Healthcare Providers as Trusted Messengers: Results From Three Timepoints During the COVID-19 Pandemic

Abstract

During the COVID-19 pandemic, healthcare professionals struggled to get accurate, up-to-date information to community members, especially to minoritized, marginalized, and underserved communities. Healthcare providers themselves are often viewed and used as trusted messengers, but it has been unclear as to the effectiveness of that approach over time. In this study, we examine quantitative data on trusted messengers of COVID-19 information at three timepoints (2021, n = 150; 2023, n = 52; 2024, n = 51) in racial/ethnic minoritized communities in Arizona to determine whether trusted messengers remained consistent over time. In addition, a 2022 rural Arizona healthcare provider survey (n = 65) assessed COVID-19 needs around support and training during the pandemic. Using a frequency analysis, results showed that community members consistently reported that healthcare providers were the most trusted source of accurate information, but healthcare providers indicated a need for additional support and training to communicate more effectively with their patients. This study advances knowledge for practice by demonstrating the persistent trust placed in healthcare providers by minoritized, marginalized, and underserved communities during the COVID-19 pandemic, while also identifying a clear need for enhanced support and training to help these providers effectively fulfill their role as trusted messengers.

Keywords

COVID-19 patient–provider communication community health health disparities pandemic race/ethnicity rural health

Background

There is a growing scientific literature that explores the role of trusted public health messengers, particularly following the COVID-19 pandemic (Leonard et al., 2022). Trusted public health messengers are individuals or groups who hold credibility within a specific community and often include healthcare providers, community leaders, faith leaders, peer educators, or others who share cultural or social ties with their audience. By bridging the gap between health entities and those they aim to serve, trusted messengers play a crucial role in fostering trust and ensuring important health information is accessible and actionable while increasing community participation and sustainability of interventions (Carmona et al., 2023). A recent examination of trust highlighted learnings for future inquiry, pointing to the need for recognizing trust as evolving and assessing cultural and contextual factors over time (Schiavo & Chou, 2023).

Healthcare providers are consistently seen as trusted messengers for COVID-19 vaccines, specifically among underserved communities (Rabin & Kohler, 2023). Providers have heightened professional obligations to communicate best available health information (Bautista et al., 2021) and foster and maintain trust for the public’s health (Skirbekk et al., 2023). Yet, minoritized, marginalized, and underserved populations have disproportionately expressed decreased levels of trust in medicine and healthcare, often in relation to providers (Webb Hooper et al., 2022). The ability to utilize trusted messengers in a community must align with culturally tailored messaging and the population’s values and lived experiences to strengthen the relevance of the message (Kroll et al., 2023). In the context of COVID-19, scientific, health, social, and policy uncertainties meant that the information and the messengers relied upon by the public were subject to change over time (Kroll et al., 2023).

Thus, Carmona et al. (2023) suggested that it is important for future studies to examine whether and how sources people trust shift over time, and during the COVID-19 pandemic. In this study, we examined data on trusted messengers of COVID-19 information at three timepoints during the pandemic to determine whether trusted messengers remained consistent over the years.

Method

Data came from online surveys with Arizona residents, administered at three timepoints (2021, 2023, and 2024) by the Arizona Community Engagement Alliance (AZ CEAL). AZ CEAL is part of a national research network designed to work with communities and community-based organizations to identify promising engagement and outreach practices that communicate trustworthy, science-based information to communities experiencing health disparities (Ignacio et al., 2023, 2024). In addition, a CDC-sponsored needs assessment conducted an online survey administered in 2022 to healthcare providers in the rural Arizona counties to assess the state of services provided and desired around COVID-19 (Wolfersteig et al., 2024). Informed consent was obtained from all participants. Ethical approval for this study was granted by the universities of the Arizona Board of Regents.

