COVID-19 vaccines — and our health care system — are not universally trusted. The AAMC’s new Principles of Trustworthiness were developed to highlight and address those concerns.
The conversation still sticks with Susan Massick, MD, a dermatologist at The Ohio State University Wexner Medical Center (OSUMC) in Columbus. Massick and a hospital employee were discussing health care, and the woman shared that she was reluctant to reveal certain information to her primary care physician.
“She didn’t feel comfortable being as honest with her physician as she would’ve liked because she felt the physician wasn’t always listening well,” says Massick. “What it boils down to is that essential trust, which is always crucial for providing quality care and certainly is now for increasing vaccine confidence.”
Massick is a participant in AAMC CHARGE, the AAMC Center for Health Justice’s national collaborative of health equity experts and champions, who recently interviewed and partnered with 30 residents of local communities to co-create the AAMC’s Principles of Trustworthiness. Launched in May by the organization’s Center for Health Justice, the project features videos, interactive workshops to learn how to apply the Principles of Trustworthiness, and other tools for building equitable and trusted relationships between local communities and major institutions like hospitals. The principles apply to patient-provider relationships as well.
Below, Massick and two other team members share tips for speaking with people who might not have confidence in the COVID-19 vaccines.
Tip #1: Don’t assume you know more than they do
Too often, physicians assume that their experience and knowledge mean they know what’s best for others. “We sometimes think everyone should just follow our lead,” says Bola Ekezue, PhD, assistant professor of health care management at Fayetteville State University in North Carolina. “But people can experience that as disrespect.”
Instead, Ekezue tries to spark open conversations about the COVID-19 vaccines by simply sharing her personal experience. When talking with her students, for example, she let them know that she had chills, body aches, and a slight fever after her second shot but felt better a couple of days later.
Massick advises listening to local voices that are well-versed in community needs. For example, because people value free health screenings, this June OSUMC adapted its annual Healthy Community Day to include those services along with free COVID-19 vaccinations — as well as ample opportunity to ask questions about the vaccines and the pandemic.
At Children’s National Hospital in Washington, DC, efforts focused on meeting community members where they are — on their terms. This year, the institution hosted 10 virtual town hall meetings on COVID-19-related topics, including mental health, suggested by community members. The sessions featured diverse speakers, from teachers and teenagers to clinicians and community leaders.
“We had a number of voices, but they all were speaking with one voice about the value of vaccines,” explains Desiree de la Torre, MPH, MBA, director of community affairs and population health improvement.
Tip #2: Prove trustworthiness by taking concrete action
Inspiring confidence requires much more than lip service. It demands significant steps to support staff and community members.
“Our medical center’s goal was that any employee who wanted a vaccine should be able to get one, and we worked hard to provide full-day vaccine clinics at multiple sites,” says Massick. In addition, she notes, “there was a focus on equity in the rollout. If you had the same risk of exposure, you got the vaccine at the same time, whether you were a respiratory therapist, resident, or department chair.”
At Children’s National, hospital leaders recognized the need for — and quickly implemented — a drive-through and walk-up testing center for children and an initiative to provide vaccines to local schools. “When it comes to [addressing] COVID-19, my office was only one piece,” says de la Torre. “It took organization-wide coordination to support community health.”
Tip #3: Be thorough, take your time, do it right
“Demonstrating trustworthiness is not a one-and-done proposition,” reads advice in a toolkit on the principles.
OSUMC made sure to provide information related to COVID-19 vaccines every day via email, says Massick. It also offered numerous town hall sessions where employees could pose questions to infectious disease experts, critical care physicians, and hospital leaders and hosted smaller staff meetings to encourage open communication.
At Children’s National, hospital leaders launched seven focus groups in English and two in Spanish over several months to more fully understand employees’ vaccine concerns. Often, potential side effects were a key concern. Participants’ feedback also indicated a need to communicate about vaccines in multiple formats, including video, print, and text messages.
“We heard that we need to use different formats to reach different audiences, including our employees,” says de la Torre. “We also heard that we should partner with community organizations in all these efforts because they offer that trusted voice.”
In her work with the Principles effort, Ekezue says community members frequently emphasized the need for an ongoing commitment from health care institutions. “They said that we sometimes seem to take, but not give back. Instead, we need to be involved in the community, to be seen as a neighbor. That’s how people will feel that we care and are telling them the truth.”
The Principles of Trustworthiness:
- The community is already educated; that’s why it doesn’t trust you.
- You are not the only experts.
- Without action, your organizational pledge is only performance.
- An office of community engagement is insufficient.
- It doesn’t start or end with a community advisory board.
- Diversity is more than skin deep.
- There’s more than one gay bar, one “Black church,” and one bodega in your community.
- Show your work.
- If you’re going to do it, take your time, do it right.
- The project may be over, but the work is not.
Read more about the Principles of Trustworthiness.