Institutional Mistrust Research Articles

Evidence of Strategic Information Literacy Practices in Early Career Teachers' Navigation of TeachersPayTeachers

Teachers Pay Teachers (TPT) has emerged as the most popular online educational marketplace of the moment, but exactly how curriculum marketplaces support professional learning and classroom curriculum design is still an emerging area of inquiry in educational research. This paper explores the perspectives of six novice teachers on the supplemental teaching materials available on TPT. Through semi-structured think-aloud interviews, we identified tensions related to teachers’ landscapes of practice, institutional mistrust, perceived authoritativeness of TPT sellers, curriculum marketplaces as altruistic platforms, and the affordances and constraints of TPT for managing finite resources. Findings suggest that professionals who work with preservice and in-service teachers must reframe their discussion of curriculum marketplaces toward developing early-career teachers’ critical curriculum cultivation practices. Such reframing has the potential to influence how educators make use of online curriculum marketplaces, what resources they download, and how those resources are employed.

Low health literacy is associated with health-related institutional mistrust beyond education

Abstract Background Institutional mistrust, the lack of confidence and overall suspicion towards authorities or systems, usually governmental, but also extending to the health sector, poses a major obstacle towards public health policies and actions. Lower educational attainment has been linked to higher mistrust, but the role of health literacy in particular remains unclear. Methods Cross-sectional study in the general adult population of Greece and Cyprus following proportional quota sampling (January 2022 to May 2023). The current analysis is based on a sub-sample of 292 participants, with complete information on health literacy (main exposure, assessed via the validated HLS-EU-Q16) and health-related institutional mistrust (main outcome, assessed via a new culturally adopted questionnaire comprising 11 items). Multiple linear regression was used to determine associations between the aforementioned factors, adjusting for educational attainment and other potential confounders. Results Exploratory factor analysis revealed 3 health-related institutional mistrust dimensions, towards: (a) governmental authorities and the media (i.e., the system), (b) doctors and other health professionals, and (c) the scientific community. Health literacy was negatively associated with all mistrust dimensions, with associations being particularly strong with mistrust towards the system (B, 95% CI per unit increase in the HL scale: -0.87, -1.58; -0.15) and the scientific community (-0.71, -1.11; -0.32). These association remained robust to adjustment for educational attainment and other sociodemographic factors. Conclusions Mistrust towards a perceived system, comprising the government and media, as well as towards the scientific community on health-related matters, is higher among individuals with low health literacy, irrespective of educational attainment. Enhancing health literacy could act as a novel target for public health approaches aiming to tackle health-related institutional mistrust. Key messages • Health-related institutional mistrust is a complex phenomenon, which appears to have different dimensions, relevant to the perceived system, health professionals, and the scientific community. • Low health literacy is an independent predictor of health-related institutional mistrust, rendering it a novel target for attempts towards reversing this phenomenon and its adverse health consequences.

Assessing the impact of institutional mistrust on parental endorsement for COVID-19 vaccination among school communities in San Diego County, California.

Institutional mistrust has weakened COVID-19 mitigation efforts. Assessing to what extent institutional mistrust impacts parental decision making is important in formulating structural efforts for improving future pandemic response. We hypothesized that institutional mistrust is associated with lower parental endorsement for COVID-19 vaccination. We distributed an online survey among parents from schools in areas with high levels of social vulnerability relative to the rest of San Diego County. We defined vaccination endorsement as having a child aged 5 years or older who received at least one COVID-19 vaccine dose or being very likely to vaccinate their child aged 6 months-4 years when eligible. Institutional mistrust reflected the level of confidence in institutions using an aggregate score from 11 to 44. We built a multivariable logistic regression model with potential confounding variables. Out of 290 parents in our sample, most were female (87.6%), reported their child as Hispanic/Latino (73.4%), and expressed vaccination endorsement (52.1%). For every one-point increase in mistrust score, there was an 8% reduction in the likelihood of participants endorsing vaccination for their child. Other statistically significant correlates that were positively associated with vaccination endorsement included parent vaccination status, child age, parent age, and Hispanic/Latino ethnicity. Our study further demonstrates how institutional mistrust hinders public response during health emergencies. Our findings also highlight the importance of building confidence in institutions and its downstream effects on pandemic preparedness and public health. One way that institutions can improve their relationship with constituents is through building genuine partnerships with trusted community figures.

