Conceptual framework guiding this project

The TRUST in Public Health project team created an evidence-informed conceptual framework to describe how different components of the project connect with each other. These components are: (1) trust in emergency preparedness and response (PHEPR), (2) the spread of misleading rumors, (3) approaches to counter misleading rumors, and (4) efforts to build trust. Each component was developed based on data collected and analyzed throughout the course of the project.

What is the conceptual framework?

This framework uses the metaphor of liquid in a tank to think about trust in PHEPR. The amount of liquid in the tank—that is, the level of public trust in PHEPR—can rise or fall based on various factors. One of these factors is the spread of misleading rumors, which decreases trust in PHEPR. However, approaches to counter rumors and harmful narratives can reduce their spread and, therefore, improve trust in PHEPR over time. Also affecting the level of trust in PHEPR are efforts to build trust, which directly and indirectly increase the level of trust.

What does each component of the framework represent?

A: Visualize the level of public trust in PHEPR as water in a tank—a “trust tank.” Many factors can affect whether the level of trust in the “trust tank” rises or falls. Some factors can add more trust into the “trust tank” and increase its level, while other factors could decrease its level by opening the valve at the bottom and causing trust to drain into a sink.

B: Misleading rumors often spread during public health emergencies (PHEs) and certain kinds of rumors seemed to emerge repeatedly during several past PHEs. The TRUST in Public Health team identified 11 types of rumors that arise repeatedly during PHEs. They fall into 3 overarching and overlapping categories—cognition, culture, communication—or into the intersections of these categories. Learn more about common rumors that emerge during public health emergencies.

C: The spread of misleading rumors can open the valve at the bottom of the “trust tank” and decrease the level of trust in PHEPR. Likewise, low levels of trust in public health can increase the spread of misleading content.

D: There are several promising approaches to manage and counter misleading rumors. These approaches tend to act on the information, individual, interpersonal, or institutional levels. Learn more about approaches to manage and counter misleading rumors and deliberately false narratives.

E: Approaches to manage and counter misleading rumors and deliberately false narratives are helpful for proactively and reactively reducing its spread.

F: There are many efforts and activities that practitioners use to build trust in PHEPR. Among them, the TRUST in Public Health team recommends 5 evidence-informed activities that can build practitioners’ capacity to strengthen public trust before, during, and after PHEs. Learn more about the Checklist to Build Trust, Improve Public Health Communication, and Anticipate Rumors During PHEs.

G: Approaches to manage and counter misleading rumors often aim to build trust over the long term and support the implementation of trust-building activities. Trust-building activities, like approaches to manage and counter misleading rumors and false narratives, can act on information, individual, interpersonal, and institutional levels.

H: Most trust-building activities directly fill the “trust tank” and increase levels of public trust in PHEPR. 

I: Many trust-building activities can intercept the process by which the spread of rumors reduces trust in PHEPR and vice versa. This process strengthens the public’s resilience to health-related rumors.

J: Over time, trust-building activities strengthen public health capacities and promote recovery from systemic loss of trust in PHEPR. This recovery process also fills the “trust tank” and increases levels of trust in PHEPR.

How did we create the conceptual framework?

The TRUST in Public Health team identified linkages between different data collection efforts undertaken to establish the evidence base for this project. This includes:

• A thematic analysis of rumors that emerge repeatedly during PHEs.
• An analysis of approaches used to respond to, manage, and counter misleading rumors and deliberately false narratives.
• A mapping exercise to assess how approaches used to manage and counter misleading rumors could be leveraged to respond to each type of rumor.
• Key informant interviews and focus group discussions with public health professionals and communicators to understand strategies to build trust, improve public health communication, and anticipate rumors during public health emergencies.
• A participatory diagramming process to create a conceptual framework for predicting and responding to future misleading rumors that also illustrates the flow of logic between core components of this project: trust in public health systems, rumors and false narratives, approaches to manage and respond to such information, and capabilities to strengthen trust in PHEPR.