Trust During the Early Stages of the 2009 H1N1 Pandemic

Abstract

Distrust of the government often stands in the way of cooperation with public health recommendations in a crisis. The purpose of this paper is to describe the public’s trust in government recommendations during the early stages of the H1N1 pandemic and identify factors that might account for these trust levels. We surveyed 1543 respondents about their experiences and attitudes related to H1N1 influenza between June 3, 2009 and July 6, 2009, during the first wave of the pandemic using the Knowledge Networks (KN) online panel. This panel is representative of the US population, and uses a combination of random-digit dial and address-based probability sampling frames covering 99% of the US household population to recruit participants. To ensure participation of low-income individuals and those without Internet access, KN provides hardware and access to the Internet if needed. Measures included standard demographics, a trust scale, trust ratings for individual spokespersons, involvement with H1N1, experience with H1N1, and past discrimination in health care. We found that trust of government was low (2.3 out of 4) and varied across demographic groups. Blacks and Hispanics reported higher trust in government than did Whites. Of the spokespersons included, personal health professionals received the highest trust ratings and religious leaders the lowest. Attitudinal and experience variables predicted trust better than demographic characteristics. Closely following the news about the flu virus, having some self-reported knowledge about H1N1, self-reporting of local cases and previously experiencing discrimination were the significant attitudinal and experience predictors of trust. Using a second longitudinal survey, trust in the early stages of the pandemic did predict vaccine acceptance later but only for white, non-Hispanic individuals.

Exploring Communication, Trust in Government, and Vaccination Intention Later in the 2009 H1N1 Pandemic: Results of a National Survey

“…Consistent with Freimuth et al, 13 who investigated trust during the early phase of the pandemic, we found that closely following the news, the quality of communication, and role models were associated with higher trust in government actions and spokespersons. Additionally, we found that the perceived quality of communication has an impact on trust in government actions.…”

“…Interestingly, while elected officials were typically less trusted than public health authorities, President Obama was the next most trusted after the HHS secretary. When we examine only government spokespersons, these findings in the middle of the pandemic are consistent with our results in the early phase of the pandemic, 13 suggesting that there was some stability over time for trust in public health spokespersons at the national, local, and state levels as well as for the president.…”

“…Local and state elected officials did not fare as well as trusted spokespersons either early 13 or in the midst of the pandemic. In a pandemic, it is neither uncommon nor inappropriate for elected officials to garner media coverage.…”

“…15 There is growing literature that examines the importance of communication and trust specifically related to vaccination behavior during a pandemic. 12,[16][17][18] Freimuth et al 13 found a small association between trust and vaccination, but 2 studies found that communication about vaccines from official government sources was a consistent predictor of higher vaccination rates during the pandemic, resulting in a call for sufficient, clear, and timely communication to ''maintain public confidence and trust to increase compliance. '' 12(pD10) Additional research suggests that people who relied on unofficial sources were less likely to be vaccinated and that, during the H1N1 pandemic in the United States, mistrust and conspiracy theories promulgated by local clergy, the media, and social media sources were potential factors in H1N1 immunization disparities in African Americans.…”

“…26 Little research has explored the interaction of these elements and their impact on trust. 13,14,18 Using components from Meredith et al, 10 as well as elements of the Trust Determination Model, Quinn et al 27 developed a quantitative trust scale that includes questions to assess respondents' level of trust regarding the government's openness, honesty, commitment, caring and concern, and competence in addressing H1N1; the extent to which respondents believe the government's actions in response to H1N1 are in their personal best interest; and how much respondents believe the government will protect them from H1N1. These items were used in the current study to measure levels of trust in the government handling of the H1N1 pandemic.…”