Subjective Expectations and Health-Related Behavior

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DESCRIPTION (provided by applicant): Subjective expectations are an important determinant of health-related behaviors in developing country contexts as individuals face substantial uncertainty about their own and other family members' health, the relationships between health-inputs and health-outcomes, the effectiveness of treatment strategies and health-seeking behaviors, and the risk-environment affecting the severity of the disease burden and the consequences of behavioral choices. Yet, little is known about health-related expectations in these contexts. This lack of knowledge severely limits our ability to understand the decision processes affecting individual's health in developing countries and to devise effective health interventions. The overall goal of this project is therefore to analyze, for the first time in a sub-Saharan context, newly-collected, large-scale and exceptionally detailed data on probabilistic subjective expectations, that is, expectations that are measured on a numeric scale and can be interpreted as probabilities. These data have been collected in 2006 using an innovative interactive elicitation format, developed by this research team, from about 3,000 respondents living in rural Malawi, and include probabilistic subjective expectations about individual's own and family member's health, mortality, morbidity, changes in economic conditions, and perceptions of treatment effectiveness. In particular, this project will evaluate (i) whether respondents in sub-Saharan Africa have well-defined probabilistic expectations, and how those relate to expectations elicited using a verbal scale, (ii) whether subjective expectations are accurate and vary systematically with health risks and risk-taking behaviors, (iii) whether these expectations are determined and/or correlated with socioeconomic characteristics and measures of respondents prior behaviors, (iv) how subjective expectations reflect the perceived effectiveness of important health interventions that are currently being implemented in sub-Saharan African countries, and (iv) how subjective expectations are updated over time, including particularly after providing individuals knowledge about their objective health status. Finally, the findings of this project will be used to develop recommendations for the elicitation and analysis of health-related subjective expectations in developing country contexts, and the results of these analyses will inform a future R01 application by this research team that develops and estimates structural models of health decision-making under uncertainty to understand the mechanisms through which subjective expectations affect important health-outcomes in sub-Saharan contexts with high morbidity and mortality. PUBLIC HEALTH RELEVANCE: Subjective expectations are an important determinant of health-related behaviors in developing country contexts, yet little is known about health-related expectations in these contexts. This lack of knowledge not only limits our understanding of relevant behaviors, but also hampers the development of appropriate health-interventions. Utilizing data that has been collected during 2006 in rural Malawi using an innovative interactive elicitation technique, the proposed project promises to provide significant and important new in- sights to our knowledge of health-related expectations in sub-Saharan Africa.