and difficult to gain or to win back. Building trust requires a continuous process of establishing and maintaining relationships between experts and the people who are being asked to rely on them. But we are excited to see a growing number of people and organizations putting in the hard work to build trust in science, especially the science around public health, and making change really happen.
Last spring, we convened a diverse group of researchers, science communicators, journalists, and policy analysts to dig into the details of how to build public trust in science. We summarized our findings in an Aspen report, Tactics for Trust. Our aim was to move beyond analyzing the obstacles to trust and to focus intently on how to go about achieving it. Doing so includes listening closely to what people really care about and to why they often feel that the scientific enterprise is irrelevant or even contrary to their needs.
Let’s start with the goal of involving local leaders. We have watched many well-intentioned efforts go awry, as organizations hold events intended to reach a general audience but end up talking mostly to themselves. There is some value simply to making information about science-related issues available to the public. But trust-building is much more powerful when it is designed around collaborative projects that draw in members of the local community, giving them meaningful roles and fostering lasting relationships.
Lisa Goldman Rosas, faculty director of the office of community engagement in Stanford University’s School of Medicine, is taking that approach with her office’s Health Equity Ambassadors Program. It solicits and funds partners from local nonprofits to spend nine months working with university researchers on community-engaged research projects, so that everyone learns together. This past year, “our program participants developed climate change and health equity projects that truly reflected what mattered to their communities,” Rosas says.
One of these projects, led by Maya Paulo of the California-based nonprofit Climate Resilient Communities, surveyed residents of East Palo Alto to help identify conditions that put them at risk of serious harm from extreme weather. The project focused on hazards at home, work, and all through this low-income community. Paulo and her colleagues then held public information sessions about extreme-weather risks and provided local residents with resources to help them prepare for future conditions. Afterward, 8 in 10 homeowners in the area (responding to an English-language survey) said they had taken action to upgrade their roofing.
Ultimately, the Health Equity Ambassadors Program aims to create a network of local leaders who can act as its namesake “ambassadors” between Stanford and partnering organizations. Those ambassadors help design and perform research to understand the needs of the community and to translate their findings into programs and policies that promote health equity.
“We know that building trust takes time and that no one strategy works for all communities,” Rosas says. “One way that we do this is by recognizing the expertise of our community partners through funding, support for featuring their work in ways that are meaningful to them, and ensuring that our research projects provide results directly to participants and communities involved in the research.”
Brittney Doyle, who founded the nonprofit consulting organization Wise Health SF in 2015, also speaks about the importance of building trust with local leaders. Wise Health SF creates health programs tailored to the needs of vulnerable populations in the San Francisco Bay Area. They partner with community groups, government agencies, and nonprofits and offer services such as health-education workshops and community health “pop-up” events. The organization also hosts focus groups to make sure that their efforts are genuinely useful in connecting high-need communities with public health and healthcare resources.
Instead of barging in with a pre-defined approach, Wise Health SF works together with the community to identify pressing local health issues and develop tailored solutions. “Building trust should be the first thing that happens,” Doyle says. “Whenever you’re planning programming, there should at least be 90 days set in place strictly for getting to know the players.”
Trust in science is especially crucial during moments of crisis.
Among Wise Health SF’s partners is the San Francisco Department of Public Health. They collaborated to develop wellLINK, a program that provides HIV education and treatment for people experiencing homelessness. The program also distributes items such as nutritious meals-to-go and personal supplies (soap, toothbrush, socks, sleeping bags, etc.), and shares onsite-referrals to shelters and other housing solutions. The need is acute: Over the course of a year, more than 20,000 people in San Francisco seek homeless services.
Before starting wellLINK, Doyle took her own advice on building trust. She made sure that Wise Health SF employees and volunteers had a consistent presence at the wellLINK program site well ahead of the launch of the project. “It’s important that I am collaborating with partners that are already doing the work and are recognized in the community. That just makes it easier to reach communities experiencing homelessness,” she says.
Leaders in science communication and outreach frequently stress how important it is to know your community so that initiatives can tailor their engagement efforts to the cultural world of the people they are trying to reach. One of us, Jylana Sheats, knows firsthand how difficult that kind of focus can be in practice.
Early in her position at Tulane University’s Celia Scott Weatherhead School of Public Health and Tropical Medicine, Sheats received funding to conduct a culturally informed project aimed at improving eating behaviors among middle-aged and older Black people in New Orleans. Her plan was to develop a text-message system that could encourage healthier food choices, such as fruits and vegetables, and limit common sugary drinks such as soda and juice.
Sheats conducted focus groups to learn what “healthy eating” meant to people in the community, and what beliefs and barriers shaped their eating habits. She quickly realized that her identity as a Black woman didn’t automatically translate to understanding the cultural nuances of older Black residents in New Orleans, so she added a small community advisory board to provide input on text message content. One seemingly small but crucial lesson sticks in her memory. Sheats was sharing a healthier recipe for mac & cheese, and learned that “in New Orleans, a dish of macaroni and cheese is typically made with spaghetti noodles, not elbow macaroni,” she says. “This detail allowed us to create a video cooking demonstration that was authentic to local preference.”
Local connections merge with global connections at Ciencia Puerto Rico (CienciaPR), a network that promotes science education and science careers for Puerto Rican communities around the world. Mónica Feliú Mójer, who directs public engagement with science at CienciaPR, explains that successful community engagement requires commitment as well as empathy. “We invest so much energy to make sure our relationships are lasting and resilient—meaning that our relationships are able to withstand differences, challenges, and misunderstandings,” she says.
