Trust in faith-based HIV/AIDS care: the importance of uninterruptable courage Open Access

Griswold, Emily Paige (2014)

Permanent URL:



The relationship quality between clients and staff may strengthen clients' commitment to HIV treatment, which is critical for a successful health outcome. Trust may affect this relationship and the quality of care that clients receive. Faith-based organizations may have unique features that promote trust. This qualitative study investigates the role of trust in faith-based HIV clinics in Kenya.


Using a grounded theory approach, we conducted and analyzed 26 in-depth interviews with clients and staff across three comprehensive care clinics supported by the Christian Health Association of Kenya. Interviews were transcribed verbatim and analyzed to produce themes. The themes were compared to produce an overarching process framework describing the nature and role of trust, perceptions of HIV care, and opinions of faith-based health services.


Participants described trust in terms of confidentiality, honesty, meeting needs and expectations, and empathy. Trust stemmed from and was reinforced by reliable, holistic, multidisciplinary, collaborative, and patient-centered care provided to clients. Staff made extraordinary efforts to meet clients' unique needs, developing partnerships with them through good rapport. Clients then demonstrated their trust through honesty, commitment to care, and expectations of high-quality services; staff reciprocated and strengthened this trust through kindness, respect, and empathy.

Institutions encouraged these processes by supporting and trusting staff as well as through continuous capacity building. Faith-based status was perceived to enhance rapport between clients and staff; it also conveyed a reputation for and expectation of quality services. Although these sites were well known for providing quality services, which helped create trust, trust independently signified a particular kind of quality - care that was reliable, comprehensive, individualized, and humane.


Generators of trust and quality of care function in a mutually reinforcing cycle. Nurturing each of these serves to enhance the other - a process which could greatly improve adherence and outcomes in HIV. This study thus has implications for the manner in which HIV care, and potentially other health services, is provided in Kenya.

Table of Contents

Chapter 1: Introduction

1.1 Background

1.2 Purpose

Chapter 2: Literature review

2.1 HIV/AIDS in Kenya

2.2 Trust

2.3 Faith-based organizations

2.4 Objectives

Chapter 3: Methods

3.1 Study sites

3.2 Questionnaire development

3.3 Recruitment and study procedures

3.4 Ethical considerations

3.5 Data analysis

Chapter 4: Results

4.1 Participants

4.2 Overview

4.3 Critical domains of trust

4.4 How the "faith-based" status enhanced trust

4.5 Enabling factors supporting the process of trust building

4.6 Themes and theoretical frameworks

Chapter 5: Discussion

5.1 Alignment with the literature

5.2 Strengths and limitations

5.3 Implications for policy and practice

5.4 Areas for further research

5.5 Conclusion


Appendix A: Interview guide for clients

Appendix B: Interview guide for staff

Appendix C: Consent script

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Partnering Agencies
Last modified

Primary PDF

Supplemental Files