The Trust-Link Relational Transition Model: A Unitary Caring Framework for Youth With HIV Transitioning to Adult Healthcare.

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Learn more: PMC Disclaimer | PMC Copyright Notice J Adv Nurs . 2025 Aug 5;82(5):5479–5492. doi: 10.1111/jan.70131 Search in PMC Search in PubMed View in NLM Catalog Add to search The Trust‐Link Relational Transition Model: A Unitary Caring Framework for Youth With HIV Transitioning to Adult Healthcare Emily Anne Barr Emily Anne Barr 1 Cizik School of Nursing at University of Texas Health Science Center at Houston, Houston, Texas, USA 2 School of Nursing, University at Buffalo, Buffalo, New York, USA Find articles by Emily Anne Barr 1, 2, ✉ , Sara Horton‐Deutsch Sara Horton‐Deutsch 3 School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA Find articles by Sara Horton‐Deutsch 3 Author information Article notes Copyright and License information 1 Cizik School of Nursing at University of Texas Health Science Center at Houston, Houston, Texas, USA 2 School of Nursing, University at Buffalo, Buffalo, New York, USA 3 School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA * Correspondence: Emily Anne Barr ( [email protected] ) ✉ Corresponding author. Revised 2025 Jun 30; Received 2024 Dec 20; Accepted 2025 Jul 24; Issue date 2026 May. © 2025 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. PMC Copyright notice PMCID: PMC13069258  PMID: 40762399 ABSTRACT Aims To develop a conceptual model integrating Robinson's Theory of Trust and Watson's Caritas Processes to guide trust‐building approaches and caring practices that support adolescents and young adults with HIV during the healthcare transition from paediatric to adult care. Design This is a discursive, theory synthesis paper that integrates theoretical frameworks and conceptually relevant literature to inform model development. The paper emphasises the importance of trust and caring science in the context of long‐term engagement in care. Methods An inductive theory‐building approach was used to identify key themes related to trust, stigma and the patient‐provider relationship. Using Pound and Campbell's guidelines for theory synthesis, we developed a conceptual model reflecting the intersection of trust theory and caring science. The synthesis was further grounded in Robinson's concept of theoretical coalescence, supporting the development of a relational framework to guide future research and practice. Data Sources A structured literature review was conducted across PubMed, CINAHL, EBSCOhost and Google Scholar. Peer‐reviewed articles published between 1987 and 2022 were included to capture the historical and contemporary perspectives on paediatric HIV care and healthcare transition. A snowballing method was also used to identify additional conceptually relevant sources. Results The Trust‐Link Relational Transition Model highlights trust as a protective factor during transition for adolescents and young adults with HIV and its close links to medication adherence, care engagement and viral suppression. Fostering trust through caring science practices, such as Watson's 10 Caritas Processes, enhances patient‐provider relationships, promotes reciprocal trust and empowers patients while addressing stigma, fear of new providers and loss of familiar teams, while promoting autonomy. Conclusion The Trust‐Link Model, integrating trust theory and caring science, provides a framework for improving healthcare transition. By emphasising trust‐building and caring interventions, this model aims to promote autonomy, support adherence and improve health outcomes for youth with HIV transitioning to adult care. Keywords: adolescent health, conceptual models of nursing, health promotion, HIV/AIDS, holistic care, interpersonal communication, nurse ‐ patient relationships, nursing theory, vulnerable populations Summary. What is already known ○ Trust enhances HIV engagement and adherence, reducing transmission and supporting well‐being and longevity. ○ Youth are at a higher risk of disengagement from care during transition than adults. ○ Caring science and trust theory are effective foundations for relationship‐centred care. What this paper adds ○ Introduces the Trust‐Link Relational Transition Model, a conceptual framework integrating Robinson's Trust Theory and Watson's Caritas Processes. ○ Identifies four transition‐supportive elements: informed trust, compassionate care, preparation and autonomy. ○ Demonstrates that Trust‐Link strategies promote engagement and address stigma during care transition. Implications for practice/policy ○ The Trust‐Link Relational Transition Model provides a framework to inform provider education and trust‐centred transition planning. ○ Supports interventions that enhance trust to improve care retention and health outcomes. ○ Informs policy aimed at strengthening HIV transition programmes for adolescents and young adults. Early in the HIV pandemic, most healthcare providers were concerned that children with HIV might not live to adulthood (Andiman 2011 ). With the advent of highly active antiretroviral therapy, adolescents and young adults with HIV (AYA‐HIV) are likely to survive into adulthood. In addition to the traditional milestones of youth, AYA‐HIV must also navigate transitioning their HIV care from their established paediatric care team to a new adult care setting. AYA‐HIV transitioning to adult‐focused HIV care are at particular risk for disengaging with care, abruptly stopping their HIV treatment, leading to public health risks of further transmission and increased morbidity and mortality related to untreated HIV (Tepper et al. 2017 ). Research suggests that patient‐provider trust increases engagement in care among adult people living with HIV (PWH) (Wood, Koester, et al. 2018 ) and that the patient‐provider relationship is known to play a significant role in how AYA‐HIV perceive the quality of their healthcare (Barr et al. 2022 ). However, the specific role that patient‐provider trust plays in AYA‐HIV engagement in care during health care transition (HCT) from paediatric to adult HIV care contexts has not been a major focus of research. The international HIV epidemic continues to disproportionately impact young people, with an estimated 1.7 million adolescents living with HIV worldwide (UNAIDS 2024 ). Despite progress, healthcare transitions remain a critical vulnerability point internationally, as youth disengagement from care during transition contributes to ongoing HIV transmission and morbidity (UNAIDS 2024 ). Addressing trust in healthcare relationships is essential across diverse settings, and the conceptual model presented here offers a framework that can be adapted, studied and applied globally to strengthen engagement and health outcomes for youth with HIV. Our first aim is to explore the concepts of trust, patient‐provider relationship quality and HIV stigma in the literature on HCT from paediatric to adult HIV care. This second aim is to synthesise a conceptual model to be used as a framework for continued scholarship focusing on the critical issue of trusting patient‐provider relationships as a protective factor to care engagement during HCT among AYA‐HIV. This paper presents the Trust‐Link Relational Transition Model , a conceptual framework grounded in trust theory and Unitary Caring Science to support HCT for AYA‐HIV. The purpose of this framework is to promote sustained engagement in care among AYA‐HIV during the vulnerable period of HCT through the development of evidence‐based protocols, policies and workforce education to build trust among adult HIV health care providers and the AYA‐HIV who enter their care. Enhancing the level of trust and overall quality of the patient‐provider relationship between AYA‐HIV and their adult health care providers (HCPs) could be a bridge between the familiar paediatric care team and the new adult health care team. By understanding the role of trust in this relationship, researchers, leaders in the field and adult HIV HCPs can build better relationships with their young adult patients and decrease the incidence of disengagement in care that can lead to adverse health outcomes for AYA‐HIV. 1. Background As AYA‐HIV approach young adulthood and assume significant responsibility for self‐care, they also transition to healthcare settings that serve adult PWH. Healthcare transition (HCT) describes the process of shifting chronic disease management from paediatric or adolescent‐focused care to adult‐focused health care (Momplaisir et al. 2023 ; Newman et al. 2014 ; Ritchwood et al. 2020 ). Research has identified a measurable decline (on a population basis) in markers of engagement in care and adherence to prescribed therapy during HCT for AYA‐HIV (Ritchwood et al. 2020 ). It is estimated that only about 40%–70% of the 50,000 AYA‐HIV in the U.S. who experience HCT will transition to adult care in the next decade and will remain engaged in health care 12 months after HCT (CDC 2022 ; Ritchwood et al. 2020 ; Tepper et al. 2017 ; Zanoni and Mayer 2014 ). People with perinatally acquired HIV with specific disease markers while in paediatric care tend to have poorer health outcomes after transitioning to adult care (Foster et al. 2020 ). Disengagement in care can have direct health impacts for AYA‐HIV, including disease progression and can create a public health risk of ongoing transmission of HIV (Philbin et al. 2017 ). PWH who are not engaged in care do not have access to antiretroviral therapy (ART) or accurate monitoring of their HIV viral load (the amount of HIV measured in the plasma). When AYA‐HIV disengage with care, they are at an increased risk of HIV transmission to their partners and children. AYA‐HIV are the only subgroup of PWH in which HIV‐related deaths are still increasing (Foster et al. 2020 ; Foster and Fidler 2018 ). The long‐term health of these young people and their families hinges on a successful HCT (Ritchwood et al. 2020 ). The challenges associated with AYA‐HIV HCT were first recognised in the early 1990s. Many early studies examining HIV HCT used qualitative methods to understand the barriers and develop transition plans (Barr et al. 2022 ). The major themes across studies included the patient‐provider relationship, trust, stigma, disclosure, adherence to medication, childhood trauma, poor communication between adult and paediatric providers, mental health and a lack of a standardised HCT plan (Barr et al. 2022 ; Gray et al. 2018 ; Tepper et al. 2017 ). A significant barrier identified by providers caring for AYA‐HIV during this early stage was described by Andiman ( 2011 ) as a familial connection with their young patients, who acknowledged that it could be challenging for providers to transition their patients out of their care. Over time, studies shifted from describing the barriers to looking to create HCT preparedness (Fair et al. 2012 , 2011 ) and developing and describing HCT plans and programmes (Lolekha et al. 2017 ). The healthcare community has recently shifted focus from identifying barriers to successful HCT among AYA‐HIV to improving and evaluating programmes designed to support AYA‐HIV in HCT (Barr et al. 2022 ; Gray et al. 2018 ). Research among adult PWH has demonstrated that trust plays a central role in long‐term engagement in care (Dawson‐Rose et al. 2016 ; Krause and May 2016 ; Relf et al. 2019 ). Quality of the patient‐provider relationship and trust have been recognised as a