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Examining the Relationship Between Interpersonal and Institutional Trust in Political and Health Care Contexts



While many agree that interpersonal and institutional trust are key ingredients for social order, the differences between the two and how they influence one another remain unclear. We define trust as the willingness to be vulnerable to another party, and focus our discussion on situations where the trustor (trusting party) is an individual member of the public and the trustee (party being trusted) is an institution or one of its members. We review the literature on trust and related concepts that address the potential relationships between interpersonal trust and institutional trust, focusing on two illustrative contexts: the political arena and health care. For each context, we examine extant research to provide definitions of institutions and note how these definitions have implications for defining institutional trust in each context. Second, we examine how characteristics of the trustor (individual-level characteristics) may affect the relationship between interpersonal and institutional trust. For example, a trustor’s gender, race and ethnicity, and familiarity with the institutional trustee may frame his/her interactions with, and subsequently their trust in, the institution. Being cognizant of these factors will improve understanding of the cases where a relationship between interpersonal and institutional trust exists. We conclude by highlighting how these arguments can inform future research.
99© Springer International Publishing Switzerland 2016
E. Shockley et al. (eds.), Interdisciplinary Perspectives on Trust,
DOI 10.1007/978-3-319-22261-5_6
Examining the Relationship Between
Interpersonal and Institutional Trust
in Political and Health Care Contexts
Celeste Campos-Castillo , Benjamin W. Woodson , Elizabeth Theiss-Morse ,
Tina Sacks , Michelle M. Fleig-Palmer , and Monica E. Peek
Scholars commonly portray institutional and interpersonal trust as instrumental for
social order. Many depict institutional trust—trust in institutions, such as health
care and government—as necessary for fostering interactions free from malfea-
sance (e.g., Giddens,
1990 ; Gilson, 2003 ; Zucker, 1986 ). Similarly, scholars portray
interpersonal trust—trust in individuals who represent these institutions—as crucial
for sustaining trust in institutions (Kramer,
1999 ; Maguire & Phillips, 2008 ;
Rousseau, Sitkin, Burt, & Camerer,
1998 ; Shamir & Lapidot, 2003 ). A relationship
between individual and institutional trust is intuitive, yet scholars have rarely exam-
ined the existence of this relationship explicitly (e.g., Rousseau et al.,
1998 ;
Schoorman, Mayer, & Davis,
2007 ).
For purposes of this chapter, we adopt Mayer, Davis, and Schoorman’s
2006 ) defi nition of trust as a willingness to be vulnerable to another party.
C. Campos-Castillo (*)
Department of Sociology , University of Wisconsin–Milwaukee , Milwaukee , WI 53202 , USA
B. W. Woodson
Department of Political Science , University of Missouri–Kansas City ,
Kansas City , MO 64110 , USA
E. Theiss-Morse
Department of Political Science , University of Nebraska–Lincoln , Lincoln , NE 68588 , USA
T. Sacks
School of Social Welfare, University of California , Berkeley , CA 94720 , USA
M. M. Fleig-Palmer
Management Department , University of Nebraska–Kearney , Kearney , NE 68849 , USA
M. E. Peek
Section of General Internal Medicine, University of Chicago , Chicago , IL 60637 , USA
Schoorman, Wood, and Breuer ( 2015 ) suggest that this defi nition of trust, although
initially developed for the micro-level of analysis, is applicable to the macro-level
of analysis as well. We also focus our discussion on situations where the trustor
(trusting party) is an individual member of the public and the trustee (party being
trusted) is an institution or an individual representing the institution. In our approach,
we explore how different researchers have defi ned what constitutes the latter (an
“institution”), which reveals unique insights into whether a relationship exists
between interpersonal trust and institutional trust. Put differently, while others have
approached the problem through discussing the defi nition of “trust,” we highlight
that researchers have taken for granted that a shared consensus exists about what is
an institution.
We examine the evidence concerning the reciprocal relationship between inter-
personal and institutional trust. Our discussion focuses on two institutional con-
texts: the political arena and health care. Examining these two specifi c contexts
permits a better understanding of the relationship between individual and institu-
tional trust. First, we consider the differences in how research has conceptualized
what constitutes an “institution.” Whereas there is a consensus that interpersonal
trust occurs between two people, there is little agreement about where institutional
trust is directed. These differences in what constitutes the “institution” carry impor-
tance in determining the type of relationship between interpersonal and institutional
trust. Second, we examine a trustor’s individual-level characteristics and how these
infl uence the relationship between interpersonal and institutional trust. Specifi cally,
we analyze how the trustor’s individual-level characteristics have an impact on the
direction and strength of the relationship between interpersonal and institutional
trust. Further, evidence suggests that certain characteristics infl uence the level of
trust directed at any trustee, but we elaborate on these fi ndings by considering how
researchers defi ne an institution.
D e ning the Institution
Across the range of defi nitions for what is an institution, two patterns emerge. First,
an institution is not only a brick-and-mortar organization, but can be a role or a
specifi c type of person (e.g., physicians and judges). In each case, the institution is
robust to the turnover of the individuals who compose it, indicating that the institu-
tion is persistent and stable. Second, researchers have examined institutions that
range in their proximity to the trustor. We characterize a “local” institution as one
where the trustor has direct contact with the individuals who are members of the
institution and a “remote” institution where such direct contact is minimal or absent.
By locating the institution under investigation in this range, we can better under-
stand the nature of the relationship between interpersonal trust and institutional
trust. Of course, a trustor can have frequent, mediated contact with an institution
(e.g., following relevant news reports about the institution), but the absence of direct
contact maintains the remoteness of the institution. Further, a trustor can have an
C. Campos-Castillo et al.
experience with an institutional artifact, such as its Web site, which can infl uence
trust in the institution. These cases, however, are outside of our focus because they
circumvent the role of interpersonal trust.
