The state of (mis) trust: Human-centered technology development & implementation in intensive mental health settings.

Innovative technology-based solutions in mental healthcare promise significant improvements in care quality and clinical outcomes. However, their successful implementation is profoundly influenced by the levels of trust patients hold toward their treatment providers, organizations, and the technology itself. This paper delves into the complexities of building and assessing patient trust within the intensive mental health care context, focusing on inpatient settings. We explore the multifaceted nature of trust, including interpersonal, institutional, and technological trust. We highlight the crucial role of therapeutic trust, which comprises both interpersonal trust between patients and providers, and institutional trust in treatment organizations. The manuscript identifies potential key barriers to trust, from sociocultural background to a patient's psychopathology. Furthermore, it examines the concept of technological trust, emphasizing the influence of digital literacy, socio-economic status, and user experience on patients' acceptance of digital health innovations. By emphasizing the importance of assessing and addressing the state of trust among patients, the overarching goal is to leverage digital innovations to enhance mental healthcare outcomes within intensive mental health settings.

The improvised expert: Staging authority at an OECD Nuclear Energy Agency workshop in Fukushima.

In recent years, concerns about a crisis of expert authority have been expressed across the globe. Japan is no exception to this trend. Scandals surrounding the (mis)management of the 2011 Fukushima Daiichi nuclear power plant disaster severely damaged public confidence in state institutions, posing an additional challenge for those engaged in radiological protection. This article examines how claims to expert authority are made in these conditions of low public trust. To this end, I offer an ethnographic account of the OECD Nuclear Energy Agency's (NEA) Workshop on Post-Accident Food Safety Science-an event staged at the request of the Japanese Cabinet Office with the aim of inspiring confidence in Fukushima produce. I analyse the practices through which the organizers craft a credible public persona using the idiom of dramaturgical improvisation; drawing attention to the 'performed resourcefulness' with which they adapted extant institutional scripts in response to a discerned crisis of public reason. Concretely, improvisation invites us to consider how and why nuclear policy actors have sought to demarcate two variants of the deficit model: the (psychological) discourse of 'radiophobia' and the (economic) discourse of 'reputational damage'. Where prior scholarship has identified the continuities between the two discourses, an attention to this boundary work reveals the dramaturgical advantages of 'reputational damage' over 'radiophobia' in contesting critics' claims to the mantle of victimhood, securing international support, and producing the expert's body as a site of evidence.

IOTASDN: IOTA 2.0 Smart Contracts for Securing Software-Defined Networking Ecosystem.

Software-Defined Networking (SDN) has revolutionized network management by providing unprecedented flexibility, control, and efficiency. However, its centralized architecture introduces critical security vulnerabilities. This paper introduces a novel approach to securing SDN environments using IOTA 2.0 smart contracts. The proposed system utilizes the IOTA Tangle, a directed acyclic graph (DAG) structure, to improve scalability and efficiency while eliminating transaction fees and reducing energy consumption. We introduce three smart contracts: Authority, Access Control, and DoS Detector, to ensure trusted and secure network operations, prevent unauthorized access, maintain the integrity of control data, and mitigate denial-of-service attacks. Through comprehensive simulations using Mininet and the ShimmerEVM IOTA Test Network, we demonstrate the efficacy of our approach in enhancing SDN security. Our findings highlight the potential of IOTA 2.0 smart contracts to provide a robust, decentralized solution for securing SDN environments, paving the way for the further integration of blockchain technologies in network management.

The influence of partner trustworthiness and relationship closeness on interpersonal trust in individuals with attachment anxiety: An ERP study.