positive factors for successful HCT among young people with other chronic conditions, such as cancer (Kenney et al. 2017 ), haemophilia (Quon et al. 2015 ), gastrointestinal diseases (Brooks et al. 2017 ) and cystic fibrosis (Goralski et al. 2017 ). Momplaisir et al.'s ( 2023 ) study of YLH identified challenges in establishing and/or building a trusting relationship as the ‘most impactful’ barrier to HCT. In addition to the potential for an increased need for trust within patient‐provider relationships during HCT among AYA‐HIV, these young patients may also face increased barriers to building trust with new providers. Studies have described the significance of the relationship between paediatric patients with perinatally‐acquired HIV and their paediatric HIV care provider (Barr et al. 2022 ). The stigma of HIV remains pervasive and has an impact on paediatric HIV patients. The stigma of HIV can be further compounded by profound experiences of loss faced by many young people with HIV. AYA‐HIV with perinatally‐acquired HIV may have lost parents to HIV disease. The lasting effects of parental loss compounded by the stigma of HIV can foster a familial‐type bond between the AYA‐HIV and their paediatric healthcare team. Research has also identified that these patients often report fear about HCT to adult‐focused care (Barr et al. 2022 ). The loss of another familial‐type bond and fears that their new care team may hinder successful HCT (Barr et al. 2022 ). While some HCT protocols suggest actions to increase patient‐provider trust during HCT, such as having the AYA‐HIV patient meet the adult provider prior to HCT (Acree 2017 ; Judd et al. 2017 ; Tanner et al. 2017 ), the concept of building trust over time to support AYA preparing for and/or navigating HCT has not been given the emphasis it is due even in current research and protocols (Coyne et al. 2019 ; Dinç et al. 2024 ). For example, coping with the loss of the previous significant provider relationship or addressing fears regarding a new provider relationship are not addressed in depth in widely used HCT protocols used to guide clinical practice for AYA‐HIV, such as the American Academy of Paediatrics clinical report on adolescent HCT (White et al. 2018 ). 2. Methods This conceptual paper employed a structured literature review and inductive theory synthesis approach to examine the role of patient‐provider trust and caring science during HCT from paediatric to adult HIV care for AYA‐HIV. The review was conducted to identify and synthesise themes related to trust, patient‐provider relationships, stigma and transition engagement in the context of chronic illness and HIV care. We conducted a comprehensive literature review of peer‐reviewed articles published between 1987 and 2022 to capture the historical context of paediatric HIV care and the evolution of HCT practices. This timeframe begins at the emergence of paediatric HIV in the medical literature and extends through contemporary approaches to care and transition. Databases searched included PubMed, CINAHL, EBSCOhost and Google Scholar, and a snowballing method was used to identify additional relevant sources from reference lists. Keywords included combinations of: trust, patient‐provider relationship, adolescent HIV, paediatric HIV, transition to adult care, stigma, caring science and healthcare transition . Studies were included if they addressed at least one of the following: patient‐provider trust in chronic illness or HIV care, HCT for AYA‐HIV, or stigma related to HIV and youth engagement. Qualitative and quantitative research, reviews and theoretical articles were eligible for inclusion. Articles were catalogued and thematically analysed to identify recurring concepts and relationships among trust, stigma, transition experiences and outcomes. An inductive synthesis approach was applied to build theory from these findings, allowing emergent patterns and gaps to guide the development of a new conceptual model. To guide the development of the conceptual framework, we used a theory synthesis approach informed by the guidelines of Pound and Campbell ( 2015 ), whose structured yet flexible method supports the integration of conceptual models in nursing and health research. Their framework was applied specifically to the analysis and model development phase, enabling us to identify points of convergence between Robinson's Middle Range Theory of Trust and Watson's Unitary Caring Science. This process was further grounded in Robinson's ( 2016 ) concept of theoretical coalescence and supported by an inductive, theory‐building process. While the literature review was comprehensive and structured, it was not conducted as a systematic review. Rather, our goal was to identify and synthesise conceptually relevant literature to inform model construction, consistent with methodological approaches used in discursive and theoretical nursing scholarship. To ground this synthesis in established theory, we integrated Robinson's Middle Range Theory of Trust in Healthcare Relationships with Watson's Unitary Caring Science and the 10 Caritas Processes. These frameworks were selected for their emphasis on long‐term, relational and trust‐based care, qualities deemed essential for supporting AYA‐HIV through vulnerable periods like transition. The result is a novel conceptual model informed by theory and built upon empirical findings, designed to guide clinical protocols, workforce training and future research on transition outcomes for youth with HIV. This conceptual framework's title, the Trust‐Link Relational Transition Model: A Unitary Caring Framework for Youth with HIV Transitioning to Adult Healthcare , reflects the emphasis on trust and interconnection across the healthcare transition process in youth with HIV. 3. Review of Literature A strong relationship between a PWH and a provider is characterised by collaboration, intimacy and trust (Wood, Ratcliffe, et al. 2018 ). Robinson and Thorne ( 1984 ) examined patient‐provider relationships in the mid‐1980s (Thorne and Robinson 1988a , 1988b , 1989 ) and developed a model of trust and patient‐provider relationships in people living with chronic illnesses, which was later updated to meet the changing dynamics of chronic illness and health care provision (Robinson 2016 ). 3.1. Trust ‘Trust is the expectation that individuals and institutions will meet their responsibilities to us. It affects almost every aspect of doctor‐patient interaction, from personal disclosure to cooperation in treatment’ (Mechanic 1998 , 662). Trust plays a central role in healthy relationships of all types and has been identified as integral in sustaining patient engagement in care among PWH (Krause and May 2016 ; Relf et al. 2019 ). Among PWH, the heightened need for trust in the patient‐provider relationship arises from a state of vulnerability associated with the stigmatisation of the condition and the life‐long, potentially fatal course of HIV infection. ‘Trust serves the patient's needs especially well during periods of greatest vulnerability’. There is an element of risk in placing confidence in a provider when a trusting relationship has not yet been built (Rowe and Calnan 2006 ), and breaches of trust between the patient and the provider are not uncommon in long‐term chronic care (Preau et al. 2004 ; Robinson 2016 ). Early scholars, such as Hwang and Burgers ( 1997 ), posited that being willing to take a risk is necessary for all interactions involving trust. They determined that increased trust supports cooperation, which helps decrease the risk of victimisation or vulnerability. This supports the concept that improved trust promotes a more collaborative and ultimately higher quality patient‐provider relationship. This vulnerability is magnified by the disparate status inherent in the patient‐provider relationship. In a seminal work on the subject, Sellman ( 2007 ) conceptualised this relationship as one in which the medical provider is the specialist, and the patient is dependent upon the provider for care. This is especially true when the patient has an illness like HIV because only a few HCPs can provide the specialised care required for the long‐term management of HIV. Often, in any given location, there may only be one or two HIV clinics to choose from for one's care. In an early work on the patient‐provider relationship, Hams' ( 1997 ) explored the vulnerability that patients experience in the healthcare setting and the importance of empowering both patients and providers. Hams' ( 1997 ) discusses the positive effect trust and strong communication within the multidisciplinary healthcare team can have on building patient trust. This concept is rarely discussed in the literature on patient‐provider trust. Still, according to Hams' ( 1997 ), trusted communication among the healthcare team appears to play a role in developing trusting patient‐provider relationships. Hams' ( 1997 ) definition of trust is: A willingness to engage one self in a relationship that has reliance upon either a person(s) or thing(s) , with an expectation that vulnerability may arise from either the trustee's or truster's performance . The primary aim, however, is to empower both parties. (p. 353) Thorne and Robinson ( 1988a , 1988b , 1989 ) found that the most crucial feature of a patient‐provider relationship for fostering mutual trust was the practice of behaviours like compassion, rapport, honesty and understanding. Incidentally, they also found a positive relationship between trust and engagement in care. Barr et al. ( 2022 ) explored the patient‐provider relationship in the context of HCT in HIV care through a qualitative metasynthesis of 14 studies from 8 countries with 478 participants and found that one unifying element of descriptions of successful HCT for HIV care from both patients and providers was the importance of patient‐provider trust. Recent arts‐based research using film to explore youth experiences of trust during HIV care transition further highlights how trust is conceptualised and built in patient‐provider relationships (Barr et al. 2025 ). 