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Since 2015, the AAMC has produced an annual series of Community Engagement Toolkits in collaboration with our members and their communities. These toolkits provide unvarnished community perspectives on crucial issues and views about how our members can be better partners. 

The AAMC Collaborative for Health Equity: Act, Research, Generate Evidence (CHARGE) — the AAMC’s national collaborative of health equity scholars, practitioners, and community partners — gathered perspectives from a diverse set of 30 community members from across the United States regarding trust, COVID-19, and clinical trial participation.  

These 10 Principles of Trustworthiness integrate local perspectives with established precepts of community engagement to guide health care, public health, and other organizations as they work to demonstrate they are worthy of trust. The AAMC Center for Health Justice will continue this work to support organizations right now and in the future as they partner with communities and the many sectors that serve them to develop ways to shift our society toward health equity and justice.

The Principles of Trustworthiness Community Video

This video underscores reasons and causes for mistrust of the health care system and offers suggested actions that organizations of all kinds can take to demonstrate they are trustworthy.

Video available in Spanish

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The Principles of Trustworthiness

Deserving trust is crucial to equitably partner with the communities you engage and to achieve health justice.

Remember, though, the process of engagement is as important as the product. Here are 10 principles that community stakeholders endorse as the guiding compass on your journey to establishing trustworthiness.


1. The community is already educated; that’s why it doesn’t trust you.

Circle with an ‘x’ in the middle

Words matter. Be mindful of how you frame your relationship. It is not your job to teach to the gaps you assume the community has. Mistrust is a rational response to actual injustice. The community knows what it doesn’t know and will ask when it thinks you have answers it can trust. (This goes for “empowering” the community, too.)

2. You are not the only experts.

Triangle

People closest to injustice are also those closest to the solutions to that injustice. (That is probably not you or your organization and, even if it is, there’s a power imbalance.) Listen to people in your community. They have deployed survival tactics and strategies for decades — centuries, even. Take notes. Co-develop. Co-lead. Share power.

3. Without action, your organizational pledge is only performance.

A circle with three rectangles going out of it

Walk the walk, please. Deploy resources. Coordinate across your organization. Hire someone to the C-suite and a network or coalition of experts to be responsible for transformation because transformation is not a one-person job. Be authentic. Don’t just say you’re committed to the goal of health equity; do the work to achieve it.

4. An office of community engagement is insufficient.

Stacks of two, four, and three circles

One full-time employee doesn’t cut it. Don’t jam this work into your existing diversity and inclusion office, either. Trustworthiness is not a “minority tax”; we are all responsible. This is systemwide, all-hands-on-deck work and, as such, should be acknowledged, incentivized, and promoted in material ways.

5. It doesn’t start or end with a community advisory board.

A circle surrounded by smaller circles

Running your thoughts by a group of self-appointed community leaders for a thumbs-up does not suffice. Take to the streets to get some unfiltered opinions. And then work together with the community to put that wisdom into the work. Make it clear to all you’ve done so, and explain the benefits accrued.

6. Diversity is more than skin deep.

Three circles placed as a Venn diagram

We are diverse within our diversity. Do not rely solely on matching skin tones to make a difference. Think intersectionality and multiple identities, but remember: humility and honesty are the foundation for earning trust.

7. There’s more than one gay bar, one “Black church,” and one bodega in your community.

A bar chart with up and down bars

Not all gay people go to the club, and not all people of color go to the same church (or go at all). Know all of your community’s assets. Visit them. Meet the patrons. Meet the leaders. Break bread and share a meal — at their tables.

8. Show your work.

A line chart that goes up and down

The community does not think you are perfect, and the past is always present. So be transparent about your limitations, your biases, your goals, your funding, and the outcomes that matter to you. Then ask the community to do the same. Identify the “win-win” for all parties. No secrets, no surprises.

9. If you’re gonna do it, take your time, do it right.

Stacks of three, two, and one blocks

Demonstrating trustworthiness is not a one-and-done proposition. Keep at it. Be mindful. Remember, it takes a long time to build trust and only a split second to destroy it. Pace yourself.

10. The project may be over, but the work is not.

An arrow pointing to the right

Do not drop in and drop out. Share results. Partner on next steps. Close the loop. The community is constant — it is not there only for the duration of your grant or initiative. Be there for the community, always, and it is more likely to want  to be there for you.

The Principles of Trustworthiness Toolkit

This toolkit of materials is for organizations to download and use to facilitate discussions within their communities, develop relationships with a broad coalition, and track lessons learned. It includes the kinds of questions, discussions, and activities that will help an organization and its community to unpack the Principles of Trustworthiness, explore how they come to life locally, and determine what local actions might be taken to demonstrate trustworthiness.

These resources can be used to help build vaccine confidence as part of the AAMC’s cooperative agreement with the Centers for Disease Control and Prevention (CDC). Learn more about this effort at VaccineVoices.org.

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The Principles of Trustworthiness Workshops

At these interactive working sessions, presented by the AAMC Center for Health Justice, participants learned about and discussed the Principles of Trustworthiness Toolkit and heard experiences of early adopters, as well as from those who are working to translate the Principles into actions as their organizations build partnerships, foster trust, and work toward health equity in their communities. 

Download the slides (PDF)

Facilitators:

Etsemaye P. Agonafer, MD, MPH, MS
Assistant Professor, Department of Health System Science
Kaiser Permanente Bernard J. Tyson School of Medicine

Maranda Ward, EdD, MPH
Assistant Professor
The George Washington University School of Medicine and Health Sciences

Marshala Lee, MD, MPH
Harrington Community Partnership Director
ChristianaCare’s Institute for Research on Equity and Community Health

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This work is funded by a cooperative agreement from the Centers for Disease Control and Prevention (CDC): Improving Clinical and Public Health Outcomes through National Partnerships to Prevent and Control Emerging and Re-Emerging Infectious Disease Threats (Award # 1 NU50CK000586-01-00). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The information included does not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the federal government.