Abstract for: Dynamics of pregnant people’s trust in providers on maternal health outcomes in Northern Plains Native American communities

Maternal Morbidity remains a significant public health challenge in the United States, with disproportionally high rates among marginalized populations, including Native Americans and Black communities, and low-income, underserved, and rural areas. While previous research focused on increasing availability and access to care, trust in providers remains a critical key determinant when it comes to seeking prenatal care and engagement with the healthcare systems. In this study, we follow a community-based system dynamics approach to clarify specific ways that trust is a necessary central component for promoting perinatal care utilization and quality, considering pregnant people, providers, and health systems. Using a stock-and-flow model, we identify six key feedback loops that drive the level of pregnant people’s trust in providers over time. In particular, the model shows that trust is not a static factor influencing a single decision to seek prenatal care but rather an ongoing and evolving construct, which is affected by healthcare system constraints such as provider turnover, burnout, and infrastructure capacity. Our findings show that efforts to improve maternal healthcare must go beyond increasing access and availability to address the structural factors shaping workforce stability, continuity of care, and provider retention. By integrating these qualitative insights from patient experiences, healthcare systems can develop more targeted strategies to break cycles of mistrust and improve long-term maternal health outcomes. check grammar