3.2. Trusting Patient‐Provider Relationship Watson and Brewer ( 2015 ) argue that ‘helping‐trusting relationships’ (p. 235) are vital components of a caring healing environment that helps patients remain engaged in care. Long‐term, trusting patient‐provider relationships are integral to the health of peopleiving with HIV (PWH) (Beichler et al. 2022 ). Beach et al. ( 2006 ) found that the quality of the patient‐provider relationship is directly related to positive health outcomes in PWH. Brion ( 2014 ) and Wang and Wu ( 2007 ) found that a trusting relationship improved adherence to HIV antiretroviral therapy (ART). In a qualitative metasynthesis, Barr et al. ( 2022 ) described the importance that patient‐provider trust plays during the transition from adolescent to adult HIV care. In a systematic review of HCT in diverse chronic conditions, Gray et al. ( 2018 ) found that a repeated theme across all conditions was the importance of the patient‐provider relationship, including both the existing long‐term relationship with the paediatric provider and the burgeoning relationship with the new adult provider. In a qualitative study with AYA‐HIV at HCT, Kronschnabel et al. ( 2016 ) found that participants did not want to leave the comfort and familiarity of their paediatric clinic, and even those who felt they were ready to move on to adult care shared concerns about being able to build the same kind of trust in their new care relationship. Participants shared a common feeling that their paediatric providers have been like ‘family’ (Kronschnabel et al. 2016 ). This familial feeling stems not only from the long‐term nature of the patient‐provider relationship in the management of chronic conditions but also because these HCPs have been alongside these young patients through serious hospitalisations and sometimes also the loss of parents, family members and friends who were also living with HIV (Barr et al. 2022 ). There are times when the paediatric HIV provider is one of the few stable adults in the lives of children with HIV (Barr et al. 2022 ). An added level of connection lies in the fact that very few others may even know about the AYA‐HIV's HIV status, and often, their HCPs are the only people with whom they feel safe talking about HIV, sexuality, stigma and disclosure (Barr et al. 2022 ; Kronschnabel et al. 2016 ). For AYA‐HIV, HCT not only signifies great change but potentially also a profound loss, further emphasising the need for building genuine trust with a new adult provider. Mbalinda et al. ( 2021 ) explored the ethical challenges adolescents and young people with HIV face during healthcare transition (HCT) to adult ART clinics in Uganda. The study identified that trust in the healthcare system itself, including trust in the availability, confidentiality and perceived fairness of care, was a major factor influencing young people's engagement during transition. However, the study did not specifically focus on the nuances of patient‐provider trust or relational dynamics with individual clinicians. Instead, systemic trust issues, such as fear of stigma, concerns about confidentiality breaches and uncertainty about adult clinic procedures, were highlighted as barriers to successful transition. Brion ( 2014 ) described the importance of the patient‐provider relationship in highly adherent PWH: Participants described their providers or the patient‐provider relationship as affectionate and connected. They used words such as loving, compassionate, knowledgeable, pleasurable, friendly, teacher, excellent and family‐like. Many participants named provider attributes that favored the development of a caring and supportive patient‐provider relationship enhanced progress toward acceptance of their illness, and ultimately allowed them to achieve successful adherence behavior by meeting specific patient needs. (p. 127) In an influential early study of PWH patient trust in their providers, Beach et al. ( 2006 ) surveyed PWH ( N = 1743) and asked them if they felt their provider ‘knew them as a person’ (p. 661); they then compared this to whether they were prescribed ART, adherent to ART and monitored their HIV viral load. This study found that patients who responded that their provider ‘knew them as a person’ (p. 661) were more likely to be engaged in HIV treatment, to be adherent to that treatment and to have an undetectable HIV viral load (meaning their HIV was well suppressed). Krause and May ( 2016 ) interviewed a random sample of PWH across Mississippi regarding access to care, health‐related quality of care and unmet needs. The authors noted the importance of finding ways to improve patient trust, especially in populations who may have lower trust. In a cross‐sectional study of the impact of patient‐provider relationships on health outcomes for women with HIV, higher patient‐provider trust was associated with adherence (Trepka et al. 2023 ). Even in the earlier days of the HIV pandemic, when medications were more complicated and there was less knowledge about treating HIV, Altice et al. ( 2001 ) studied HIV in a prison population. They found a greater acceptance and adherence to ART when trust was higher in their medical provider. These studies demonstrate the usefulness of focusing on trust as a central component in high‐quality patient‐provider relationships for chronic conditions that cut across the lifespan and require lifelong engagement in care. 3.3. HIV Stigma and Transition Gray et al. ( 2018 ) completed a systemic review on paediatric to adult HCT and found there were unique challenges that affect some youth with certain chronic conditions, like stigma. For example, those with diabetes experience stigma related to their condition. However, it is different for AYA‐HIV due to the communicability and negative life‐limiting connotation of HIV disease. Stigma is mentioned as a barrier to HCT or, at the very least, a strong consideration in nearly every study reviewed, both qualitative and quantitative (Barr et al. 2022 ; Davies and Hamlyn 2018 ; Foster and Fidler 2018 ; Kronschnabel et al. 2016 ; Straub and Tanner 2018 ; Wiener et al. 2011 ; Williams et al. 2017 ). Davies and Hamlyn ( 2018 ) found family secrecy and HIV‐related stigma to be barriers to a successful HCT in Sub‐Saharan Africa. There is not only a stigma of living with HIV but also stigma related to some of the common side effects of the treatment, like lipodystrophy, which can affect adherence and mental health, which further challenges engagement in care (Foster and Fidler 2018 ). Finally, often, there is more stigma associated with attending an adult‐focused HIV clinic, which may not hide the fact that it serves PWH the way paediatric HIV clinics do. Occasionally, those living with perinatally acquired HIV struggle to assimilate in a clinic, caring mainly for those living with non‐perinatally acquired HIV (Barr et al. 2022 ; Masese et al. 2019 ; Verma and Sahay 2019 ). Stigma has been found to be a factor that can affect engagement in HIV care in adults (Onono et al. 2020 ) and in AYA‐HIV who are transitioning from paediatric to adult HIV care (Masese et al. 2019 ). While some other diseases carry stigma, HIV is somewhat unique due to the history of the disease and due to the nature of how it is transmitted. There can be shame around having the diagnosis of HIV, of passing the disease onto one's child and around how one acquired HIV. Historically, HIV has been associated with same‐sex relationships, condomless sex, commercial sex work, having multiple partners and IV substance use. Societal judgement regarding each of these variables collectively makes HIV a disease that people are ashamed and afraid of. In the early days of HIV and AIDS, there were few to no effective treatments and many people died (Levine 1987 ). Most adults today are aware that the disease can be deadly, and fewer realise there are effective treatments that make living with HIV a chronic lifelong illness (Davtyan et al. 2017 ). Therefore, one cannot examine patient‐provider trust and Unitary Caring Science without understanding the trappings of how HIV‐related stigma may impact building and maintaining trust through HCT. 4. A Conceptual Model of Trusting Patient‐Provider Relationships 4.1. Robinson's Middle‐Range Theory of Trust Robinson developed her middle‐range theory of trust in healthcare relationships in the context of chronic illness through theoretical coalescence by combining data from previous work (Robinson and Thorne 1984 ; Thorne and Robinson 1988a , 1988b , 1989 ), analysing patterns in patient‐provider relationships and identifying stages of trust‐building within these relationships. Prior to Robinson's work, research had addressed trust within patient‐provider relationships, but Robinson ( 2016 ) argues that earlier work focused on acute care scenarios, which may have different characteristics than the relationships between providers and patients living with chronic illness. People living with chronic conditions have greater dependence on their healthcare team and higher levels of long‐term uncertainty than their healthy or transiently acutely ill counterparts. Therefore, developing trust with HCPs may arguably be more significant to the well‐being of patients with chronic conditions than those in acute care scenarios. Robinson noticed that previous research has focused on the patient component of the patient‐provider relationship as if in a vacuum. But Robinson recognised that the patient side of that relationship does not only reflect the person experiencing the chronic illness but also includes the influence of the patient's family or supportive caregiver since children and youth living with a chronic condition often have family members who are intimately involved in their care. This finding is typical of paediatric and AYA‐HIV engaged in HIV care (Andiman 2011 ; Silva‐Suarez et al. 2015 ; Vijayan et al. 2009 ). For these reasons, Robinson's theory also considers the patient within the context of their family or supportive network. The underlying assumptions of this theory are that the patient‐provider relationship in the context of chronic illness often includes family members, is reciprocal and involves developing trust that changes over time and leads to a mutual understanding between patient and provider that results in a patient living well with a chronic illness. Robinson's theory critically analyses the patient‐provider relationship through three types of trust: distrust (Robinson 2016 ). Distrust is described within three phases of the theory: safekeeping, disenchantment and guarded alliance phases. The guarded alliance is then broken down into four relationship types: hero worship, resignation, consumerism and team playing (Robinson 2016 ). The staged model of Robinson's theory is depicted in Figure 1 . FIGURE 1. Open in a new tab Evolution of trust in health care relationships. This model depicts the three stages of trust, including the expanded and dynamic view of the guarded alliance and reciprocal trust stage. 4.1.1. Safekeeping Safekeeping is the first phase of the patient‐provider relationship, often co‐occurring with the new diagnosis of a chronic condition or when meeting a new provider, such as is typical with HCT. This stage is characterised by naïve trust. During this time, the patient and family are vulnerable and, in the case of a new diagnosis, are navigating their new reality and may think of the illness as an ‘unwelcome intruder’ (Robinson 2016 , 3). During this phase, patients and their families may believe that the healthcare provider knows what is best, deferring decisions to the HCP. As the patient and family become more comfortable with the new diagnosis or care setting, they may develop goals and expectations that are not in alignment with the HCP's plans for the patient's care. If this relationship is not appropriately tended, an erosion of the burgeoning naïve trust can occur during this time, leaving both the family and the HCP frustrated, which leads to the disenchantment phase. 4.1.2. Disenchantment During the disenchantment stage, naïve trust has eroded into shattered trust, leaving the relationship to be defined by distrust. The family feels that they have discovered that their priorities for living well with the illness and their day‐to‐day experiences do not match up with the provider's goal of addressing acute exacerbations and long‐term complications. The family may perceive that the medical team seems preoccupied with challenges rather than focusing on daily family accomplishments. The family begins to fear the medical system and becomes angry, and their relationships can become adversarial. Providers may perceive the patients and their families as irrational, ungrateful, or even putting the patient at risk by interfering with appropriate care. Families can feel torn during this phase because they continue to be dependent on the medical team while also feeling that the patient is still at risk, causing even greater anxiety and stress. It is often challenging to recover from shattered trust (Robinson 2016 ). When patient‐provider relationships can successfully transition from safekeeping or the disenchantment phases into a phase of deeper trust and collaboration, they have reached the critical third stage of Robinson's theory: the guarded alliance. 