Exploring social influences on healthcare user decision-making.

Commonly used choice models in healthcare assume that decision-making is an individualistic process, while other individuals or groups (i.e., influencers) can in fact impact decision-making. The purpose of this study is to examine different ways in which influencers affect healthcare user decision-making as an important step towards improving these choice models in healthcare. Two focus groups (n = 12) and 41 semi-structured interviews were conducted, within a range of healthcare domains: influenza vaccination, birth care, joint replacement and prostate cancer treatment domains. Both healthcare users and physicians were interviewed. Participants were recruited through collaborations with a GP, hospital and a research panel. Data were analyzed with a grounded theory approach. Results reveal three main elements of decision-making which were affected by different social influence mechanisms. In the information-gathering phase the perception of alternatives, attribute levels and risks was influenced by information retrieved from someone in the social network, others' experiences, and social norms. In the preference formation phase, the relative importance of attributes and the value of alternatives were impacted by social norms, advice, and consideration of an influencer's stake in the decision. Finally, the process of actual decision-making could be more deliberation-based or intuition-based through discussion with or consultation of others. The exact strength and impact of these influences differed per healthcare domain. This study provides further insights into social influences on healthcare user decision-making across multiple healthcare domains and provides comparisons between these domains. Several connections between influencers, social influence mechanisms and choice constructs were identified. These findings can help choice modelers develop models that more accurately reflect the decision-making process in health.