Subjective Expectations and Health-Related Behavior

描述（由申请人提供）：在发展中国家，主观期望是健康相关行为的一个重要决定因素，因为个人在自身和其他家庭成员的健康、健康投入和健康结果之间的关系、治疗策略和寻求健康行为的有效性以及影响疾病负担严重程度和行为选择后果的风险环境方面面临着很大的不确定性。然而，在这些背景下，人们对健康相关的期望知之甚少。这种知识的缺乏严重限制了我们了解影响发展中国家个人健康的决策过程和制定有效卫生干预措施的能力。因此，该项目的总体目标是首次在撒哈拉以南地区分析新收集的关于概率性主观期望的大规模和非常详细的数据，即以数字尺度衡量并可解释为概率的期望。这些数据是在2006年使用该研究小组开发的一种创新的互动启发格式从生活在马拉维农村的约3000名答复者中收集的，其中包括对个人和家庭成员的健康、死亡率、发病率、经济条件变化和对治疗效果的看法的概率主观期望。特别是，该项目将评估(i)撒哈拉以南非洲的受访者是否具有明确定义的概率期望，以及这些期望与使用口头量表得出的期望之间的关系；（ii）主观期望是否准确，并随着健康风险和冒险行为而系统地变化；（iii）这些期望是否确定和/或与社会经济特征和受访者先前行为的衡量相关联。（四）主观期望如何反映撒哈拉以南非洲国家目前正在实施的重要卫生干预措施的有效性，以及（四）主观期望如何随着时间的推移而更新，特别是在向个人提供有关其客观健康状况的知识之后。最后，这个项目的结果将用于制定建议，以便在发展中国家的情况下引出和分析与健康有关的主观期望。这些分析的结果将为该研究小组未来的R01应用提供信息，该研究小组将开发和估计不确定性下健康决策的结构模型，以了解主观期望影响撒哈拉以南高发病率和死亡率环境中重要健康结果的机制。

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.