Because of our focus on the political and healthcare contexts as well as different
levels of analysis, we defi ne an institution, using Barley and Tolbert (
1997 ), as
“shared rules and typifi cations that identify categories of social actors and their
appropriate activities or relationships” (p. 100). This defi nition permits us to con-
sider an institution that is a brick-and-mortar organization as well as one that is a
role or a specifi c group of persons. The notion of an institution also being viewed as
a role is consistent with the Oxford English Dictionary (
2015 ) defi nition of an insti-
tution as the “establishment in a charge or position.” Thus, our discussion of trust in
institutions could address a specifi c institution such as the Supreme Court or a hos-
pital or a specifi c group of people such as judges and physicians.
There are two characteristics of institutions that are pertinent to our discussion.
First, regardless of the level of analysis, an institution should be robust to the turn-
over of its members, indicating that the institution is persistent and stable. Second,
the spatial location of the institution in relationship to the trustor is an important
consideration (Gössling,
2004 ). Geographic proximity will vary at the level of the
trustor, depending on his/her personal circumstances. Local institutions are those in
which the trustor has frequent contact directly with members of the institution.
Remote institutions are those in which direct contact is minimal or absent. A trustor
can have frequent, mediated contact with an institution (e.g., following relevant
news reports about the institution), but the absence of direct contact maintains the
remoteness of the institution. The permanence and the proximity of an institution
will infl uence the nature of the relationship between interpersonal and institutional
In the context of political institutions, interpersonal trust involves trust in those
individuals who compose the institution—e.g., a member of Congress, a justice of
the U.S. Supreme Court, or the police offi cer walking the beat in a person’s neigh-
borhood. Institutional trust involves the two aspects discussed above: trust in the
institution regardless of the people involved (what we refer to as the “ brick-and-
mortar ” institution, for lack of a better term) and trust in the institutional roles and
types of individuals. When the institution is a brick-and-mortar organization, the
literature is fairly straightforward—people can trust or distrust the U.S. Congress,
U.S. Supreme Court, or federal government—because the boundaries of the institu-
tion (where it starts and ends) are straightforward. These institutions are persistent
and stable, which results in trustors possessing political attitudes toward those insti-
tutions that differ from their attitudes toward members of those institutions. For
example, people’s feelings about the members of Congress are usually much
Examining the Relationship Between Interpersonal and Institutional Trust…
different from how they feel about the U.S. Congress as an institution (Hibbing &
Theiss- Morse, 1995 ).
Another line of research concerns institutions that are roles , or specifi c types o f
individual (Caldeira,
1986 ; Richardson, Houston, & Hadjiharalambous, 2001 ). The
dividing line between interpersonal and institutional trust, in this case, is less clear.
Nonetheless, because roles are persistent and stable even when the individuals occu-
pying the role change, trust in the role (or type of individual) may be defi ned as
institutional trust, while trust in specifi c individuals who occupy the role, such as
Representative Alcee Hastings or Senator Susan Collins, is interpersonal trust. The
role of being a member of Congress exists long after Hastings and Collins leave
The following discussion will lay out the current research that elucidates the
relationship between these different levels of trust—trust in specifi c individuals,
trust in roles or specifi c types of individuals, and trust in brick-and-mortar institu-
tions—for the three major forms of political institutions: the judicial, legislative,
and executive.
Judicial . For judicial institutions the relationship between trust in a specifi c
judge and trust in a court depends on the type of court. For some courts—like a local
criminal court—people interact directly with the individuals composing that court.
Conversely, people rarely interact directly with the individuals who compose more
remote courts like the U.S. Supreme Court. These differences change not only the
relationship between interpersonal and institutional trust, but also the nature of
interpersonal trust. An interpersonal trust based on direct experiences will be much
different from an interpersonal trust based on other, indirect information.
For institutions that are more local to the trustor, such as lower level courts,
research consistently shows that interactions with the individuals composing that
institution affect perceptions of the legitimacy of an institution, an attitude that con-
tributes to trust (see Tyler,
2006a for a review). Tyler ( 2006b ) found that when
people perceive that judges are using a fair decision-making process, they are more
likely to perceive the institution as legitimate and trust the institution. Crucially, the
evidence from Tyler (
2006b ) involves people’s perception of their direct interac-
tions with the courts. Based on Tyler’s work, we propose that this effect operates
through interpersonal trust: people develop interpersonal trust through their interac-
tions with an individual and their perceptions of a “proper process” being followed
in an institution, and this interpersonal trust then affects their trust in the
The relationship between interpersonal trust and trust in institutions that are
more remote is less established. In the case of judicial institutions, the most salient
remote institution is the U.S. Supreme Court. One reason for the lack of evidence on
the nature of cross-level trust is that surveys rarely include questions about indi-
vidual justices. Further, research has not (to our knowledge) tied attitudes toward
specifi c individual justices to attitudes toward the institution. The closest approxi-
mation to a question about individual justices are the popular items that assess peo-
ple’s confi dence in the “leaders” of the U.S. Supreme Court (without specifying the
names of the specifi c occupiers of the bench) or that ask about the procedures and
C. Campos-Castillo et al.
process that justices generally use to make decisions (e.g., Casey, 1974 ; Gibson &
2011 ; Scheb & Lyons, 2000 ). However, aside from the fact that these
items do not measure trust as we are defi ning it, they focus more on the institutional
rather than the interpersonal because they ask about a person’s perception of a
role—U.S. Supreme Court justices—rather than a specifi c individual.
While this research cannot directly answer the question of the relationship
between interpersonal trust in specifi c individual justices and institutional trust in
the U.S. Supreme Court, a debate between Tyler and Rasinski (
1991 ) and Gibson
1989 , 1991 ) over the relationship between procedural fairness and institutional
legitimacy perceptions provides some theoretical guidance. In this debate, Gibson
1991 ) made a distinction between remote institutions like the U.S. Supreme Court
where people often rely on indirect information about how the institution actually
functions and local institutions where people interact directly with the individuals
who compose the institution. When people directly interact with a local institution,
Gibson (
1991 ) concedes that their experience with the individuals composing that
institution affects their institutional trust, but for the remote institutions the opposite
occurs—trust in the institution affects their views of how the institution operates
because people have no direct experience with, and thus no direct information on,
the decision-making process . 1 While Gibson ( 1991 ) examined procedural fairness
perceptions rather than interpersonal trust, the same distinction likely applies to the
relationship between interpersonal and institutional trust for remote and local insti-
tutions. For local institutions, people interact with the individuals within the institu-
tion and develop a sense of interpersonal trust that can then affect institutional trust.
