Restricted accessResearch articleFirst published online 2026-1
Associations Between Trust in Healthcare Professionals and Perceptions of Modifiability of Dementia and Stroke Risks Through Maintaining or Changing Lifestyle Habits
To investigate the trust levels in health information sources from a United States (U.S.) sample, and to examine the relationships between trust in healthcare professionals (HCPs) and perceptions of modifiability of dementia and stroke risks through maintaining or changing lifestyle habits.
Design
Cross-sectional.
Setting
A survey distributed via the vendor platform Prolific to a sample of the U.S. population.
Participants
Data included on U.S. adults (n = 1478) in 2023.
Measures
Outcome variables were perceiving that dementia and stroke risk can be modified through maintaining or changing lifestyle habits. Independent variables were trust levels in HCPs.
Analysis
Descriptive analysis was performed to assess levels of trust in information sources. Subsequently, we performed multivariable regression analyses between trust in HCPs and perceptions of risk modifiability in dementia and stroke. A hierarchal cluster analysis was conducted to characterize trust patterns in this cohort.
Results
Participants with high trust in HCPs compared to those with low trust in HCPs were more likely to perceive that maintaining (adjusted odds ratio [aOR] = 1.57, 95% confidence interval [CI]:1.15-2.12) and changing lifestyle habits (aOR = 1.72, 95% CI: 1.26-2.33) could reduce risk of dementia. Similar associations were found for perceptions of stroke risk reduction through maintaining (aOR = 1.49, 95% CI: 1.07-2.04) and changing (aOR = 2.68, 95% CI: 1.72-4.12) lifestyle habits. Cluster analyses identified three trust patterns amongst the participants: (i) a generally trusting cluster, (ii) a trusting of “official” health sources only cluster, and (iii) a generally not trusting cluster.
Conclusion
This study found statistically significant associations between trusting HCPs and the perceptions that maintaining or changing lifestyle habits can modify risks of dementia and stroke, highlighting the importance of trust when developing preventive strategies.
BiswasTTownsendNHudaMM, et al.Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: a population-based study. eClinicalMedicine. 2022;52:101591. doi:10.1016/j.eclinm.2022.101591
2.
BraininMFeiginVLNorrvingBMartinsSCOHankeyGJHachinskiVWorld Stroke Organization Board of Directors. Global prevention of stroke and dementia: the WSO declaration. Lancet Neurol. 2020;19(6):487-488. doi:10.1016/S1474-4422(20)30141-1
3.
ZissimopoulosJMTysingerBCStClairPACrimminsEM. The impact of changes in population health and mortality on future prevalence of Alzheimer’s disease and other dementias in the United States. J Gerontol: Ser Bibliogr. 2018;73(suppl_1):S38-S47. doi:10.1093/geronb/gbx147
4.
DuncanPWBushnellCDJonesSB, et al.Comparing a Care Program and Usual Care to Help Patients Transition Home From the Hospital After a Stroke -- the COMPASS Study. Washington, DC: Patient-Centered Outcomes Research Institute (PCORI); 2022. https://www.ncbi.nlm.nih.gov/books/NBK610535/. Accessed 31 January 2025.
5.
LivingstonGHuntleyJLiuKY, et al.Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet. 2024;404(10452):572-628. doi:10.1016/S0140-6736(24)01296-0
6.
PandianJDGallSLKateMP, et al.Prevention of stroke: a global perspective. Lancet. 2018;392(10154):1269-1278. doi:10.1016/S0140-6736(18)31269-8
7.
SinghSDOreskovicTCarrS, et al.The predictive validity of a brain care score for dementia and stroke: data from the UK biobank cohort. Front Neurol. 2023;14:1291020. doi:10.3389/fneur.2023.1291020
8.
NutbeamD. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259-267. doi:10.1093/heapro/15.3.259
9.
NutbeamD. The evolving concept of health literacy. Soc Sci Med. 2008;67(12):2072-2078. doi:10.1016/j.socscimed.2008.09.050
10.
ThomDHHallMAPawlsonLG. Measuring patients’ trust in physicians when assessing quality of care. Health Aff. 2004;23(4):124-132. doi:10.1377/hlthaff.23.4.124
11.
ChenXHayJLWatersEA, et al.Health literacy and use and trust in health information. J Health Commun. 2018;23(8):724-734. doi:10.1080/10810730.2018.1511658
12.
ClaymanMLManganelloJAViswanathKHesseBWAroraNK. Providing health messages to Hispanics/Latinos: understanding the importance of language, trust in health information sources, and media use. J Health Commun. 2010;15(sup3):252-263. doi:10.1080/10810730.2010.522697
13.
RoweRCalnanM. Trust relations in health care: developing a theoretical framework for the “new” NHS. J Health Organisat Manag. 2006;20(5):376-396. doi:10.1108/14777260610701777Calnan M, Rowe R, eds.
14.
