Community Health Worker Perspectives on Building Patient-Provider Trust in Rural Communities of the San Joaquin Valley, California: A Qualitative Study.

Abstract

Patient-provider trust is essential for effective healthcare delivery, influencing care engagement, disclosure, and adherence. Mistrust can delay diagnoses, reduce care utilization, and worsen outcomes. While cultural competence trainings aim to improve provider awareness, few studies examine how community health workers (CHWs) perceive and support trust-building in clinical care. To explore strategies for building and maintaining patient-provider trust from the perspectives of CHWs. Using a Community-Based Participatory Research approach, 39 CHWs from 3 rural-serving health centers in California participated in semi-structured focus groups. English and Spanish sessions were co-led by University researchers and trained CHW partners. Deductive thematic analysis was conducted in Dedoose, and descriptive statistics were generated using Stata 17. CHWs identified 3 factors that shape patient-provider trust: (1) Power dynamics, such as provider-dominated conversations and time constraints, limit trust-building; (2) Communication that fosters emotional safety, including provider attentiveness and respectful verbal and nonverbal behaviors; and (3) Cultural respect and competence, emphasizing the importance of recognizing patients' beliefs and providing language-concordant care. CHWs offer community-informed insights on trust-building that can inform culturally responsive and equity-oriented interventions, particularly in rural and underserved regions. Future efforts should explore co-developing training modules with CHWs to strengthen patient-provider trust.