Meanwhile for remote institutions, they never interact with the individuals and thus
cannot develop a fi rm sense of interpersonal trust. Instead, their institutional trust
affects their views of how the individuals operate and thus their interpersonal trust.
Executive . Distinguishing among the institution, the specifi c type of person, and
an individual is less straightforward with the executive branch . Because of this dif-
culty, the Presidency would seem to be the prime case to fi nd a strong relationship
between interpersonal trust in the current president and institutional trust in the
Presidency. However, in one study less than half (46 %) approved of the current
president, despite near consensus of approval (96 %) of the presidential institution,
suggesting that distrusting the individual occupying the offi ce does not lead to dis-
trusting the institution (Hibbing & Theiss-Morse,
1995 ). Political scientists, how-
ever, rarely ask about the institution of the executive branch, focusing instead on the
specifi c president or on the leadership of the executive branch. Associating the
president with the executive branch makes sense since the president “is the embodi-
ment of the executive branch to most people” (Moy & Pfau,
2000 , p. 13), and
approval of the president is signifi cantly and positively related to trust in govern-
ment, although the direction of causation has been debated (Citrin,
1974 ;
2005 ; Williams, 1985 ).
While some people will develop a sense of interpersonal trust with a salient and
prominent person such as the president, the research suggests that whatever inter-
1 See Mondak ( 1993 ) for experimental evidence supporting Gibson’s ( 1991 ) argument.
Examining the Relationship Between Interpersonal and Institutional Trust…
personal trust is developed does not affect institutional trust. However, we expect
that much of the interpersonal trust developed toward the president is highly infl u-
enced by institutional trust. While the president is a part of the institution of the
Presidency, the president is also a member of many other role-type institutions such
as “politician” or, to be more specifi c in the case of the current president, Barack
Obama, a “Democratic politician.” The fact that one of the largest predictors of any
individual’s approval rating of a president is political party affi liation (Bond &
2001 ; Gilens, 1988 ) provides ample support that most of the interpersonal
trust developed toward a president is a result of that president fulfi lling the role of a
“Democratic politician” or a “Republican politician” and actually has little to do
with the individual himself.
Like the distinction between local courts and the Supreme Court, few people
have direct or unmediated interactions with the president, but they do with individu-
als who work for the executive branch, such as their mail carriers and other federal
workers. At the same time that people distrust the government and have negative
views of the federal bureaucracy, they report positive experiences with federal
employees (Rein & O’Keefe,
2010 ) and positive assessments of various bureau-
cratic agencies (Pew Research Center,
2013 ). People can trust their mail carrier to
do a good job delivering the mail; yet, because they do not equate the United States
Postal Service with the executive branch of government, this does not produce insti-
tutional trust. Consequently, in the case of the executive branch, it appears that trus-
tors do not make the connection between interpersonal trust and institutional trust.
Legislative . The most explicit discussion of the relationship between interper-
sonal and institutional trust occurs within research on Congress. People clearly
make a distinction between their own member of Congress (an individual), mem-
bers of Congress as a whole (a specifi c type of person), and the institution of
Congress. Hibbing and Theiss-Morse (
1995 ), using approval rather than trust, found
that almost 90 % of Americans approved of the institution of Congress (88 %), two-
thirds approved of their own member of Congress (67 %), and less than a quarter
approved of the members of Congress as a whole (24 %).
People are taught to appreciate the role of the institution of Congress in the con-
stitutional design of the American government but are encouraged to distrust mem-
bers of Congress in general. In other words, they trust the brick-and-mortar institution
of Congress but do not trust Congress members as a specifi c type of person or role.
Fenno (
1975 ) provides perhaps the best explanation for the juxtaposition between
trusting one’s own specifi c member of Congress and distrusting Congress members
more generally. Individual members of Congress spend a great deal of time in their
districts working to develop trust with their constituents. They do this through their
self-presentations: by emphasizing their qualifi cations and their ability to get things
done in Washington; identifying with their constituents; and displaying empathy,
especially when constituents are experiencing diffi culties. At the same time, they
actively disparage Congress when they run for reelection. All of the negatives asso-
ciated with Congress—such as special interest infl uence, unwarranted perquisites of
offi ce, ineffi ciency, corruption, and scandals—are due to the undifferentiated mass
of other members, not to the representative himself or herself.
C. Campos-Castillo et al.
The distrust people have toward Congress members is also related to the institu-
tion of Congress. Congress is the most transparent institution in the federal
government; all of its dirty laundry gets aired in public. In contrast, much of the
work of the Supreme Court and the president is conducted behind closed doors.
This distinction in transparency helps explain why trust of Congress members is
low compared to the Supreme Court justices and the president and bureaucrats
(Hibbing & Theiss- Morse,
1995 ).
Health Care
Regardless of the referent, there are two common themes in defi nitions of trust in
health care research: risk and vulnerability (e.g., Abelson, Miller, & Giacomini,
2009 ; Gilson, 2003 , 2006 ; Hall, Dugan, Zheng, & Mishra, 2001 ; Mechanic, 1996 ).
Patients who are ill are vulnerable because they do not have the knowledge or skills
to cure themselves but must depend upon the expertise and good will residing in
healthcare institutions (c.f., Gilson,
2003 ). The risk is that they will not be cured, or
even may suffer further injury or harm.
Changes to the structure of health care delivery have altered the image that
comes to mind when an individual thinks about a health care institution (for
detailed discussions, see Scott, Ruef, Mendel, & Caronna,
2000 ; Mechanic, 1996 ;
Rao & Hellander,
2014 ), making it more diffi cult than in the case of politics to
defi ne “institution.” In health care, research into institutional trust has examined
various referents including health systems and medical institutions such as hospi-
tals and clinics (e.g., Abelson et al.,
2009 ; Cook & Stepanikova, 2008 ; Gilson,
2003 , 2006 ; Hall et al., 2001 ). Therefore, for purposes of this chapter, we defi ne a
health care institution broadly as an organization established for the purpose of
treating, managing, and preventing disease. Such organizations could be a hospital,
an outpatient clinic, or a health plan (Cook & Stepanikova,
2008 ; Hall et al., 2001 ;
1996 ).
