Trust is essential: implementing paediatric care coordination in rural Australia

BACKGROUND: Trust is essential to effective healthcare relationships with service users and a key mechanism for successful implementation of service improvements. In rural settings, systemic barriers, such as workforce shortages, fragmented services, and access inequities, can erode trust in the healthcare system. Integrated care models that prioritise relational approaches may help build trust, particularly for families of children with medical complexity (CMC) who frequently navigate multiple healthcare services. OBJECTIVE: This study explored how trust was operationalised between families of CMC and care coordinators in the Rural Kids Guided Personalised Service (RuralKidsGPS) model, and how relational and contextual factors shaped trust-building processes. METHODS: Semi-structured interviews with parents (n = 13), family groups (n = 9), and Paediatric Care Coordinators (PCCs) (n = 8). A hybrid inductive/deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR), was used to evaluate the implementation barriers and enablers of RuralKidsGPS. Drawing on established theories, including the Trust Triangle and leveraging validated frameworks, we developed the Trust in Implementation Practice (TIP), comprising five relational constructs: Authenticity, Empathy, Competency, Vulnerability, and Reciprocity. These constructs guided analysis of trust-building mechanisms across families, PCCs, and the healthcare system. RESULTS: Factors enabling or undermining trust-building emerged as key themes from the CFIR-guided thematic analysis. Trust was fostered through PCCs' relational competencies, authenticity, empathy, and local knowledge, enabling responsive care and sustained healthcare relationships. Trust dynamics were shaped by psychosocial and economic disadvantage, geographic isolation, systemic inequities in service access, and previous adverse healthcare experiences. PCCs were perceived as trustworthy intermediaries who promoted equity, continuity, and access to care. Thematic findings identified six key contextual modifiers, leading to expansion into the TIP-Context (TIP-C) framework. CONCLUSION: Trust operates as both a mechanism and an outcome in the implementation of integrated care. The TIP-C framework offers a novel, theory-informed lens for understanding and operationalising trust-building in healthcare implementation. Future research is needed to validate and/or amend the TIP-C in other implementation settings.