Interpersonal trust (IT) is a combination of individuals' cognitive evaluations of others' trustworthiness and affective considerations related to the relationships. Individuals' trust decisions overly relying on the intimacy of the relationship can be detrimental to their socialization. Attachment styles provide a theoretical framework for explaining individual differences in IT and the balance between cognition control and affective evaluation in social-information processing. However, it remains unclear whether high attachment anxiety (AX) individuals with high interpersonal needs exhibit non-socially adaptive trust decisions, characterized by an over-reliance on relationship closeness (RC), independent of partner trustworthiness (PT). A coin-toss task, combined with event-related potential (ERP), was utilized to explore the performance and temporal characteristics of trust decision-making among individuals with high and low AX under the influence of the two factors. The behavioral results showed that high-AX individuals tended to trust close others regardless of their trustworthiness, while low-AX individuals only trusted close others under low-PT conditions, with no differences in RC for high-PT. The ERP results revealed that high-AX individuals exhibited an enhanced positive P1 by low-trust partners, only discerning differences in RC for high-trust partners (more negative N2 by strangers than friends), reflecting poor conflict-detection abilities confronted with low-trust partners. Low-AX individuals' neural activity showed higher consistency with their behavioral performance, indicating that trust in close others under low-trust conditions was due to the fewer conflicts elicited and higher expectations of them, reflecting smaller N2 and larger P3. Overall, these findings indicated that high-AX individuals' IT decision-making was primarily influenced by their reliance on affective evaluation in information processing and weaker cognitive-control abilities, highlighting the contribution of attachment to social-information processing.

A social science trust taxonomy with emergent vectors and symmetry.

Introduction: Trust is foundational to all social science domains, but to date, there is no unifying theory or consistent measurement basis spanning the social sciences. This research hypothesized that trust forms the basis of an ontology that could unify the social science domains. The proposed ontology comprises a Cartesian plane with axes self-trust and other-trust. Self-trust manifests in dominant behaviors, and other-trust manifests in cooperative behaviors. Both axes are divided into five discrete categories, creating a matrix of 25 cells. All words in the lexicon are allocated into one of these 25 cells. Methods: This research started with an existing 14,000-word lexicon of dominance and affiliation. The lexicon was extended by manually identifying and including socially descriptive words with information regarding self-trust, other-trust, dominance, and cooperation. The taxonomy was optimized using the Gradient Descent machine learning algorithm and commercially curated synonyms and antonyms. The t-test was employed as the objective (or loss) function for Gradient Descent optimization. Word vectors were identified using groups of four words related as synonyms and antonyms. Results: Over 30,000 words were identified and included in the lexicon. The optimization process yielded a t-score of over 1,000. Over 226,000 vectors were identified, such as malevolent-mean-gentle-benevolent. A new form of symmetry was identified between adjectives and verbs with a common root; for example, the words reject and rejected are horizontally reflected. Discussion: The word vectors can create a metrologically compliant basis for psychometric testing. The symmetries provide insight into causes (verbs) and effects (adjectives) in social interactions. These vectors and symmetries offer the social sciences a basis of commonality with natural sciences, enabling unprecedented accuracy and precision in social science measurement.

Impact of inpatient self-efficacy and trust in physicians on inpatient satisfaction with medical services: the mediating role of patient participation in medical decision-making.

Objective: Patient satisfaction reflects the social benefits of hospitals and is an important indicator of hospital performance. This study explores the mechanism through which inpatients' trust in physicians, self-efficacy, and participation in medical decision-making impact their satisfaction with medical services. Methods: A questionnaire was administered to 814 inpatients in 10 randomly selected tertiary hospitals and 10 randomly selected secondary hospitals in Hangzhou, China. A correlation analysis and hierarchical linear regression were conducted to analyze the factors influencing inpatient satisfaction. Results: The outcome measures of trust in physicians and participation in medical decision-making behaviors had significant positive effects on inpatient satisfaction.Trust in physicians was shown to directly influence inpatient satisfaction, while inpatient participation in decision-making partially mediated this relationship. Inpatient participation in medical decision-making fully mediated the relationship between self-efficacy and inpatient satisfaction. Conclusion: While inpatients were relatively satisfied, there is room for improvement. Healthcare providers should improve patient trust by actively listening to their needs and providing feedback, establishing effective communication mechanisms. Patient self-efficacy can be enhanced through health education, special lectures, and case sharing. Patients should also be encouraged to actively participate in medical decision-making. Practical implications: Based on inpatient feedback during a preliminary survey, we refined this study's questionnaire to enhance its feasibility for future research. This article shares key findings for healthcare managers and providers, advising that patient satisfaction can be enhanced through trust, self-efficacy, and participation.

