The Hidden Trust Equation: A Guide for Healthcare Marketers

Understanding Institutional vs. Relational Trust (And Why You Need Both)

By Lucy Shores Kosturko, PhD and Deepthi Chandra

Trust is one of the most frequently cited goals in healthcare marketing, yet also one of the least clearly defined. We often frame it as binary. Patients either trust us, or they do not. But from a behavioral science perspective, trust is not so simple. It is a complex system of judgments, formed through psychological pathways responding to concrete cues: for example, the clarity of a consent form, tone of a clinician’s language, or visual order of a waiting room.

Trust develops through every healthcare interaction, whether it’s an annual wellness visit, medical bill, or front desk call. In each of these touch points, patients are answering the quiet questions:

• Can I trust this healthcare system to be competent, fair, and safe?

• Can I trust the people within it to see me as human and guide me well?

  
  

These questions are related, but not identical. And they are not answered in the same places.

The Two Halves of the Trust Equation

Institutional Trust: “Does this system look competent?”

Institutional trust reflects confidence in the healthcare system itself, including its reliability, governance, and consistency. It is largely cognitive. Patients form it by observing professionalism, stability, clarity, and scale.

Research shows that institutional trust predicts engagement with care, compliance with public health guidance, willingness to participate in preventive services, and even self-reported health status. On the other hand, distrust of the healthcare system has been shown to correlate with worse self-reported health.

This is the kind of trust brand-level marketing channels are especially good at building. Polished campaigns, system-wide storytelling, and centralized messaging reinforce brand pillars and create cognitive ease. Institutional trust-oriented communications demonstrate innovation and competence. They reflect that a healthcare practice is a place where you’d want to work, receive care, or support philanthropically. 

Interpersonal Trust: “Do I feel a human connection?”

Interpersonal trust, also known as relational trust, forms between people. It is emotional, experiential, and highly contextual.

A large meta-analysis spanning nearly 35,000 patients found that trust in individual healthcare professionals is consistently associated with higher adherence, satisfaction, and engagement in health-promoting behaviors. In chronic illness care, interpersonal trust facilitates disclosure, continuity, and shared decision-making, all of which are key for long-term outcomes.

While institutional trust answers the question, "Will I receive world-class care?" interpersonal trust answers, "Will you care about me?"

In healthcare, that distinction matters because it affects what patients believe before they ever book an appointment.

Both Matter, But They Do Different Work

Competence builds respect. Warmth builds trustworthiness.

Behavioral science shows that people evaluate others first on warmth and then on competence. In particular, healthcare is uniquely warmth-weighted because it involves vulnerability, uncertainty, and asymmetric knowledge. Patients may respect a system’s expertise, but they trust care through people.

This raises a question healthcare marketing rarely asks explicitly: Where does warmth live in the organization’s communications strategy?

Why Interpersonal Trust Wins: Three Psychological Truths We Often Ignore

Truth 1: We Trust “Friend” Before “Expert”

Warmth judgments precede competence judgments. Before people ask whether someone is capable, they ask whether that person’s intentions are good. In practice, this means posts demonstrating humanness tend to land before posts emphasizing expertise.

Applying this back to healthcare marketing, brand channels excel at signaling competence: I see your system; whereas interpersonal channels signal warmth: I feel your people.

A nationally representative study of U.S. adults found that trust in the health system is far from universal, suggesting that patients are even more likely to rely on interpersonal trust in individual clinicians and care teams as their primary source for health information.

Truth 2: “Too Polished” Can Feel Inauthentic

Brand alignment does not always equal psychological alignment.

Research on processing fluency suggests that overly smooth or controlled messaging can trigger skepticism. Patients do not infer honesty from perfect presentation. Instead, they perceive it from perceived spontaneity and human effort.

Cognitive comfort comes less from polish and more from shared identity. An informal, but informative, post from a local clinic can feel more trustworthy than a flawless brand graphic since it reduces emotional distance.

Truth 3: Patients Want a Relationship, Not a Broadcast

Humans are wired for relationships, not one-way communication.

