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Primary Submission Category: Public Health Communication and Trust
How is Trust in Public Health Authorities Conceptualized and Measured in the Context of U.S. Public Health Crises? A Systematic Review
Authors: Samantha Kloft, Daniel López-Cevallos, Jung Hee Hyun, Elizabeth Bertone-Johnson, Airín Martínez,
Presenting Author: Samantha Kloft*
Trust in public health authorities (TiPHA) is critical for effective public health preparedness, yet there is limited consensus on how trust is defined or measured. Inconsistent conceptualizations hinder efforts to compare findings, evaluate interventions, and strengthen relationships between communities and public health agencies. Hence, the present study evaluated how TiPHA is conceptualized and measured. A systematic review following PRISMA guidelines identified studies examining TiPHA across multiple disciplines, including peer-reviewed and gray literature. Eligible studies defined or measured TiPHA in the context of public health emergencies, ranging from pandemics to natural disasters and biological/chemical threats. Forty-three studies met inclusion criteria; 70% (30/43) provided a definition of trust and 81% (35/43) included at least one measure. Definitions varied widely and were often implicit. Competence was the most frequently referenced dimension (25 studies), while dimensions such as integrity, transparency, and fairness appeared inconsistently. Most research was conducted with general adult populations (33), with relatively little attention to specific, emergency-affected communities or public health practitioners. Studies most often assessed trust in federal agencies, with state and local authorities referenced less frequently. Measurement approaches varied substantially and included single-item ratings, multi-item scales, “most trusted source” questions, and qualitative assessments. Most quantitative studies relied on non-validated measures or did not report psychometric properties. These findings demonstrate substantial conceptual and methodological inconsistency in how TiPHA is defined and measured. The review synthesizes definitions and measurement approaches and offers recommendations to support more consistent definitions and standardized measures of TiPHA, advancing future research and trust-building efforts in public health preparedness.