We examine trust at the theory level as an engine driving sustainable change. We propose a new measurable dimension of the trust construct: reciprocity. Cooperative reciprocal relationships are its building blocks, enabling stakeholders to ‘try out’ interactions with less risk, calibrating level of effort, time and emotional investment before continuing further. Reciprocity includes three measurable elements: common goals furthering equitable and healthier communities, mutual self-interests and gratitude/indebtedness. We utilize a process model showing how these building blocks interrelate within a health systems context to jump-start and sustain reciprocal relationships. Process models are valuable in addressing internal dynamics of human relationships in complex systems as a complement to factor- or variance-based models. We applied theory by longitudinally tracking community health volunteers, examining reciprocity in close-to-the-community health systems. These methods and application of theory have relevance to environments where institutional structures are open to multistakeholder-driven innovation.

中文翻译：

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信任是变革的引擎：卫生系统中建立信任的概念模型

我们将理论层面的信任视为推动可持续变革的引擎。我们提出了信任结构的一个新的可衡量维度：互惠。合作互惠关系是它的基石，使利益相关者能够“尝试”以较低风险进行的互动，校准努力水平、时间和情感投资，然后再继续进行。互惠包括三个可衡量的要素：促进公平和健康社区的共同目标、共同的自身利益和感恩/负债。我们利用一个流程模型来展示这些构建块如何在卫生系统环境中相互关联，以启动和维持互惠关系。过程模型在解决复杂系统中人际关系的内部动态方面是有价值的，作为基于因素或方差的模型的补充。我们通过纵向跟踪社区卫生志愿者来应用理论，检查靠近社区卫生系统的互惠性。这些方法和理论应用与制度结构对多方利益相关者驱动的创新开放的环境相关。