4.1.3. Guarded Alliance Robinson's guarded alliance phase is reached when the family has come to terms with the fact that the patient's chronic condition requires ongoing lifelong medical care and that they will need to develop trust with their HCPs in order to facilitate cooperation and collaboration (Entwistle and Quick 2006 ). A new kind of trust emerges in this stage called informed trust, which is more realistic than naïve trust, as it takes into consideration the strengths and limitations of both the family and the HCP. During this stage of guarded alliance, Robinson ( 2016 ) explains that families become more competent, motivated and involved in their care. They, in turn, engage with their providers, developing greater trust both in the HCP and in their own abilities. In the guarded alliance stage, personal connections can serve to lessen the ‘emotional distance’ (Robinson 2016 , 7) between HCP and patient. The family may use strategies such as gift‐giving, asking about the healthcare provider's family and recognising the difficulties and stress in their jobs (Robinson 2016 ). In Robinson's theory, it is critical that the patient and provider get to a place of guarded alliance, as this is the only phase that allows for a dynamic trust that fosters a collaborative relationship while also supporting patient autonomy. The guarded alliance phase is more satisfying to the patient and the HCP and ultimately promotes greater engagement in care (Robinson 2016 ). Robinson describes four patient‐provider relationship subtypes that can emerge during this phase: hero worship, resignation, consumerism and team playing (Figure 2 ). FIGURE 2. Open in a new tab Model of Trust in the Health Care Team. As trust in one's competence and informed trust in one's providers' increases, a guarded alliance develops and they become more like team members working together. 4.1.3.1. Hero Worship In hero worship, elements of naïve trust remain. The family and patient continue to defer to the HCP, and the patient tends to have low trust in their own ability to manage their illness. This dependent relationship does not allow for patient‐provider collaboration, provider error, or changes in providers because the patient has no autonomy and has not developed any independent skills. 4.1.3.2. Resignation When the patient ultimately does not trust the provider and has minimal trust in their capabilities, this is termed resignation. Resignation leaves patients and families feeling hopeless and powerless, and these patients are at high risk of disengaging in care (Robinson 2016 , 7). 4.1.3.3. Consumerism The consumerism relationship occurs when the patient feels competent and trusts their own decisions over the advice of their HCP. This happens when families work hard at managing their care and enjoy more control over their health care. These patients end up appearing more adherent to therapy despite their distrust of their HCP. 4.1.3.4. Team Playing Patient‐provider relationships defined by a high level of mutual trust are defined by Robinson as team playing. Providers must be willing to view the family as an equal part of the healthcare team to achieve this type of relationship. Team playing is based on mutual respect, collaboration and joint decision‐making. This epitomises a patient‐focused or family‐centred care model. The four subtypes of relationships within the guarded alliance phase demonstrate that the more a patient trusts in their own competence to manage their health and their providers' expertise in providing appropriate care, the more likely they are to achieve a team‐player relationship. The team‐player relationship is the gold standard of the guarded alliance relationship subtypes and is characterised by mutual respect between all members of the team. The relationship is collaborative, and the responsibility for patient health is shared. Robinson identifies four characteristics necessary for an HCP to exhibit to support trust‐building with a patient. These four practices are that the provider will serve as a ‘curious listener, compassionate stranger, the non‐judgmental collaborator and the mirror for family strengths’ (Robinson 2016 , 9). These provider characteristics are depicted in Figure 2 . Robinson's theory provides a theoretical model of the stages of patient‐provider relationships centreing on the role of trust in this trajectory and including provider characteristics to foster trust‐building within the patient‐provider relationship. However, when considering discrete steps for building the informed trust required to achieve the ideal team player patient‐provider relationship at the heart of Robinson's theory, strategies, behaviours and protocol are not made explicit in the theory. Jean Watson's philosophy of unitary caring science provides an extensive body of work to build patient‐centred strategies into Robinson's theoretical model (Watson 2018 ). Robinson's theory is consistent with findings that suggest that the strongest predictors of living well with a chronic illness are when patients and their families develop trust in their own competence and are engaged in their care (Robinson 2016 , 2017 ). This theory has been used to study patient‐provider trust in diverse populations and has potentially profound clinical applications (AlRuthia et al. 2020 ; Čáp et al. 2024 ; Mielke et al. 2024 ). 4.2. Building Trust With Watson's 10 Caritas Processes Caring Science is a discipline‐specific framework that unifies nursing knowledge, theory and practice, integrating ontological competencies of compassion, presence and human connection to advance holistic, transformative nursing education and care (Watson and Smith 2002 ; Horton‐Deutsch et al. 2025 ). Unitary caring theory uses many forms of caring science scholarship to understand and describe the human phenomena of caring, healing, health and well‐being, and the multitude and nuanced concepts that relate these phenomena to the holistic human experience. These concepts include but are not limited to love, forgiveness, self‐care, intentionality, equanimity, spirituality and trust (Turkel et al. 2018 ). The integration of Watson's Caritas Processes promotes the development of compassionate care and creates a guide for integrating these concepts into practice (Horton‐Deutsch et al. 2025 ). The 10 Caritas Processes provide a menu of caring activities, ways of knowing and descriptions of the caring‐healing processes essential to the transpersonal relationship nurses have with their patients, their environment and themselves (Watson 2018 ). The Caritas Processes describe transpersonal caring moments based on trust, love, altruism, equanimity, deep reflective listening, non‐judgmental attitudes, attention to self‐care, meeting patients where they are at, being open to spirituality and leaving room for the beautifully unexplained (Watson 2008 ). While Watson's Caritas Process Four, ‘Developing and sustaining a helping‐trusting caring relationship’ (Watson 2008 , 71), arguably carries the strongest connection to Robinson's theory of trust, there are common threads found throughout. The key propositions of Robinson's middle‐range trust theory are that trust is dynamic, reciprocal, and built in stages over time and that while trust can be shattered, it is possible to recover a patient‐provider relationship through listening, non‐judgement and mirroring family trust (Robinson 2016 ). As a lens for exploring trust within the patient‐provider relationship, Watson's 10 Caritas Processes adds rich texture to Robinson's theory. By incorporating practices grounded in unitary caring theory into the framework of Robinson's middle‐range trust theory, the predictable problems inherent in each phase of building patient‐provider trust have useful solutions. Robinson's curious listener is reflective and skilled at creating a safe space to be open and to allow for sharing of thoughts and ideas. This provider is ‘present to and supportive of the expression of positive and negative feelings’ (Watson 2008 , 101), the third Caritas Process. Watson explains that this skill is often overlooked, yet it is vitally important for building trust. When there is space for ‘constructive expression’ of feelings, ‘we create a foundation of trust and caring’ (Watson 2008 , 102). Robinson's concept of the compassionate stranger and Watson's theory of unitary caring can both be linked to the philosophical ideas of Emmanuel Lévinas and Karl Løgstrup (Watson 2005 ). Lévinas describes how trust is the defining feature as the self relates to the ‘Other’. And that the ethical approach to the Other is where, through trust, one takes responsibility for the Other (Peperzak et al. 1996 ). According to Løgstrup ( 1997 ): It is characteristic of human life that we normally encounter one another with natural trust. This is true not only in the case of persons who are well acquainted with one another but also in the case of complete strangers. Only because of some special circumstances do we ever distrust a stranger in advance. … Initially we believe one another's word; initially we trust one another. (p. 8) The third attribute that fosters trust between a patient and a provider, being a non‐judgmental collaborator , is also one that is paramount in serving to end HIV‐related stigma. Watson talks about meeting a patient with equanimity in the first Caritas Process One, explaining, ‘Cultivating the practice of loving‐kindness and equanimity toward self and other [is] foundational to Caritas consciousness’ (Watson 2008 , 47). Equanimity is the process of letting things be as they are and not interfering or trying to change the status quo. Approaching a patient and their story with equanimity, without the stigma that is often experienced by individuals with HIV, is a way of being non‐judgmental. Collaborating with a patient is one of the themes that is woven throughout several of the Caritas Processes. A provider collaborates when they are supportive of both positive and negative feelings (Caritas Process Five), engaging in teaching and learning that meets the patient where they are at (Caritas Process Seven) and providing basic non‐stigmatising care along with the patient and their family (Caritas Process Nine) (Watson 2008 ). The final attribute of being a mirror for family strengths is closely linked to Caritas Process Two, ‘Being authentically present: Enabling, sustaining and honoring the faith and deep belief system and the inner‐subjective life world of self/other’ (Watson 2008 , 61). Honouring the strengths of the patient and their family allows them to be part of the collaborative team and tells them that the provider understands that they are the expert when it comes to their own mind, body and spirit and when it comes to making health care decisions. This begins by honouring their belief system and inner world. Watson bases this ‘on the wisdom that the body has the power at some deep intrinsic level to heal itself’ (Watson 2008 , 65). People seek inner strength from their beliefs and spirituality, and when providers are able to reflect this back to the patient and family as a positive attribute, it helps the patient have more faith and trust in their provider (Robinson 2016 ). In Figure 3 , practices drawn from Watson's unitary caring theory (specifically the 10 Caritas Processes) are mapped onto Robinson's four provider attributes that ‘foster trust and invite healing’ (p. 9). This conceptual synthesis demonstrates that, as patients and families begin to trust their own competencies alongside the simultaneous development of trust with their HCP, the patient‐provider team can attain the functional state of reciprocal trust that is key to successful HCT. FIGURE 3. Open in a new tab Reciprocal themes between Robinson's theory and Watson's Caritas processes. Reciprocal themes between Robinson's theory of trust, health care relationships and chronic illness (2016) are mapped to Watson's Theory of Unitary Human Caring (2018), specifically, the 10 Caritas Processes (CP). 