Person: Hwong, Alison R.
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Hwong
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Alison R.
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Hwong, Alison R.
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Publication Social Ties and Health: An Analysis of Patient-Doctor Trust and Network-Based Public Health Interventions Through Randomized Experiments and Simulations(2016-05-16) Hwong, Alison R.; Onnela, Jukka-Pekka; Christakis, Nicholas A.; Lehmann, Lisa S.; Marsden, Peter V.Humans are social creatures, bound by relationships. This dissertation investigates the structure and function of such interpersonal ties in two different contexts: patient-doctor trust and the diffusion of public health interventions across social networks. Each chapter of the dissertation focuses on a particular type of relationship: in Chapter 1, the patient-doctor relationship; in Chapter 2, friendship; and in Chapter 3, ties among friends, spouses, and siblings. The hope is that a better understanding of the nature of these ties and the work they do will enable policymakers to develop regulations and programs that promote the benefits and minimize harm in these exchanges. In Chapter 1, I present the results of a randomized controlled lab study on the effects of disclosure of payments that physicians receive from the pharmaceutical and medical device industry on patient-doctor trust. I find that certain dimensions of patient-doctor trust—honesty and fidelity—are lower for individual physicians when participants view payments of over $13,000 compared to lesser or no payments, but ratings of the physician’s competence do not change. In addition, trust in the medical profession and industry are not affected by disclosure. These findings suggest that industry payments to physicians that exceed $13,000 may need to be regulated, or at least carefully monitored. In Chapter 2, I present a sex-stratified analysis of a randomized controlled field experiment on the network-based diffusion of public health interventions. While men and women are more likely to have same-sex friends, they are both more likely to distribute the public health products to women than to men, revealing a contrast between the nominated ties and activated ties. This finding demonstrates that a traditional name generator for friend ties is a poor predictor of behavior regarding the spread of health-related phenomena. Further research is needed to explore alternative ways to elicit social network data to optimize diffusion, or else network-based strategies for the spread of socially beneficial innovations may need to be reconsidered. In Chapter 3, I use simulations based on the Susceptible-Infected (SI) process to explore the generalizability of the Honduras Study findings to other contexts. In particular, I look at the spread of public health interventions in the Karnataka (India) networks and compare the spreading processes to those in Honduras. The simulations reveal underlying network processes that can variably constrain and promote access to health information and products. As a whole, these studies seek to quantify the nature of social ties and related implications for health care providers and public health programming.