Patient trust in community-based interventions versus health-facility care: an economic experiment in Cameroon

Trust in patient-provider relationships is central to healthcare utilisation in health facilities, but also in community-based interventions, particularly in contexts embedded within weak health systems. Neglected tropical disease (NTD) control programmes rely heavily on community-based mass drug administration (MDA) to reach over one billion individuals worldwide each year. However, empirical evidence on behavioural trust in any community-based interventions remains limited, especially in sub-Saharan Africa. We measured trust across two healthcare settings in Cameroon: health facilities and community-based MDA for schistosomiasis and soil-transmitted helminthiases (STH). In 2024, we conducted a cross-sectional mixed-methods study in Bafia health district among households seeking care at health facilities (n = 117) and those eligible for community MDA (n = 109). Subjects completed (i) patient surveys, including the Trust in Physician Scale, (ii) trust games, and (iii) provider knowledge surveys administered to 17 health-facility and 11 community-based providers. Multivariate regression models identified trust determinants. Behavioural trust was high across settings (mean = $1.14; p = 0.99). However, self-reported trust was significantly higher in health facilities (mean = 43/55) than community-based (mean = 38/55; p < 0.01). Provider communication - greeting (β = 1.70; SE = 0.48), eye contact (β = 1.62; SE = 0.46) - and key sociodemographic characteristics, such as isolation (β = -1.88; SE = 0.34), ethnicity (β = -1.39; SE = 0.68), strongly predicted self-reported trust, whereas behavioural trust was primarily associated with socioeconomic status. Providers in both settings demonstrated high trustworthiness, but health-facility providers showed greater disease knowledge. This study provides the first behavioural evidence of trust in a community-based health intervention. Lower self-reported trust in community-based interventions highlights the importance of strengthening provider training and communication to enhance programme effectiveness and support progress toward NTD elimination.