Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context
Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context
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DOI：
10.1016/j.socscimed.2019.112369
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发表时间：
2019-08-01
影响因子：
5.4
通讯作者：
Castelli, Michele
中科院分区：
文献类型：
--
作者：
Hamill, Heather;Hampshire, Kate;Castelli, Michele
在监管薄弱的地方，药品交易的特点可能是药品质量和疗效的不确定性，买家在通常不对称的交易中承担更大的风险负担。根据深入访谈（N = 220）和对药品交易的观察，以及对监管机构的访谈（N = 20），我们探讨了加纳人如何应对这种不确定性，并对某种药物产生足够的信任，从而购买或服用这种药物。我们确定了两种机制--试图通过寻找可观察到的质量迹象来减轻不确定性，并试图减少信息不对称--这是对药物可信度的认知评估的基础。然而，这些“认知”形式的信任评估在不确定性很高且可信度仍然不可知的情况下具有有限的牵引力，因此第三种机制开始发挥作用：一种基于情感关系的机制，其中交易是社会嵌入的。然而，即使这些措施也不能消除不确定性，因为更广泛的供应链具有分散和监管不足的性质。最后，我们反思需要仔细研究供应链上的行为者的做法和决策，以制定更有效的政策和法规。
Where regulation is weak, medicine transactions can be characterised by uncertainty over the drug quality and efficacy, with buyers shouldering the greater burden of risk in exchanges that are typically asymmetric. Drawing on in-depth interviews (N = 220) and observations of medicine transactions, plus interviews with regulators (N = 20), we explore how people in Ghana negotiate this uncertainty and come to trust a medicine enough to purchase or ingest it. We identify two mechanisms - attempts to mitigate uncertainty through seeking observable signs of quality and attempts to reduce informational asymmetry - that underpin cognitive assessments of a medicine's trustworthiness. However, these 'cognitive' forms of trust assessment have limited traction where uncertainty is high and trustworthiness remains unknowable, so a third mechanism comes into play: one based on affective relationships within which transactions are socially embedded. Even these, however, cannot eliminate uncertainty, because of the dispersed and under-regulated nature of wider supply chains. In conclusion, we reflect on the need for careful research on actors' practices and decision-making across supply chains to inform more effective policy and regulation.