Patient Reporting Reticence from Social Proximity

In Simple Words

Imagine visiting a local neighborhood store where the owner overcharges you, but because the owner is a neighbor you interact with regularly, you choose not to report the infraction to a watchdog agency to avoid personal conflict, guilt, or informal retaliation.

Research question

Participatory bottom-up monitoring schemes rely on citizens filing complaints against underperforming service providers, but citizen uptake is frequently low. Existing social connections and fear of retribution can deter citizens from reporting provider misconduct.

Participants

N = 164 trusting patients (subsample of 216 total patients who sent positive amounts in the game) recruited from public and private health facilities in Nairobi, Kenya.

Study Design

Strategy elicitation method measuring patients' binary choices to file complaints and the number of complaint cards sent (0 to 5 cards at 50 KES lump cost), comparing treatments with tangible provider penalties against a standard Complaint Box control.

Results

Patients were 7.4 to 10.3 percentage points less likely to file complaints when complaints led to tangible monetary or peer-shaming consequences for providers (a 25% to 33% reduction from the Complaint Box mean of 29.3%), driven primarily by patients who personally recognized health workers participating in the session.

Takeaway

Design citizen reporting channels with complete individual anonymity and external third-party data collection to eliminate social friction and fear of retaliation when reporting local service providers.

Read alongside the research

Plain-English glossary

Original explanations, informed by the references below. Examples are illustrations, not data from the studies above. The research text stays unchanged.

Percentage points

The difference between two percentages.

ExampleA rise from 40% to 50% is 10 percentage points. Relative to the starting value, that is a 25% increase.

Office for National Statistics · Percentages ↗Read more about percentage points →

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