Who Relies on Social Media Influencers for Political Information? A Cross-Country Study Among Youth

Social media influencers (SMIs) are defined as regular individuals who become well-known via self-branding on social media. Youth use content posted by SMIs not just for entertainment, but also for political information. However, we know little about which groups of young people are most likely to be exposed to their political messages or why some youth seem to favor SMIs’ political information over news content from other sources. Inspired by the selective exposure paradigm, this cross-country study conducted between April 2022 and March 2023 explored which variables positively relate to selecting SMIs as primary political information sources among a quota-based sample of emerging adults (16–22 years old) in Germany ( N = 559) and Belgium ( N = 495). We focused on dispositional factors, namely young people’s political predispositions (e.g., subjective political knowledge, institutional mistrust) and source perceptions (e.g., perceived expertise, perceived opinion leader functions), that may be associated with selecting SMIs for political information. Overall, 59 percent of youth in our study were able to name a favorite political SMI. In this analytical sample, youth who were male, politically active, or ascribed opinion leader functions to SMIs were likely to consider them central political information sources. Moreover, country-specific multi-group analysis showed that, in Germany, low subjective political knowledge and parasocial relationships developed with SMIs were linked with relying on them for political information.

Determinants of Vaccine Hesitancy among African American and Black Individuals in the United States of America: A Systematic Literature Review.

Despite the crucial role the COVID-19 vaccine played in curbing the pandemic, a significant portion of Black and African American individuals expressed hesitancy toward being vaccinated. This review aimed to identify the determinants of COVID-19 vaccine hesitancy among Black and African American individuals in the U.S. The literature search was conducted in December 2022 according to the PRISMA criteria focusing on empirical studies. Data extraction methods, critical appraisal, and secondary thematic analysis were conducted on both quantitative and qualitative studies. Sixteen quantitative studies identified the key factors associated with vaccine hesitancy, such as confidence in vaccine effectiveness, safety, and trust in the healthcare system. Fourteen qualitative studies revealed major themes of mistrust, fear, and information needs, including historical mistrust, concerns about the vaccine development process, and contemporary institutional mistrust. The synthesis of quantitative and qualitative findings derived from this review provides a nuanced understanding of the determinants of vaccine hesitancy in Black and African American communities in the U.S., offering a foundation for the development of evidence-based interventions. Mistrust in the healthcare system, fear, and informational gaps on vaccine safety and effectiveness were identified as significant barriers to vaccination, demanding targeted interventions.

"Black Is Not Monolithic": Complexities in COVID-19 Vaccine Decision-Making.

Longstanding inequities in the USA have resulted in the disproportionate impact of COVID-19 on Black Americans. Coupled with medical mistrust, COVID-19 vaccine uptake is lower in Black populations. We sought to understand the perspectives of Black parents on the COVID-19 pandemic, COVID-19 vaccination for themselves and their children, and trust with the medical community. Using qualitative methodology, we conducted in-depth semi-structured in-person interviews of Black parents of children admitted to the inpatient pediatric units in our tertiary academic medical center in Connecticut from July to November 2021. We used the grounded theory approach, and the constant comparative method until saturation was reached. We interviewed 20 parents who identified as Black; 50% were vaccinated against COVID-19. The following 5 themes and sub-themes emerged: (1) mixed feelings influenced COVID-19 vaccine decision-making ranging from much needed relief and feelings of uncertainty, distrust, and fear; (2) COVID-19 vaccine uptake was influenced by individual and family's health concerns and job or school mandates; (3) deferring the COVID-19 vaccine was influenced by the perception of risk and concerns about vaccine integrity; (4) institutional mistrust within the Black community bred by systemic racism influenced vaccine decision-making; and (5) conflicted feelings about the COVID-19 vaccine for their child. Our findings reiterate the complexities around vaccine decision-making and underscore the importance of recognizing the pervasive influence of institutional mistrust when counseling Black families about the COVID-19 vaccine.