Participants and Recruitment

Community-Based Participants

Participants were recruited from across Arizona but mainly in the Phoenix and Tucson metro areas through partnerships with community-based organizations. Recruitment efforts were designed to overrecruit participants who identified as African American/Black, Hispanic/Latinx, or American Indian/Alaska Native. Following recruitment, a 20-minute online survey was sent to participants. All respondents received a US$45 incentive for participating; in 2021 and 2023, participation also included a focus group, with those findings reported elsewhere (Ignacio et al., 2023, 2024). In total, 253 participants responded (2021 = 150 participants, 2023 = 52 participants, and 2024 = 51 participants). Participant demographics are presented in Table 1.

Table 1

Sample Demographics for Community-Based Participants Across the Three Study Timepoints (2021, 2023, and 2024)

	Timepoint 1 2021	Timepoint 2 2023	Timepoint 3 2024
Participant Demographics	n (% or SD)	n (% or SD)	n (% or SD)
Number of participants	150	52	51
Mean Age	43.7 (15.2)	48.9 (16.2)	31.4 (12.9)
Gender^a
Male	40 (27.6%)	7 (13.7%)	23 (46.9%)
Female	105 (72.4%)	44 (86.3%)	26 (53.1%)
Race/Ethnicity
Hispanic/Latinx	63 (46.0%)	10 (19.2%)	17 (34.7%)
Black/African American	42 (30.7%)	17 (32.7%)	18 (36.8%)
American Indian/Alaska Native	32 (23.4%)	25 (48.1%)	6 (12.2%)
Another Race/Ethnicity (White non-Hispanic, Asian, Multiracial)	0 (0%)	0 (0%)	8 (16.3%)
Education
No high school diploma	15 (10.6%)	4 (7.8%)	11 (22.4%)
High school graduate or GED	35 (35.5%)	9 (17.6%)	19 (38.8%)
Some college—no degree	0 (0%)	14 (27.5%)	15 (30.6%)
College degree	91 (53.9%)	24 (47.1%)	4 (8.2%)
Annual household income
Less than US$20,000	20 (18.2%)	13 (28.3%)	22 (47.8%)
US$20,000–US$34,999	16 (14.5%)	11 (23.9%)	16 (34.8%)
US$35,000–US$49,999	22 (20.0%)	7 (15.2%)	5 (10.9%)
US$50,000 and above	52 (47.3%)	15 (32.6%)	3 (6.5%)

Only one participant identified as Nonbinary, Genderqueer, Genderfluid, Transgender female or trans woman, or Transgender male or trans male. For privacy and confidentiality reasons, their data are not reported in a survey year column.

Healthcare Providers

Healthcare providers were recruited through a nonprofit organization that represents 23 Community Health Centers (CHCs) across rural Arizona. No incentives were provided. A total of 65 providers completed the survey. The majority were female (75.0%). Over half of providers indicated they were White (55.8%), with one-fourth reporting Hispanic (25.0%). Most healthcare providers worked at a federally qualified health center (FQHC) (67.7%), with one-third responding they were affiliated with a rural health clinic/free clinic (36.9%). The most common primary practice specialty type for providers was family medicine (73.8%), followed by mental health (29.2%) (Wolfersteig et al., 2023).

Instruments and Measures

Community-Based Participants

The NIH CEAL Common Survey Data Elements (Walker et al., 2024) were used at the three timepoints and included the trusted messenger question, although the question and responses varied slightly across versions. Participants were asked to indicate their level of trust in each of nine sources of health information: “How much do you trust each of these sources to provide correct information about COVID-19?” Sources assessed were doctors or healthcare providers; faith leaders; close friends and family; work colleagues or classmates; news on the radio, TV, online, or in newspapers; social media contacts; the U.S. government, the U.S. Coronavirus Task Force, or the Centers for Disease Control and Prevention (CDC); and Arizona Department of Health Services or state government. Participants indicated their level of trust on a 3- or 4-point Likert-type scale from not at all to a great deal. Trust ratings were dichotomized for each source into high trust (a great deal) versus low trust (all other responses).

