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Trust is essential: implementing paediatric care coordination in rural Australia
Karen Hutchinson1,2, Anneliese de Groot3, Hayley Smithers-Sheedy4,5
1Centre for Health, Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia. karen.hutchinson@unsw.edu.au.
Implementation Science Communications
|July 18, 2026
Summary
Building trust in rural healthcare is crucial for families of children with medical complexity (CMC). Relational approaches and care coordinators foster trust, overcoming systemic barriers to improve healthcare access and continuity.
Area of Science:
- Healthcare Implementation Science
- Rural Health Equity
- Patient-Family Centered Care
Background:
- Trust is vital for effective healthcare relationships and service improvement.
- Rural healthcare faces challenges like workforce shortages and access inequities, eroding patient trust.
- Integrated care models prioritizing relationships can build trust, especially for families of children with medical complexity (CMC).
Purpose of the Study:
- To explore trust operationalization between families of CMC and care coordinators within the RuralKidsGPS integrated care model.
- To examine how relational and contextual factors influence trust-building processes in this setting.
Main Methods:
- Semi-structured interviews were conducted with parents (n=13), family groups (n=9), and Pediatric Care Coordinators (PCCs) (n=8).
- A hybrid thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR), was employed.
- The Trust in Implementation Practice (TIP) framework, comprising five relational constructs, was developed and used to analyze trust-building.
Main Results:
- PCCs' authenticity, empathy, competency, and local knowledge fostered trust and responsive care.
- Trust was influenced by psychosocial/economic disadvantage, geographic isolation, service inequities, and prior adverse healthcare experiences.
- PCCs acted as trusted intermediaries, enhancing equity, continuity, and access to care, leading to the TIP-Context (TIP-C) framework.
Conclusions:
- Trust functions as both a mechanism and an outcome in integrated healthcare implementation.
- The novel TIP-C framework provides a theory-informed approach to understanding and operationalizing trust-building in healthcare.
- Further research is recommended to validate the TIP-C framework in diverse implementation settings.
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