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Fostering Trust and Advancing Health Equity: An Innovative Pilot Curriculum Rooted in Principles of Trustworthiness

Henderson, Cynterria (2024) Fostering Trust and Advancing Health Equity: An Innovative Pilot Curriculum Rooted in Principles of Trustworthiness. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: Medical mistrust, or skepticism that healthcare providers and organizations genuinely care for patients' interests, is associated with disparities in healthcare utilization, healthcare engagement, and health outcomes. Trust is foundational for behavior change and trustworthiness is an essential prerequisite to trust. It is critical that health science professionals and trainees establish their trustworthiness to combat medical mistrust and promote health equity. Research emphasizes the need for educational curricula that extend beyond cultural competence and equips students and trainees with the necessary skills and knowledge to earn trust though such curricula are rare, revealing a critical gap. Purpose: To describe a novel trustworthiness curriculum for future health science professionals and evaluate the impact of the curriculum on trainee knowledge and beliefs.
Methods: The curriculum was informed by existing literature and findings from six 30-minute, semi-structured interviews with public health professionals and community members. Thematic affinity cluster analysis revealed four key themes. The curriculum pilot included an 18-item pre-post survey to assess changes in students’ knowledge and beliefs post-curriculum exposure. Belief questions addressed three subthemes: understanding and addressing mistrust, recognizing the importance of medical mistrust, and preparedness for building trust.
Results: Key themes that emerged from six interviews included the challenges of mistrust, principles of trustworthiness, behaviors to avoid, and considerations for working with minoritized and vulnerable communities that experience medical mistrust. The principles of trustworthiness include reliability, presence, humility, and reciprocity. Fourteen students participated in the curriculum pilot, consisting of women (100%) between the ages of 18 and 24 (87%) between their first and second year (60%) studying in the school of public health (53%). The survey showed increased knowledge (71% to 83%, p=0.082) and belief scores post-curriculum exposure (34 to 37, p=0.059). Significant changes in responses were observed for the “preparedness for building trust” (11 to 13, p=0.001) and “understanding and addressing mistrust” (9 to 10, p=0.042) belief subthemes.
Conclusion: Pilot results show significant shifts for two belief subthemes, emphasizing the need for intentional efforts in health science education to include medical mistrust and trustworthiness in their trainee education to foster health equity.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Henderson, Cynterriacrh56@pitt.educrh560000-0003-2995-4388
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairElias, Thistleelias@pitt.eduelias
Committee MemberDocumet, Patriciapdocumet@pitt.edupdocumet
Committee MemberRagavan, Mayaragavanm@chp.edumir99
Date: 17 May 2024
Date Type: Publication
Defense Date: 3 April 2024
Approval Date: 17 May 2024
Submission Date: 9 April 2024
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 66
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: health science education, curriculum, training, medical mistrust, health equity, trustworthiness, trust
Date Deposited: 17 May 2024 17:20
Last Modified: 17 May 2024 17:20


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