4.3. Conceptual Model Development The process of developing the final conceptual model, The Trust‐Link Relational Transition Model, (Figure 4 ) was iterative and grounded in both inductive synthesis and theoretical alignment. Following the structured literature review, all included studies were reviewed for key themes related to trust, patient‐provider relationship quality, HIV‐related stigma and healthcare transition outcomes. Using an inductive, theory‐building approach, we coded and organised findings into conceptual categories, such as trust‐building behaviours , barriers to engagement and caring relationships . These emergent themes were then mapped onto the core components of Robinson's Middle Range Theory of Trust and Jean Watson's 10 Caritas Processes. FIGURE 4. Open in a new tab The trust‐link relational transition model: a unitary caring framework for youth with HIV transitioning to adult healthcare. The arrows connecting the components emphasise the dynamic and cyclical nature of the Trust‐Link Model. Each domain builds upon the other, illustrating how informed trust fosters compassionate care, which supports preparation and connection, ultimately promoting autonomy and independence. This interconnected and relational framework, grounded in Unitary Caring Science and Trust Theory, supports a holistic and developmentally appropriate healthcare transition for youth living with HIV, addressing their emotional, informational and psychosocial needs. We used theory synthesis methods described by Pound and Campbell ( 2015 ) to explore points of convergence between these two frameworks. We identified that Robinson's four provider attributes (curious listener, compassionate stranger, non‐judgmental collaborator and mirror for family strengths) aligned conceptually with key Caritas Processes, particularly those focused on relational presence, equanimity and mutual respect. Through this synthesis, we developed a conceptual map that visually and narratively integrates these overlapping elements to explain how trust and caring science can be operationalised during the healthcare transition process for AYA‐HIV. The final model was refined through multiple rounds of review, ensuring consistency with the empirical literature, clinical practice experience and the philosophical underpinnings of both theoretical frameworks. This model serves to guide future research, inform clinical training and support the development of interventions to improve HCT outcomes. 4.4. Application The clinical implications of applying patient‐provider trust theory and Unitary Caring Science to health care transition (HCT) for adolescents and young adults living with HIV (AYA‐HIV) are complex yet promising. This synthesis has the potential to inspire innovative and transformative transition programmes in HIV prevention and care. By focusing on addressing common challenges during the shift from paediatric to adult care, such as the loss of familiar providers and fear of stigmatisation, which often lead to disengagement, we may improve retention in care. Arts‐based approaches, such as film‐based research exploring trust and stigma among youth with HIV, offer additional tools for strengthening empathetic, trust‐building clinical practices (Barr et al. 2025 ). Additionally, this model (Figure 4 ) emphasises the importance of supporting autonomy and individuation, fostering self‐efficacy and independence as youth navigate their transition to adult care. Caring Science fosters not only trust but also autonomy and individuation, emphasising the importance of reflective, human‐centred practices (Horton‐Deutsch et al. 2025 ). This approach could result in higher rates of individuals remaining engaged, adhering to antiretroviral therapy and achieving undetectable viral loads as they progress into adulthood, college, careers, partnering and parenting. Informed Trust: Improving Continuity and Retention in Care The integration of Robinson's trust theory into clinical practice helps build a foundation of informed trust between patients and adult providers, reducing the risk of disengagement. When trust is established, young patients are more likely to remain adherent to ARV therapy, attend follow‐up visits and communicate openly about health issues, ultimately improving viral suppression and long‐term health outcomes. 2 Compassionate Care: Addressing Emotional and Psychological Needs Watson's 10 Caritas Processes provide tools for healthcare providers to offer compassionate, holistic, non‐biased care by recognising the emotional, social and psychological needs of AYA‐HIV. Providers who practise intentional empathy and non‐judgemental listening create a sense of safety for patients to disclose sensitive issues related to HIV stigma and mental health challenges. This emotional support fosters a therapeutic relationship mirroring the nurturing environment experienced with paediatric care teams, facilitating a smoother transition to adult healthcare. 3 Preparation and Connection: Guiding Clinical Protocols and Workforce Training The framework informs the development of clinical protocols that focus on establishing early connections between paediatric and adult providers, emphasising the importance of pre‐transition meetings and coordinated care plans. It also highlights the need for workforce training, equipping adult providers with skills to build trust with AYA‐HIV patients who may have experienced loss, trauma and HIV‐related stigma. This strategy ensures that providers are trauma‐informed and prepared to address barriers to care, such as fear of disclosure or discrimination within adult care settings. 4 Autonomy and Independence: Promoting Engagement and Relational decision‐making By fostering trust and empowering AYA‐HIV to actively participate in their care, this model encourages relational decision‐making (Barr et al. 2024 ) between patients and providers. This collaboration promotes patient autonomy, helping young adults build confidence and self‐efficacy in managing their health independently. As a result, the framework not only improves immediate engagement during HCT but also cultivates lifelong habits of care adherence essential for managing chronic HIV with positive health outcomes. Future research will be enhanced by integrating Robinson's trust theory and unitary caring science as a conceptual framework to evaluate the effectiveness of transition programmes. Future studies can utilise this model to measure trust and engagement outcomes, helping to identify specific interventions that enhance care retention while building trust. The framework also guides the development of protocols for healthcare providers, emphasising trust‐building strategies like relational decision‐making (Barr et al. 2024 ) and continuity of care. As research on HCT evolves, this combined theory offers a pathway to reducing the high attrition rates observed among AYA‐HIV, ensuring better public health outcomes due to reduced HIV transmission and improved individual wellness via long‐term engagement in care. 5. Conclusion As the population of AYA‐HIV continues to grow, there is an urgent need for strategies that support successful HCT from trusted paediatric providers to adult care teams. Trust‐building with new providers is a critical factor in transition success, yet fear of losing established relationships remains a major barrier (Machado et al. 2016 ). The risks associated with disengagement during HCT highlight the importance of developing innovative, relationship‐centred approaches. This study offers the Trust‐Link Relational Transition Model (Figure 4 ), a conceptual framework that integrates Robinson's theory of trust and Watson's Caritas Processes to guide efforts to strengthen trust and support engagement during this vulnerable period. The integration of Robinson's trust theory and caring science serves as a guide for implementing trust‐building strategies and caring interventions in HCT settings. This study demonstrates the many ways the Trust‐Link Model can be applied to generate new clinical methods, provider training approaches and relationship‐centred models of care to foster successful HCT for AYA‐HIV. At the centre of this model are trust and caring practices, emphasising that building informed, reciprocal trust is critical for ensuring patient engagement, adherence and long‐term health outcomes. Beyond clinical practice, the model provides a foundation for informing healthcare policy by highlighting trust as a measurable quality metric in transition programmes, encouraging system‐level support for structured, trust‐centred HCT protocols. It also offers a research roadmap for future studies to evaluate the impact of trust‐building interventions on viral suppression, retention in care, mental health outcomes and transition readiness. By offering this framework to the research and policy communities, we aim to advance a more holistic, relationship‐centred standard for healthcare transition not only for youth with HIV but also for individuals with other chronic conditions navigating the critical period of transfer to adult healthcare systems. Author Contributions Emily Anne Barr: conceptualisation, methodology, literature review and synthesis, writing – original draft, writing – review and editing, visualisation, project administration, supervision, and conceptual model development. Sara Horton‐Deutsch: conceptualisation, methodology, synthesis, writing – review and editing, visualisation, supervision and theoretical framework support. Both authors meet the ICMJE authorship criteria and have approved the final version of the manuscript. Conflicts of Interest The authors declare no conflicts of interest. Acknowledgements The authors would like to thank Markeda Wade, ELS, and Mary Lingwall MPH, BSN, for their extensive edits and support with formatting. We also extend our gratitude to Karen H. Sousa, RN, PhD, FAAN and Kathleen S. Oman, RN, PhD, CEN, FAEN for their invaluable guidance and support with theoretical models, caring science, and theory integration. Barr, E. A. , and Horton‐Deutsch S.. 2026. “The Trust‐Link Relational Transition Model: A Unitary Caring Framework for Youth With HIV Transitioning to Adult Healthcare.” Journal of Advanced Nursing 82, no. 5: 5479–5492. 10.1111/jan.70131. Funding: This work was supported by the Sumner Roy Kates Charitable Trust. Data Availability Statement The authors have nothing to report. References Acree, M. E.