HillenMAde HaesHCJMSmetsEMA. Cancer patients’ trust in their physician—a review. Psychooncology. 2011;20(3):227-241. doi:10.1002/pon.1745
15.
GrahamJLShahaniLGrimesRMHartmanCGiordanoTP. The influence of trust in physicians and trust in the healthcare system on linkage, retention, and adherence to HIV care. AIDS Patient Care STDS. 2015;29(12):661-667. doi:10.1089/apc.2015.0156
16.
AlRuthiaYSalesIAlmalagH, et al.The relationship between health-related quality of life and trust in primary care physicians among patients with diabetes. Clin Epidemiol. 2020;12:143-151. doi:10.2147/CLEP.S236952
17.
JneidSJabbourHHajjA, et al.Quality of life and its association with treatment satisfaction, adherence to medication, and trust in physician among patients with hypertension: a cross-sectional designed study. J Cardiovasc Pharmacol Therapeut. 2018;23(6):532-542. doi:10.1177/1074248418784292
18.
ThakurNMPerkelRL. Prevention in adulthood: forging a doctor-patient partnership. Prim Care. 2002;29(3):571-582. doi:10.1016/S0095-4543(02)00018-0
19.
SenffJTackRWPMallickA, et al.Modifiable risk factors for stroke, dementia and late-life depression: a systematic review and DALY-weighted risk factors for a composite outcome. J Neurol Neurosurg Psychiatry. 2025;96(6):515-527. doi:10.1136/jnnp-2024-334925
20.
JonesDECarsonKABleichSNCooperLA. Patient trust in physicians and adoption of lifestyle behaviors to control high blood pressure. Patient Educ Counsel. 2012;89(1):57-62. doi:10.1016/j.pec.2012.06.003
21.
HaywardWBuchERNoratoG, et al.Procedural motor memory deficits in patients with long-COVID. Neurology. 2024;102(3):e208073. doi:10.1212/WNL.0000000000208073
22.
SinghSSagarR. A critical look at online survey or questionnaire-based research studies during COVID-19. Asian J Psychiatr. 2021;65:102850. doi:10.1016/j.ajp.2021.102850
23.
PeerERothschildDGordonAEverndenZDamerE. Data quality of platforms and panels for online behavioral research. Behav Res. 2022;54(4):1643-1662. doi:10.3758/s13428-021-01694-3
GrechRGrechP. The stroke knowledge assessment tool (SKAT): development, reliability and validity. Jmhs. 2021;2(2):81-90. doi:10.32996/jmhs.2021.2.2.9
26.
AnnearMJToyeCElliottKEJMcInerneyFEcclestonCRobinsonA. Dementia knowledge assessment scale (DKAS): confirmatory factor analysis and comparative subscale scores among an international cohort. BMC Geriatr. 2017;17(1):168. doi:10.1186/s12877-017-0552-y
27.
KimSSargent-CoxKCherbuinNAnsteyKJ. Development of the motivation to change lifestyle and health behaviours for dementia risk reduction scale. Dement Geriatr Cogn Dis Extra. 2014;4(2):172-183. doi:10.1159/000362228
28.
Budin-LjøsneIMowinckelAMFriedmanBB, et al.Public perceptions of brain health: an international, online cross-sectional survey. BMJ Open. 2022;12(4):e057999. doi:10.1136/bmjopen-2021-057999
29.
GrantSLiaoKMillerCPetersonSEltingLGuadagnoloBA. Lower levels of trust in the medical profession among white, younger, and more educated individuals with cancer. Am J Clin Oncol. 2021;44(4):150-157. doi:10.1097/COC.0000000000000771
30.
WalkerSNVolkanKSechristKPenderN. Health-promoting life styles of older adults: comparisons with young and middle-aged adults, correlates and patterns. ANS Adv Nurs Sci. 1988;11(1):76-90. doi:10.1097/00012272-198810000-00008
31.
Von BothmerMIKFridlundB. Gender differences in health habits and in motivation for a healthy lifestyle among Swedish university students. Nurs Health Sci. 2005;7(2):107-118. doi:10.1111/j.1442-2018.2005.00227.x
32.
SmithD. Health care consumer’s use and trust of health information sources. J Commun Healthc. 2011;4(3):200-210. doi:10.1179/1753807611Y.0000000010
33.
ArmstrongKRavenellKLMcMurphySPuttM. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283-1289. doi:10.2105/AJPH.2005.080762
34.
HarrisJCMereishEHFaulknerML, et al.Racial differences in the association between alcohol drinking and cigarette smoking: preliminary findings from an alcohol research program. Alcohol Alcohol. 2021;57(3):330-339. doi:10.1093/alcalc/agab038
35.
BondsDEFoleyKLDuganEHallMAExtromP. An exploration of patients. J Health Care Poor Underserved. 2004;15(2):294-306. doi:10.1353/hpu.2004.0018
36.
CutlerDMLleras-MuneyA. Understanding differences in health behaviors by education. J Health Econ. 2010;29(1):1-28. doi:10.1016/j.jhealeco.2009.10.003
37.