The question remains, however, whether interpersonal trust and institutional
trust infl uence one another. The management of health care delivery has become
more remote to the trustor (e.g., Swetz, Crowley, & Maines,
2013 ), yet individuals
still have direct contact with their physicians and health care team. Exploring the
framework that commonly informs trust in health care—Mayer and colleagues’
model—helps us understand institutional trust (Schoorman et al.,
2015 ) and how
interpersonal trust helps develop institutional trust (Schilke & Cook,
2013 ). Since
many of the scales that measure institutional trust in health care have conceptual
roots in this model, a reasonable working claim is that interpersonal trust and insti-
tutional trust can infl uence one another in health care. Researchers should exercise
caution with our tentative claim, however, since those who constructed these trust
models deliberately paid little attention to context in an effort to develop the most
generalizable model; research will need to consider whether health care poses an
interesting contingency in the extent that these models generalizes across settings.
Examining the Relationship Between Interpersonal and Institutional Trust…
Lastly, just as with politics we consider the existence of cross-level interaction
when the institution is a role or a specifi c type of person. The existence of this
relationship within health care is less clear than in politics. In one study, researchers
modeled their measure of trust in the physician profession after a similar measure of
trust in a specifi c physician (Hall, Camacho, Dugan, & Balkrishnan,
2002 ). Unlike
the latter measure, the validated items that resulted in the former did not refl ect a
dimension of trust in confi dentiality. The lack of isomorphism in the structure of the
two measures raises the question of whether cross-level interaction can occur.
Moreover, the study found that, while there was a signifi cant correlation between
trust in a specifi c physician and trust in the physician profession, the correlation was
only moderate and was lower than correlations with the other measures they used to
determine validity. Just as in the political arena, however, research fi nds that trust in
a specifi c physician remains high even in the face of declining trust in the medical
profession (Blendon & Benson,
2001 ; Hall, Camacho et al., 2002 ; Pescosolido,
Tuch, & Martin,
2001 ).
In examining the role of physicians, trustors develop perceptions of physicians
in general not only through interpersonal interactions but also through portrayals
in books or the media (c.f., Hall, Camacho et al.,
2002 ), thus the institution of
physicians as a role is more remote because it is more impersonal. If we extrapo-
late this characterization to the role of medical professionals as more remote to the
patient than a more specifi c health institution (e.g., a specifi c hospital or clinic),
then we can develop preliminary claims as we did for the political context. As
posited earlier, a relationship between interpersonal trust and institutional trust is
more likely to occur as the institution becomes more local to the trustor. Indeed,
research fi nds that patients’ trust in a specifi c physician is associated with their
trust in their local health care team (Kaiser et al.,
2011 ) and insurance plan (Zheng,
Hall, Dugan, Kidd, & Levine,
2002 ). A relationship between interpersonal and
institutional trust in the cases where the institution is a role, however, is likely
weaker because the institution is remote. Accordingly, we expect a weaker rela-
tionship between trust in one’s physician and trust in medical professional roles
than when the institution is more local.
Trustors’ Characteristics
Demographics . One moderator that likely affects the relationship between interper-
sonal and institutional trust is the trustor’s demographics. Specifi cally, whenever a
trustor shares demographic traits with the decision makers within an institution, the
type of interpersonal trust developed through shared demographics can translate
into greater institutional trust, but this only occurs when the institution as a whole is
representative of the trustor’s demographics. In political science this phenomenon
C. Campos-Castillo et al.
is known as descriptive representation. For example, a woman might feel greater
trust in her female legislator than in her male legislator. Generalizing to the whole
legislature, women might have greater trust in the legislature when it consists of a
representative number of women (about 50 %) than when it is dominated by men.
The cause of the descriptive representation phenomenon is complex. Both
Mansbridge (
1999 ) and Williams ( 1998 ) argue that, theoretically, the positives that
come with being represented by someone who shares one’s race or gender—includ-
ing feeling better able to communicate with the representative and better repre-
sented in terms of their shared interests—contribute to more interpersonal trust
between the representative and the constituent, and this subsequently leads to
greater trust in the institution.
Empirical work provides a less clear picture than the theoretical argument. In
terms of race and ethnicity, whites are more likely to respond favorably to same-race
representatives than African Americans (Gay,
2002 ). Whites are more likely to
remember what their legislators have accomplished, to approve of their job perfor-
mance, and to view them as resources when their representatives are white. African
Americans do not have the same positive responses to their African American rep-
resentatives. Contrary to expectations, then, it is white constituents who react most
positively to having a same-race representative. However, this deals with attitudes
toward individual members of Congress rather than attitudes toward the institution.
Approval of Congress as an institution is not related to descriptive representation
2002 ). Support for the importance of descriptive representation increases
when attention shifts from the federal to the local level. African Americans are more
likely to trust their local government when they have an African American mayor
than a white mayor (Abney & Hutcheson,
1981 ; Howell & Fagan, 1988 ). Latinos
also feel less alienated from the political system when they are descriptively repre-
sented (Pantoja & Segura,
2003 ), likely because they feel less excluded from the
political system (Abramson,
1972 ; Bobo & Gilliam, 1990 ).
The theoretical argument is better supported when the focus turns to women. As
the proportion of female legislators increases, women view the legislature as more
legitimate (Norris & Franklin,
1997 ). Schwindt-Bayer and Mishler ( 2005 ) nd, in a
cross-national study, that women’s descriptive representation is signifi cantly related
to perceived legitimacy of the government. As with race and ethnicity, the descrip-
tive representation of women has a more pronounced effect at the local rather than
the national level. Focusing on people with a moderate amount of political aware-
ness, Ulbig (
2007 ) found that women living in municipalities with more female
representation had signifi cantly more trust in the municipal government than women
who experienced more male representation. Interestingly, men reacted in the oppo-
site way, becoming much less trusting the more women representatives there were
in local government.
