Trust is the engine of change: A conceptual model for trust building in health systems

We examine trust at the theory level as an engine driving sustainable change. We propose a new measurable dimension of the trust construct: reciprocity. Cooperative reciprocal relationships are its building blocks, enabling stakeholders to 'try out' interactions with less risk, calibrating level of effort, time and emotional investment before continuing further. Reciprocity includes three measurable elements: common goals furthering equitable and healthier communities, mutual self-interests and gratitude/indebtedness. We utilize a process model showing how these building blocks interrelate within a health systems context to jump-start and sustain reciprocal relationships. Process models are valuable in addressing internal dynamics of human relationships in complex systems as a complement to factor- or variance-based models. We applied theory by longitudinally tracking community health volunteers, examining reciprocity in close-to-the-community health systems. These methods and application of theory have relevance to environments where institutional structures are open to multistakeholder-driven innovation.