Patient Consent and The Right to Notice and Explanation of AI Systems Used in Health Care.

Given the need for enforceable guardrails for artificial intelligence (AI) that protect the public and allow for innovation, the U.S. Government recently issued a Blueprint for an AI Bill of Rights which outlines five principles of safe AI design, use, and implementation. One in particular, the right to notice and explanation, requires accurately informing the public about the use of AI that impacts them in ways that are easy to understand. Yet, in the healthcare setting, it is unclear what goal the right to notice and explanation serves, and the moral importance of patient-level disclosure. We propose three normative functions of this right: (1) to notify patients about their care, (2) to educate patients and promote trust, and (3) to meet standards for informed consent. Additional clarity is needed to guide practices that respect the right to notice and explanation of AI in healthcare while providing meaningful benefits to patients.

Effect of older adults willingness on telemedicine usage: an integrated approach based on technology acceptance and decomposed theory of planned behavior model.

BACKGROUND: Telemedicine, as a novel method of health management system, has demonstrated to have a significant impact on health levels. However, a challenge persists in the form of low usage rates and acceptance among older adults in China. There are accumulating evidence that willingness will affect the telemedicine usage among older adults. This study investigates factors influencing older users' trust in adopting telemedicine technology, thereby promoting actual use. METHODS: A questionnaire survey was conducted with 400 urban seniors aged 60 and above. Drawing from the Technology Acceptance Model (TAM) and the Decomposed Theory of Planned Behavior (DTPB), the author combines elements such as Perceived Usefulness, Perceived Ease of Use, Subjective Norms, Service Environment, Self-Efficacy, Behavioral Intention to Use, and Usage Behavior. The aim is to explore the interrelationships between these factors. RESULTS: Perceived Usefulness (PU) and Service Environment (SE) significantly and positively impact Behavioral Intention (BI) to use telemedicine, with Trust (TR) identified as a crucial mediating variable. Enhancing trust can substantially increase older adults' intention to use telemedicine services. Furthermore, the study reveals a significant relationship between older adults' trust in telemedicine and factors such as Perceived Usefulness (PU), Service Environment (SE), Subjective Norms (SR), as well as Emotional Risk (ER) and Cost Risk (CR), the latter two tending to decrease Trust(TR). CONCLUSIONS: This paper constructs and validates a combined model based on TAM and DTPB, comprehensively exploring the potential factors influencing the older adults' intention to use telemedicine. The findings suggest that telemedicine services for older adults should prioritize improving user perception and enhancing trust throughout the service process to effectively increase their willingness to use these services.

How Expectations and Trust in Telemedicine Contribute to Older Adults' Sense of Control: An Empirical Study.

As numerous nations transition into digital and aging societies, the digital divide has emerged as a significant impediment to older adults' autonomous engagement in the digital society. Enhancing the well-being of elderly individuals through remote medical technology represents a prevailing and prospective trend. Nevertheless, remote medical technology extends beyond the realm of healthcare, offering promise for narrowing the digital divide through the deployment of digital devices and provision of intergenerational support. Therefore, this study investigates the role of trust and expectations in the use of telemedicine, indicating potential pathways for how these products can improve older adults' daily living abilities. Through the construction of a theoretical model, we collected the relevant data of 661 elderly people who use telemedicine technology in China and analyzed the data with SmartPLS4 to obtain the research results. The study discovered that, among older people using telemedicine technology, (1) healthcare expectations promote the breadth of telemedicine product use; (2) trust in product safety increases the depth of telemedicine product use; (3) trust in the service provider promotes the breadth of telemedicine product use; and (4) when compared to the depth of product use, the breadth of telemedicine product use increases older adults' sense of control over their digital lives. The findings provide new empirical data to support growing beliefs about how expectations and trust can increase a sense of control over one's life. They also provide practical contributions on how to boost older adults' usage of telemedicine products, promote their digital literacy and competency, and enhance their sense of control over their digital lives.