2017. “Transition of Care for Youth With HIV.” Pediatric Annals 46, no. 5: e198–e202. 10.3928/19382359-20170424-02. [ DOI ] [ PubMed ] [ Google Scholar ] AlRuthia, Y. , Alwhaibi M., Almalag H., et al. 2020. “The Relationship Between Trust in Primary Healthcare Providers Among Patients With Diabetes and Levels of Depression and Anxiety.” PLoS One 15, no. 9: e0239035. 10.1371/journal.pone.0239035. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Altice, F. L. , Mostashari F., and Friedland G. H.. 2001. “Trust and the Acceptance of and Adherence to Antiretroviral Therapy.” Journal of Acquired Immune Deficiency Syndromes 28, no. 1: 47–58. 10.1097/00042560-200109010-00008. [ DOI ] [ PubMed ] [ Google Scholar ] Andiman, W. A.

2011. “Transition From Pediatric to Adult Healthcare Services for Young Adults With Chronic Illnesses: The Special Case of Human Immunodeficiency Virus Infection.” Journal of Pediatrics 159, no. 5: 714–719. 10.1016/j.jpeds.2011.06.040. [ DOI ] [ PubMed ] [ Google Scholar ] Barr, E. A. , Abuogi L., and Smith C.. 2024. “A Review of Updated Guidelines on Breastfeeding With HIV Using Relational Decision‐Making and Intellectual Humility to Support Infant Feeding Choices.” Nursing Clinics of North America 59, no. 2: 309–327. 10.1016/j.cnur.2023.12.004. [ DOI ] [ PubMed ] [ Google Scholar ] Barr, E. A. , Brasch J., Glenny C., Jones J. J., Oman K., and Reed S. M.. 2025. “Trust in the Patient‐Provider Relationship: An Arts‐Based Research Film Exploring Trust in Adolescents and Young Adults With HIV.” Arts and Health: 1–18. 10.1080/17533015.2025.2493148. [ DOI ] [ PubMed ] [ Google Scholar ] Barr, E. A. , Raybin J. L., Dunlevy H., Abuogi L., and Jones J.. 2022. “Transition From Pediatric and Adolescent HIV Care to Adult HIV Care and the Patient‐Provider Relationship: A Qualitative Metasynthesis.” Journal of the Association of Nurses in AIDS Care 33, no. 2: 132–154. 10.1097/JNC.0000000000000239. [ DOI ] [ PubMed ] [ Google Scholar ] Beach, M. C. , Keruly J., and Moore R. D.. 2006. “Is the Quality of the Patient‐Provider Relationship Associated With Better Adherence and Health Outcomes for Patients With HIV?” Journal of General Internal Medicine 21, no. 6: 661–665. 10.1111/j.1525-1497.2006.00399.x. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Beichler, H. , Grabovac I., Leichsenring B., and Dorner T. E.. 2022. “Involvement, Perception, and Understanding as Determinants for Patient–Physician Relationship and Their Association With Adherence: A Questionnaire Survey Among People Living With HIV and Antiretroviral Therapy in Austria.” International Journal of Environmental Research and Public Health 19, no. 16: 10314. https://www.mdpi.com/1660‐4601/19/16/10314 . [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Brion, J.

2014. “The Patient‐Provider Relationship as Experienced by a Diverse Sample of Highly Adherent HIV‐Infected People.” Journal of the Association of Nurses in AIDS Care 25, no. 2: 123–134. 10.1016/j.jana.2013.01.006. [ DOI ] [ PubMed ] [ Google Scholar ] Brooks, A. J. , Smith P. J., Cohen R., et al. 2017. “UK Guideline on Transition of Adolescent and Young Persons With Chronic Digestive Diseases From Paediatric to Adult Care.” Gut 66, no. 6: 988–1000. 10.1136/gutjnl-2016-313000. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Čáp, J. , Miertová M., Bóriková I., Žiaková K., Tomagová M., and Gurková E.. 2024. “Trust in Healthcare Professionals of People With Chronic Cardiovascular Disease.” Nursing Ethics 31, no. 6: 1092–1105. 10.1177/09697330231209285. [ DOI ] [ PubMed ] [ Google Scholar ] Centers for Disease Control . 2022. HIV and Youth: HIV Incidence. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/age/youth/index.html . [ Google Scholar ] Coyne, I. , Sheehan A., Heery E., and While A. E.. 2019. “Healthcare Transition for Adolescents and Young Adults With Long‐Term Conditions: Qualitative Study of Patients, Parents and Healthcare Professionals' Experiences.” Journal of Clinical Nursing 28, no. 21–22: 4062–4076. 10.1111/jocn.15006. [ DOI ] [ PubMed ] [ Google Scholar ] Davies, M. A. , and Hamlyn E.. 2018. “HIV and Adolescents: Challenges and Opportunities.” Current Opinion in HIV and AIDS 13, no. 3: 167–169. 10.1097/COH.0000000000000461. [ DOI ] [ PubMed ] [ Google Scholar ] Davtyan, M. , Olshansky E. F., Brown B., and Lakon C.. 2017. “A Grounded Theory Study of HIV‐Related Stigma in U.S.‐Based Health Care Settings.” Journal of the Association of Nurses in AIDS Care 28, no. 6: 907–922. 10.1016/j.jana.2017.07.007. [ DOI ] [ PubMed ] [ Google Scholar ] Dawson‐Rose, C. , Cuca Y. P., Webel A. R., et al. 2016. “Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care.” Journal of the Association of Nurses in AIDS Care 27, no. 5: 574–584. 10.1016/j.jana.2016.03.001. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Dinç, F. , Yıldız D., and Ercan N.. 2024. “The Effectiveness of an Education Program Based on Healthcare Transition in Adolescents With Asthma: A Randomized Controlled Trial.” Pediatric Allergy and Immunology 35, no. 3: e14101. 10.1111/pai.14101. [ DOI ] [ PubMed ] [ Google Scholar ] Entwistle, V. A. , and Quick O.. 2006. “Trust in the Context of Patient Safety Problems.” Journal of Health Organization and Management 20, no. 5: 397–416. 10.1108/14777260610701786. [ DOI ] [ PubMed ] [ Google Scholar ] Fair, C. D. , Sullivan K., Dizney R., and Stackpole A.. 2012. “It's Like Losing a Part of My Family: Transition Expectations of Adolescents Living With Perinatally Acquired HIV and Their Guardians.” AIDS Patient Care and STDs 26, no. 7: 423–429. 10.1089/apc.2012.0041. [ DOI ] [ PubMed ] [ Google Scholar ] Fair, C. D. , Sullivan K., and Gatto A.. 2011. “Indicators of Transition Success for Youth Living With HIV: Perspectives of Pediatric and Adult Infectious Disease Care Providers.” AIDS Care 23, no. 8: 965–970. 10.1080/09540121.2010.542449. [ DOI ] [ PubMed ] [ Google Scholar ] Foster, C. , Ayers S., McDonald S., et al. 2020. “Clinical Outcomes Post Transition to Adult Services in Young Adults With Perinatally Acquired HIV Infection: Mortality, Retention in Care and Viral Suppression.” AIDS 34, no. 2: 261–266. 10.1097/QAD.0000000000002410. [ DOI ] [ PubMed ] [ Google Scholar ] Foster, C. , and Fidler S.. 2018. “Optimizing HIV Transition Services for Young Adults.” Current Opinion in Infectious Diseases 31, no. 1: 33–38. 10.1097/QCO.0000000000000424. [ DOI ] [ PubMed ] [ Google Scholar ] Goralski, J. L. , Nasr S. Z., and Uluer A.. 2017. “Overcoming Barriers to a Successful Transition From Pediatric to Adult Care.” Pediatric Pulmonology 52: S52–S60. 10.1002/ppul.23778. [ DOI ] [ PubMed ] [ Google Scholar ] Gray, W. N. , Schaefer M. R., Resmini‐Rawlinson A., and Wagoner S. T.. 2018. “Barriers to Transition From Pediatric to Adult Care: A Systematic Review.” Journal of Pediatric Psychology 43, no. 5: 488–502. 10.1093/jpepsy/jsx142. [ DOI ] [ PubMed ] [ Google Scholar ] Hams, S. P.

