Welfare Service Professionals, Migrants, and the Question of Trust. A Danish Case

Theoretical background and the state of research

In sociological theories of professions and professionalism, trust is described as an important ingredient of the professional—citizen relationship and has been identified as an important precondition for the work of professionals in general (Di Luzio, 2006). There is a broad consensus that this is a form of impersonal trust (although there may be borderline cases, such as that of a long-term general practitioner). Di Luzio states (2006, p. 554): “The object of trust is not the practitioner as such—it is rather institutions that provide the main basis and justification for client trust.”

Thus, in this tradition, trust between the client and the professional is seen as possible because it is embedded systemically, that is, the client can trust the professional because there is a reliance on a system of autonomous control. This system of professional control ensures the professional’s orientation towards public welfare (Parsons, 1939) and the validity of his expert knowledge (Giddens, 1990). In a classical profession, such as medicine, this is based on scientific knowledge, which is certified and regulated, mainly by the profession itself (using regulations that are ultimately embedded in state regulations). In the view of, among others, Abbot (1988), the classical professions are constituted of an entanglement of knowledge and power, and this entanglement grants a form of authority.

In his account on trust and medical professions, Grimen (2009) emphasizes the importance of the power aspect and its consequences for trust. The power asymmetry between the professional and the client is caused by the expert’s knowledge, professional autonomy, and discretion. Welfare service professionals, including medical ones, often serve as gatekeepers to services, which gives them considerable power vis-à-vis the citizen. Thus, sometimes the exit options and the alternatives to trusting are very limited or very extreme (especially when it comes to the health sector). It can even be questioned whether, in these cases, we can speak of trust after all.

In their theoretical deliberations on trust, both Luhmann (1979) and Giddens (1990) mention the connection between client trust and institutional or system trust. Luhmann states that in trusting the professional one trusts something abstract in a generalized, yet diffuse way. This stems from a form of trust in a diffuse system, Luhmann argues, which basically relies on the inherent controls installed in the system. In the case of welfare service professionals, we can establish that the welfare state is in charge of some of these control mechanisms (Luhmann, 1979). Giddens (1990) particularly emphasizes the role of professionals as access points to the system. He argues that encounters with these “face workers” of the system are of crucial importance for trust: “They are places of vulnerability for abstract systems, but also junctions at which trust can be maintained or built up” (Giddens, 1990, p. 88).

Research in the field of the medical professions tends to back up this claim—in this strand of research the role of the professional in the meeting with the citizen is emphasized in terms of both client trust and the emergence of institutional or system trust in health care institutions in particular (Brown, 2009; Legido-Quigley et al., 2014).

Having provided a general introduction to client trust, I want to introduce the substantive features of this relationship in order to provide an adequate framework for the analysis. What characterizes trust-boosting encounters between professionals and citizens? Which micro-processes enable trust or lead to distrust? First I will present some specific aspects of functionally specific client trust in the public sector and in professionals, and then I will present some more general theories on the function of trust on the micro-level.

Several authors (e.g., Kumlin & Rothstein, 2005; Van Ryzin, 2011) have emphasized the role of procedural justice as a substantive feature of the working practice of welfare service professionals that contributes to being considered trustworthy. In the context of trust in civil servants, Van Ryzin lists the following characteristics of encounters between civil servants and citizens as playing a role in the perceived trustworthiness of the civil servant:

(Van Ryzin, 2011, p. 747)

In his study, Van Ryzin finds that these characteristics play a role in the trust placed by citizens in civil servants and the civil service in general (Van Ryzin, 2011).

Hardin (2002) presents another, related argument. He emphasizes the importance of the concept of trustworthiness. Among other things, he identifies competence and the moral disposition of the trustee as possible causes of trustworthiness. This is very much in line with the ideas of the aforementioned sociological classics on the foundations of client trust, Parsons and Giddens. In the context of this paper, the interesting point is whether the professional in the encounter is viewed as being competent, as behaving morally, or both, and how this is interpreted by the interviewee. Taking the considerations about procedural justice into account, we can also discuss whether the trustworthiness of professionals is based on perceived moral behavior by the professionals in question or perceived procedural justice.

As mentioned above, the findings of studies in the field of medical sociology strongly emphasize the importance of encounters with medical professionals for the development of trust, both in professionals and in the health care system in general. Concerning the question of the specific aspects of these encounters, in their study on trust in the Spanish health care system by British pensioners living in Spain, Legido-Quigley et al. (2014, p. 1254-1255) write that trust is “fostered through interpersonal elements such as the communication of reciprocity, respect, and (often embodied) empathy.” More importantly, the authors add that it “has to be earned by clinicians, and earned primarily through the skilled performance of interrelational skills rather than clinical competence.”

This also seems to be confirmed by Brown’s findings among gynaecology patients in the UK, which he illustrates with the following example:

Concerning the nature of the encounters upon which the decision to trust or distrust a professional is made, Zinn’s (2008) thoughts on the intersections of trust, intuition and emotions appear relevant. The author emphasizes that trust is something that is built in between rationality and irrationality, and states: “[…] the key characteristic of trust is not its combination of rationality and belief but rather its use of pre-rational knowledge and intuition placing trust in between rationality and non-rationality, neither fully rational nor irrational” (Zinn, 2008, p. 446).