Familiarity . We conceive of familiarity with the political institution as political
knowledge, which we expect to be a key moderator affecting whether interpersonal
trust can affect institutional trust within politics. One requirement that must occur
before interpersonal trust can affect institutional trust is knowing the people who
compose the institution. In the case of political institutions, this basic requirement
Examining the Relationship Between Interpersonal and Institutional Trust…
is not met by much of the American public. Political science is rife with studies
bemoaning Americans’ lack of knowledge concerning politics (Gaziano,
1997 ;
Gilens, Vavreck, & Cohen,
2007 ; Prior, 2005 ). In Delli Carpini and Keeter’s ( 1993 )
highly infl uential study on political knowledge, only 29 % of the sample could name
their own member of the House of Representatives. If someone cannot name his/her
own House member, he/she probably also does not have a sense of interpersonal
trust toward that member; lacking that, his/her interpersonal trust cannot affect insti-
tutional trust.
While a certain level of political knowledge is required for interpersonal trust to
affect institutional trust, political knowledge may also provide a buffer that prevents
interpersonal trust from affecting institutional trust. Those with more political knowl-
edge should be better at separating their feelings concerning what Hibbing and
Theiss-Morse (
1995 ) called the Constitutional and the Washington system, or alterna-
tively what Easton (
1965 ) called the regime and the current authorities. In both cases,
the former involve political institutions while the latter involve the individuals who
compose those institutions. Only those with an adequate understanding of the politi-
cal system can separate the disagreeable actions of the current occupants of an institu-
tion from their feelings about the institution itself. Both McCloskey and Zaller (
1984 )
and Delli Carpini and Keeter (
1993 ), for example, show that those with more political
knowledge were more likely to support democratic values, a key component of which
is supporting the political system even when they dislike the current political authori-
ties. A survey by Hibbing and Theiss-Morse (
1995 ) nds more direct evidence that
knowledgeable citizens are more likely than the average citizen to separate their feel-
ings about the people who compose an institution from the institution itself. In their
survey, while all groups of people disliked members of Congress and liked Congress
as an institution, political involvement, which often is a proxy for political knowl-
edge, increased the disconnect between these two types of evaluations. Those who are
more involved in politics are more likely to disapprove of members of Congress but
also more likely to approve of the institution of Congress. Thus, it appears that know-
ing more about politics, and presumably more about the individual members compos-
ing an institution, does not necessarily lead to a greater relationship between
interpersonal and institutional trust but instead may inhibit that relationship.
Health Care
The focus within the health care literature has been primarily on trust in a specifi c
physician, but this research sheds light on whether interpersonal and institutional
trust infl uence one another in this context. Research documents that trust in one’s
own physician infl uences patient satisfaction, adherence to treatment, continuity
with a provider, disclosure of medically relevant information, and seeking health-
care services (Calnan & Rowe,
2006 ; Saha, Jacobs, Moore, & Beach, 2010 ). The
C. Campos-Castillo et al.
fact that trust has been found to vary based on individual-level patient factors
including gender, race, and education has raised numerous questions about whether
trust explains health and health care disparities.
Indeed, the literature suggests whites, women, and those with more education are
generally more trusting than their counterparts. The evidence suggests African
Americans and Latinos are less likely than whites to trust their physician, even after
controlling for socioeconomic status, health status, and healthcare access
(Armstrong, Ravenell, McMurphy, & Putt,
2007 ; Boulware, Cooper, Ratner,
LaVeist, & Powe,
2003 ; Johnson, Saha, Arbelaez, Beach, & Cooper, 2004 ; LaVeist,
Nickerson, & Bowie,
2000 ; Peek et al., 2013 ; Schnittker, 2004 ). With regard to
gender, the evidence suggests men are less likely to trust their health care provider
compared to women (Armstrong et al.,
2007 ; Schnittker, 2004 ). Race moderates
this relationship for women, in that black women generally report lower trust than
white women (Armstrong et al.,
2007 ). Lastly, studies have found people with less
education, particularly less than a high school diploma, report lower trust than those
with a high school diploma and/or a college degree (Schnittker,
2004 ).
The persistence of these fi ndings speaks to the relationship between interper-
sonal and institutional trust within health care. A confl uence of factors predisposes
certain subgroups not to trust in physicians or in health care more generally.
Consider, for example, the residue of historic and contemporary racial discrimina-
tion in health care. Although the 1932 Tuskegee Syphilis Study is often the most
well-known example of racial discrimination in medical research, experimentation
and poor treatment occurred before and after this oft-cited historical event (Gamble,
1997 ). A signifi cant body of literature documents more recent instances of experi-
mentation and substandard medical care (Dittmer,
2009 ; Washington, 2006 ). All
told, historical and contemporary social forces likely affect racial minorities’ trust
in the health care context (Gamble,
1997 ; Washington, 2006 ).
These issues are particularly relevant in the context of minority, female, and low-
income patients who may be more likely to experience discrimination, both in gen-
eral and in health care settings. For example, the literature suggests a lack of trust
may not necessarily be focused on a single provider. Rather, negative experience
with one provider may lead to lower trust of the health care sector in general (LaVeist,
Isaac, & Williams,
2009 ; Peek, Sayad, & Markwardt, 2008 ). Consistent with this,
other research fi nds that black women tend to have low trust in primary care provid-
ers, which is often associated with lower trust in their health care team (Kaiser et al.,
2011 ). Based on extant research in the medical fi eld, interpersonal and institutional
trust are interdependent such that a person’s assessment of one level or domain is
likely to affect the other and demographic variables infl uence this relationship.
The persistence of demographic differences in trust raises the question of how
familiarity contributes to the relationship between institutional and interpersonal
trust in health care. Just as in politics, the lack of familiarity with a key institutional
Examining the Relationship Between Interpersonal and Institutional Trust…
representative—in this case, a specifi c health care professional—hinders the trans-
lation of interpersonal to institutional trust. Many studies document that utiliza-
tion—i.e., experience with specifi c healthcare professionals—is positively
associated with trust (O’Malley, Sheppard, Schwartz, & Mandelblatt,
2004 ; Whetten
et al.,
2006 ). In the case of racial and ethnic minorities, however, the issue is com-
plex because racial and ethnic minorities may cite lower trust precisely because of
their experience, and even with a lack of recent or regular experience with a physi-
cian. One study (Campos-Castillo,
in press ) nds that racial and ethnic differences
in trust in health care professionals (the role, not a specifi c person who occupies the
role) are equivalent between those who are more familiar (i.e., had a recent
health care experience) and less familiar (i.e., did not have a recent health care expe-
rience). Thus, further research is needed.
