Research in Social and Administrative Pharmacy xxx (xxxx) xxx Please cite this article as: Paul AM. Gregory, Zubin Austin, Research in Social and Administrative Pharmacy, https://doi.org/10.1016/j.sapharm.2020.07.023 Available online 10 August 2020 1551-7411/© 2020 Elsevier Inc. All rights reserved. How do patients develop trust in community pharmacists? Paul AM. Gregory a , Zubin Austin b, * a Leslie Dan Faculty of Pharmacy, University of Toronto, Canada b Leslie Dan Faculty of Pharmacy and the Institute for Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto Canada, Canada ABSTRACT Background: Pharmacists frequently self-describe as “the most trusted health care professional” in society. Beyond the rhetoric of such self-promoting statements, there is little empirical evidence regarding how trust between pharmacists and patients is formed, nurtured, and sustained. Objectives: This exploratory qualitative study in Ontario, Canada was undertaken in early 2020 to characterize trust-enhancing factors in community pharmacy practice. Methods: Recruitment posters/handouts in purposively-selected pharmacies using a convenience sampling of people collecting prescriptions was used to recruit 28 patient-participants. Inclusion criteria included a minimum of six conversations with a pharmacist regarding health/medication use in the previous 12 months. A semi-structured interview protocol was used to elicit descriptions from patients regarding how experiences with community pharmacists shaped or influenced trust formation in both individual pharmacists and the profession as a whole. Results: A total of 28 patients were interviewed for this study. Five trust-enhancing factors were identified: i) availability; ii) affability; iii) acknowledgement; iv) respect; and v) interpersonal chemistry. Within each factor, sub-factors or facets were also identified that focused on specific behaviours of community pharmacists that helped enhance trust. This study suggests that trust-enhancing factors include a series of interpersonal communication behaviours and skills that are within the control of pharmacists; leveraging these behaviours and skills in a more consistent and effective manner may support more trusting relationships between phar- macists and patients. Conclusions: For pharmacists to truly live up to the moniker of “most trusted health care professional” it is important to better understand how trust is built and sustained, and to consider opportunities to focus on specific trust-enhancing behaviours that ultimately support better patient care and outcomes. Background It is not an overstatement to describe “trust” as the foundation for interpersonal relationships and social life. 1 Trust can be defined as “… firm belief in the reliability, ability, truth, or strength of someone …” and describes a psychologically complex amalgam of emotions and thoughts. 2 While this definition of trust focuses primarily on the cognitive (“belief”) element, most psychologists note the central importance of intuition and non-cognitive factors that shape individual perceptions of trusting other people. 3,4 The psychological dimensions of trust are more frequently described philosophically rather than empirically. 5 There is general consensus that trust can vary considerably in its constancy, its strength, and its breadth. 5,6 There appears to be a connection between underlying indi- vidual psychological traits (such as the Big 5) and trust: for example, those who score more highly on the conscientiousness domain of the Big 5 may be more inclined towards trust, while those who score highly on the neuroticism domain may be less inclined towards trusting others; there is no consensus as to whether the remaining Big 5 traits (openness, extroversion, and agreeableness) impinge upon trust in any significant or meaningful way. 7 While the word trust has a generally accepted meaning, it appears individuals vary considerably in the way they acquire and demonstrate trust in others. 8 One important psychological element of trust is the distinction be- tween conferred and earned trust. 9,10 Conferred trust is built upon a foundation of external social cues, for example job title, awards, physical stature or gender roles. When trust is conferred on an individual, it is in part a function of generalized trust applied to an entire social category; the individual upon whom trust is conferred simply happens to belong to, or possess at least some or superficial similarities with other members of, the social category. For example, when individuals say they “trust” judges, this in part may reflect trust in the social category of those who have that job title. Conferred trust becomes a form of privilege given by an individual to a group of others, without necessarily knowing much or anything at all about the individual characteristics of the specific person they are trusting. In contrast, earned trust is generally built upon a foundation of lived interpersonal experiences and a consistent track * Corresponding author. 144 College Street, Toronto, ON, M5S 3M2, Canada E-mail address: zubin.austin@utoronto.ca (Z. Austin). Contents lists available at ScienceDirect Research in Social and Administrative Pharmacy journal homepage: www.elsevier.com/locate/rsap https://doi.org/10.1016/j.sapharm.2020.07.023 Received 22 April 2020; Received in revised form 20 July 2020; Accepted 21 July 2020