RodriguezMZCominCHCasanovaD, et al.Clustering algorithms: a comparative approach. PLoS One. 2019;14(1):e0210236. doi:10.1371/journal.pone.0210236. Kestler HA, ed.
38.
TangMKaymazYLogemanBL, et al.Evaluating single-cell cluster stability using the Jaccard similarity index. Bioinformatics. 2021;37(15):2212-2214. doi:10.1093/bioinformatics/btaa956Inanc B, ed.
39.
JacksonDNPetersonEBBlakeKDCoaKChouWYS. Americans’ trust in health information sources: trends and sociodemographic predictors. Am J Health Promot. 2019;33(8):1187-1193. doi:10.1177/0890117119861280
40.
GreeneJRamosC. A mixed methods examination of health care provider behaviors that build patients’ trust. Patient Educ Counsel. 2021;104(5):1222-1228. doi:10.1016/j.pec.2020.09.003
41.
RichardsonAAllenJAXiaoHValloneD. Effects of race/ethnicity and socioeconomic status on health information-seeking, confidence, and. Trust. 2012;23(4):1477-1493. doi:10.1353/hpu.2012.0181
42.
ChaudhuriSLeTWhiteCThompsonHDemirisG. Examining health information–seeking behaviors of older adults. Comput Inform Nurs. 2013;31(11):547-553. doi:10.1097/01.NCN.0000432131.92020.42
43.
KowittSDSchmidtAMHannanAGoldsteinAO. Awareness and trust of the FDA and CDC: results from a national sample of US adults and adolescents. PLoS One. 2017;12(5):e0177546. doi:10.1371/journal.pone.0177546
MichieSvan StralenMMWestR. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. doi:10.1186/1748-5908-6-42
46.
ChiuveSERexrodeKMSpiegelmanDLogroscinoGMansonJERimmEB. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118(9):947-954. doi:10.1161/CIRCULATIONAHA.108.781062
47.
FanQOngASEKohMSDoshiK. The mediating role of trust in physician and self-efficacy in understanding medication adherence in severe asthma. Respir Med. 2021;190:106673. doi:10.1016/j.rmed.2021.106673
48.
YeMLyuZ. Trust, risk perception, and COVID-19 infections: evidence from multilevel analyses of combined original dataset in China. Soc Sci Med. 2020;265:113517. doi:10.1016/j.socscimed.2020.113517
49.
LiHChenBChenZ, et al.Trust in COVID-19 information from different media types and its association with preventive measures adoption in the U.S. J Health Commun. 2023;28(10):633-647. doi:10.1080/10810730.2023.2245373
50.
HesseBWNelsonDEKrepsGL, et al.Trust and sources of health information: the impact of the internet and its implications for health care providers: findings from the first health information national trends survey. Arch Intern Med. 2005;165(22):2618-2624. doi:10.1001/archinte.165.22.2618
51.
JacobsWAmutaAOJeonKC. Health information seeking in the digital age: an analysis of health information seeking behavior among US adults. Cogent Social Sci. 2017;3(1):1302785. doi:10.1080/23311886.2017.1302785Alvares C, ed.
GlynnRWShelleyELawlorBA. Public knowledge and understanding of dementia-evidence from a national survey in Ireland. Age Ageing. 2017;46(5):865-869. doi:10.1093/ageing/afx082
54.
EkohPCGeorgeEOEjimakaraonyeCOkoyeUO. An appraisal of public understanding of dementia across cultures. J Social Work Devel Soci. 2020;2(1):54-67.
55.
TakumiKTaroM. The impact of questionnaire length on the accuracy rate of online surveys. J Mar Anal. 2021;9(2):83-98. doi:10.1057/s41270-021-00105-y
56.
FedakKMBernalACapshawZAGrossS. Applying the Bradford Hill criteria in the 21st century: how data integration has changed causal inference in molecular epidemiology. Emerg Themes Epidemiol. 2015;12(1):14. doi:10.1186/s12982-015-0037-4
57.
GoldRCookNDankovchikJ, et al.Cardiovascular disease risk management during COVID: in-person versus virtual visits. Am J Manag Care. 2024;30(1):e11-e18. doi:10.37765/ajmc.2024.89489
58.
SenffJRTackRWPTanBYQ, et al.Knowledge and practice of healthy behaviors for dementia and stroke prevention in a United States cohort. Scientific Reports. 2025;15(1):15172. doi:10.1038/s41598-025-99246-8
59.
SinghSDGutierrez-MartinezLNewhouseASonniAChemaliZRosandJ. Brain health begins with brain care. Lancet Neurology. 2022;21(11):961-962. 36270304
60.
SinghSDRivierCAPapierK, et al.The predictive validity of a Brain Care Score for late-life depression and a composite outcome of dementia, stroke, and late-life depression: data from the UK Biobank cohort. Frontiers in Psychiatry. 2024;15:1373797. doi:10.3389/fpsyt.2024.1373797
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
