The role of trust in the implementation and uptake of COVID-19 response measures: a qualitative study of health professionals’ experiences in Tanzania

Abstract

Background Even though trust is placed at the central point in ensuring proper functioning of the health systems, studies remain scant on how it affects both the implementation and uptake of COVID-19 response measures in low- and middle-income countries such as Tanzania. This study, therefore, explored the role of trust in the implementation and uptake of recommended COVID-19 response measures including vaccines from the perspective of health professionals in Tanzania. Methods This cross-sectional qualitative study was implemented in four of Tanzania’s thirty-one regions. Qualitative data was collected through 26 in-depth interviews held with regional and district disease outbreak response teams, district cold chain co-ordinators and health facility in-charges. In addition, five focus group discussions and seven group interviews were conducted with healthcare workers from the lower-level health facilities. Thematic analysis was conducted and applied the trust constructs. Results Interpersonal trust and health system trust emerged as two major themes in the study. Interpersonal trust was reported to stem from lack of transparency that instigated fear, worries, and confusion regarding the implementation and uptake of the recommended response measures. The distrust was mainly between health professionals in health facilities and those assigned to isolation centres as well as between patients and community members. On the other hand, the health system trust was shaped by mixed feelings regarding COVID-19 vaccine national decisions, and conflicting messages from national officials, politicians and religious leaders on COVID-19 responses, safety, and effectiveness of the vaccines. Questions surrounding the short duration of clinical trials, indeterminate post-vaccination protection duration, impotence-linked beliefs, freemasonry notion and unclear vaccinated cards information are other reported contributory factors to mistrust in the health system. However, after a comprehensive health education and experience in COVID-19 vaccination administration most professionals affirmed the effectiveness of the vaccines in limiting infections and its severe consequences. Conclusion Participants indicated limited trust at both interpersonal and health system levels aggravated by lack of transparency, unclear and conflicting messages on COVID-19 infections and response measures. Enforced transparency on pandemics alongside standardised messages from the reliable sources is crucial in enhancing trust in implementation and uptake of the recommended response measures.

Healthcare-seeking behavior among people with HIV undergoing TB screening during the COVID-19 pandemic

“…These low rates of testing and vaccine uptake are consistent with prior studies from sub-Saharan Africa, 10–12 where access to testing and vaccination has lagged relative to middle- and high-income settings due to numerous structural, resource and implementation challenges, 10,12,13 alongside fear of discrimination and stigma. 9–11,14 Our results support the need for interventions to address these multifaceted reasons for delaying care to ensure timely access to HIV, TB, and COVID-19 care.…”

“…Pre-COVID-19 qualitative analyses consistently demonstrated that resource availability, costs and stigma were major drivers of delayed entry into care in high TB/HIV burden settings, and our findings suggest that these factors continue to affect healthcare-seeking among adults with HIV in Uganda. 9–12 This demonstrates the importance of maintaining disease-specific and systems-oriented initiatives related to combatting stigma and barriers to access during times of acute public health crisis.…”