Trust-Building through Truth-Telling—Centering Voices of Community Leaders in Harlem to Understand the Concept of Trust amidst Institutional and Historical Oppression

Background and purpose: The COVID-19 pandemic shed stark light on existing health inequities in health and mental health within communities of color, attributable to a legacy of slavery and entrenched structural racism. Academic institutions that hold research, educational, and healthcare roles in the community have contributed deeply to these legacies of oppression - resulting in a profound mistrust between institutions of care and the communities within which they interact. This mistrust often means that community members turn to local and spiritual leaders in times of crisis instead of other professionals and institutional care. Indeed, community and spiritual leaders have played a major role in providing informational and emotional support as well as leadership during the COVID-19 pandemic, contributing to added stress as they seek to provide support for their communities while simultaneously struggling with the needs of themselves and their loved ones. This paper provides key insights resulting from an integrated psychoeducation pilot study that aimed to explore trust between academic institutions of care and the community of Harlem and provide support to spiritual and community leaders that continue to play such a critical role in the care of their communities during the COVID-19 pandemic.

Methods: Insights are a result of in-depth discussions with community and spiritual leaders in Harlem as they took place in the community collaborative board, focus group, and psychoeducation-based intervention sessions of the pilot study. Discussions were guided by questions about the most important components of trust, the nature of trust in relationship between the community and institutions, and the ways that institutions can earn trust moving forward, all positioned within the context of naming the truth about academic institutions’ oppressive and harmful past. Researchers utilized reflexive practice as a core component of trust building and accountability. Thematic analysis was used to identify key themes.

Results: Six themes emerged from generously shared thoughts and experiences of Harlem leaders. The themes included: Authenticity, telling the truth, and listening; Intention, motivation, and care; Integrity; Communication and comfort; Shared humanity; Time, commitment, and sharing power. They centered around the nature of trust and how it is built, disrupted, and repaired in the context of relationships with oppressive institutions and systems. It is important to acknowledge that findings are influenced by their theoretical frameworks, positionalities and resulting biases.

Conclusions and Implications: These themes signify the vital importance of trust and the powerful impact trusting has in decision-making about health, accessing resources, and individual and community-level relationship building. While more exploration and analysis on trust is needed with close collaboration with community leaders, this pilot project signified the vital importance of trust and the powerful impact trusting has in decision-making about health, accessing resources, and individual and community-level relationship building. Moreover, it highlighted the importance of being with, holding space for truth-telling, story-sharing and bearing witness as one way to repair trust among community leaders, providers and members of institutions of care.