“Going vaccine hunting”: Multilevel influences on COVID-19 vaccination among racialized sexual and gender minority adults—a qualitative study

ABSTRACT High levels of COVID-19 vaccine hesitancy have been reported among Black and Latinx populations, with lower vaccination coverage among racialized versus White sexual and gender minorities. We examined multilevel contexts that influence COVID-19 vaccine uptake, barriers to vaccination, and vaccine hesitancy among predominantly racialized sexual and gender minority individuals. Semi-structured online interviews explored perspectives and experiences around COVID-19 vaccination. Interviews were recorded, transcribed, uploaded into ATLAS.ti, and reviewed using thematic analysis. Among 40 participants (mean age, 29.0 years [SD, 9.6]), all identified as sexual and/or gender minority, 82.5% of whom were racialized. COVID-19 vaccination experiences were dominated by structural barriers: systemic racism, transphobia and homophobia in healthcare and government/public health institutions; limited availability of vaccination/appointments in vulnerable neighborhoods; absence of culturally-tailored and multi-language information; lack of digital/internet access; and prohibitive indirect costs of vaccination. Vaccine hesitancy reflected in uncertainties about a novel vaccine amid conflicting information and institutional mistrust was integrally linked to structural factors. Findings suggest that the uncritical application of “vaccine hesitancy” to unilaterally explain undervaccination among marginalized populations risks conflating structural and institutional barriers with individual-level psychological factors, in effect placing the onus on those most disenfranchised to overcome societal and institutional processes of marginalization. Rather, disaggregating structural determinants of vaccination availability, access, and institutional stigma and mistrust from individual attitudes and decision-making that reflect vaccine hesitancy, may support 1) evidence-informed interventions to mitigate structural barriers in access to vaccination, and 2) culturally-informed approaches to address decisional ambivalence in the context of structural homophobia, transphobia, and racism.

Migration, Remittances, and Local Development in Moldova

Remittances and know-how transfer play a significant role in economic development in countries with high out-migration, and Moldova, in this regard, has been abundantly studied. In our research, we tried to assess the influence of remittances and knowledge transfer on local development from the point of view of migrants’ families, local entrepreneurs, and stakeholders. We used the empirical data obtained from a nationwide survey of about 600 rural households whose members experienced international migration and from the interviews with stakeholders and focus groups with farmers’ attendees. The results revealed that remittances often support the household's budget, covering the salary gap, and contribution on initiation of the local businesses. To encourage the investment of remittances in local infrastructure and entrepreneurship, the government launched several programs that aim to subsidize migrants’ business incentives. However, the results show that migrants prefer to invest in improving living conditions and are more reluctant to invest in their own businesses, either because of the lack of a market or because of institutional mistrust. The local authorities acknowledge the importance of remittances on local development, but at the same time, they are concerned about the demographic resilience of the localities and emphasize the lack of labor force caused by migration. In the context of labor shortage, entrepreneurs in the agricultural field admit that they have to improve the technology of production processes but also adapt their field of activity to one that requires less intensive manual work. The obtained results contribute to a better understanding of the influence of remittances on migrants’ households and local development.

