JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic significantly impacted public trust in public health, medical care, scientific, and governmental institutions; in turn, influencing health and health seeking behaviours and adherence to public health measures. Understanding the evolution of trust is necessary for informing future public health crisis management and strategies. Rebuilding public trust is a key goal of pandemic preparedness worldwide. This research protocol examines these trust dynamics, their determinants, and implications for health equity.

Objective:

The study aims to investigate the evolution of public trust in scientists, public health and medical care institutions, governments, and social and personal networks during the COVID-19 pandemic. It seeks to identify key factors contributing to trust maintenance or erosion, particularly in marginalized and minority communities, and understand the impact of trust level on public health adherence.

Methods:

A sequential, explanatory mixed-methods approach was implemented, consisting of an initial quantitative survey followed by qualitative interviews. The nationally representative survey included 5,609 Canadian residents as of March 2020. The questionnaire assessed trust in six key trust sources before and during the pandemic: provincial and federal governments, public health authority, medical care providers, health scientists, and social and personal networks. To complement, 41 qualitative interviews were conducted to understand participants’ lived experiences, perceptions and how trust played into both. Data have been analyzed using statistical techniques for quantitative data and thematic analysis for the qualitative data and results integrated to derive comprehensive insights.

Results:

This Canadian survey included participants from all 10 provinces and two territories; provinces and territories samples matched the proportions of each in the overall Canadian population. Age, sex/gender were well distributed in the sample. Additionally, 18.6% identified as an ethnic minority, 12.7% identified as Indigenous, including 7.2% First Nations, 4.8% MĂ©tis, and 0.4% Inuit. Fifty-five percent (55.2%) had received at least one dose and planned to stay up to date with booster recommendations, while 36.6% were vaccinated but did not intend to receive additional doses. A small percentage, 0.7%, had not yet been vaccinated but were open to it, whereas 6.4% had not received a vaccine and did not plan to take a vaccine.

Conclusions:

The COVID-19 pandemic has underscored the critical role of trust in shaping public health behavior and crisis response. This study aims to explore how consistent, transparent communication and equity-driven policies may contribute to maintaining public trust, particularly among marginalized communities. By examining trust dynamics and identifying potential disparities, the study seeks to generate insights that can inform future evidence-based public health strategies and improve preparedness for future health emergencies. Clinical Trial: Not Applicable