1997. “Concept Analysis of Trust: A Coronary Care Perspective.” Intensive & Critical Care Nursing 13, no. 6: 351–356. https://www.ncbi.nlm.nih.gov/pubmed/9564353 . [ DOI ] [ PubMed ] [ Google Scholar ] Horton‐Deutsch, S. , Willis D. G., Llasus L., et al. 2025. “Weaving Caring Science Into the AACN Essentials: A Cross‐Impact Analysis and Resource Guide.” Journal of Professional Nursing 56: 36–48. 10.1016/j.profnurs.2024.11.001. [ DOI ] [ PubMed ] [ Google Scholar ] Hwang, P. , and Burgers W.. 1997. “Properties of Trust: An Analytical View.” Organizational Behavior and Human Decision Processes 69, no. 1: 67–73. [ Google Scholar ] Judd, A. , Collins I. J., Parrott F., et al. 2017. “Growing Up With Perinatal HIV: Changes in Clinical Outcomes Before and After Transfer to Adult Care in the UK.” Journal of the International AIDS Society 20, no. Suppl 3: 21577. 10.7448/ias.20.4.21577. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Kenney, L. B. , Melvin P., Fishman L. N., et al. 2017. “Transition and Transfer of Childhood Cancer Survivors to Adult Care: A National Survey of Pediatric Oncologists.” Pediatric Blood & Cancer 64, no. 2: 346–352. 10.1002/pbc.26156. [ DOI ] [ PubMed ] [ Google Scholar ] Krause, D. D. , and May W. L.. 2016. “Is It a Trust Issue? Factors That Influence Trust for Persons Living With HIV/AIDS.” Health Promotion Practice 17, no. 5: 711–721. 10.1177/1524839916629388. [ DOI ] [ PubMed ] [ Google Scholar ] Kronschnabel, K. , Puga A., and Eaton L.. 2016. “Preparing to Transition From Pediatric to Adult HIV‐Related Care: Qualitative Assessment and Model Development.” Vulnerable Children & Youth Studies 11, no. 2: 146–159. 10.1080/17450128.2016.1189020. [ DOI ] [ Google Scholar ] Levine, C.

1987. AIDS in the Mind of America: The Social, Political, and Psychological Impact of a New Epidemic. Vol. 92, 1515–1518. University of Chicago Press. [ Google Scholar ] Løgstrup, K. E.

1997. The Ethical Demand, edited by Fink H. and MacIntyre A. C.. University of Notre Dame Press. [ Google Scholar ] Lolekha, R. , Boon‐Yasidhi V., Na‐Nakorn Y., et al. 2017. “The Happy Teen Programme: A Holistic Outpatient Clinic‐Based Approach to Prepare HIV‐Infected Youth for the Transition From Paediatric to Adult Medical Care Services in Thailand.” Journal of the International AIDS Society 20, no. Suppl 3: 21500. 10.7448/ias.20.4.21500. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Machado, D. M. , Galano E., de Menezes Succi R. C., Vieira C. M., and Turato E. R.. 2016. “Adolescents Growing With HIV/AIDS: Experiences of the Transition From Pediatrics to Adult Care.” Brazilian Journal of Infectious Diseases 20, no. 3: 229–234. 10.1016/j.bjid.2015.12.009. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Masese, R. V. , Ramos J. V., Rugalabamu L., et al. 2019. “Challenges and Facilitators of Transition From Adolescent to Adult HIV Care Among Young Adults Living With HIV in Moshi, Tanzania.” Journal of the International AIDS Society 22, no. 10: e25406. 10.1002/jia2.25406. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Mbalinda, S. N. , Bakeera‐Kitaka S., Amooti D. L., Magongo E. N., Musoke P., and Kaye D. K.. 2021. “Ethical Challenges of the Healthcare Transition to Adult Antiretroviral Therapy (ART) Clinics for Adolescents and Young People With HIV in Uganda.” BMC Medical Ethics 22, no. 1: 35. 10.1186/s12910-021-00602-w. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Mechanic, D.

1998. “The Functions and Limitations of Trust in the Provision of Medical Care.” Journal of Health Politics, Policy and Law 23, no. 4: 661–686. https://www.ncbi.nlm.nih.gov/pubmed/9718518 . [ DOI ] [ PubMed ] [ Google Scholar ] Mielke, J. , Cajita M. I., Denhaerynck K., et al. 2024. “Trust in the Transplant Team Associated With the Level of Chronic Illness Management‐A Secondary Data Analysis of the International BRIGHT Study.” Transplant International 37: 11704. 10.3389/ti.2024.11704. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Momplaisir, F. , McGlonn K., Grabill M., et al. 2023. “Strategies to Improve Outcomes of Youth Experiencing Healthcare Transition From Pediatric to Adult HIV Care in a Large U.S. City.” Archives of Public Health = Archives Belges de Santé Publique 81, no. 1: 49. 10.1186/s13690-023-01057-8. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Newman, C. , Persson A., Miller A., and Cama E.. 2014. “Bridging Worlds, Breaking Rules: Clinician Perspectives on Transitioning Young People With Perinatally Acquired HIV Into Adult Care in a Low Prevalence Setting.” AIDS Patient Care and STDs 28, no. 7: 381–393. 10.1089/apc.2013.0346. [ DOI ] [ PubMed ] [ Google Scholar ] Onono, M. , Odwar T., Abuogi L., et al. 2020. “Effects of Depression, Stigma and Intimate Partner Violence on Postpartum Women's Adherence and Engagement in HIV Care in Kenya.” AIDS and Behavior 24, no. 6: 1807–1815. 10.1007/s10461-019-02750-y. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Peperzak, A. , Critchley S., and Bernasconi R., eds. 1996. Emmanuel Levinas: Basic Philosophical Writings. Indiana University Press. [ Google Scholar ] Philbin, M. M. , Tanner A. E., Chambers B. D., et al. 2017. “Transitioning HIV‐Infected Adolescents to Adult Care at 14 Clinics Across the United States: Using Adolescent and Adult Providers' Insights to Create Multi‐Level Solutions to Address Transition Barriers.” AIDS Care 29, no. 10: 1227–1234. 10.1080/09540121.2017.1338655. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Pound, P. , and Campbell R.. 2015. “Exploring the Feasibility of Theory Synthesis: A Worked Example in the Field of Health Related Risk‐Taking.” Social Science & Medicine 124: 57–65. 10.1016/j.socscimed.2014.11.029. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Preau, M. , Leport C., Salmon‐Ceron D., et al. 2004. “Health‐Related Quality of Life and Patient‐Provider Relationships in HIV‐Infected Patients During the First Three Years After Starting PI‐Containing Antiretroviral Treatment.” AIDS Care 16, no. 5: 649–661. 10.1080/09540120410001716441. [ DOI ] [ PubMed ] [ Google Scholar ] Quon, D. , Reding M., Guelcher C., et al. 2015. “Unmet Needs in the Transition to Adulthood: 18‐ to 30‐Year‐Old People With Hemophilia.” American Journal of Hematology 90, no. Suppl 2: S17–S22. 10.1002/ajh.24219. [ DOI ] [ PubMed ] [ Google Scholar ] Relf, M. V. , Pan W., Edmonds A., Ramirez C., Amarasekara S., and Adimora A. A.. 2019. “Discrimination, Medical Distrust, Stigma, Depressive Symptoms, Antiretroviral Medication Adherence, Engagement in Care and Quality of Life Among Women Living With HIV in North Carolina: A Mediated Structural Equation Model.” Journal of Acquired Immune Deficiency Syndromes 81: 328–335. 10.1097/QAI.0000000000002033. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Ritchwood, T. D. , Malo V., Jones C., et al. 2020. “Healthcare Retention and Clinical Outcomes Among Adolescents Living With HIV After Transition From Pediatric to Adult Care: A Systematic Review.” BMC Public Health 20, no. 1: 1195. 10.1186/s12889-020-09312-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Robinson, C. A.

