Alison Hwong

Alison Hwong

VA Scholar, National Clinician Scholars Program, UCSF

Dissertation Title:  “Social Ties and Health: An Analysis of Patient-Doctor Trust and Network-Based Public Health Interventions Through Randomized Experiments and Simulations”

This dissertation investigates the structure and function of interpersonal ties in two different contexts: patient-doctor trust and social network-based public health interventions. 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 $10,000 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. In Chapter 2, I examine sex-based differences in the spread of two public health interventions that were introduced in a cluster randomized controlled field experiment to 32 village networks in Western Honduras. 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 ascertained ties and activated ties. This finding recommends careful reconsideration of the use of network-based strategies for public health interventions. 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.

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