A Qualitative Study of Naturally Living Parents and Child Oral Health: Omissions and Commissions.

BACKGROUND: Oral health continues to be one of the most common and costly diseases in early childhood, and there is a need for further, innovative research. PURPOSE: We explored the ways naturally living parents (those who embody the "natural" within their parenting ideology and behavior) navigated and perceived their children's oral health. METHODS: Twelve participants who identified as being "naturally living parents" participated in semistructured interviews. Data were thematically analyzed, and findings were aligned to an omissions and commissions framework to exhibit the complexity of parent decision-making. RESULTS: Parents performed distinct omissions, including omitting fluoride, sugar, and "toxins" to maintain their children's oral health. Parents talked about having a commitment to knowledge building to protect their children's oral health (e.g., ingredient label reading and increasing knowledge of "safe" ingredients). Findings also provide insight into how parents consider and trust health information and health care providers and ways they gather information relating to oral health. CONCLUSIONS: Analysis indicated that although parents navigated both omissions and commissions, omissions were more overtly present. Compared to previous health research using this framework, omissions and commissions were not as clearly demarcated in relation to oral health. The results show that oral health is a complex interplay of omissions and commissions, and parents must navigate not only discrete elements that affect the oral health of their children but also how these are influenced by considerations including social well-being. KNOWLEDGE TRANSFER STATEMENT: The study highlights the need for dentists and early childhood health professionals to consider the complex way some parents perceive, inform, and rationalize decisions regarding their children's oral health. There is a need for nuance when considering children's oral health and naturally living parenting, especially in relation to effectively communicating health information that fosters trust and is considerate of broader lifestyle and health factors.

Sustainable Digital Transformation: Its Impact on Perceived Value and Adoption Intention of Industry 4.0 in Moderating Effects of Uncertainty Avoidance.

Background: Industry 4.0 is a significant technical revolution that combines big data analytics, the Internet of Things (IoT), and cyber-physical systems to improve manufacturing productivity. This study investigates the impact of digital trust and sustainable attitude on perceived value and the intention to adopt Industry 4.0 technologies. It also examines the moderating role of uncertainty avoidance in these relationships. Methods: Data were collected from 189 employees of leading manufacturing companies in Indonesia that are recognized for their Industry 4.0 practices. The data were analyzed using Partial Least Squares (PLS) methodology with SmartPLS software to test the proposed hypotheses and explore the moderating effects. Results: The findings reveal that both digital trust and sustainable attitude significantly influence perceived value. However, these factors do not directly affect the intention to adopt Industry 4.0 technologies. Uncertainty avoidance moderates the relationship between digital trust and adoption intention. Specifically, in environments with high uncertainty avoidance, digital trust becomes a critical factor influencing the decision to adopt Industry 4.0 technologies. Conclusions: The study provides valuable insights for organizations aiming to implement Industry 4.0 initiatives. It highlights the importance of fostering digital trust and considering cultural dimensions, such as uncertainty avoidance, in their technology adoption strategies.

Self-rated health of Latino day laborers during the COVID-19 pandemic: a cross-sectional study.

