Earning Trust Before the Crisis: Health Literacy and Communication Readiness in Healthcare Systems.

Risk communication and community engagement are fundamental to healthcare preparedness, yet many systems still focus solely on communication during a public health emergency. At this point, trust may be fragile, misinformation may be circulating, and healthcare professionals may be asked to explain changing guidance without sufficient preparation or organizational support. This Perspective starts from the premise that communication and community engagement should begin before a crisis. We argue that messaging alone is insufficient to earn trust; healthcare systems must be transparent, accessible, consistent, responsive, and equitable. Health literacy should not be viewed solely as an individual responsibility. We suggest five strategies to build communication readiness: (1) Listen to communities. (2) Prepare healthcare professionals. (3) Partner with trusted organizations. (4) Adapt communications to different populations. (5) Evaluate understanding of messages and support for protective action. Healthcare organizations must improve the access, understandability, and usability of information and services for populations with language barriers, disabilities, limited access to digital technologies, cultural differences, and inequitable access to care. These approaches need to be embedded in routine healthcare operations, not only during emergencies. Embedding communication readiness, organizational health literacy, and organizational trustworthiness into routine preparedness may provide a foundation for improving public understanding, equitable access to information, and healthcare resilience; however, these relationships require further study.