Introduction to the Toolkit
Why Trustworthiness Matters
A long and ongoing history of mistreatment has fostered mistrust in the health care system and other institutions. Racism, classism, ableism, and other systems that unfairly assign value and unjustly distribute opportunity have left and continue to leave lasting scars and harms not easily forgotten. This erosion of trust is compounded by the spread of misinformation and disinformation which continues to undermine confidence in institutions today. Recent data trends confirm that trust in institutions among U.S. adults is steadily declining, reinforcing the urgency of institutional accountability and repair.
Trustworthiness is the foundation of community engagement and the multisector partnerships necessary to ensure all communities have a fair and just opportunity to thrive. But trustworthiness is not a destination. It is an ongoing process that requires intentional listening, meaningful reflection, cocreated action, and continuous reassessment.
“The principles resonated with our partners. They saw them as values we need to have going into events for [the community].”
— Community Representative, Atlanta, Georgia
The 10 Principles of Trustworthiness, created by the AAMC Center for Health Justice in collaboration with researchers and communities from across the United States, serve as a compass to navigate this journey and help organizations move beyond intent and toward action and accountability.
The Principles of Trustworthiness Toolkit
The Principles of Trustworthiness Toolkit provides a structured, community-driven framework and offers practical tools that organizations of any kind can use to become more trustworthy partners.
What makes this toolkit unique are its community-centered origins, its scalability, and its adaptability. It can be applied in any community or sector, allowing institutions to implement actions that are grounded in local realities. As more communities use the toolkit and share their trust-building strategies, the toolkit will expand as a growing resource of community-vetted solutions.
How the Principles of Trustworthiness Toolkit Evolved
The toolkit reflects several years of partnership, learning, and iteration. It was cocreated by people directly impacted by the systems that have failed them.
Since 2015, the AAMC has partnered with its members and their community partners to develop Community Engagement Toolkits that elevate honest community perspectives on key issues and offer guidance on building stronger partnerships. For one such effort, in 2020 the AAMC Collaborative for Health Equity: Act, Research, Generate Evidence (AAMC CHARGE) engaged 30 community members nationwide to gather insights on trust, COVID-19, and participation in clinical trials. These findings helped inform the development of the Principles of Trustworthiness Toolkit, detailed in Frontiers in Public Health.
Watch the 2020 community video here:
In 2024-25, the AAMC Center for Health Justice supported four multisector community partnerships, which formally piloted, implemented, and evaluated the Principles of Trustworthiness Toolkit. Their insights and experiences shaped the toolkit’s evolution, ensuring it remains a practical, community-centered resource for fostering trust. The lessons learned from this collaborative effort reinforced the importance of recognizing community expertise, taking meaningful action, and sustaining a critical power shift from institutions that traditionally define trust on their terms, to communities who demand that institutions earn their trust. Thanks to the dedicated efforts of community partners, the toolkit is a stronger resource to guide institutions in putting trust into action.
Take Action and Use the Toolkit
The Principles of Trustworthiness Toolkit is designed to be adaptable for a range of contexts — whether implemented by a single organization aiming to strengthen community relationships, a group of like-minded institutions, or a cross-sector coalition working toward systemic change. Its flexible structure supports both incremental improvements and coordinated, large-scale efforts.
To get started
- Review the four-phase trust-building cycle: Listen, Reflect, Act, and Revisit, to understand the overall framework.
- Engage with each phase sequentially or nonlinearly, depending on existing needs, goals, and readiness.
- Leverage and adapt the included tools such as session templates, reflection guides, and action-planning resources to fit local realities.
- Revisit tools and stages over time, because trust building is an iterative, ongoing process.
This toolkit supports organizations in shifting how they engage with communities by providing structure without prescribing a one-size-fits-all approach. It challenges institutions to relinquish control, embrace discomfort, and demonstrate humility through an ongoing cycle of listening, reflection, action, and reassessment.
"This gave us an opportunity to build relationships and work together in ways we hadn’t before."
— Community Representative, Omaha, Nebraska