Background: This study assesses the relationship between trust in sources of information in regard to the Coronavirus Disease 2019 (COVID-19) pandemic and self-rated health (SRH) in a sample of Latino Day Laborers (LDLs) and explores whether these associations were mediated by mental health measures. Methods: A rapid needs assessment survey was conducted with 300 LDLs, recruited at randomly selected hiring locations in Houston, Texas, during November and December 2021. Two measures of trust were developed, and SRH was measured by a single item. Depression, anxiety, and stress were measured by previously validated scales. We applied the product of coefficients approach to assess our mediation model. Using Hayes' PROCESS version 4.2 in SPSS, linear regression models were generated simultaneously to assess the total effect of trust on SRH, effect of trust on the mental health mediator, and effect of the mediator on SRH, controlling for trust. Demographic characteristics were entered as covariates. Results: Greater trust in formal sources of information (such as Spanish-speaking television networks) as well as greater levels of anxiety and depression were associated with lower SRH. There were no significant associations between formal trust and mental health measures. As such, the association between formal trust and decreased SRH was not mediated by mental health. Trust in informal sources of information (conversations with friends, family, and coworkers) was not significantly associated with SRH or mental health. Higher levels of depression and anxiety, however, were associated with lower SRH. Conclusions: LDLs' perception of their health was inversely associated with their level of trust in formal sources of information and with greater levels of depression and anxiety. Nevertheless, these pathways were independent of each other. The results indicate the direct impact of COVID-19 public information on subjective well-being, a relationship that merits further exploration.

Ethical analysis of informed consent methods in longitudinal cohort studies: A Chinese perspective.

In longitudinal cohort studies involving large populations over extended periods, informed consent entails numerous urgent challenges. This paper explores challenges regarding informed consent in long-term, large-scale longitudinal cohort studies based on the longitudinal and dynamic nature of such research. It analyzes and evaluates widely recognized broad consent and dynamic consent methods, highlighting limitations concerning their ability to adapt to evolving research objectives and participant perspectives. This paper discusses trust-based informed consent and emphasizes the needs to establish and maintain trust with research participants and to balance information disclosure with respect for participants' autonomy. Informed consent in long-term studies is an evolving process that must adapt to changing research environments. Based on participant trust, researchers should observe and assess potential research risks. Finally, the paper recommends enhancing institutional credibility, implementing reconsent procedures, and ensuring robust ethical oversight to safeguard participants' rights despite the complexity of modern biomedical research.

Trust in government, social media and willingness to vaccinate.

Vaccine hesitancy is considered one of the biggest global health threats. The prevalence of false information about vaccines on social media amplifies this challenge, making it more urgent. This study examines the relationship between social media use, trust in information sources, beliefs about vaccination rates, and willingness to adopt vaccines using data gathered in late 2023 from 975 respondents in South Africa. Our results suggest that people who rely on social media as their primary news source are more hesitant to get vaccinated for themselves and their children. Trust, which includes various sources including confidence in the government, is positively linked to vaccination decisions. Trust is especially important when it comes to less traditional vaccines such as COVID-19 and flu vaccines for both adults and children. We also note gender differences, with South African men showing more reluctance to get vaccinated as adults. Additionally, there is a negative correlation between social media use and the willingness of males to get vaccinated, but this relationship is not evident among females. Our research highlights the need for targeted interventions aimed at improving vaccine uptake, taking into account the links with information sources about vaccination and government trust.