Andrea Isabel López, who worked with CienciaPR on public communication and outreach, emphasizes a concept called reflexivity: “an examination of our identities, beliefs, assumptions, privileges, prejudices, practices, and motives and how they influence what we do or think in a situation.” She identifies reflexivity as an important reason for CienciaPR’s success at boosting vaccination rates in Puerto Rico during the early stages of the Covid pandemic, as discussed in another article in this series.
“Being honest about our identity as an organization is vital for establishing trust, especially given the potential harms these partners may have previously experienced from scientists or academics,” López says.
Efforts to “improve the information ecosystem” are especially urgent for public health organizations that are seeking to share potentially life-saving guidance in a style and format that people can easily relate to. In today’s reality, that means sharing information through videos, social media, and other media that mix education with entertainment. “They offer powerful tools to bridge the gap between complex health information and the communities that need it most,” says Tambra Stevenson. She is the founder and CEO of WANDA (Women Advancing Nutrition Dietetics and Agriculture), a nonprofit dedicated to providing Black women and girls with better access to healthy, culturally relevant foods.
Trust-building is much more powerful when it is designed to draw in members of the local community.
Stevenson shares her favorite example from these efforts: the creation of “Little WANDA,” a character for a bilingual children’s book series and an associated doll, shared on social media as #IamWanda. The story of Little WANDA educates children of African descent about nutrition, agriculture, and health in a relatable way. “We are on a mission to reclaim our food traditions, restore our health, and return to our roots,” Stevenson says. “We’ve seen increased interest in health and nutrition topics among the children and families we serve.”
Stevenson is taking a long-term approach by starting with materials tailored to elementary-school-age girls and then building on that engagement as the girls age into adulthood. The #IamWanda campaign veers far from old, institutional strategies for trust-building, because studies and anecdotal experiences have repeatedly shown that direct appeals to “trust science” have little effect. A storybook character who looks like her intended audience and lives in a world that resembles their own is much more likely to encourage participation and to inspire the desired actions.
“By integrating culturally relevant narratives and engaging educational tools, we build a foundation of trust within the communities we serve,” Stevenson says.
Hip Hop Public Health is another effort to present health information in ways that reflect the culture and interests of its intended audience. The project was established in 2011 by Olajide Williams, a neurologist at Columbia University, and Doug E. Fresh, a Barbadian-American artist and rapper. They merged their talents, creating lyrics for rap music that explains fitness, vaccines, hypertension, stroke, and other health topics in a quick, catchy way. They are reaching out to a range of underserved communities, where traditional attempts at health communication have proven ineffective. Since its founding, Hip Hop Public Health has produced more than 200 songs and videos—combining music with performance or animation—which collectively have been streamed more than 500 million times.
There are as many approaches to developing relatable health information as there are communities that need it. CareMessage, founded by former Stanford classmates Vineet Singal and Cecilia Corral in 2012, works with health care organizations to engage with patients using personalized, culturally tailored text messages. They aim to get those patients to be more responsive to appointment reminders or to completing a prescribed treatment regimen. CareMessage also shares information about preventive care, disease management, and behavior change.
Singal and Corral are targeting health care among low-income populations who have historically faced a variety of health care inequities. They focus specifically on access to care, clinical outcomes, and social drivers of health. CareMessage has generated more than 70 million interactions with patients. Measuring the impact of those messages is difficult, but Corral reports that the organization’s internal evaluations found a 50 percent success rate at bringing diabetes patients back into medical care after a gap in treatment.
Some of the organizations deploying novel approaches to building trust in science are reaching out to audiences beyond the U.S., which adds another layer of social complexity. John Cook, a senior research fellow at the Melbourne Center for Behavior Change, designed the Cranky Uncle game to help people strengthen their critical thinking skills in a fun and widely relatable way, integrating humor and playful cartoons while teaching users to spot misinformation. “Understanding how science works is an important step toward building trust in science,” he says.
Cook conducted an eye-tracking study, which revealed the kinds of details that cause people’s eyes to linger and influenced his approach. He argues that “humorous, visual science communication grabs people’s attention longer than more conventional science communication, and it’s through the greater attention that the messages have an effect.” Cook’s first version of Cranky Uncle, focused on climate-related misinformation, was released in 2020 for Apple and Android users, and is available in 12 languages. This year he released a second version focused on misinformation about vaccines, initially tailored to users in several nations in Africa.
One of the few efforts specifically designed to increase trust on a global scale is the nonprofit Global Listening Project, co-founded by Heidi Larson, an anthropologist, health researcher, and expert on vaccine hesitancy. She and her colleagues started the global organization in response to the Covid pandemic and the ruptures it showed in public trust. They are running a long-term effort to document people’s experiences during the pandemic and to bring those voices to the notice of policy makers.
Larson and her team have already completed a series of focus groups around the world and conducted a 70-country survey. They hope that their results will help policymakers design strategies and public messages that foster more social cohesion and trust in science, medicine, and other social institutions. At the same time, the Global Listening Project is also sharing information about the ways that science and health leaders pay attention to public experiences and concerns. Societies need to bolster trust and social cohesion, Larson argues, so that they can respond more rapidly and effectively when the next health crisis occurs.
Although building trust in science on a global scale can seem daunting, the necessary steps we see are largely the same as those we see working well locally: learn about your community, cultivate relationships with leaders in that community, and demonstrate that you are trustworthy. Above all, communicate with people in ways that relate to their own cultures and perspectives—and maybe even to the things they do for fun.
This article was found originally at Nautilus as part of our Science Box at the Ballot Box collaboration.
