Paper short abstract:

We apply the principles of Signalling Theory to understanding how prospective patients in Ghana come to trust certain healers and how healers try to signal their trustworthiness, and consider the usefulness of this approach in relation to other trust problems in global health.

Paper long abstract:

Today's increasingly globalised and dispersed healthcare arenas are characterised by a proliferation of therapeutic possibilities that pose serious trust problems for prospective patients. The decision to trust a healer or medicine is often based on limited (and biased) information with little possibility of redress if something goes wrong. The implications of misplacing trust for both individual and public health are serious. Such risks are widely discussed in the literature, but attempts at rigorous theorisation are limited. In this paper, we propose that signalling theory - an approach used principally in economics and evolutionary biology - offers a useful tool for understanding trust problems in healthcare. After outlining the basic principles of signalling theory, we apply it to an empirical example: how prospective patients in Ghana come to trust certain healers and how both healers and patients engage in 'signalling games' that enable production of trust. We conclude by considering the potential contribution of signalling theory to other 'trust problems' in contemporary global health.