Trust as a component of quality of care for people with Multiple Long-Term Conditions (MLTC)

Trust in healthcare is a multidimensional construct shaped by lived experiences and closely linked to confidence in science and professional expertise. Since COVID-19, trust in medical care and research has declined, affecting public health through strained patient–provider relationships, reduced adherence to interventions, weaker continuity of care and poorer self-reported health. Understanding what erodes or strengthens trust is essential for improving care quality and reducing inequities among people with multiple long-term conditions (MLTC).

To examine how perceptions of care quality relate to trust in healthcare, among people with MLTC, and to identify aspects of quality of care that promote or erode trust.

Twenty semi-structured interviews were conducted with adults living with or caring for someone with two or more chronic conditions. This analysis derives from a broader qualitative study examining how people with MLTC define high-quality care. During reflexive thematic analysis, trust emerged as a central component of care quality, prompting a focused sub-analysis of trust-related theme. Participants were purposively recruited, interviews recorded, transcribed and analysed using a reflexive inductive thematic analysis following Braun and Clarke’s six-stage approach. Themes were refined with input from four community partners with lived experience of MLTC and mapped onto two established domains of trust: interpersonal and institutional.

Six quality of care themes that shaped trust were identified. Interpersonal trust was promoted by: 1) Respectful care, reflected in not having to "fight" for access; and 2) Workforce interactions that were sensitive and non-discriminatory, supported by health education offering consistent advice, reliable information sources, and critical thinking that enabled shared decision-making. Institutional trust was maintained by: 3) Regular follow-up, focused on preventative care, including clear discharge plans to support avoidance of hospital admission; 4) Human Resources that are appropriately trained and adequately funded enabling longer consultations and continuity of care; 5) Reduced waiting times, improving access to timely services; and 6) Systems and procedures that support a shared electronic health record system, promote pathways that enable care coordination and lower administrative burden for patients and caregivers.

Trust is a central dimension of care quality that should be monitored throughout the patient journey and not measured as a single outcome. Measuring and embedding trust requires attention to central components of care quality such as continuity, communication, responsiveness, and follow-up, rather than relying solely on clinical indicators. Strengthening collaboration and co-design with local communities is key to developing systems that cultivate and measure trust at both the patient–provider and organisational levels.

Participants' demographics