2016. “Trust, Health Care Relationships, and Chronic Illness: A Theoretical Coalescence.” Global Qualitative Nursing Research 3. 10.1177/2333393616664823. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Robinson, C. A.

2017. “Families Living Well With Chronic Illness: The Healing Process of Moving on.” Qualitative Health Research 27, no. 4: 447–461. 10.1177/1049732316675590. [ DOI ] [ PubMed ] [ Google Scholar ] Robinson, C. A. , and Thorne S.. 1984. “Strengthening Family ‘Interference’.” Journal of Advanced Nursing 9, no. 6: 597–602. https://www.ncbi.nlm.nih.gov/pubmed/6569880 . [ DOI ] [ PubMed ] [ Google Scholar ] Rowe, R. , and Calnan M.. 2006. “Trust Relations in Health Care: Developing a Theoretical Framework for the “New” NHS.” Journal of Health Organization and Management 20, no. 5: 376–396. 10.1108/14777260610701777. [ DOI ] [ PubMed ] [ Google Scholar ] Sellman, D.

2007. “Trusting Patients, Trusting Nurses.” Nursing Philosophy 8: 28–36. [ DOI ] [ PubMed ] [ Google Scholar ] Silva‐Suarez, G. , Bastida E., Rabionet S. E., Beck‐Sague C., Febo I., and Zorrilla C. D.. 2015. ““That's True Love”: Lived Experiences of Puerto Rican Perinatally HIV‐Infected Youth Within Their Families' Context.” International Journal of Environmental Research and Public Health 13, no. 1. 10.3390/ijerph13010007. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Straub, D. M. , and Tanner A. E.. 2018. “Health‐Care Transition From Adolescent to Adult Services for Young People With HIV.” Lancet Child Adolesc Health 2, no. 3: 214–222. 10.1016/S2352-4642(18)30005-1. [ DOI ] [ PubMed ] [ Google Scholar ] Tanner, A. E. , Philbin M. M., Ma A., et al. 2017. “Adolescent to Adult HIV Health Care Transition From the Perspective of Adult Providers in the United States.” Journal of Adolescent Health 61, no. 4: 434–439. 10.1016/j.jadohealth.2017.05.011. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Tepper, V. , Zaner S., and Ryscavage P.. 2017. “HIV Healthcare Transition Outcomes Among Youth in North America and Europe: A Review.” Journal of the International AIDS Society 20, no. Suppl 3: 21490. 10.7448/IAS.20.4.21490. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Thorne, S. E. , and Robinson C. A.. 1988a. “Health Care Relationships: The Chronic Illness Perspective.” Research in Nursing & Health 11: 293–300. [ DOI ] [ PubMed ] [ Google Scholar ] Thorne, S. E. , and Robinson C. A.. 1988b. “Reciprocal Trust in Heatlh Care Relationships.” Journal of Advanced Nursing 13: 782–789. [ DOI ] [ PubMed ] [ Google Scholar ] Thorne, S. E. , and Robinson C. A.. 1989. “Guarded Alliance: Health Care Relationships in Chronic Illness.” Journal of Nursing Scholarship 21: 153–157. [ DOI ] [ PubMed ] [ Google Scholar ] Trepka, M. J. , Ward M. K., Fennie K., et al. 2023. “Patient‐Provider Relationships and Antiretroviral Therapy Adherence and Durable Viral Suppression Among Women With HIV, Miami‐Dade County, Florida, 2021‐2022.” AIDS Patient Care and STDs 37, no. 7: 361–372. 10.1089/apc.2023.0029. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Turkel, M. C. , Watson J., and Giovannoni J.. 2018. “Caring Science or Science of Caring.” Nursing Science Quarterly 31, no. 1: 66–71. 10.1177/0894318417741116. [ DOI ] [ PubMed ] [ Google Scholar ] UNAIDS . 2024. The Urgency of Now: AIDS at a Crossroads: 2024 Global AIDS Update. Joint United Nations Programme on HIV/AIDS (UNAIDS). https://www.unaids.org/en/resources/documents/2024/2024‐global‐aids‐update . [ Google Scholar ] Verma, A. , and Sahay S.. 2019. “Healthcare Needs and Programmatic Gaps in Transition From Pediatric to Adult Care of Vertically Transmitted HIV Infected Adolescents in India.” PLoS One 14, no. 10: e0224490. 10.1371/journal.pone.0224490. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Vijayan, T. , Benin A. L., Wagner K., Romano S., and Andiman W. A.. 2009. “We Never Thought This Would Happen: Transitioning Care of Adolescents With Perinatally Acquired HIV Infection From Pediatrics to Internal Medicine.” AIDS Care 21, no. 10: 1222–1229. 10.1080/09540120902730054. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Wang, X. , and Wu Z.. 2007. “Factors Associated With Adherence to Antiretroviral Therapy Among HIV/AIDS Patients in Rural China.” AIDS 21, no. Suppl 8: S149–S155. 10.1097/01.aids.0000304711.87164.99. [ DOI ] [ PubMed ] [ Google Scholar ] Watson, J.

2005. “Caring Science: Belonging Before Being as Ethical Cosmology.” Nursing Science Quarterly 18, no. 4: 304–305. 10.1177/0894318405280395. [ DOI ] [ PubMed ] [ Google Scholar ] Watson, J.

2008. Nursing: The Philosophy and Science of Caring. University Press of Colorado. [ Google Scholar ] Watson, J.

2018. Unitary Caring Science: The Philosophy and Praxis of Nursing. University Press of Colorado. [ Google Scholar ] Watson, J. , and Brewer B. B.. 2015. “Caring Science Research: Criteria, Evidence, and Measurement.” Journal of Nursing Administration 45: 235–236. 10.1097/nna.0000000000000190. [ DOI ] [ PubMed ] [ Google Scholar ] Watson, J. , and Smith M. C.. 2002. “Caring Science and the Science of Unitary Human Beings: A Trans‐Theoretical Discourse for Nursing Knowledge Development.” Journal of Advanced Nursing 37, no. 5: 452–461. https://www.ncbi.nlm.nih.gov/pubmed/11843984 . [ DOI ] [ PubMed ] [ Google Scholar ] White, P. H. , Cooley W. C., Transitions Clinical Report Authoring Group , American Academy of Pediatrics , American Academy of Family Physicians , and American College of Physicians . 2018. “Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home.” Pediatrics 142, no. 5: e20182587. 10.1542/peds.2018-2587. [ DOI ] [ PubMed ] [ Google Scholar ] Wiener, L. S. , Kohrt B. A., Battles H. B., and Pao M.. 2011. “The HIV Experience: Youth Identified Barriers for Transitioning From Pediatric to Adult Care.” Journal of Pediatric Psychology 36, no. 2: 141–154. 10.1093/jpepsy/jsp129. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Williams, E. F. , Ferrer K., Lee M. A., Bright K., Williams K., and Rakhmanina N. Y.. 2017. “Growing Up With Perinatal Human Immunodeficiency Virus‐A Life Not Expected.” Journal of Clinical Nursing 26, no. 23–24: 4734–4744. 10.1111/jocn.13826. [ DOI ] [ PubMed ] [ Google Scholar ] Wood, S. , Ratcliffe S., Gowda C., Lee S., Dowshen N. L., and Gross R.. 2018. “Impact of Insurance Coverage on HIV Transmission Potential Among Antiretroviral Therapy‐Treated Youth Living With HIV.” AIDS 32, no. 7: 895–902. 10.1097/QAD.0000000000001772. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Wood, T. J. , Koester K. A., Christopoulos K. A., Sauceda J. A., Neilands T. B., and Johnson M. O.. 2018. “If Someone Cares About You, You Are More Apt to Come Around: Improving HIV Care Engagement by Strengthening the Patient‐Provider Relationship.” Patient Preference and Adherence 12: 919–927. 10.2147/PPA.S157003. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Zanoni, B. C. , and Mayer K. H.. 2014. “The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities.” AIDS Patient Care and STDs 28: 128–135. 10.1089/apc.2013.0345. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement The authors have nothing to report. Articles from Journal of Advanced Nursing are provided here courtesy of Wiley ACTIONS View on publisher site PDF (995.6 KB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top