Survey Details General Public's Eroding Trust Level with Healthcare After COVID-19

Roy Perlis, MD, MSc

Credit: Massachusetts General Hospital

New data from a survey of nearly 450,000 US adults details how the COVID-19 pandemic contributed to an erosion of trust in physicians and hospitals among the general public.¹

Led by a team from Massachusetts General Hospital (MGH) and Harvard Medical School, results of the study indicate the proportion of adults indicating they had “a lot of trust” for physicians and hospitals dropped from more than 70% in April 2020 to less than half in January 2024, with additional data suggesting these associations persisted regardless of partisanship and were seen across subgroups defined by age, gender, educational level, income, race, and urbanicity.¹

“In every sociodemographic group in this survey study, trust declined substantially over the course of the pandemic, with lower trust likely representing a barrier to getting vaccinated or receiving boosters. Strategies may be needed to rebuild this trust to achieve public health priorities,” said lead author Roy H. Perlis, MD, MSc, an associate chief of research in the Department of Psychiatry and the director of the Center for Quantitative Health at MGH.²

The strain COVID-19 has placed on public health systems was historic and deleterious on a multitude of fronts, with measures and policies to mitigate the impact of the pandemic drawing significant degrees of scrutiny and ire. The current study was launched by Perlis and colleagues to better understand the specific extent to which trust in physicians and hospital had changed during the pandemic. With this in mind, investigators designed their study as an analysis of 582,634 responses from 444,345 respondents who took part in a 24-wave survey conducted by PureSpectrum between April 2020 and January 2024.¹

Of the 443,455 respondents, the unweighted mean age was 43.3 (SD, 16.6) years and 65.0% reported female gender. With regard to racial representativeness, 71.1% identified as White, 11.1% as Black, 8.7% as Hispanic, 5.0% as Asian American, 0.7% as Native American, 1.3% as Pacific Islander, and 2.2% as other.¹

The survey waves were conducted approximately every 1 to 2 months beginning in April 1, 2020, through January 31, 2024, among individuals aged 18 years or older residing in all 50 states and the District of Columbia. Investigators highlighted the representativeness of the ample for US adults by pointing out the survey used quotas for gender, age at first survey completion, and race and ethnicity within each state as well as attention checks and open-ended answers to filter out unreliable or automated respondents.¹

The question assessing trust in physicians and hospitals was worded as: “How much do you trust the following people and organizations to do what is right?”. It offered respondents with 4 options for responses: a lot, some, not too much, or not at all.¹

Results of their analyses of survey data indicated the proportion of adults reporting a lot of trust for physicians and hospitals decreased from 71.5% (95% Confidence Interval [CI], 70.7% to 72.2%) in April 2020 to 40.1% (95% CI, 39.4% to 40.7%) in January 2024. Further analysis using logistic regression models suggested being 25 to 64 years of age relative to being 18 to 24, female gender, lower educational level, lower income, Black race relative to White race, and living in a rural setting were all features associated with lower trust as of spring and summer 2023.¹

Investigators called attention to analysis of open-ended questions related to why they indicated the level of trust selected in their survey responses. In these analyses, responses among the 2 lowest levels of trust pointed to the idea that physicians and hospitals favored financial motives over patient care (35.0%), poor quality of care and negligence (27.5%), and influence of external entities and agendas (13.5%) as primary reasons. Investigators also spotlighted additional analyses detailing associations between greater trust and increased likelihood of vaccination for SARS-CoV-2 (adjusted odds ratio [OR], 4.94; 95% CI, 4.21 to 5.80) or influenza (adjusted OR, 5.09; 95% CI, 3.93 to 6.59) and receiving a SARS-CoV-2 booster (adjusted OR, 3.62; 95% CI, 2.99 to 4.38).¹

“People have different reasons for not trusting doctors and hospitals, and restoring trust will require that we consider those different reasons, rather than adopting a ‘one size fits all’ approach,” Perlis added.² “But for us to be ready for the next pandemic, winning back this trust is imperative.”

References:

1. Perlis RH, Ognyanova K, Uslu A, et al. Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults. JAMA Netw Open. 2024;7(7):e2424984. doi:10.1001/jamanetworkopen.2024.24984
2. Massachusetts General Hospital. Trust in physicians and hospitals declined over the course of the COVID-19 pandemic. EurekAlert! July 31, 2024. Accessed July 31, 2024. https://www.eurekalert.org/news-releases/1053051.