BOSTON– A cross-representative survey of adults in the United States showed decreasing levels of trust in physicians and hospitals during the COVID-19 pandemic—and the lower the trust, the less likely an individual was to get vaccinated against SARS-CoV-2 or influenza. The findings come from a survey study of more than 400,000 U.S. adults published in JAMA Network Open by a team co-led by investigators at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system.
"Trust in physicians and hospitals can be critical for public health, and restoring the trust that was lost during the pandemic will need to target multiple possible contributors to mistrust," 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.
Because medicine and public health policies became politicized during the COVID-19 pandemic, Perlis and his colleagues wondered whether the pandemic may have represented a turning point in trust, with a profession previously seen as trustworthy increasingly subject to doubt.
To investigate, the researchers examined data from 24 waves of internet surveys they conducted throughout and after the COVID-19 pandemic—every one to two months from April 1, 2020, to January 31, 2024. The combined data included 582,634 responses from 443,455 adults residing in all 50 states and the District of Columbia.
The proportion of adults reporting a lot of trust for physicians in hospitals decreased from 71.5% in April 2020 to 40.1% in January 2024. Features associated with lower trust as of the spring and summer of 2023 included age 25 to 64 years, female gender, lower educational level, lower income, and living in a rural setting. These associations persisted even after accounting for partisanship—that is, they weren't simply an indication of someone's political affiliation.
Greater trust was associated with 4.9-times higher odds of vaccination for SARS-CoV-2, a 5.1-times higher odds of vaccination for influenza, and a 3.6-times higher odds of receiving a SARS-CoV-2 booster.
"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," said Perlis. "Strategies may be needed to rebuild this trust to achieve public health priorities."
In another part of the study, Perlis and his colleagues asked participants the reasons for their low levels of trust and used a large language model (GPT-4) to categorize their responses.
Among the leading contributors to low trust were concerns about financial motives, quality of care, influence of other entities or agendas, and perception of discrimination or bias.
"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," said Perlis. "But for us to be ready for the next pandemic, winning back this trust is imperative."
Authorship: Roy H. Perlis, Katherine Ognyanova, Ata Uslu, Kristin Lunz Trujillo, Mauricio Santillana, James N. Druckman, Matthew A. Baum, and David Lazer.
Disclosures: Disclosure forms provided by the authors are available with the full text of this article.
Funding: This work was supported by the National Institute of Mental Health, the National Science Foundation, the John S. and James L. Knight Foundation, the Peter G. Peterson foundation, Harvard University, Northeastern University, Northwestern University, and Rutgers university.
Paper cited: Perlis RH et al. "Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State US Survey." JAMA Network Open DOI: 10.1001/jamanetworkopen.2024.24984