Healthcare Providers

In assessing needs around COVID-19, healthcare providers (n = 65) were asked, “What type of support/training do you need?” and could select all that apply (134 total responses). Types of support/training included COVID-19 conversations, Long COVID management, best practices in answering COVID-19 questions, mental health, cultural awareness, using respirators, creating a referral process for patients with social service needs, telehealth services, resources for the community [specify], and other [specify]. Responses were dichotomized for each type of support/training into yes (1) versus no (0).

Data Analysis

All analyses were conducted at the item level. Participants with missing data for specific items were excluded from the corresponding analyses. Using SPSS v.29, a frequency analysis was conducted to summarize and describe the distribution of responses at each timepoint. Results are presented as percentages for those community participants who endorsed “a great deal of trust” and healthcare providers who endorsed “yes” to a specific type of support/training. In addition, for community participants at each timepoint, results were ranked from 1 to 9, with 1 representing the source with the highest percentage of participants expressing a great amount of trust, and 9 representing the source with the lowest percentage.

Results

As reported in Table 2, across the three surveys, the response “your doctor or healthcare provider” was selected as the most highly trusted source with an average ranking of 1 at all three timepoints, 83.1% in 2021, 64.6% in 2023, and 71.7% in 2024. The U.S. Coronavirus Task Force/CDC ranked second at all timepoints, with an average ranking of 2.3. Likewise, the least trusted sources remained steady over time. “Your contacts on social media” ranked at 9, with “a great deal” of trust percentages at only 9.4%, 9.5%, and 15.2%, respectively; “people you go to work or class with or other people you know” ranked next to last over all three timepoints, with an average rank of 7.3. At timepoint 3, 66.6% (n = 18) of 27 respondents who had a primary care doctor said that they trusted their provider to “provide you with accurate health information.”

Table 2

Percentage of Participants Responding “A Great Deal” for Trusted Sources of COVID-19 Information

	Timepoint 1 2021, n = 150		Timepoint 2 2023, n = 52		Timepoint 3 2024, n = 51		Average rank
Trusted Sources of COVID-19 Information	%	Rank	%	Rank	%	Rank	Average rank
Your doctor or healthcare provider	83.1	1	64.6	1	71.7	1	1.0
U.S. Coronavirus Task Force/CDC	66.2	2	48.9	3	59.1	2	2.3
Your close friends and members of your family	48.9	4	50.0	2	40.0	4	3.3
Your faith leader	45.1	5	46.9	4	41.9	3	4.0
Arizona Department of Health Services/state government	64.9	3	22.7	5	34.1	6	4.7
The U.S. government	37.2	6	22.2	7	37.8	5	6.0
News on the radio, TV, online, or in newspapers	30.5	7	22.7	5	31.3	8	6.7
People you go to work or class with or other people you know	20.0	8	20.0	8	34.1	6	7.3
Your contacts on social media	9.4	9	9.5	9	15.2	9	9.0

For the healthcare providers’ survey, data are shown in Table 3. The most reported need for support or training was “Long COVID management” (35.4%, n = 23), followed by “COVID-19 conversations training,” “cultural awareness,” and “mental health support training,” all reported by 29.2% (n = 19). The lowest rated priority was “dealing with multiple comorbidities with Long COVID problems.”

Table 3

Support and Training Needed by Rural Healthcare Providers (n = 65)

Types of Support and Training	Number	Percent (%)
Long COVID management	23	35.4
COVID-19 conversations training	19	29.2
Cultural awareness	19	29.2
Mental health support training	19	29.2
Training on best practices in answering COVID-19 questions	18	27.7
Training in creating a referral process for patients with social service needs	13	20.0
Training and support for providing and billing for telehealth services	9	13.8
Resources for the community	6	9.0
Training in the use of respirators	5	7.7
None	2	3.0
Dealing with multiple comorbidities with Long COVID problems	1	1.5

