Building better health through trust
Helena Godinho Nascimento (BSc ’21, PhD in progress) is working to improve immigrants’ experience of public health systems.
When Helena Godinho Nascimento’s family moved to Canada, they arrived with hopes for a new beginning. But like many immigrant families, they quickly discovered that building a life in a new country also means learning how unfamiliar systems work.
Language barriers, complex paperwork and navigating services like health care were part of the adjustment. As the oldest daughter, Godinho Nascimento often helped her parents translate documents and understand how institutions functioned.
Those early experiences shaped the questions that now guide her research as a PhD candidate in the Faculty of Health at the University of Waterloo: How do immigrants come to trust the institutions that influence their health and well-being?
“Immigrant families arrive with dreams and aspirations,” she says. “But starting over can be difficult. Many families are trying to learn how everything works while facing barriers like language, discrimination or limited resources.”
A Waterloo journey
Godinho Nascimento began her academic path in the University of Waterloo’s Health Studies program (now Health Sciences) shortly after moving to Canada. She was drawn to the program’s interdisciplinary approach.
“We studied health from many perspectives, including biology, psychology, epidemiology, ethics and public health,” she says. “It helped me see that health is shaped not only by biology but also by social and structural factors.”
The Faculty of Health’s supportive environment also made a strong impression.
“Because it’s a smaller Faculty, you get to know your professors and peers well,” she says. “Over time, it became a place where I felt challenged in positive ways, and I could grow both personally and academically.”
Education had always been important in Godinho Nascimento’s family. Her parents, who immigrated to Canada to create opportunities for their children, often reminded her that education opens doors.
When Godinho Nascimento learned she could fast-track from her master’s degree into a PhD, she saw it as an opportunity to pursue a long-held goal.
“As the first person in my family to earn a university degree, pursuing a PhD at Waterloo brings a great sense of pride, not just for me but for my family as well.”
Research shaped by the pandemic
Godinho Nascimento completed her undergraduate degree and entered graduate studies during the COVID-19 pandemic, an experience that shaped her research interests.
At the time, she was taking a course on vaccine-preventable infectious diseases, where students discussed emerging research on COVID-19 each week.
“It felt strange to be studying these topics while living through them.”
Her pandemic experience also sparked her curiosity: Why do some people follow public health guidance while others reject it?
Working with her supervisor, Dr. Samantha Meyer, a professor in Waterloo’s School of Public Health Sciences, Godinho Nascimento began studying vaccine hesitancy and public trust in institutions. That work led her to focus more deeply on how immigrant communities experience trust in health-care systems and public institutions.
Why trust matters
Godinho Nascimento’s research shows that trust plays a critical role in how public health systems function. Many policies depend on people voluntarily following guidance from health authorities, whether that means getting vaccinated, seeking care or adopting preventive behaviours.
“When people trust institutions, it becomes easier to coordinate collective responses to health challenges,” she says.
Trust is also linked to health-care access, treatment adherence and patient satisfaction. When trust declines, engagement with health-care systems can decline as well.
For immigrants, trust can be shaped by many factors, including language barriers, discrimination, access to services and broader social conditions.
“These experiences can influence how immigrants perceive institutions and whether they feel supported by them,” Godinho Nascimento says.
A surprising pattern
One finding that surprised Godinho Nascimento is that immigrants often arrive in a new country with relatively high levels of trust in institutions. But that trust can decline over time.
“This pattern can mirror what researchers call the healthy immigrant effect, where immigrants arrive with health advantages that gradually diminish,” she says.
“In some ways, immigrants can experience a double burden, where both health outcomes and trust in institutions decline over time.”
Godinho Nascimento’s doctoral research explores why this decline occurs and how institutions might maintain the trust immigrants bring with them when they first arrive.
Building trust through action
Godinho Nascimento believes immigrant communities offer important insight into how institutions can better serve diverse populations.
But building trust requires more than communication campaigns.
“Trust cannot be built through messaging alone,” she says. “It also requires addressing the social and structural barriers communities face.”
For governments and public health leaders, that may mean engaging communities more directly and designing policies that reflect people’s lived realities.
As a first-generation immigrant herself, Godinho Nascimento says the research is deeply personal.
“I hope to highlight the value immigrant communities bring while also helping institutions think more carefully about how they can better support newcomers and build stronger, more trusting relationships over time,” she says.