title: Do social norms play a role in explaining involvement in medical decision-making?
abstract: Patients' involvement in medical decision-making is crucial to provide good quality of care that is respectful of, and responsive to, patients' preferences, needs and values. Whether people want to be involved in medical decision-making is associated with individual patient characteristics, and health status. However, the observation of differences in whether people want to be involved does not in itself provide an explanation. Insight is necessary into mechanisms that explain people's involvement. This study aims to examine one mechanism, namely social norms. We make a distinction between subjective norms, that is doing what others think one ought to do, and descriptive norms, doing what others do. We focus on self-reported involvement in medical decision-making.
  
  
  
  A questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%; N = 974). A regression model was used to estimate the relationship between socio-demographics, social norms and involvement in medical decision-making.
  
  
  
  In line with our hypotheses, we observed that the more conservative social norms are, the less people are involved in medical decision-making. The effects for both types of norms were comparable.
  
  
  
  This study indicates that social norms play a role as a mechanism to explain involvement in medical decision-making. Our study offers a first insight into the possibility that the decision to be involved in medical decision-making is not as individual as it at first seems; someone's social context also plays a role. Strategies aimed at emphasizing patient involvement have to address this social context.
authors.affiliation: NIVEL, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands a.brabers@nivel.nl.
authors.forename: Anne E M
authors.initials: AE
authors.lastname: Brabers
authors.affiliation: NIVEL, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
authors.forename: Liset
authors.initials: L
authors.lastname: van Dijk
authors.affiliation: NIVEL, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.|Department of Sociology, Department of Human Geography, Utrecht University, PO Box 80125, 3508 TC Utrecht, the Netherlands.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Groenewegen
authors.affiliation: NIVEL, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
authors.forename: Judith D
authors.initials: JD
authors.lastname: de Jong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005195:Family Relations; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010358:Patient Participation / Q000706:statistics & numerical data*; D057566:Self Report; D066262:Social Norms; D012959:Socioeconomic Factors; D014171:Transients and Migrants / Q000706:statistics & numerical data; D055815:Young Adult