Exploring the use of signals of trust in health and care services to improve workforce wellbeing and retention

Why is the research needed?

Trust is the central element of any healthcare system, without which patients may ignore public health recommendations or refuse to seek care or adhere to medical guidance. Moreover, in the context of an increasingly diverse health workforce in England – along with an incendiary political environment – prejudices against clinicians from former British colonies may damage the wellbeing of these professionals, undermining the healthcare system. Understanding how people place trust in a healthcare context, and the experiences of internationally trained clinicians met with structural racism and ethnocentrism, is critical for maintaining an effective and equitable care system.

What are we doing?

We will aim to understand how and whether a speaker’s appearance and accent determine the likelihood of being rated as trustworthy by a member of the UK public. We are also conducting qualitative interviews to understand how non-native speakers from countries including Ghana and Nigeria evaluate their experiences as healthcare providers and researchers, and whether they believe their accent plays a role in any biases towards them.

The specific research questions for are:

• Does a non-native accent affect the likelihood that a listener will trust the recommendations of the speaker in the healthcare or research settings?
• Are transnational healthcare workers who have already emigrated to the UK rated as more trustworthy in these settings than are either native speakers or those who have not yet emigrated?
• Does gender interact with accent to determine the likelihood that a speaker will be listed as trustworthy in these settings?
• Do transnational healthcare workers recount any experience of communication challenges/barriers, communication accommodation, and the impact of these on trust and their interactions, with patients and colleagues?

How are we working with communities, services and organisations?

We have both national and international collaborators for this project, including:

National Collaborations (These collaborators are supporting us with recruitment, data analysis, and dissemination):

• RAND Europe
• The University of Suffolk
• The North London Regional Research Delivery Network
• Addenbrooke's Hospital
• Cambridge Public Health
• Health Innovation East

International Collaborations:

• Nigeria collaboration: Lagos State University College of Medicine (LASUCOM): LASUCOM is a world-class medical university based in Lagos, Nigeria (Lagos State University College of Medicine 2020) which aims to contribute to medical practice and research on a national and global scale (Lagos State University College of Medicine 2020).
• Ghana collaboration: University for Development Studies (UDS), Tamale Ghana: UDS focuses on academic activities that produce practical solutions which promote equitable socio-economic transformation of communities (University for Development Studies 2025).

What will the impact and benefits of this research be?

Experiences of prejudice or bias shape retention, onward migration, and return migration decisions. Yet there remains a lack of robust data tracking the complex migration patterns of international health care workers. This gap limits the ability of policymakers to design adaptable migration policies that support equitable movement and retention of healthcare workers from countries like Nigeria and Ghana to the UK. We aim to help close this gap and provide policymakers with the knowledge necessary for maintaining an effective NHS workforce.

What do we have planned for knowledge mobilisation and implementation?

We will work with policy partners in Cambridge, Health Innovation East, RAND Europe, and the ARC network to disseminate our findings in public-facing publications and policy briefs following any academic outputs from this work.