@article {Tibbelse2100429, author = {Natalie Tibbels and Zo{\'e} Hendrickson and Hannah Mills and Sidikiba Sidib{\'e} and Claudia Vondrasek and Tilly Gurman}, title = {The Salience of Trust to the Client-Provider Relationship in Post-Ebola Guinea: Findings From a Qualitative Study}, volume = {10}, number = {1}, elocation-id = {e2100429}, year = {2022}, doi = {10.9745/GHSP-D-21-00429}, publisher = {Global Health: Science and Practice}, abstract = {Key FindingsTrust is a vital determinant of health care seeking and should be a key consideration for global health programs operating in postemergency settings.Trust is a composite of various underlying domains, and rebuilding trust depends on understanding and addressing the domains that are salient to clients.This analysis provides a case study of how a global health program used qualitative research to explore salient domains of trust within the client-provider relationship in post-Ebola Guinea and developed interventions to address those domains.Key ImplicationsTo improve care-seeking practices where trust barriers exist between communities and the health system, program managers should seek to center the clients by defining and addressing their conception of trust.Lack of trust in the health care system can serve as a barrier to service utilization, especially in pandemic and postemergency settings. Although previous research has identified domains of trust that contribute to individuals{\textquoteright} trust in the health system, little research exists from low- and middle-income countries, particularly during and after infectious disease outbreaks. The current study{\textemdash}conducted to inform activities for a post-Ebola program{\textemdash}explored perceptions and experiences of health care provision in post-Ebola Guinea, with particular attention to trust. Researchers conducted in-depth interviews with health workers (n=15) and mothers of young children (n=29) along with 12 focus group discussions with grandmothers of young children and 12 with male heads of household. The study occurred in Basse Guin{\'e}e and Guin{\'e}e Foresti{\`e}re{\textemdash}2 areas hardest hit by Ebola. Respondents identified a breach of trust during the epidemic, with several domains emerging as relevant for renewed trust and care-seeking practices. At the core of a trusting client-provider relationship was the inherent belief that providers had an intrinsic duty to treat clients well. From there, perceived provider competence, the hospitality at the facility, provider empathy, transparency about costs, and commitment to confidentiality emerged as relevant influences on participant trust in providers. Community members and providers expressed similar viewpoints regarding trust and discussed the role of open communication and community mobilization in rebuilding trust. Study findings informed a variety of program activities, including the development of campaign messages and interpersonal communication trainings for health workers. This study provides valuable insight about some underlying components of trust that can provide key leverage points to rebuild trust and promote care seeking in postemergency settings. This insight is informing program activities in the current Ebola response in Guinea and could be useful in other crises, such as the global coronavirus disease (COVID-19) pandemic.}, URL = {https://www.ghspjournal.org/content/10/1/e2100429}, eprint = {https://www.ghspjournal.org/content/10/1/e2100429.full.pdf}, journal = {Global Health: Science and Practice} }