Wednesday, August 13, 2008

Consumer trust: benevolence vs. expertise

There is an old saying in medicine that patients judge their doctors on the "three A's", affability, availability, and last (and least) ... ability. New research in psychology confirms this old aphorism, and helps explain why some women may ignore the advice of experts in favor of the advice of people they like better.

According to Tiffany Barnett White, writing in the Journal of Consumer Pyschology (Consumer Trust and Advice Acceptance: The Moderating Roles of Benevolence, Expertise, and Negative Emotions):
... Participants solicited advice from experts when their decisions were low in perceived emotional difficulty but favored the advice of predominantly benevolent providers when making highly emotionally difficult decisions. Although consumers who faced emotionally difficult decisions were willing to trade off expertise for benevolence, they did not perceive this non-normative trade-off to influence decision quality. Instead, ... consumers were more confident in the accuracy of predominantly benevolent providers' advice.
In other words, somewhat paradoxically, the more important a decision is, the less likely people are to rely on expertise and the more likely they are to rely on how much they like the advice giver. White suggests that people facing high-stakes decisions are unconsciously searching for ways to buffer stress, while consciously believing that they are making decisions based on evidence.

White identifies several factors that impact high-stakes decision making:
... [H]ighly emotionally difficult decisions appear to be distinct in that they also trigger the desire to cope with (i.e., minimize) negative decision-related emotions. Thus, individuals may be motivated to make the best decision ... [but] they must also manage the negative emotions that are associated with the decision... Drolet and Luce noted that in such decisions, consumers often "sacrifice decision accuracy in order to minimize negative emotions, even (and perhaps especially) in consequential decisions"...
People facing difficult decisions are often seeking emotional support:
Individuals who anticipate stressful or negative outcomes often seek the social support of others in an attempt to cope with such stress ... To the extent that the goal of minimizing negative decision-related emotions may dominate the goal of maximizing decision accuracy when decisions are emotionally difficult, the motivation to seek the advice and support of providers who can help to minimize these negative emotions may be preferred.
White asks:
When consumers trade off the accuracy-enhancing skills and abilities of predominant experts for the emotion-enhancing caring and empathy of predominantly benevolent providers ... do such trade-offs reflect a conscious choice? That is, do consumers actually believe they are sacrificing accuracy in such conditions?
She answers her own question:
Theory and research on social support has suggested that the positive effect of emotional support ... is ... the "psychological buffer" it provides against real or imagined stressful outcomes... [T]his buffering occurs because emotional support seekers are optimistic that they can avoid potentially negative outcomes as a result of this support... Thus, although consumers may trade off perceived expertise for perceived benevolence, such a trade-off does not reflect a motivated decision to accept less accurate advice. Rather, consumers may actually perceive the advice of predominantly benevolent providers to be more accurate.
This has obvious and important implications for the decision to employ a DEM rather than an obstetrician. Even though DEMs claim they are "experts" in normal birth, there are probably very few women who would not admit that obstetricians have far greater expertise. Homebirth advocates justify the decision to employ a provider with far less knowledge by a variety of conscious and unconscious strategies.

The conscious strategies include claims that childbirth is inherently safe, that DEMs are "experts" in normal birth, and that there is plenty of time to seek expert advice (by transferring) if unanticipated complications develop. The unconscious strategies involve an effort to manage the emotional stress of childbirth. Simply choosing a provider who is more personable and supportive reduces stress. Indeed, this stress reduction strategy is consciously justified by claiming that reducing stress ("fear") improves outcomes (though it does not). Second, and more importantly for our discussion, women often judge the advice of a supportive provider to be more accurate than the advice of someone less supportive, even though there is no correlation between benevolence and expertise.

Women contemplating employing a DEM would benefit from thinking about these issues. Is the decision to hire a DEM made because she truly has enough knowledge and experience to provide childbirth care, or is it made because it is less stressful to deal with a DEM at home than an obstetrician at a the hospital? Are homebirth advocates confident in the decision making ability of DEMs or does the more supportive nature of DEMs encourage women to believe in their decision making ability even though the two characteristics are not related? And can homebirth advocates come up with a more accurate way of assessing a DEM's knowledge and experience than deciding by whether how much they like her?

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