According to Zinn, this gives rather intangible characteristics, such as feelings and emotions, a role in the development of trust. He argues that

To sum up, concerning the substantive aspects of encounters between professionals and citizens, several issues emerge in the literature. One emphasizes the elements of procedural justice that can be operationalized, for example, as in the list by Van Ryzin (2011) above, while others instead emphasize the perceived moral dispositions of the trustees as an important precondition for trust. Research in medical sociology points to the importance of interpersonal and communicative characteristics that show care. Last but not least, feelings are named as an important element. In the analysis, both general assumptions about client trust (as presented in the first part of this section) as well as assumptions about the substantive features of encounters (as presented in the second part of this section) are taken up and discussed. Thus, the following analysis aims to contribute to the exploration of client trust in the context of public welfare professionals.

Research design and methods

This article is based on the empirical material consisting of 14 guided interviews with migrants in Denmark. Qualitative methods are especially suitable for analyses of how people make sense of experiences because they allow for the differentiated and open inclusion of topics and individual background information in both data collection and analysis. Concerning the criteria for choosing interviewees, the logic of “maximizing differences” (Glaser & Strauss, 1999) was applied. Thus, migrants with quite different backgrounds (from Western and non-Western countries, with different educational backgrounds, male and female, refugees and expatriates, etc.) were interviewed. Following Glaser and Strauss’s concept, the idea was that if commonalities among very different migrants could be found, the differences in the background would strengthen the argumentation that these commonalities are connected to the setting and experiences in the host country. As the focus of the project was on experiences with social policy and the welfare state, one important criterion for choosing interviewees was that they had actually had enough time to have such experiences, as well as having access them (i.e. they needed to be entitled to social rights). Thus we chose relatively settled migrants, and all of them had been resident in Denmark for at least 4.5 years (see Table 1).

The interview guides were generally constructed as open and explorative—using open questions with the aim to create narratives on meanings, interpretations, and practices concerning the encounters with the welfare state and front-line professionals. The structure of the interview guides was designed to follow the experiences of the interviewees. After some general, open questions about their experiences with the Danish welfare state, the interviewees were asked which specific parts, institutions and professionals they had encountered. This was followed by open questions that aimed to stimulate a free narrative about their respective encounters and experiences. Direct questions about the research topics such as trust were only included at the very end of the interview. The aim was to generate empirical material suitable for qualitative analysis about the characteristics of encounters with the welfare state and its professionals. This meant that topics such trust were frequently brought up by the interviewees themselves. The downside, however, was that a wide range of interview material was created that included several parts of the welfare state, and thus encompassed professionals who differ profoundly in their roles (see Appendix 1 for a full interview guide).

Table 1 provides an overview of the interviewees and their socio-demographic characteristic

The interviews were coded thematically in Nvivo and the analysis was guided by a hermeneutical understanding (Gadamer, 1989) of each interview as a separate case. The coding process included both open, in-vivo codes, and codes that were generated beforehand by the research questions. The following Table 2 contains a list of codes.

The following presentation of the analysis is thus guided by the topics that emerged during the analysis and appeared relevant to the topic of professional-citizen relationships from the perspective of trust. For instance, the issue of feelings and emotions emerged from the empirical analysis, while procedural justice was a topic that had already been identified as potentially relevant in the research literature. All of the topics could be identified in several interviews, although not every topic could be found in each of the narratives, and certain specific individual practices and interpretations were identified. These are contextualized in the specific individual narratives, as this was a crucial aspect of the analytical approach. As the research approach follows the logics of hermeneutics (Gadamer, 1989; Fersch, 2013), the findings and insights are not seen as established once and for all but are able to change in the light of new empirical knowledge or theoretical approaches. Considering the relatively limited number of interviews and the methodological perspective, the presented claims drawn from the empirical material are, of course, limited. The aim of this analysis is to reveal some (new) tendencies that can be investigated further in future research.

Analysis

The focus of this article is, as previously mentioned, the topic of client trust in the context of welfare service professionals. Due to the open structure of the interview guide, information and stories about encounters with professionals were only collected if the interviewees themselves considered them relevant, as the original research interest focused on institutional trust in general and not client trust in particular. However, the fact that many interviewees brought up encounters with professionals in this bottom-up way actually strengthens the assumption that welfare service professionals as the face of the welfare state play an important role not only concerning client trust but also concerning institutional or system trust as well (see above and Giddens, 1990).

In general, the interviewees tell rather positive stories about their encounters with professionals, although some also report negative experiences. The focus of this section is to have a closer look at the meaning-making processes: how did the interviewees interpret their experiences and what does this mean for the development of client trust?

Concluding remarks

The analysis in this article was guided by the question of which substantive features in the encounter between the professional and the citizen established the professionals as trustworthy or otherwise with the interviewees. The analysis of the empirical material indicates that several aspects appear to play a role as sources of trustworthiness, namely procedural justice and the perceived morality of the professionals, with feelings acting as a possible enforcer. Further research into this subject and the relationship between the two possible sources of client trust would be fruitful. In all the interviews, accounts mentioning procedural fairness, morality, or both could be found regarding professionals related to services and the administration of social rights such as unemployment benefits or social assistance and, to a lesser extent and in a modified way, in the medical sector. Feelings as a promoter of trust, on the other hand, were mainly referred to in relation to childcare professionals. The material also brought up other insights into client trust, such as transnational exit practices in the case of distrust, and the “overriding” of client distrust by system trust.

The final aspect is a migration-specific one, namely the idea that welfare state professionals can be seen as “representatives” of the state and society of the host country, and that trustworthy experiences with front-line welfare service professionals could thus even enhance the development of generalized social trust (Kumlin & Rothstein, 2010). Indeed this was a dynamic that could be found across different professional groups. Thus enhancing client trust might even have a “hidden” integrative potential that could be relevant in the current climate.