Little is known about how people evaluate credence attributes, that is, those attributes which the consumer often cannot fully evaluate even after purchasing and consuming the product. And yet consumers struggle to evaluate quality in several important product categories dominated by credence attributes such as food safety, medical services, legal services, and pharmaceuticals, among others. The dissertation explores the processes by which people form quality evaluations of services high in credence attributes and the consequences of those evaluations. Drawing on the service quality, dual-process social information processing, expert-novice and risk literatures, I develop a conceptual model to illustrate how skill and motivation moderate the ways people seek and integrate observable information to infer unobservable quality. The influence of quality evaluations on outcome, satisfaction, value, and loyalty is mapped. The model is tested in the context of a classic credence service, health care services with two large datasets using structural equation modeling. Study 1 draws on an existing patient satisfaction database (6,280 records) to measure the sources and consequences of quality evaluations. Study 2 validates Study 1 findings and extends those findings to show the moderating roles of product expertise and perceived risk on quality evaluation processes. The second study is tested with 1,379 consumers (patients) drawn from an online consumer panel. The research suggests service quality in this context refers narrowly to the attributes of the core product (here, the physician‘s medical competence); interpersonal and organizational quality are associated with value, satisfaction and loyalty, rather than overall quality. Two paths to quality evaluations appear to exist. In the first, consumers integrate evidence of the physician‘s capabilities, practices, and prior outcomes to reach evaluations of technical quality. In the second path, consumers rely on a trust heuristic in which observed interpersonal and organizational quality signals are used to build trust in the physician; that trust, in turn, influences perceptions of technical quality. The trust heuristic appears to be used when the stakes are low and, counterintuitively, when the stakes are high, just when superior evaluations are most needed.

A positive physician-patient relationship is crucial for high quality and effective health care. Yet, cultural and language differences between providers and patients often challenge the establishment of effective physician-patient relationships. These challenges are especially evident in provider-refugee-patient interactions in which patients have experienced loss, torture, and trauma. Understanding of what constitutes a positive doctor-patient relationship is fundamental to diagnosis and treatment and is crucial for the delivery of quality care for diverse patient populations, including refugees. This qualitative, phenomenological case-study focuses on physician-reported experiences caring for refugees in order to identify what experiential factors contribute to effective therapeutic relationships.

The conception of illness and healing in contemporary Mexican Catholic discourse highlights both particular and ubiquitous instances of a health experience perceived locally and widespread. Catholic healing masses are utilized as supplemental methods of individual health restoration coupled with Western medicinal techniques in Catholic dramas. Aside from the spiritual and religious significance of this practice, the use of healing masses as an additional means to achieving an optimal health status implies that something is lacking in current biomedical models. The purpose of my research is to explore the humanistic terms under which healing masses operate and translate these terms into a biomedical conversation towards enhanced secular medical care.