The application of Signalling Theory to health-related trust problems: The example of herbal clinics in Ghana and Tanzania

Abstract

In contexts where healthcare regulation is weak and levels of uncertainty high, how do patients decide whom and what to trust? In this paper, we explore the potential for using Signalling Theory (ST, a form of Behavioural Game Theory) to investigate health-related trust problems under conditions of uncertainty, using the empirical example of ‘herbal clinics’ in Ghana and Tanzania. Qualitative, ethnographic fieldwork was conducted over an eight-month period (2015–2016) in eight herbal clinics in Ghana and ten in Tanzania, including semi-structured interviews with herbalists (N = 18) and patients (N = 68), plus detailed ethnographic observations and twenty additional key informant interviews. The data were used to explore four ST-derived predictions, relating to herbalists' strategic communication (‘signalling’) of their trustworthiness to patients, and patients' interpretation of those signals. Signalling Theory is shown to provide a useful analytical framework, allowing us to go beyond the primary trust problem addressed by other researchers – cataloguing observable indicators of trustworthiness – and providing tools for tackling the trickier secondary trust problem, where the trustworthiness of those indicators must be ascertained. Signalling Theory also enables a basis for comparative work between different empirical contexts that share the underlying condition of uncertainty.

Conceptual model for pluralistic healthcare behaviour: results from a qualitative study in southwestern Uganda

“…Community members may consider healers more trustworthy than biomedical providers. 50 Biomedicine could learn a great deal from healers regarding the power of interpersonal relationships as part of the healthcare process. 75 76 For example, Moshabela et al 77 considered the roles of traditional healers in the context of a community-wide HIV testing and treatment intervention.…”

Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context

“…In recent years, research has increasingly included resource-poor contexts, where inadequate service provision and financial barriers may severely constrain choice (e.g. Birungi, 1998; Gilson et al, 2005; Russell, 2005; Ozawa and Walker, 2011; Tibandebage and Mackintosh, 2005; Hampshire et al, 2017; Ackatia-Armah et al, 2016). This work has highlighted the importance of social relationships and mutual understanding between healthcare providers and those seeking care (Gilson, 2003; Tibandebage and Mackintosh, 2005:1385; Brhlikova et al, 2011; Ecks and Basu, 2014).…”

Contested or complementary healing paradigms? Women’s narratives of COVID-19 remedies in Mwanza, Tanzania

“…In the context of uncertainty from the COVID-19 pandemic, participants and community members adhered to the recommendations of those in their social sphere on how to deal with it. Trustworthiness of the remedies was reinforced through social recommendation [10,11]. In this case, the power of social relations to influence health-seeking behavior is evident-through production of the recommended behavioral outcomes [30,31].…”

“…Uncertainty makes treatment-seeking behavior more complex. It sets into motion complex treatment-seeking choices and processes as communities use different means to ascertain the trustworthy of medications and their efficacy [10,11]. To quell fear and embrace hope against new illness, communities tend to explore their sociocultural and local knowledge systems for answers [12][13][14].…”