Whether interpersonal trust and institutional trust infl uence one another is a common
question raised within the literature. Whereas others have focused on defi ning
“trust,” we considered how the defi nition of an “institution” impacts the answer to
this question. Our defi nition supports the conceptualization of an institution as an
organization of “ bricks and mortar” or as a group of people in an identifi ed role. Two
characteristics of institutions, as we have defi ned them, are that they are robust to the
turnover of individuals and that they vary with respect to proximity to a trustor.
Whether an institution is local or remote to the trustor infl uences the type of relation-
ship between interpersonal and institutional trust. In the context of these features, we
also considered how the individual-level characteristics of the trustor, demographics
and familiarity, factor into the relationship between interpersonal and institutional
trust. A close examination of research questions that scholars have asked within the
two illustrative institutional contexts—health care and the political arena—reveals
many differences and agreements. While the approach to the problem has differed,
there is much that each institutional context can learn from the other.
Many within health care, for example, lament that progress in understanding
trust falls behind the progress in other fi elds (e.g., Gilson,
2003 ; Ozawa & Sripad,
2013 ). Indeed, even a cursory overview of the literature reveals stark differences.
Whereas the literature in politics can easily be organized based on which specifi c
institution is the focus, within health care it is very diffi cult to develop such clear
organization. Part of this, as we stated earlier, has to do with the changes in the
structure of healthcare delivery, which blur the boundaries of where an institution
starts and ends. We noted, however, that in the few instances in which researchers
have clearly defi ned what an “institution” is, respondents were able to differentiate
among the numerous referents. Future research on institutional trust within health
care should defi ne carefully what comprises the referent.
One consistent trend across both domains is that racial minorities are less likely
to trust institutions than whites. Reducing this gap may be easier for local than for
C. Campos-Castillo et al.
remote institutions. If the members of the local institution provide a positive experi-
ence for those interacting with them, the interpersonal trust developed will likely
transfer into institutional trust. The same may not hold for remote institutions. Even
if the people composing the remote institution provide positive experiences, the
interpersonal trust may not transfer into institutional trust. This can make it diffi cult
to bridge the racial trust gap for remote institutions. Even when traditionally disen-
franchised groups perceive an individual within an institution providing benefi cial
services—whether as a representative in Congress or as a health care provider—
they may separate that individual’s actions from the institution. This dynamic can
be seen in the impact of descriptive representation, which increases trust for local
institutions but not for remote national institutions. Some other strategy besides
individuals providing positive services may be required to increase trust in remote
In both contexts we noted a paucity of research that examined explicitly the
direction of causality. We relied on peripheral but relevant research to develop a
claim that the extent to which an institution is remote or local to the trustor impacts
whether interpersonal trust affects institutional trust, or the reverse. Such causal
claims are best examined through longitudinal research or controlled laboratory
environments, methods rarely used by researchers in politics and health care to
examine trust (for some exceptions, see Hall, Dugan, Balkrishnan, & Bradley,
2002 ;
Pearson, Kleinman, Rusinak, & Levinson,
2006 ; Scherer & Curry, 2010 ). Given the
heightened cynicism many Americans feel toward a variety of institutions and the
individuals composing those institutions, determining whether interpersonal trust
can increase institutional trust or vice versa is of the utmost importance.
Lastly, current changes in the health care and political arenas may potentially
complicate the delineation of what constitutes an institution. For example, contem-
porary changes stemming from the passage of the Affordable Care Act (ACA) stand
to open the door for greater prominence of existing actors that the public tradition-
ally does not consider to be members of the health care fi eld (e.g., lawyers, drug
courts) and of the rise of brand new actors (e.g., community health workers) needed
to fi ll new roles (Kellogg,
2014 ; Peek et al., 2012 ). The recent push by the federal
government to incentivize the adoption of electronic health records (EHRs) also
complicates the fi eld. A recent study, for example, found that patients’ trust in gov-
ernment impacts their acceptance of federal involvement in the push for EHR adop-
tion (Herian, Shank, & Abdel-Monem,
2014 ). These two institutional contexts—the
political arena and health care—while examined separately thus far will increas-
ingly need to be examined jointly by researchers.
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Examining the Relationship Between Interpersonal and Institutional Trust…
... On the one hand, citizens want their political leaders to interpersonally resonate with them, and to consider both the personal values and interests of the public as well as expert advice during complex decision making. On the other hand, what the public wants from their scientifically oriented government agencies can be quite different: transparent, non-ideological communications and instructions, directly from scientific experts, on complicated and evolving crises [33][34][35]. Therefore, the ultimate responsibility for crisis management actually resides within the national and local agencies, and their historical competence and consistency especially during crises is what fosters institutional trust [32][33][34]. ...
... On the other hand, what the public wants from their scientifically oriented government agencies can be quite different: transparent, non-ideological communications and instructions, directly from scientific experts, on complicated and evolving crises [33][34][35]. Therefore, the ultimate responsibility for crisis management actually resides within the national and local agencies, and their historical competence and consistency especially during crises is what fosters institutional trust [32][33][34]. ...
... In our context, national political leader trust is expected to be more influenced by the interpersonal and political dimensions, and trust in public health agencies is expected to be more influenced by the institutional trust dimension [28,[36][37][38]. Theoretically, the institutional trust dimension is recognized to be more influenced by legal regulations and precedence, civic norms, and social contracts, and is further strengthened by agencies being comprised of staff trained to fulfill the trusted social roles of scientific and medical experts [30,34,36,79,86]. Thus, our finding that national institutional trust is more predictive than trust in national political leaders for securing public health compliance during a pandemic makes conceptual sense, due to the inherent differences in the nature of political leader trust versus institutional trust [34]. ...