The influence of the perception, attitude, and level of trust on the uptake of COVID-19 vaccinations among pregnant women attending antenatal care clinic in mbeya urban, Tanzania.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) has been associated with adverse effects and death among people with low immunity, including pregnant women. Despite introducing the vaccine as the proper means to curb the spread of the pandemic, vaccine uptake is still low. This study assessed the influence of perception, attitude, and trust toward COVID-19 vaccine uptake among pregnant women attending Antenatal Care Clinics. METHODS: A cross-sectional study design was used, utilizing a quantitative approach with a cross-sectional analytical design conducted in Mbeya urban, distribution of sample size during data collection based on client's volume at three government health facilities (one tertiary health facility, one secondary health facility, and one primary health facility) in Mbeya Urban, Tanzania. Data were collected from 333 pregnant women who attended ANC during the data collection period using a questionnaire with closed-ended questions administered to respondents face-to-face. Data cleaning and analysis were done using Excel and Stata/SE 14.1 software for bivariate and multivariate data; Pearson's chi-squire and Fisher's test were used to analyze the independent determinants of COVID-19 vaccine uptake. RESULTS: The proportion of pregnant women vaccinated with the COVID-19 vaccine was 27%. There was a statistically significant association between the respondents' vaccine uptake with primary education and < 5 work experience to vaccine uptake P = 0.015 (AOR = 6.58; 95% CI; 1.45-29.85), and P = 0.046 (AOR = 2.45; 95% CI; 1.02-5.89) respectively. The association of attitude influence to COVID-19 vaccine uptake was statistically significant (acceptance of vaccine due to its availability, vaccine acceptance for protection against COVID-19 pandemic to respondent and her baby, experience from other vaccines) was statistically significant at P = 0.011 (AOR = 4.43; 95% CI; 1.41-13.93), P = 0.001 (AOR = 45.83; 95% CI; 18.6-112.89) respectively. The level of trust in the COVID-19 vaccine influenced respondents' association with vaccine uptake in the 2nd and 3rd trimesters of pregnancy (P = 0.633 (AOR = 1.23; 95% CI; 0.53-2.48), respectively. CONCLUSION: Pregnant women's positive attitude and trust in the COVID-19 vaccine influenced them to uptake it; our conclusion supports the WHO guidelines that the COVID-19 vaccine should be administered to pregnant women since it is a safer means to curb COVID-19 pregnancy-related complications.

Health concerns, access to care, and trust in research and researchers among community members with bipolar disorder.

BACKGROUND: Data are needed on differences in community-dwelling populations with bipolar disorder (BP) regarding trust in research and access to care. We characterized community members by lifetime history of bipolar disorder. We hypothesized that those with BP would have less trust in research, visit a health provider less, and participate less in research than those without BP. We also hypothesized that those with BP would be more likely to have a history of marijuana (MJ) use. METHODS: A cross-sectional design was used for this analysis. The study population consisted of 12,489 members (78.0%) from the HealthStreet community engagement program who were interviewed by a Community Health Worker about health history and demographics. RESULTS: Among the sample, the rate of BP was 10.6% (n = 1326). Those reporting BP were more likely than those who did not (n = 11,163), to report muscle, bone, and mental health problems, to be younger, female, to have visited the doctor in the past 12 months, to be interested in participating in research, and be current MJ users. Trust did not differ between BP groups. CONCLUSIONS: Our analysis found that persons with BP had higher access to care and more interest in research, thus our primary hypothesis was rejected. Our secondary hypothesis, that persons with BP were more likely to have a history of MJ use was upheld. These findings are important because they address a crucial gap in the literature surrounding BP and lay the groundwork for future community-level research.

Trustworthy and ethical AI-enabled cardiovascular care: a rapid review.

