When nurse researcher Heather K. Hardin was working as a Women, Infants and Children (WIC) nurse serving a population of mostly low-income mothers, she kept hearing the same question.

“Moms would tell me, ‘I don’t trust so and so,’ or ‘Can I come back and talk to you about this?’ I was a PhD student and had been studying health literacy and confidentiality, so I knew how to behave to make patients feel safe, and that showed up in my practice,” said Hardin, now an assistant professor at the Frances Payne Bolton School of Nursing.

Intrigued by the concept of what builds trust between patients and care providers, she began to look at literature on trust in health care and how different patient groups perceive health care providers (HCPs).

Hardin’s research has revealed a wide gap among certain groups in how much they trust health care providers—and that gap could have very real health effects, further widening an existing disparity.

“When we look at trust of health care providers, we know that there are certain groups less likely to have it, younger folks and other marginalized groups,” she said. “Some groups’ mistrust reflects historical aspects of health care and irresponsible and unethical treatment. Low-income folks get the message that they’re less important and that shows up in their relationships.”

Building trust can be cyclical. Listening to a trusted HCP influences health behavior. Adopting healthier behaviors influences health outcomes. Patients seeing positive health outcomes have greater satisfaction with their HCP who provided the advice.

“Patients who have a good relationship with their health care provider are much more likely to take their advice, take their prescriptions and change their lifestyle,” Hardin said. “We know making those behavior and lifestyle changes can be difficult to do, but people are more likely to do it if the advice comes from someone they trust, especially a health care provider.”

Hardin’s primary research focus is on young adults and adolescent patients, and she found adolescents are more concerned with privacy and confidentiality because parents are involved in their care, while adults are evaluating HCPs for competency. Young people with chronic conditions, however, fall more with adults in looking for experience and knowledge from their HCP.

“Youth who have had a chronic condition have much more experience with health care because they receive a lot more. They tend to develop strong feelings about trust and what they expect from a provider,” she said. “Those younger patients start to develop an ability to evaluate competency better than their peers.”

Sensitive topics, like reproductive health concerns, weight and mental health are also front and center concerns with adolescents, in addition to confidentiality.

“As we transition into adulthood, we start to understand things like HIPAA and we lose a lot of our sensitivities about different conditions,” Hardin said. “Young people just don’t have that, and they don’t understand the rules about confidentiality and it really does show up in their trust of providers. A couple of different studies have reported one bad experience with an authority figure tarnishes young peoples’ relationships with other adult authority figures. As health care providers, we have to keep that in mind and know that we may be trying to make up for the mistakes of someone else.”