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Risk, trust and patients’ strategic choices of healthcare practitioners

Chauhan, Apurv and Campbell, Catherine (2020) Risk, trust and patients’ strategic choices of healthcare practitioners. Sociology of Health and Illness. ISSN 0141-9889

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Identification Number: 10.1111/1467-9566.13198


Research on patients’ choice of healthcare practitioners has focussed on countries with regulated and controlled healthcare markets. In contrast, low- and middle-income countries have a pluralistic landscape where untrained, unqualified and unlicensed informal healthcare providers (IHPs) provide significant share of services. Using qualitative data from 58 interviews in an Indian village, this paper explores how patients choose between IHPs and qualified practitioners in the public and formal private sectors. The study found that patients’ choices were structurally constrained by accessibility and affordability of care and choosing a practitioner from any sector presented some risk. Negotiation and engagement with risks depended on perceived severity of the health condition and trust in practitioners. Patients had low institutional trust in public and formal private sectors, whereas IHPs operated outside any institutional framework. Consequently, people relied on relational or competence-derived interpersonal trust. Care was sought from formal private practitioners for severe issues due to high-competence-based interpersonal trust in them, whereas for other issues IHPs were preferred due to high relationship-based interpersonal trust. The research shows that patients develop a strategic approach to practitioner choice by using trust to negotiate risks, and crucially, in low- and middle-income countries IHPs bridge a gap by providing accessible and affordable care imbued with relational–interpersonal trust.

Item Type: Article
Official URL:
Additional Information: © 2020 The Authors
Divisions: Psychological and Behavioural Science
Subjects: R Medicine > RA Public aspects of medicine
B Philosophy. Psychology. Religion > BF Psychology
Date Deposited: 15 Oct 2020 10:18
Last Modified: 21 Jun 2024 01:12

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