Parasocial Relationship Theory explains that people develop emotional bonds with familiar figures over time, even through mediated environments like healthcare. Aligning with this theory, clinic-level social media allows patients to feel known before they are technically known, creating continuity, familiarity, and trust.

In short, presence signals willingness to care. Community investment signals ability to care. Together, they create trust that feels genuine rather than promotional.

So What? Patient-Centered Marketing Is a People Business

Building interpersonal trust does not require perfection. It requires intentionality.

Here are five ways health systems can foster interpersonal trust:

• Empower Local Pages: Allow clinics to post candid, everyday content. Trust local teams to share staff spotlights and informal moments.

• Embrace Minor Mistakes: Do not fear typos or unedited photos. The Pratfall Effect shows that imperfections can increase perceived warmth and likability.

• Curate for Collective Impact: Act like a neighbor, not a billboard. Highlight local nonprofits, community partners, and relevant public events.

• Prioritize People Over Polish: Shift the focus from self-promoting to sharing the most helpful resources and voices, even when created outside the organization.

• Favor Voice Over Visual Uniformity: Consistent emotional tone matters more than adherence to a design template. Sound human first.

  
  

The Data: Patients Are Asking for This

What patients want is clear.

Research shows that the vast majority of engagement on clinician social media is positive. Ninety-three percent of patients say they would follow their healthcare provider on social media, if active. More than 75% report that provider social media presence influences their choice of care.

These platforms are already shaping decisions. The question is now whether health systems choose to engage intentionally, or leave interpersonal trust to chance.

Risk Versus Reward: What If We Post the Wrong Thing?

This is often the moment when health systems hesitate.

The concern is understandable: What if an individual practice posts something faulty? What if the message isn’t fully polished or on-brand? But those questions miss the more important issue: What happens when trusted clinical voices are absent altogether?

The majority of healthcare decisions are made outside of the exam room. Patients decide whether to follow a care plan, schedule a screening, enroll in a clinical trial, or delay treatment long after the visit ends. Those choices are shaped by what they see, hear, and trust in their day-to-day lives. When health systems silence the digital voices of their clinicians and practices, they leave that influence to less reliable sources.

Based on behavioral science, absence is not neutral. When trusted voices are missing, patients default to what is visible. Availability bias elevates whatever information is easiest to find. In other words, repetition creates perceived truth, regardless of accuracy. 

In contrast, even imperfect communication from a familiar provider strengthens interpersonal trust. It signals presence, accessibility, and ongoing care beyond the clinic walls. Patients don’t expect healthcare provider voices to sound like marketing, but rather human, relevant, and timely.

When clinicians and practices are allowed to communicate consistently and authentically, many benefits arise:

• Greater patient engagement and adherence

• Increased satisfaction and loyalty

• Stronger continuity of care

• And trust that compounds over time

  
  

The real risk isn’t that a message might be slightly imperfect. The real risk is the missed opportunity to guide patient behavior when it matters most.

The Paradox of Trust and a Way Forward

Healthcare systems face a paradox. They must appear competent at scale while remaining warm at the individual level.

The solution is not choosing one over the other. It is building infrastructure that enables both. Clear guardrails reinforce institutional trust, while flexibility, within the bounds of brand and privacy guidelines, allows for interpersonal presence. In other words, institutional trust makes care feel safe, and interpersonal trust makes care feel possible.

Above all, patients do not experience healthcare as a logo. They experience it as a conversation, a face, and a moment of being understood. As a result, the strongest healthcare brands are not the most controlled ones. They are the ones that understand where trust actually lives and design marketing systems for it intentionally.

This is where platforms like Social Cascade can help. Not as a content engine, but as infrastructure that allows health systems to maintain governance while empowering healthcare providers to show up as people.

Questions to Leave With

• Where does your system currently ask institutional trust to do interpersonal work?

• Where might local voices strengthen your brand credibility?

• If trust is built through experiences, which ones are your patients having online?

About Me

Lucy Shores Kosturko, PhD: As a cognitive psychologist, I study how people make decisions under uncertainty. Healthcare marketing is one of the clearest real-world examples of how psychology and communication intersect, often without explicit acknowledgment.