How forcing community resilience in rural communities harms sustainable development

Community resilience is critical to managing the effects of climate change and in achieving the United Nations (UN) Sustainable Development Goals (SDG). Resilient communities are able to manage stressors and recover from them, such as in instances of energy service outages. Instances like these can lead to communities that feel forced to exhibit individual characteristics of resilience, such as neighbors relying on each other in times of need because history has shown them that they cannot rely on outside institutions for help. Communities may adopt factors of individual psychological resilience in the face of energy service outages because they lack structural support to exhibit community resilience or to pursue resilient energy systems. This lack of access to support and resources is in conflict with principles of procedural justice and energy sovereignty while reinforcing institutional mistrust within affected communities and contributing to social vulnerability. This article contemplates and expounds on the idea of coerced resilience in the face of energy service outages and severe weather within a rural, remote community in Michigan’s Upper Peninsula (UP). The UP is located at the tail end of electricity infrastructure, putting its residents at increased risk of experiencing energy service outages that are further complicated by its isolation and severe winter weather. We examine the idea of coerced resilience, its relation to social vulnerability, and how it conflicts with concepts of energy justice and the UN’s SDG. We further go on to highlight how certain populations and youth can minimize instances of coerced resilience and contribute to sustainable development making it an important consideration to achieve sustainable development goals.

Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review.

Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada. Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations. The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information. We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.

Popular Among Distrustful Youth? Social Media Influencers’ Communication About COVID-19 and Young People’s Risk Perceptions and Vaccination Intentions

ABSTRACT During the COVID-19 crisis, many social media influencers (SMIs) discussed the pandemic on their channels and showcased their behavior in dealing with the virus. Drawing on the two-step flow of communication and social learning theory, we investigated the attitudinal and behavioral consequences of SMIs’ COVID-19-related communication in a two-wave panel survey among emerging adults aged 16–21 years (N T1 = 978, N T2 = 415). Our results contribute to the health communication literature by discovering that institutional mistrust determines whether young people resort to SMIs as an information source for COVID-19-related information. Those with higher mistrust in established media organizations and the government were more likely to consult SMIs for COVID-19-related information and to consider them as role models when exposed to relevant content. Moreover, consulting SMIs who promote noncompliance as a COVID-19 information source was over time related to lower vaccination intentions.

Young Adult Boot Camp Translation in the Engaging Communities of Hispanics for Aging Research (ECHAR) Network

AbstractBackgroundHispanic/Latin American (H/L) populations are at an increased risk for developing Alzheimer’s disease and related dementias (ADRDs). Yet, H/Ls are less likely to participate in research due to several recruitment barriers such as research related stigma, health literacy, and institutional mistrust. Considering family dynamics, household composition, and cultural scripts, young H/L individuals may serve as mediators to help facilitate H/L recruitment and mitigate these key barriers.MethodFollowing the Boot Camp Translation (BCT) approach of the ECHAR Network, we recruited 10‐15 H/L young adults, ages 18 to 35, to carry out the BCT in Houston, Texas. Through the BCT, we (1) developed community relevant awareness, education, and recruitment materials and (2) designed outreach and dissemination strategies that will be used to target H/Ls young adults and their older‐adult family members for participation in ADRD research.Result10 young adults (mean age (range) = 21.50± 3.75 (18‐31), mean education (range) = 14.60± 1.65 (12‐16), 80% female) participated in the Houston young adult BCT. Participants agreed that the central message should convey a sense of urgency and accountability (i.e., “Alzheimer is real. Healthy or not: On which side do you want to be?”) and focused on dispelling common myths associated with ADRDs. Participants categorized H/Ls by age groups to be targeted according to the sense of urgency of the message. Finally, graphic materials should be intergenerational, representative of the H/L community, informative, and simple.ConclusionThe young adult BCT leveraged intra‐familial health communication to enhance ADRD‐specific health education. Results demonstrated that culturally relevant messages can be communicated by young adult children to their parents and/or grandparents with downstream effects for engagement and recruitment into ADRD research.

