Trust in Public Health within Black African and Caribbean Communities: Grounded Theory as applied to the COVID-19 Vaccine Uptake

Trust plays a critical role in public health, encouraging community unity and cooperation with health initiatives. Despite substantial research on trust, its relationship with race and power dynamics remains under-explored.
To address this research gap, the study focused on exploring the relationship between race and trust, particularly within Black African and Caribbean populations that have historically faced discrimination and exclusion in society and healthcare. The study aimed to understand the unique experiences and perspectives of these communities, especially in the context of the COVID-19 pandemic and vaccination efforts in the UK.

The study utilised a critical grounded theory methodology, influenced by Community Psychology values, to conduct interviews with 15 self-identified Black African and Caribbean individuals. The discussion explored their public health experiences and their perceptions of trust, with emphasis on the COVID-19 pandemic.

The study developed an ecological model to conceptualise the dynamic nature of trust in public health within these communities. The model highlights the influence of social power and structural societal factors, acknowledging that historical marginalisation, colonial injustices, and political distrust contribute to avoidance and scepticism towards public health measures.

It proposes that trust in public health is community-driven, highlighting the role of communities in fostering trust, improving health outcomes, and ensuring care continuity and safety. The research advocates for tailored multi-level interventions centred on community engagement and trust to effect enduring change in health outcomes for these communities.

It calls for a paradigm shift in public health to promote research, training, and clinical approaches that address systemic biases and encourage the decolonisation of health-related knowledge. The study's implications extend to public health policy, clinical practice, training, and future research.

In conclusion, the study underscores the importance of consistent, trustworthy, and transparent actions and accountable processes in public health initiatives, fostering partnerships with marginalised communities to promote equitable and inclusive health practices.