Introduction: Research on healthcare trustworthiness has largely focused on clinical interactions, overlooking how encounters with non-health institutions in neighborhoods may shape medical mistrust through spillover effects. Little work has centered community perspectives on how neighborhood institutional experiences relate to healthcare trustworthiness.

Research Question: How do neighborhood institutions influence the trustworthiness of healthcare providers and systems?

Methods: We conducted six focus groups (N=72) with residents in Winston-Salem, NC. Using inductive–deductive thematic analysis, we examined how residents depicted neighborhood conditions, interactions with health and non-health institutions, and healthcare expectations.

Results: Participants described uneven neighborhood infrastructure, safety, and service access as indicators that communities defined by race, ethnicity, socioeconomic status, and zip code are deprioritized “by design.” Experiences with non-health institutions such as police, government, housing, and transportation informed broad institutional expectations. Non-responsiveness, differential treatment by race/ethnicity or language, and high navigation burdens indicated that systems do not listen or act fairly. These indicators appeared in healthcare through transportation, language, and navigation barriers. Rushed, transactional care further fostered mistrust, while care continuity, listening, and navigation support signaled trustworthiness.

Conclusion: Neighborhood residents may judge institutional trustworthiness through responsiveness to community needs. When non-health institutions are unresponsive, this perceived disinvestment may spill over into medical mistrust. Strengthening healthcare trustworthiness may require making institutional responsiveness visible in neighborhoods before people enter medical settings, while ensuring care continuity, listening, and navigation support are present when people do enter clinical settings.