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Publication:

Medical Decisions and Social Class: How Social Influence and Context Shape Choice Across Class Lines

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2025-04-21

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Individuals from lower socioeconomic status (SES) backgrounds face disproportionate health challenges and poorer outcomes. While prior work suggests social influence may shape behavior more strongly in lower-SES groups, less is known about how SES relates to the broader factors that shape medical decisions. This study uses a three-part design to examine how SES influences which factors people rely on and how they respond to social input in medical decision-making: (1) a survey prompting qualitative reflections on past medical decisions (n = 50), (2) a survey rating the influence of various decision-making factors in hypothetical scenarios (n = 477), and (3) a randomized experimental task (n = 508). In Study 1, thematic analysis of open-ended responses identified five core influences on medical decisions—information sources, costs, sources of support, emotional or physical pain, and cultural or societal influences—with notable SES differences in how often each was mentioned. These themes informed the design of Study 2, which found that higher-SES participants rated most factors, including social norms and input from friends and family, as more influential than lower-SES participants—a surprising pattern given prior literature. Study 3 found no significant SES differences in how participants responded to social input in deciding whether to pursue a medical intervention supported or opposed by close others. Together, the findings suggest that SES shapes how people describe influence more than how they respond to it. They complicate narratives about greater social susceptibility among lower-SES individuals and highlight the role of context, communication style, and institutional familiarity in shaping medical decision-making.

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