How do patients define their circle of trust — and what does that mean for a healthcare service that enters their home? Solo exploratory research under real constraints, with findings that reshaped the client's understanding of their own product.
Care AXL is developing an in-home healthcare service. They needed to understand how potential patients think about trust, quality, and logistics when healthcare moves from a clinical setting into their living room. The core challenge: most people have never experienced in-home healthcare, so their perceptions are shaped entirely by assumptions and prior clinical experiences.
I designed and conducted this exploratory study as a solo researcher to surface the foundational attitudes that would shape adoption of a new service model.
Research Question 1: How do patients define their circle of trust in the context of home healthcare?
Research Question 2: What are perceived elements of positive and negative healthcare experiences in the home?
Research Question 3: What are patient scheduling preferences when scheduling perceived in-home healthcare?
This study sits in the exploratory quadrant — the questions are about people within the context of home healthcare. The goal was to reveal insights about potential users, not to evaluate an existing offering.
This project operated under the kind of constraints that test whether a researcher can produce meaningful work without ideal conditions. Every methodological decision was shaped by these realities.
With no budget, no recruitment support, and no second pair of eyes in the room, I relied on friends-and-family recruitment, asynchronous note-taking via Otter.ai transcription, and a deliberate protocol design that would maximize the depth of each session.
A critical part of rigorous research is being transparent about who you couldn't reach and what that costs your findings. I documented the gap between my ideal and actual sample — not to apologize, but because understanding limitations is how you scope your confidence in results.
Ideal sample: People who schedule their own in-home healthcare appointments, from diverse demographic backgrounds, including remote settings more than an hour from a doctor's office.
Actual sample: Five participants, ages 35–78, who schedule routine healthcare appointments (not specifically in-home). Predominantly one race, all within an hour of their doctor's office. Recruited from my personal network.
What was lost: Direct experience with in-home healthcare scheduling. Geographic and demographic diversity. What was preserved: genuine attitudes toward trust, real scheduling pain points, and the ability to perceive what in-home care might look like in their lives.
I chose semi-structured interviews with an embedded card sorting activity because the research questions required depth of personal narrative — not breadth of data points. Trust is built from lived experience, and the only way to understand someone's trust rubric is to listen to them tell their story.
I designed a three-topic discussion guide that moved participants from broad trust concepts toward healthcare-specific scenarios. The protocol opened with a general trust exploration ("Name four adjectives that describe something trustworthy"), moved through healthcare trust dynamics, and closed with scheduling preferences. Each session was 60 minutes with optional extension to 90.
Mid-interview, participants sorted profession cards (food delivery driver, electrician, plumber, cleaner, babysitter, Uber driver) by the amount of trust required for each to do their job in the participant's home. This activity was conducted via FigJam for remote sessions and physical cards for in-person interviews. It served as both a generative exercise and a bridge to discussing healthcare providers entering the home.
Three participants were interviewed remotely (Zoom + Otter.ai); two were interviewed in person. Two sessions were conducted as dyads — pairs who could build on each other's responses — and three as individual interviews. This wasn't planned as a methodological choice; it was a constraint adaptation that turned out to enrich the data.
With no synchronous note-taker, I relied on recorded transcriptions and conducted thematic analysis across all five sessions. Patterns emerged around trust dynamics, scheduling emotions, and assumptions about quality — which I synthesized into personas, a trust model, a patient journey map, and actionable recommendations for Care AXL.
Analysis revealed that participants' attitudes toward healthcare trust clustered around a central axis: their assumptions about why doctors practice medicine. This shaped everything downstream — how they vetted new providers, how they responded to unexpected changes, and how they felt about healthcare entering their home.
Believes doctors enter medicine motivated by a desire to help. Open to new experiences but relies heavily on their inner circle for advocacy. Vulnerable when separated from trusted loved ones during care. Avoids rescheduling appointments because they worry it will cause conflict.
Believes some doctors are motivated by expected income. Researches peer-reviewed literature before appointments. Sets a high bar for new providers. An excellent self-advocate, but sometimes overthinks and swaps out a doctor who is actually a good match. Views rescheduling as self-advocacy.
Every participant described trust as layered and dynamic — not a binary state. Their circles of trust had concentric rings, from an innermost core of family and loved ones outward to new or unverified relationships. Providers moved in and out of these rings based on specific behaviors.
