Building trusting relationships to support implementation: A proposed theoretical model

Metz A, Jensen T, Farley A, Boaz A, Bartley L and Villodas M (2022) Building trusting relationships to support implementation: A proposed theoretical model. Frontiers in Health Services 2:894599. doi: 10.3389/frhs.2022.894599


This paper presents a theory of change that articulates (a) proposed strategies for building trust among implementation stakeholders and (b) the theoretical linkages between trusting relationships and implementation outcomes. The theory of change describes how trusting relationships cultivate increases in motivation, capability, and opportunity for supporting implementation among implementation stakeholders, with implications for commitment and resilience for sustained implementation, and ultimately, positive implementation outcomes. Recommendations related to the measurement of key constructs in the theory of change are provided. The paper highlights how the development of a testable causal model on trusting relationships and implementation outcomes can provide a bridge between implementation research and implementation practice.

This paper unpacks something we all acknowledge and say we practice without knowing how we do it. Trusted relationships as a determinant of successful implementation (and knowledge mobilization and research impact). We all say it is important but has this really been tested? Building trust is cited as a key competency for implementation support practitioners (ISP) but do we know how to build this competency? Well…read on!

This paper provides a theory of change that the authors admit is conceptual but can be subject to empirical testing which, according to them, is underway. “The proposed theory of change presented here is emergent and requires critical review, empirical substantiation, and refinement. The assumptions of this theoretical model are currently being empirically investigated.”

Developing trust is based on two core mechanisms: relational and technical. “Relational strategies are defined as strategies undertaken to build trust through strengthening the quality, mutuality, and reciprocity of interactions among team members and implementation stakeholders. Technical strategies are defined as strategies undertaken to build trust through demonstrating the knowledge, reliability, and competency to support the goals of the team.

What I really like about this article are the actions recommended to operationalize relational and technical strategies in Table 1.

Relational strategies: vulnerability; authenticity; bi-directional communications; co-learning; empathy driven exchanges

Technical strategies: frequent interactions; responsiveness; demonstration of expertise; achievement of quick wins

These are excellent briefing points when supporting a community-campus collaboration, especially important when briefing an academic researcher considering a collaboration with community partner.

There is a theory of change which the authors cite as the main purpose of the article. It is logical and not surprising which I guess is good. It provides the basis for more research to test the theory of change as opposed to providing a practitioner with guidance. That being said, I think the contributions this paper makes to practice are the actions that support relational and technical strategies of trust building. As a practitioner and not a researcher, those are my take-aways from this paper.

There is a section on measurement which provides reference to many potential scales for measurement of different sections of the theory of change, but I suspect as this theory of change is tested researchers will develop their own indicators. Nonetheless providing a starting point for evaluation is always a good thing.

And one amusement from this article. It speaks to developing trust for ISPs. But really, do any of us have much trust in our internet service provider?

Questions for brokers:

  1. This paper is about implementation support practitioners. Are these the same as knowledge mobilizers or research impact practitioners? Will they build trust the same as ISPs?
  2. How are you practicing the actions to support relational and technical strategies for trust building?
  3. When thinking about community-campus collaborations, who will have a harder time building trusted relationships: academic or community members? Or will there be challenges on both sides?

Research Impact Canada is producing this journal club series to make evidence on knowledge mobilization more accessible to knowledge brokers and to facilitate discussion about research on knowledge mobilization. It is designed for knowledge brokers and other parties interested in knowledge mobilization.