Community health workers’ efforts to build health system trust in marginalised communities: a qualitative study from South Africa

IntroductionCommunity health workers (CHWs) enable marginalised communities, often experiencing structural poverty, to access healthcare. Trust, important in all patient–provider relationships, is difficult to build in such communities, particularly when stigma associated with HIV/AIDS, tuberculosis and now COVID-19, is widespread. CHWs, responsible for bringing people back into care, must repair trust. In South Africa, where a national CHW programme is being rolled out, marginalised communities have high levels of unemployment, domestic violence and injury.ObjectivesIn this complex social environment, we explored CHW workplace trust, interpersonal trust between the patient and CHW, and the institutional trust patients place in the health system.Design, participants, settingWithin the observation phase of a 3-year intervention study, we conducted interviews, focus groups and observations with patients, CHWs, their supervisors and, facility managers in Sedibeng.ResultsCHWs had low levels of workplace trust. They had recently been on strike demanding better pay, employment conditions and recognition of their work. They did not have the equipment to perform their work safely, and some colleagues did not trust, or value, their contribution. There was considerable interpersonal trust between CHWs and patients, however, CHWs’ efforts were hampered by structural poverty, alcohol abuse and no identification documents among long-term migrants. Those supervisors who understood the extent of the poverty supported CHW efforts to help the community. When patients had withdrawn from care, often due to nurses’ insensitive behaviour, the CHWs’ attempts to repair patients’ institutional trust often failed due to the vulnerabilities of the community, and lack of support from the health system.ConclusionStrategies are needed to build workplace trust including supportive supervision for CHWs and better working conditions, and to build interpersonal and institutional trust by ensuring sensitivity to social inequalities and the effects of structural poverty among healthcare providers. Societies need to care for everyone.

The Economic Consequences of Trust and Distrust in Knowledge-Intensive Organizations

Studies measuring workplace trust in connection with leadership style and leader responsibility have become more and more important in recent years. Interest in the subject has been rising along with the recent introduction of knowledge management systems (KMSs), which has shown to be one of the most important factors of competitiveness. The aim of this research was to examine to what extent leaders of organizations are concerned about the presence of trust and/ or distrust, as well as about the economic consequences of trust and distrust. It also focused on solutions used in KMSs in knowledge-intensive organizations. Based on a model developed by the authors, the significance of a trust-based culture was examined from the viewpoint of economic consequences. Situations were analyzed in which, despite the existence of all knowledgerelated preferences, managers were not concerned about the economic consequences of trust or distrust. To test the system of relations in the model, a questionnaire survey was conducted in two neighboring European countries with different cultures. It has been found out that in most cases, there is a need for the building and/or use of a KMS at a strategic level. Appropriate tools are also used at an operative level (often spontaneously). However, trust as a general cultural prerequisite is often lacking. Businesses do not seem concerned about the consequences of trust and distrust, as related economic impacts are rarely quantified.

The Issue of Trust in Shaping the Job Involvement, Job Satisfaction, and Organizational Commitment of Southern Correctional Staff

While the issue of trust is theoretically essential for the effective operation of correctional organizations, few researchers have examined how the different types of trust are related to salient outcomes for staff. In this study, we examined the effects of coworker, supervisor, and management trust on the job involvement, job satisfaction, and organizational commitment of 322 Southern U.S. correctional staff. The types of workplace trust, however, varied in their effects. Specifically, multivariate analysis indicated only management trust had a significant positive effect on job involvement, but both coworker trust and management trust had significant positive effects on job satisfaction, whereas both supervisor trust and management trust had significant positive effects on organizational commitment. The current findings support the overall contention that workplace trust plays an important role in shaping prison staff job involvement, job satisfaction, and organizational commitment. The results underscore the need for improving perceptions of trust in the workplace, particularly management trust.