Economic insecurity, nativism, and the erosion of institutional trust

We study markers of economic insecurity and nativism as factors explaining recent declines in institutional confidence. Taking microdata from 59 middle and upper-income nations, we show that hostility towards immigrants/immigration and a synthetic measure of economic insecurity are both significant predictors of individual-level institutional mistrust. Our parameter estimates are slightly larger and more robust for economic insecurity, and the results are stronger for developed, western countries (UK, USA, Australia, Canada) than in Asia or South America. The correlations appear for a wide variety of trust metrics and do not differ meaningfully between profit-driven and non-profit making institutions. In line with the concept of economic nationalism, we also find evidence of an ‘amplification’ effect, where individuals exposed to higher levels of economic insecurity are more responsive to nativist beliefs. The results have implications for policymakers looking to promote institutional confidence and social cohesion.

"You're Socially Distant and Trying Not to Be Emotionally Distant." Physicians' Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study.

We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic. We purposively selected hospital dyads from regions in the United States that experienced early and/or large surges of patients hospitalized with COVID-19. We recruited a national sample of ICU physicians from Veteran Affairs (VA) Health Care Systems and their associated academic affiliate hospitals. None. Twenty-four intensivists from seven VA hospitals and six academic-affiliate hospitals participated. Intensivists noted the disproportionate impact of the pandemic on among people holding minoritized racial and ethnic identities, describing how language barriers and restrictive visitation policies exacerbated institutional mistrust and compromised physicians' ability to develop therapeutic relationships. We also identified several perceived influences on patient-clinician communication and the establishment of therapeutic relationships. Barriers included physicians' fear of becoming infected with COVID-19 and use of personal protective equipment, which created obstacles to effective physical and verbal interactions. Facilitators included the presence of on-site interpreters, use of web-based technology to interact with family members outside the ICU, and designation of a care team member or specialist service to provide routine updates to families. The COVID-19 pandemic has threatened patient-clinician communication and the development of therapeutic relationships in the ICU, particularly among people holding minoritized racial and ethnic identities and their families. We identified several facilitators to improve patient-clinician communication as perceived by intensivists that may help improve trust and foster therapeutic alliances.

Exploring First Responder Beliefs and Decisions to Vaccinate Against SARS-COV-2

ABSTRACT As frontline providers, first responders are not always thought of as patients with unique health beliefs. During early and continued distribution, many first responders in the United States chose to refuse vaccination. Guided by the health belief model and emerging research related to SARS-COV-2, the aim of this study was to further explore the complex message conditions that contributed to first responders’ early vaccination decisions. An online survey was conducted between March 1 and March 31 2021, among first responders in the state of Kentucky, which has lagged behind most states in the percentage of the population who are fully vaccinated. The first responder sample included Firefighters, Emergency Medical Technicians (EMTs), and paramedics who completed a Qualtrics survey that included measures aimed at assessing health beliefs about SARS-COV-2, beliefs about SARS-COV-2 vaccines, source trustworthiness, and vaccine motivation. First responders were also asked to rank the importance of various information sources about SARS-COV-2 and its vaccines. Findings suggest significant differences exist among first responders who have chosen to receive SARS-COV-2 vaccines and those who have refused, including source preference, conspiracy beliefs, and perceived risk. Future directions, including the exploration of institutional mistrust as a health belief are discussed. These findings offer practical insights that may improve continuing approaches to discover and use preferred communication sources to reach the vaccine-hesitant.

"I Feel Like That Was the Only Option I Had:" A Qualitative Study of Structural Inequities in Obstetric Hospital Choice in Trenton, New Jersey.

In the United States, more than 1.1 million women of childbearing age live in an urban maternity care desert. Trenton, New Jersey no longer has a hospital obstetrics (OB) unit within the bounds of the city. We sought to understand where pregnant people in Trenton gave birth, what their experiences were like, and what barriers to quality care exist for this population. In 2019, we conducted semi-structured interviews with 21 women living in Trenton who gave birth after 2011, when the city's last high-volume OB unit closed. A combination of deductive and inductive analysis was used to describe birth experiences, accessibility, and quality of care. Respondents were largely publicly insured and lacked choices for prenatal care or delivery hospital. Increased travel distance, institutional mistrust, and added impediments to emotional support at the time of delivery were chief barriers to entry into care and a quality care experience.

