May 21, 2026
Version 2
Building trust in humanitarian epidemic response: A scoping review V.2
- Edouard Fouqueray1,
- Umberto Pellecchia1,
- Luisa Enria2
- 1Médecins Sans Frontières, Operational Centre, Luxembourg Operational Research Unit, Luxembourg;
- 2London School of Hygiene & Tropical Medicine, London, United Kingdom
Protocol Citation: Edouard Fouqueray, Umberto Pellecchia, Luisa Enria 2026. Building trust in humanitarian epidemic response: A scoping review. protocols.io https://dx.doi.org/10.17504/protocols.io.5jyl84879g2w/v2Version created by Edouard Fouqueray
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: May 21, 2026
Last Modified: May 21, 2026
Protocol Integer ID: 317696
Keywords: trust in humanitarian epidemic response, humanitarian epidemic response, humanitarian epidemic context, mistrust in humanitarian epidemic context, humanitarian setting, west african ebola outbreak, humanitarian actor, central concern in epidemic preparedness, epidemic preparedness, widespread recognition that trust matter, emphasis on community engagement, trust, community engagement, scoping review trust, affected populations perceive public health actor, review trust, particular attention to the intervention, trust matter, perceive public health actor, literature on epidemic, intervention, epidemic, recent epidemic, evidence from recent epidemic, public health measure, public health, vaccine, central concern, social science, kinds of intervention, building trust
Abstract
Trust has become a central concern in epidemic preparedness and response, particularly in humanitarian settings where conflict, displacement, insecurity and weak public services can profoundly shape how affected populations perceive public health actors and interventions. Evidence from recent epidemics, especially the 2014 to 2016 West African Ebola outbreak and the COVID-19 pandemic, has shown that trust is critical to the uptake of public health measures, vaccines and treatment, while mistrust can seriously undermine even well designed biomedical responses. These experiences have contributed to a growing emphasis on community engagement, social science and locally grounded approaches within humanitarian and outbreak response systems. Yet, despite the widespread recognition that trust matters, there is still limited clarity on how trust is defined, how it is operationalised in practice, and what kinds of interventions effectively address mistrust in humanitarian epidemic contexts. Trust is often treated as both a goal and an assumed outcome of programming, particularly community engagement, without sufficient attention to the mechanisms through which it is built or sustained. This scoping review therefore aims to examine how trust has been conceptualised and acted upon in the published literature on epidemics in humanitarian settings, with particular attention to the interventions, strategies and practices used by humanitarian actors to foster trust, and to the evidence available on what appears to work, for whom, and under what conditions.
Title
Building trust in humanitarian epidemic response: a scoping review
Autorship
Edouard Fouqueray1; Umberto Pellecchia1; Luisa Enria2
1 Médecins Sans Frontières, Operational Centre, Luxembourg Operational Research Unit, Luxembourg
2 London School of Hygiene & Tropical Medicine, London, United Kingdom
Introduction
Trust has become a central concern in epidemic preparedness and response, particularly in humanitarian settings where conflict, displacement, insecurity and weak public services can profoundly shape how affected populations perceive public health actors and interventions. Evidence from recent epidemics, especially the 2014 to 2016 West African Ebola outbreak and the COVID-19 pandemic, has shown that trust is critical to the uptake of public health measures, vaccines and treatment, while mistrust can seriously undermine even well designed biomedical responses. These experiences have contributed to a growing emphasis on community engagement, social science and locally grounded approaches within humanitarian and outbreak response systems. Yet, despite the widespread recognition that trust matters, there is still limited clarity on how trust is defined, how it is operationalised in practice, and what kinds of interventions effectively address mistrust in humanitarian epidemic contexts. Trust is often treated as both a goal and an assumed outcome of programming, particularly community engagement, without sufficient attention to the mechanisms through which it is built or sustained. This scoping review therefore aims to examine how trust has been conceptualised and acted upon in the published literature on epidemics in humanitarian settings, with particular attention to the interventions, strategies and practices used by humanitarian actors to foster trust, and to the evidence available on what appears to work, for whom, and under what conditions.
Review question
How is trust produced and made actionable by humanitarian actors in epidemic contexts?