Participant definition of trust: "You have an expectation that you can rely on an outcome, and you have a high degree of certainty about that expectation."
Recommendations from trusted contacts — friends, family, or favorite providers
Longstanding relationships with consistent, positive interactions over time
Presence of a patient advocate during care, especially during in-home visits or emergencies
Personality fit and authenticity — calm demeanor when confronted, transparency in communication
Violation of expectations — when behavior doesn't match the patient's mental model
Dismissiveness or defensiveness — evasive responses when questioned
Separation from closest advocate during care (emergency C-sections, childhood hospitalization)
Feeling like "just a number" in larger systems or rotating care environments
Circles of trust are layered and dynamic. The patient's most trusted advocates are sometimes a key touchstone for providing optimal care. Movement into and out of the circle of trust is directly proportional to the extremity of the experience — positive or negative.
Some participants assumed care quality would drop in home settings, thinking top-tier professionals wouldn't travel between houses. Others trusted by default, assuming doctors enter the field to help people. This single assumption — why does my doctor do this job — colored every subsequent attitude toward in-home care.
Patients reported stress around feeling like a burden, needing to advocate for themselves, and juggling scheduling with insurance constraints. Some viewed rescheduling as self-advocacy; others avoided it to prevent conflict. One participant described spending 2–3 hours per week calling insurance companies to determine coverage.
Participants were enthusiastic about the comfort and reduced travel of in-home care, but surfaced significant concerns: perceived lower-tier care, space limitations, emergency preparedness fears, and coordination worries across their care team. Some Utopians framed in-home care as an accommodation for people with mobility limitations — not something for them.
Across all participants, a consistent journey emerged: a straightforward doctor visit ends with orders for follow-up care, but the scheduling process devolves into weeks of waiting, missed calls, self-directed confusion, and the real risk of patients abandoning care entirely. Each failed cycle increases abandonment risk.
This journey map synthesizes the scheduling experience described across all five participants. The emotional arc — from straightforward expectations to confusion and resilience — was remarkably consistent.
The research surfaced specific opportunities where in-home care can differentiate itself from the clinical experience — and specific concerns that must be addressed to earn patient trust.
| Opportunity | Why It Matters |
|---|---|
| Feels more personal | Patients find the humanity of in-home care appealing. One Skeptic contrasted it with a "robotic" kiosk experience at a bloodwork lab. |
| Integrate familiar tools | Patients expect ZocDoc, Healthgrades, and MyChart. Meeting them where they already are reduces friction. |
| Cross-provider coordination | Personalize engagement by integrating with all of the patient's care providers — a universal concern. |
| Eliminate the waiting room | Patients expressed genuine joy at the thought of skipping hours of waiting despite arriving on time. |
| Relaxed pacing | One participant began using an in-home service after the interview and reported: "They had time to explain everything — not rushed like in the office." |
This exploratory study opens the door to deeper investigation. My recommendations to Care AXL for continued research:
Recruit participants actively engaged in home healthcare services to validate and extend these exploratory findings with people who have firsthand experience.
Conduct in-context ethnography observing how the home healthcare experience happens in real time, supplemented with a patient diary study to capture the emotional arc over multiple visits.
Run a definition study on trust itself — discover how people define trust to better understand the foundation these findings rest on. Early leads: some patients may experience "stranger danger" fear of inviting practitioners into their home, and a sense of having to "host" — organizing the space, offering coffee.
Working as a solo researcher with no budget forced me to be deliberate about every decision — from protocol structure to how I used recording technology to replace a note-taker. The constraint of friends-and-family recruitment actually surfaced something valuable: participants were comfortable enough to share deeply personal healthcare stories that might not have emerged with strangers in a formal setting.
The dyad format, which was initially a scheduling accommodation, turned out to produce some of the richest data — participants built on each other's responses and challenged each other's assumptions in real time.
What I'd do differently: I would push harder for in-context interviews conducted in participants' homes. The remote format lost the immersive depth of experiencing firsthand where patient care happens. I would also advocate for at least one observer or synchronous note-taker — real-time insights surface differently than what you find reviewing transcripts after the fact.
The full protocol — including informed consent script, three-topic discussion guide, opening and closing procedures, card sorting activity design, project schedule, and budget documentation — is available on request.