Institutional Mistrust, Instrumental Trust, and the Privatization of Law: The Mafia as a Territorial Ruler

This article explores the link between trust and law through the prism of the mafia phenomenon. Mafias spread in a context of “endogenous mistrust” and manage to privatize law by imposing an unwritten system of rules in their territory. This alternative system of law has consequences in terms of distorted access to economic opportunities for non-Mafiosi as it is oriented in favor of its affiliates and external backers. It also leads to the emergence of negative social capital benefiting Mafiosi but unable to create relationships based on genuine trust.

Addressing Mental Health Through Community Partnerships in a Muslim Community.

The mental health of American Muslims remains significantly understudied and unaddressed, despite known obstacles to Muslims' utilization of mental health services, such as stigma and institutional mistrust. Since the inception of the Stanford Muslim Mental Health and Islamic Psychology Lab in 2014, partnerships across the Bay Area were formed among key Muslim community establishments to address obstacles to good mental health. Through a community-centered approach, diverse stakeholders engaged to identify and address the community's most pressing mental health challenges. Successful outcomes of this approach include facilitated research and mental health initiatives to support the Bay Area Muslim community.

Rapid Implementation of a Community-Academic Partnership Model to Promote COVID-19 Vaccine Equity within Racially and Ethnically Minoritized Communities.

Coronavirus disease 2019 (COVID-19) has highlighted inequities in mortalities and associated illnesses among non-Hispanic Black and Hispanic/Latino individuals. Immunization against COVID-19 is critical to ending the pandemic, especially within racial and ethnically minoritized communities. However, vaccine hesitancy and institutional mistrust in these communities, resulting from decades of mistreatment, structural racism, and barriers to vaccination access, have translated into low vaccination uptake. Trustworthy relationships with healthcare professionals and partnerships with faith and community leaders are critical to increasing vaccination rates within these minoritized communities. Loma Linda University researchers collaborated with local faith and community organizations in San Bernardino County, CA, to rapidly implement a three-tiered approach to increase the vaccination rates within non-Hispanic Black and Hispanic/Latino communities. This community–academic partnership model provided over 1700 doses of the COVID-19 vaccine within these vaccine-hesitant, targeted minoritized communities. As over 100,000 individuals are diagnosed with COVID-19 daily and updated vaccines targeting variants of the Omicron strain are expected to rollout in the coming months, the development of sustainable programs aimed at increasing vaccine uptake within vulnerable communities are of the utmost importance.

Factors associated with COVID-19 vaccine acceptance and hesitancy among residents of Northern California jails

Carceral facilities are high-risk settings for COVID-19 transmission. Factors associated with COVID-19 vaccine acceptance and hesitancy among incarcerated individuals are poorly understood, especially among jail residents. Here, we conducted a retrospective review of electronic health record (EHR) data on COVID-19 vaccine uptake in custody and additionally administered a survey to assess reasons for vaccine hesitancy, sources of COVID-19 information, and medical mistrust among residents of four Northern California jails. We performed multivariate logistic regression to determine associations with vaccine acceptance. Of 2,564 jail residents offered a COVID-19 vaccine between March 19, 2021 and June 30, 2021, 1,441 (56.2%) accepted at least one dose. Among vaccinated residents, 497 (34.5%) had initially refused. Vaccine uptake was higher among older individuals, women, those with recent flu vaccination, and those living in shared housing. Among 509 survey respondents, leading reasons for vaccine hesitancy were concerns around side effects and suboptimal efficacy, with cost and the need for an annual booster being other hypothetical deterrents to vaccination. Vaccine hesitancy was also associated with mistrust of medical personnel in and out of jail, although this association varied by race/ethnicity. Television and friends/family were the most common and most trusted sources of COVID-19 information, respectively. Overall, vaccine acceptance was much lower among jail residents than the local and national general population. Interventions to increase vaccination rates in this setting should utilize accessible and trusted sources of information to address concerns about side effects and efficacy, while working to mitigate medical and institutional mistrust among residents.