Social Influence on Patient Choices: A Systematic Review

OBJECTIVES: Healthcare decisions are influenced by social contexts, yet current econometric models often overlook these external factors. This systematic review explores how social influences affect patient choices and identifies methods to enhance the external validity of these models.

METHODS: Using PRISMA guidelines, we examined agents involved in health-related decisions, the social mechanisms influencing patients, and the choice constructs affected in four medical areas: arthroplasty, birth-setting, cancer, and immunization. From 208 out of 9,036 screened articles, we developed a conceptual framework linking social influence to choice constructs.

RESULTS: Key social influencers include family, friends, specialized physicians, and general practitioners. Social processes like comparison, support, and doctor-patient interactions were significant, with prescriptive and informational cues being predominant. Social constraints often limit choices based on goal space (e.g., maintaining social function), attribute space, or external factors (e.g., lack of support for treatment). These constraints primarily affect evaluation strategies and goal selection. Doctor-patient interactions and social relationships provide both prescriptive and informational signals, while social norms mainly offer informational cues. Variations were noted across medical domains, highlighting the context-dependent nature of social influences.

CONCLUSIONS: Our conceptual framework elucidates the social influence process in healthcare, breaking it down into mechanisms and signals, and linking them to patient choice components within specific medical contexts. This framework provides a foundation for developing enhanced measurement models that incorporate social context, potentially leading to a greater explanatory and predictive capacity in econometric models of patient choices.