How to Build Trust With Clients Using Evidence-Based Communication Strategies

By Birth & Baby University · Last updated: October 2026 · 3 min read

Trust is the working material of doula practice. Families share fears, sleep patterns, relationships and medical histories with someone they have known for weeks. Research on trust and communication comes mostly from clinical settings, so this article is careful about what it can say for doulas. It summarizes the main findings and offers communication habits that fit a non-clinical role.

Key takeaways

• A meta-analysis of 47 studies found a small to moderate correlation between patients’ trust in their health professional and health outcomes (r = 0.24), mostly for self-rated outcomes, with evidence of upward bias in the results.
• A meta-analysis of 13 randomized trials found that the patient-clinician relationship had a small but statistically significant effect on outcomes (d = 0.11).
• For teach-back, a 2026 review of 18 trials found no clear effect on knowledge but evidence, mostly of low or very low certainty, of better self-efficacy and short-term adherence.
• None of these studies involved doulas, so they inform habits and do not prove outcomes.

What the research says

Trust and the relationship

A 2017 meta-analysis of 47 studies found that patients’ trust in their health professional was correlated with health outcomes (r = 0.24, 95% CI 0.19 to 0.29). The relationship was moderate for self-rated outcomes (r = 0.30) but not significant for objective outcomes (r = -0.02) or observer-rated outcomes (r = 0.10). The authors noted evidence of upward bias and called for prospective studies, and a correlation does not show that trust causes better outcomes. A 2014 meta-analysis of 13 randomized trials in which the relationship was deliberately varied found a small effect (d = 0.11) that was statistically significant, with few trials not designed for this question.

In childbirth, a systematic review of 137 reports found that the amount of support from caregivers, the quality of the caregiver-patient relationship and involvement in decision making outweighed many other factors in how women evaluated their births. In the doula context, a Massachusetts focus group study of patients and community-based doulas found that trust was the most frequently cited indicator of a successful doula-client relationship, with a humble willingness to learn and to challenge one’s assumptions emphasized.

Teach-back and checking understanding

Teach-back means asking someone to explain information in their own words so the explainer can check that the message landed. A 2026 systematic review and meta-analysis of 18 randomized trials with 1,985 participants found no clear pattern for knowledge acquisition (very low certainty), a large increase in self-efficacy in a pooled analysis of five trials (SMD 2.40, 95% CI 0.37 to 4.44, very low certainty) and a large increase in short-term self-reported adherence in seven trials (SMD 1.04, 95% CI 0.45 to 1.64, low certainty), with wide confidence intervals and substantial heterogeneity. These trials involved clinicians and patients in medical settings.

What this means for doulas

• Trust is built by what you do repeatedly. Showing up on time, keeping confidence, following through and admitting what you do not know are the behaviors clients mention, though the studies do not measure them separately.
• Do not overstate. The honest message is that supportive relationships are associated with better experiences, not that trust prevents complications.
• Check understanding without testing. Teach-back done as “I want to be sure I explained this well” differs from quizzing the client. In your role it applies to what you explain about options and how to reach a clinician, not to medical instructions.
• Stay inside scope in conversation. Reflect, ask and refer; do not diagnose or advise.

Putting the evidence into practice

• Open visits with the client’s agenda (“What would be most useful today?”) before yours.
• Reflect back in the client’s own words, then ask whether you got it right.
• When you explain a process, such as how to contact the clinic after hours, ask the client to say what they would do, and correct your explanation if it was unclear.
• Be explicit about confidentiality and its limits, and about what you can and cannot do, at the first visit.
• Keep promises small. If you say you will text a resource list tonight, send it tonight.
• When you do not know, say so and say how you will find out, or whom you will ask.

The bottom line

Trust matters to how clients experience care, and some communication habits have supporting evidence in other health fields. For doulas, the practical conclusion is modest: listen first, check understanding gently, keep your promises and stay inside your scope. Avoid claiming that any technique guarantees outcomes.

Related reading: The Art and Science of Providing Emotional Support During Labor; The Psychology of Trust: What Makes Families Feel Confident Hiring a Doula?.

This article is for professional education. It is not medical, legal, financial or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• Birkhäuer J, et al. Trust in the health care professional and health outcome: a meta-analysis. PLoS One 2017. Read the source
• Kelley JM, et al. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2014. Read the source
• Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. American Journal of Obstetrics and Gynecology 2002. Read the source
• Falade E, et al. Perspectives on cultural competency and race concordance from perinatal patients and community-based doulas. Birth 2023. Read the source
• Vick JB, et al. Teach-Back in Clinical Communication: A Systematic Review and Meta-analysis. Journal of General Internal Medicine 2026. Read the source

Communication skills are part of how doulas are trained and mentored. Birth & Baby University’s training and mentorship options are outlined on the For Doulas page. Ask any program how it teaches and practices communication.

More for professionals: the Professionals Blog.