Table 4.

Recommendations for the Future of Health‐Related Trust Research

Rate‐Limiting Domain	Strategic Imperative	Exemplary Research Questions
Theory development	Clarify definitions	What is the relationship between trust and trustworthiness? What is the difference between mistrust and distrust? Is rustworthiness a characteristic of a person or a relationship?
	Clarify necessary and sufficient conditions	Is an expectation of goodwill necessary to using the term trust in health care? Is trusting oneself a necessary condition for trusting others?
	Clarify whether trust/worthiness is the appropriate term for all potentially relevant trustees	How, if at all, should standard intuitions about trustworthiness be adapted for nonhuman trustees (e.g., teams, organizations, and artificial intelligence)?
Methodological considerations	Focus on trust and trustworthiness as outcomes	Through what kind of process is trust in various trustors built? How, if at all, is the process for rebuilding trust after a breach different from building it the first time? What are the contextual and behavioral antecedents, drivers, or facilitators to trust in a given trustor? What signals do different types of people take information from about trustworthiness?
	Pursue causal inference when appropriate	What role can randomization, instrumental variable analysis, regression discontinuity, and related designs play in the study of trust and trustworthiness in health care?
	Conduct longitudinal studies	How do levels of trust change over time within a relationship? How do behaviors within a relationship change (e.g., information disclosure) over time as a result of changes in trust?
	Conduct dyadic/relational studies	How do changes in one person's trust effect another's trust in them? To what extent can a relationship sustain with disparate trust among the parties? To what extent are trust levels and behaviors mirrored inside of relationships?
	Assess the role of trust “spillovers” among systems, organizations, teams, and individual	To what extent do patients form independent or joined assessments of clinicians, teams, organizations, and systems’ trustworthiness? Do positive or negative experiences with a clinician or organization create spillover effects at the other level of analysis?
	Account for racism and other forms of discrimination in research designs	How do forms of interpersonal and structural racism shape trust and trustworthiness? To what extent is the value of racial concordance in therapeutic relationships a function of trust? To what extent are community‐level attitudes about the trustworthiness of health care organizations developed and sustained in minoritized communities?
	Pursue measures of optimality	If optimizing rather than maximizing trust is the goal, what can patient trust be measures against to evaluate progress?
	Adopt a reflexive stance	How does trust in a research team influenced the disclosure of information by research participants? To what extend does participating in research sponsored by a health care institution change participants’ reported trust in health care?