Discussion

Results of this study suggest that across communities, “trusted messengers” remained stable over the course of the pandemic from 2021 to 2024. Minoritized, marginalized, and underserved community members consistently viewed their doctor or healthcare provider as the most trusted source of information, while contacts on social media were consistently ranked as the lowest trusted source. Our study was able to identify the consistent and important role of healthcare providers for underserved community members by examining patterns over three timepoints during the pandemic, mirroring the individual timepoint results described in the “science of trust” special issue of the Journal of Communication in Healthcare, where doctors were one of the highest-rated trusted sources (Kroll et al., 2023). Elwood (2023) discussed the relationship of trust between patients and providers and how it is established through patient–provider communication that needs to be developed and maintained over time to impact health outcomes, since “relationships are at the core of trust” (Schiavo & Chou, 2023, p. 317).

When asked, our participants also said they trusted their doctor or healthcare provider to deliver accurate health information. Yet, many of the surveyed healthcare providers indicated that they needed more support and training in COVID-19 conversations and Long COVID management, as well as in cultural awareness and mental health support. This need for more information on the part of providers was substantiated during a follow-up debriefing held in May 2023 with a health advisory/provider task force, where providers expressed their need for support surrounding COVID messaging (Wolfersteig et al., 2024). Providers stated that community members and patients still had questions about Long COVID, and that they found it difficult to provide specific Long COVID guidance due to the variety of symptoms and interactions with comorbidities. Providers also expressed a strong need for the development of messaging materials on challenging topics like Long COVID, inclusive but not limited to handouts, flyers, infographics, and FAQ sheets in English and Spanish. Research has indicated that to ensure effective communication, providers need access to communication strategies that emphasize knowledge of content, timing, and format of messaging (Liu et al., 2025). Providers also advocated that more resources for healthcare professionals be available so they could participate in direct outreach to their community.

As healthcare providers, they recognized their role as local trusted messengers and sources of information, alongside elected officials, faith-based leaders, schoolteachers, and administrators. This role may become increasingly important as federal guidelines around the delivery of COVID-19 and other vaccines continue to evolve. Recent federal COVID-19 prescription requirements confused Arizona, despite a 2025 executive order by Governor Hobbs allowing vaccine access without a prescription (Arizona Governor’s Office, 2025). This highlights the potential need for additional resources to support healthcare providers in sharing clear information as trusted messengers. Identification of healthcare providers’ need for more information and resources surrounding communication and engagement suggests there is a gap between healthcare providers being the most trusted source and them being equipped to deliver health information and live up to their community reputation and role as trusted messengers. Healthcare settings and trainings could offer providers protected time that they can spend on understanding emerging best practices to strengthen patient-provider communication and engagement that address operational, medical, and supportive information before, during, and after patient visits to improve patient experience and patient health outcomes (Liu et al., 2025).

Limitations

These results could not be reported separately by racial/ethnic group or other demographic factors, as the number of participants was too small within groups. However, when analyzing each survey by all respondents, patterns emerged. This study was based on small convenience samples in Arizona, and results are not representative of the state and not necessarily generalizable to other regions or populations. Further, the surveys were not designed specifically to study the specific research question on trusted messengers changing over time, but with similar questions asked across time, it provided a unique opportunity to examine that topic.

Implications for Practice

The study findings suggest that patterns in sources of trusted messengers remained consistent throughout the pandemic, with underserved and minoritized community members consistently identifying their doctor or healthcare provider as their most trusted source of information. However, while healthcare professionals held this position of trust, they reported needing additional support systems and resources to effectively fulfill their role in providing patients with accurate and accessible information. These insights highlight the critical need for strengthening support for healthcare providers, ensuring they have the tools and resources necessary to maintain trust and effectively communicate essential health information, particularly in times of crisis and changing guidance.

Footnotes

Authors’ Note:

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported in this publication for the three AZ CEAL surveys was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Numbers OT2HL156812. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Research reported for the health disparities needs and resources assessment provider study was funded by the CDC-RFA-OT21-2103: National Initiative to COVID-19 Health Disparities among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities under grant Contract No. CTR056155.

ORCID iDs

Stephanie Ayers Vollrath

Sabrina Oesterle

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