Key words
We listed 4 keywords related to the key concepts of our research question : Humanitarian, epidemics, trust, operationalised
- Humanitarian context: Situation of acute crisis—often triggered by conflict, disaster, or epidemic—characterized by urgent threats to life and well‑being that exceed local response capacities and therefore require timely, coordinated intervention by external humanitarian actors operating under international humanitarian norms and emergency response mechanisms" seems the closer to our objective. Our reference framework was based on the charters and principles of OCHA (1), the ICRC (2), MSF (3)
- Epidemic/outbreak response : Ebola, cholera, COVID-19, measles, mpox…
- Trust : Trust refers to a relation between humanitarian organization and population (excluding states, Moh, health system, government, specific population)
- Operationalised : The paper is grounded in an actual intervention and documents the implementation of a trust-building strategy in practice
Eligibility Criteria
Inclusion criteria
- Publications published from 2014 to 2026
- Publications including any empirical study, literature review, and non empirical publications
- Publications focusing on humanitarian settings
- Publications adressing an infectious disease epidemic
- Publications examining trust in relation to a humanitarian organisation and affected populations
- Publications providing information on concrete implementation experience of trust building intervention
Exclusion criteria
- publications describing implementation experience outside humanitarian settings
- publications not involving a humanitarian organisation
- publications focusing exclusively on trust in states, governments, or healthcare workers
- publications not related to epidemic response
- publications published outside the 2014 to 2026 period
- publications not published in English
- publications not mentioning any concrete example of trust building intervention implementation
- publications addressing trust only at a conceptual level
Méthod
Framework used:
A scoping review approach was chosen to provide an overview of the available evidence in a given field, identify key characteristics and factors related to the concept under study, and analyse gaps in the existing knowledge base (4). The scoping review was conducted in accordance with the framework developed by Arksey and O’Malley (5). Reporting was guided by PRISMA ScR (6), and the SPIDER tool was used to frame the search strategy (7).
Search Strategy
SPIDER Framework
- Sample: Populations affected by epidemics in humanitarian crisis settings
- Phenomenon of interest: Trust in relation to humanitarian actors or services during epidemic response.
- Design: any empirical study designs, including qualitative, quantitative, and mixed methods studies, as well as program evaluationsand relevant documentary analyses, as well as discussion papers and non empirical publications mentioning concrete example on trust building intervention.
- Evaluation: Any implementation of trust-building intervention, including definitions, measurement approaches, indicators, and intervention mechanisms intended to build trust.
Information sources : MEDLINE (via Ovid) ; Web of Science ; Scopus ; PsycINFO ; Embase ; Pubmed ; Hand-searching key journals
Screening and selection process
Rayyan Software used for deduplication method and screening steps including title/abstract screening and full-text screening
Reviewers : 2 reviewers at each stage + a third reviewer for disagreements
Data extraction
Information collected : author, year, title, journal, country/setting, type of epidemic, humanitarian organization involved, study characteristic
Thematic synthesis : Categories built inductively, emerging from the data
Conflict of interest
There is no conflict of interest in this project.
Appendix
Full search terms
(Trust)
AND
(mistrust OR distrust OR trustworthiness OR skeptic OR suspicion OR doubt OR "public trust" OR "community trust" OR "trust building" OR "community engagement" OR feedback OR "community feedback")
AND
("Relief Work" OR humanitarian OR "humanitarian response" OR "aid worker" OR NGO OR "non-governmental organization" OR "non governmental organization" OR refugee OR "refugee camp" OR "internally displaced" OR IDP OR IDPs OR "Red Cross" OR "Red Crescent" OR ICRC OR IFRC OR MSF OR "Médecins Sans Frontières" OR "Doctors Without Borders")
AND
("Disease Outbreaks" OR outbreak OR epidemic OR pandemic OR "complex emergenc" OR "Hemorrhagic Fever, Ebola" OR ebola OR "COVID-19" OR "SARS-CoV-2" OR covid OR sars-cov-2 OR "HIV Infections" OR hiv OR "human immunodeficiency virus")
AND
("2015/01/01" : "2026/01/13")
References
(1) United Nations Office for the Coordination of Humanitarian Affairs. We coordinate. OCHA website. Accessed March 24, 2026.
(2) International Committee of the Red Cross. What is international humanitarian law? ICRC. July 2004. Accessed March 24, 2026.
(3) Médecins Sans Frontières. MSF charter and principles. MSF website. Accessed March 24, 2026.
(4) Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology. 2018;18(1):143. doi:10.1186/s12874-018-0611-x. PMID: 30453902.
(5) Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1):19–32.
(6) Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine. 2018;169(7):467–473.
(7) Cooke A, Smith D, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qualitative Health Research. 2012;22(10):1435–1443.