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... Reconceptualizing trust through co-production invites multiple perspectives and patterns of lived experience to the conversation including those experienced by patients and families, healthcare teams, their larger organization, or even science as a whole. Within those groups exist multiple, unique, layered and intersecting identities shaped and influenced not only by the current infodemic, but also by dynamics such as social power and political histories (15). In short, the study of "how" trust forms within larger relational contexts, not "what comprises trust" creates opportunities for new approaches to trust research in healthcare. ...
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... Maloney et al. (2000) argue that public trust in government can constitute an efficient resource for coping with collective action dilemmas in the fields of education, public health, crime, economic development, and government performance. Further studies investigate the relationships between public trust in government and interpersonal trust (Schiffman et al., 2010;Campos-Castillo et al., 2016), as well as organisational participation of citizens (Yang, & Holzer, 2006;Lee & Schachter, 2019). The authority of government is justified based on the support from the public, since building the institutional trustworthiness of government can foster cooperation and compliance with policies implemented by government (Kim, 2005). ...
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The concept of market orientation, which focuses on the entire market to address customer needs adequately, has garnered increased interest by practitioners and academics in the past decades, given its efficacy in achieving organisational performance. Despite the growing interest in the concept, the literature review has shown that scholars have primarily focused on its applicability in the for-profit organisations with limited attention to how the concept could be practised in the public sector, particularly in Sub-Saharan Africa. There is a need to examine the phenomenon in the public sector context and identify factors and antecedents necessary for applying the concept to the public sector. This chapter, therefore, seeks to (1) determine the present level of research on market orientation in the public sector, (2) determine its impact, if any, on public sector performance, and (3) identify factors or antecedents necessary for effective implementation of the concept in the public sector organisations and suggest avenues for future research in the subject area.
... As a result, mistrust of healthcare providers and medical institutions may be understood as a rational adaptation to a healthcare system that is often implicitly and explicitly hostile to Black people. The research literature suggests Black and Latinx people, including Black women, are less likely than white people to trust their physician, even after controlling for socioeconomic status, health status, and healthcare access (32). ...
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Breast cancer is the most commonly experienced cancer among women. Its high rates of incidence and survival mean that a number of women will live it for periods of their lifetimes. Group differences in breast cancer incidence and mortality occur by race and ethnicity. For example, while white women are slightly more likely to be diagnosed with breast cancer, Black women are 40% more likely to die from the disease. In this article, rather than focusing the discussion on individual-level factors like health behaviors that have the potential to blame Black women and those living in poverty for their conditions, we view breast cancer disparities through the lens of Critical Race Theory, taking a historical perspective. This allows us to delve beyond individual risk factors to explore social determinants of breast cancer disparities at the population level, paying special attention to the myriad ways in which social factors, notably views of race and discriminatory public policies, over time have contributed to the disproportionate breast cancer mortality experienced by Black women. We suggest ways of addressing breast cancer disparities, including methods of training healthcare professionals and public policy directions, that include rather than marginalize Black and lower socioeconomic status women.
Background Self-regulation is well suited for health care providers as the distinctive knowledge requirements can be effectively managed by those with the specific knowledge base compared to national or provincial/state governments. Despite their prevalence and long history in health care, self-regulating professions have become a topic of increasing debate as a result of evidence of declines in trust in a number of institutional contexts. Objective It is important that Pharmacy Regulatory Authorities (PRAs), as the regulating body for a critical health profession, can demonstrate and proactively respond to issues related to public trust. Such capabilities are needed to address an overall decline in trust in self-regulated professions and allow PRAs to quickly address issues that may impact public trust within their own jurisdiction. However, a process and best practices that allow PRAs to demonstrate institutional trustworthiness to the public is lacking. Given the need from both a research and practice perspective, this research develops a conceptual framework of how PRAs can demonstrate institutional trustworthiness to the public. Methods The literature was reviewed to identify dominant themes associated with regulatory practice that would serve to demonstrate institutional trustworthiness of PRAs to the public. Eight best practice themes emerged: public interest objective, transparency, engagement, accountability, independence, collaboration, adaptability, and awareness. Results The conceptual framework is comprised of six key steps, related to defining public interest orientation, implementing trust-related best practices, developing a communication strategy to increase public awareness of PRA activities, monitoring symbolic capital, assessing public trust in registrants (interpersonal trust), and assessing public and registrant trust in the regulator (institutional trust). Conclusion Future research should develop pharmacy-focused instruments related to trust, establish baseline measures of registrant and public trust in pharmacy regulatory authorities, and explore issues of public trust in PRAs between different cultures and developed and developing countries.
This article builds upon a multilevel theory of trust to explore the relationship between general trust in health care systems and general trust in physicians and the social-contextual factors that shape this relationship. We develop a model of trust in physicians emphasizing the embeddedness of individuals in broader social-institutional contexts. We analyze data from 30 countries in the 2011 International Social Survey Program ( N = 38,068) and specify hierarchical linear models with macro-micro level interactions. At the individual level, we find that individuals who trust the health care system are more likely to trust physicians in general. At the country level, we find that respondents from countries with predominately publicly financed health care systems are more likely to trust physicians than their counterparts in countries with less public funding of the health care system. Finally, we find that the greatest predicted probability of trust in physicians is found among individuals who trust their publicly funded health care system and the lowest probability is among individuals who have no confidence in their privately funded health care system. Based on these findings, we call for greater attention to the interaction of micro- and macro-level factors in models of trust in physicians cross-nationally.
This chapter seeks to improve our understanding of the critical role trust plays in enhancing good governance. It is generally argued that citizens’ trust in government is dwindling, which in turn poses a serious threat to representative democracy. Studies on trust and its implications for good governance have concentrated mostly on developed countries, with little focus on the developing world or the African continent in particular. This chapter provides an insight into the relationship between trust and other democratic values such as freedom of expression, judicial independence, control of corruption, accountability, and approval of democratic tenets. The increasing need for good governance has brought to the fore the significance of trust that the citizens have for their governments in promoting good governance. The chapter will also discuss the utility of the concept of the new public management in contributing to the discourse on trust and good governance. Using a qualitative research design, specifically the narrative approach, this chapter examines citizens’ trust for government. The study draws examples from Ghana, South Africa, and Bostwana to support the discussions. The study found that the declining levels of trust in Africa can be attributed to some factors, including low approval rate of democracy, lapses in control of corruption, and low levels of transparency and accountability coupled with low levels of freedom of expression. This falling trend calls for the strengthening of institutions to ensure public sector accountability, enhancing the role of the media as watchdogs in the political scene and enhancing the participation of citizens in the governance process.