BACKGROUND: Artificial intelligence (AI) is increasingly used for prevention, diagnosis, monitoring, and treatment of cardiovascular diseases. Despite the potential for AI to improve care, ethical concerns and mistrust in AI-enabled healthcare exist among the public and medical community. Given the rapid and transformative recent growth of AI in cardiovascular care, to inform practice guidelines and regulatory policies that facilitate ethical and trustworthy use of AI in medicine, we conducted a literature review to identify key ethical and trust barriers and facilitators from patients' and healthcare providers' perspectives when using AI in cardiovascular care. METHODS: In this rapid literature review, we searched six bibliographic databases to identify publications discussing transparency, trust, or ethical concerns (outcomes of interest) associated with AI-based medical devices (interventions of interest) in the context of cardiovascular care from patients', caregivers', or healthcare providers' perspectives. The search was completed on May 24, 2022 and was not limited by date or study design. RESULTS: After reviewing 7,925 papers from six databases and 3,603 papers identified through citation chasing, 145 articles were included. Key ethical concerns included privacy, security, or confidentiality issues (n = 59, 40.7%); risk of healthcare inequity or disparity (n = 36, 24.8%); risk of patient harm (n = 24, 16.6%); accountability and responsibility concerns (n = 19, 13.1%); problematic informed consent and potential loss of patient autonomy (n = 17, 11.7%); and issues related to data ownership (n = 11, 7.6%). Major trust barriers included data privacy and security concerns, potential risk of patient harm, perceived lack of transparency about AI-enabled medical devices, concerns about AI replacing human aspects of care, concerns about prioritizing profits over patients' interests, and lack of robust evidence related to the accuracy and limitations of AI-based medical devices. Ethical and trust facilitators included ensuring data privacy and data validation, conducting clinical trials in diverse cohorts, providing appropriate training and resources to patients and healthcare providers and improving their engagement in different phases of AI implementation, and establishing further regulatory oversights. CONCLUSION: This review revealed key ethical concerns and barriers and facilitators of trust in AI-enabled medical devices from patients' and healthcare providers' perspectives. Successful integration of AI into cardiovascular care necessitates implementation of mitigation strategies. These strategies should focus on enhanced regulatory oversight on the use of patient data and promoting transparency around the use of AI in patient care.

Taking it to the extreme: prevalence and nature of extremist sentiment in games.

More than half of all game players report experiencing some form of hate, harassment or abuse within gaming spaces. While prevalence assessments of these actions in digital gaming spaces are ongoing, little remains known about the more extreme forms of these behaviors. Specifically, experiences of extremism. This paper addresses the gap in research knowledge around the expression of extremist sentiment in games by evaluating their prevalence, location, and nature, and impact. Assessing experiences via an online survey, game players (n = 423) reported an alarmingly high rate of frequency for being the direct target of, as well as a witness to, all forms of extremist content. Most of these experiences were text-based, reported to be happening in-game. Most players endorsed statements relating to a normalization of extreme ideologies within gaming cultures. It is promising that reporting these behaviors was the primary action taken by players for most of the players; however, "ignoring" these actions was also a common strategy. It is possible that player inaction reflects the embeddedness and normalization of these actions in gaming spaces and/or a lack of trust in moderation systems to be responsive. The prevalence of extreme sentiment in gaming cultures should raise concern from game makers, members of the gaming community, parents, and policy makers alike.

Fostering a Trusting Relationship With Family in Dementia Special Care Units: A Participatory Action Research Project.

AIM: To explore experiences of nursing home staff in implementing self-designed interventions to foster trusting relationships with family in practice. DESIGN: This qualitative study used a Participatory Action Research approach. METHODS: Data collection included focus groups (n = 15), interviews (n = 28) and observations (n = 5). A holistic narrative approach was used for data analysis, resulting in co-constructed narratives representing experiences of nursing home staff in implementing four different interventions in five Dutch dementia special care units in nursing homes. The data collection period began in August 2021 and ended in April 2022. RESULTS: Nursing home staff implemented self-designed interventions to foster trusting relationships with family, including initiating informal conversations, sharing residents' 'happy' moments, discussing mutual expectations, and being more aware of families' emotional burdens. Identified facilitators emphasise the importance of reciprocity, familiarity, transparency, realistic goal setting and empathy. Identified barriers are related to moral uncertainty in balancing competing demands, conflicting social norms, prioritising hands-on care tasks over family contact and lack of courage to act. CONCLUSION: Nursing home staff conclude that their interventions contribute positively to building and maintaining a trusting relationship with families. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Sharing the narratives of nursing home staff with peers would support them in implementing interventions to foster trust. Regular Moral Case Deliberations can be used to address moral uncertainty. Collective dialogue among nursing home staff can be useful in establishing new social norms that prioritise family involvement. Conversation skills training can empower nursing home staff. IMPACT: Trust between nursing home staff and families can be improved by implementing the conducted interventions. REPORTING METHOD: This report adheres to the standards for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.