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Objective. To develop a scale to measure patients' trust in health insurers, including public and private insurers and both indemnity and managed care. A scale was developed based on our conceptual model of insurer trust. The scale was analyzed for its factor structure, internal consistency, construct validity, and other psychometric properties. Data Sources/Study Setting. The scale was developed and validated on a random national sample (n=410) of subjects with any type of insurance and further validated and used in a regional random sample of members of an HMO in North Carolina (n=1152). Study Design. Factor analysis was used to uncover the underlying dimensions of the scale. Internal consistency was assessed by Cronbach's alpha. Construct validity was established by Pearson or Spearman correlations and t tests. Data Collection. Data were collected via telephone interviews. Principal Findings. The 11-item scale has good internal consistency (alpha=0.92/0.89) and response variability (range=11–55, M=36.5/37.0, SD=7.8/7.0). Insurer trust is a unidimensional construct and is related to trust in physicians, satisfaction with care and with insurer, having enough choice in selecting health insurer, no prior disputes with health insurer, type of insurer, and desire to remain with insurer. Conclusions. Trust in health insurers can be validly and reliably measured. Additional studies are required to learn more about what factors affect insurer trust and whether differences and changes in insurer trust affect actual behaviors and other outcomes of interest.
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In this comparative ethnographic case study of the implementation of a reform related to the Affordable Care Act in two community health centers, I find that professionals may not compete to claim new tasks (and thereby not implement reform) if these tasks require them to acquire information unrelated to their professional expertise, use work practices that conflict with their professional identity, or do impure or low-value tasks that threaten their professional interests. In such cases, reform may be implemented if lower-status workers fill in the gaps in the division of labor between the professions targeted by the reform, playing a brokerage role by protecting each profession's information, meanings, and tasks in everyday work. When the new tasks represent professionally ill-defined problems, brokers can be more effective if they use buffering practices rather than connecting practices-managing information rather than transferring it, matching meanings rather than translating them, and maintaining interests rather than transforming them-to accomplish reform. By playing a buffering role in the interstices between existing professional jurisdictions, lower-status workers can carve out their own jurisdiction, becoming a brokerage profession between existing professions that need to collaborate with one another for reform to occur.
The authors examine determinants of satisfaction with medical care among 1,784 (781 African American and 1,003 white) cardiac patients. Patient satisfaction was modeled as a function of predisposing factors (gender, age, medical mistrust, and perception of racism) and enabling factors (medical insurance). African Americans reported less satisfaction with care. Although both black and white patients tended not to endorse the existence of racism in the medical care system, African American patients were more likely to perceive racism. African American patients were significantly more likely to report mistrust. Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care. When perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.
Objective. We investigate the extent to which the American people subscribe to "the myth of legality" - the notion that the Supreme Court's decisions are based on legal principles rather than on political influences. Methods. Using survey research, we examine the mass public's perceptions of the bases for Supreme Court decisions. We identify those perceptions that are consistent with the myth of legality and isolate the "myth holders." Finally, we embed myth holding into a broader model of public evaluation of the Supreme Court. Results. We find that the myth holders are better educated, more attentive to the Court, and more favorable to the Court as an institution, even when controlling for other determinants of public evaluation of the Court. Conclusions. The myth of legality is a viable component of American political culture that assists citizens in making sense of the Supreme Court's decision-making processes.
PurposeA fairly consistent finding in research on trust in physicians is that racial and ethnic minorities cite lower levels than whites. This research typically samples only health care users, which limits our understanding of what underlies distrust. It remains unclear whether the distrust is generalized, which is distrust that is unrelated to using health care regularly or recently. Methodology/approachUsing data from the Health Information National Trends Survey, multivariable logistic regressions assessed whether racial and ethnic differences in distrust (1) are equivalent among health care users and non-users; (2) regardless of respondents’ health and socio-economic status; and (3) manifest in other health information sources. FindingsRacial and ethnic minorities are less likely than whites to trust physicians as health information sources. These racial and ethnic differences are equivalent among health care users and non-users, regardless of respondents’ health and socio-economic status. The racial and ethnic patterns do not manifest when predicting trust in other health information sources (Internet, family or friends, government health agencies, charitable organizations). Research limitations/implicationsData are derived from a cross-sectional survey, which makes it difficult to account comprehensively for self-selection into being a health care user. Despite the limitations, this research suggests that racial and ethnic minorities possess a generalized distrust in physicians, necessitating interventions that move beyond improving health care experiences. Originality/valueMany researchers have surmised that a generalized distrust in physicians exists among racial and ethnic minorities. This chapter is the first to explicitly examine the existence of such distrust.
The theoretical foundations of this chapter are based on the work of Mayer, Davis, and Schoorman (1995) and Schoorman, Mayer, and Davis (2007) (see Fig. 2.1). First, we briefl y review the competing defi nitions of trust that have been widely adopted in the past 20 years. Next, we examine the implications of the choice of defi nition, and fi nally we will review some of the constructs used to represent trust across a number of disciplines. In doing so we view these constructs from the lens of the Mayer et al. (1995) defi nition.
Gibson (1989) questions whether the Supreme Court's ability to legitimate unpopular policies is based on public views that the Court is a fair decisionmaker. His claim is based on his analysis of a survey examining the ability of the Supreme Court to gain acceptance of the right of an unpopular political group to demonstrate. A reanalysis of Gibson's data using a model allowing for both direct and indirect effects of public views about the fairness of court decisionmaking procedures on acceptance does not support Gibson's conclusion that procedure has no influence on acceptance. Our results indicate that public views about the fairness of Supreme Court decisionmaking procedures have an indirect effect on acceptance through their influence on public views about the Court's legitimacy and support the suggestion of a number of studies that the legitimacy of both local and national legal institutions, and the willingness to accept their decisions, are influenced by views about the fairness of their decision-making procedures.