Research in Action - Summer 2021

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IN ACTION Ninth Edition | Summer 2021

INSIDE THIS ISSUE

A Pictograph is Worth a Thousand Words: Communicating Health Risks for Medications and Vaccines How Does Telehealth Affect Doctor Demand and Reputation? Are You Too Popular? Unexpected Insights from Online Dating Research Abstracts Awards and Honors RESEARCH IN ACTION

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Research Highlights

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A Pictograph is Worth a Thousand Words: Communicating Health Risks for Medications and Vaccines by Keith Giles

Improving risk communications is a stated priority of the U.S. health care system. Mixed outcomes show that there is plenty of room for improvement in how risk probabilities are presented to consumers. L. Robin Keller, professor of operations and decision technologies at the UCI Paul Merage School of Business and James Leonhardt, PhD ’13, set out to test whether visual aids might improve the understanding of probable side effect risk. The results will be published in an article titled “Communicating Health Risks to the Public,” which is forthcoming from Organization Review. RESEARCH IN ACTION

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“People aren’t good at understanding probabilities,” Keller says. “So, to help people visualize risk information for example, we proposed utilizing a visual display— literally, a pictograph checkerboard with rows of boxes— to hopefully allow people see the likelihood of possible side effects.”

Dispelling Misperceptions of Risk

When medication labeling describes more than one set of potential side effects, the patient’s perception of risk can become cumulative. Patients who read a long list of side effects tend to become fearful that the larger the number of listed side effects, the greater their risk of experiencing one, or more, of those reactions “Communicating the must be. As Keller explains, “When risks in ways people can I give you a list, you tend to focus on the side effects, but if we can understand, and providing communicate clearly how low the probabilities of those reactions really information that is clearly are, then you can focus more on the positive outcomes from taking the understandable, is the medication or vaccine.”

Painting a Clearer Picture

To determine whether or not these pictorial graphs were more effective at communicating information to patients, Keller and her colleagues James Leonhardt and Ronald Lembke, both professors at the University of Nevada, Reno, conducted a study using a hypothetical childhood vaccine with best way to help educate different possible side effects. As Therefore, the more side-effects Keller explains: “Each side effect listed, the greater the perceived risk. patients” had a different probability associated In reality, serious side effects tend with it. In our experiment we listed to be extremely rare. What patients those possible side-effects—vomiting, or high fever, et should be focused on is the likelihood of experiencing cetera—using pictographs to illustrate the likelihood of one or more of those reactions. This is where the experiencing each.” pictographs really help to reduce anxiety and improve perceptions regarding actual risks. By placing the information in a simplified visual graphic, Keller and Leonhardt discovered that participants perceived the vaccine to be less risky. “We found that combining the visual and the written description together decreased people’s perceived risk,” she says, “especially when there were multiple sideeffects.”

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“If it’s just a single side-effect, we found that people could more easily understand the information,” says Keller. “If it’s a mild fever, for example, and its probability is 10%, we found that people did pretty well understanding that. But when there was a larger list with multiple side-effects, the pictographs were more useful in clearing up any confusion.” The real challenge to measuring the importance of trademarks on a company’s valuation is quite often a lack of transparency. “Many companies file trademarks under subsidiaries,” says Teoh. “For example, Toys “R” Us often filed trademarks under the name “Geoffrey LLC” rather than the parent company’s name, which makes it especially difficult for investors to connect the dots between the company and the subsidiary which holds the trademark.”


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Calming the Conversation About Side Effects Improving communications regarding the potential side-effects serves not only to alleviate individual patient fears, it also helps to dispel some of the more alarmist propaganda surrounding vaccines and medications. “Both of us were definitely motivated to counteract some of the anti-vax messages going around. Jim’s wife is a nurse,” says Keller, “and so we wanted people to understand what the real side-effects are and how low the probability factors are.”

information more easily,” says Keller. “Communicating the risks in ways people can understand, and providing information that is clearly understandable, is the best way to help educate patients,” says Keller.

We’ve all watched ads for medications on TV with their interminable lists of possible side effects. The problem, of course, is that those ads never take the time to explain how low the percentage of experiencing those side effects might be. Without that information, people tend to imagine the cure is worse than the disease. “Those types of ads are not very helpful,” says Keller. “To just list out the bad outcomes without indicating how likely—or unlikely—they are to occur tends to have the opposite effect. People are focused on down-sides of taking the medication rather than focusing on the positive results of taking the medication.” Keller’s point is straightforward. If the risk of suffering from a childhood disease, for example, were to be displayed alongside the relatively low probability of potential vaccine side-effects, the public would have a better grasp of the true ratio between risks and rewards. Pictographs can communicate the information visually, much better than verbally, and it can help to overcome language barriers too. “People tend to process visual

Robin Keller is a professor of operations and decision technologies at the UCI Paul Merage School of Business. Her decision analysis research spans the areas of multiple attribute decision making, fairness, perceived risk, probability biases, problem structuring, temporal discounting and planning protection against terrorism, environmental, health and safety risks. In addition to her research, she has held numerous prestigious positions both at UCI and with professional organizations and governmental agencies. Over the course of her career, she has published more than 60 journal articles, technical reports, book chapters and reviews. RESEARCH IN ACTION

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How Does Telehealth Affect Doctor Demand and Reputation? by Keith Giles

There was a time not so long ago when people seeking medical diagnosis and treatment had to make an appointment and travel several miles to see a doctor face-to-face in their office building. Those days are quickly fading, as technological advancements have made online video conferences with doctors a practical reality. Hospitals and private practices are adopting new e-healthcare platforms and tele-medicine apps to facilitate more convenient options to serve their patients. But what impact do these new technologies have on a doctor’s in-person or offline practice?

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These are the questions that doctoral candidate Haonan providers over an eight-month timeframe,” says Yin. Yin PhD ’25 of the UCI Paul Merage School of Business, Specifically, they measured the number of online set out to answer in a recent study conducted with consultations and in-person doctor visits and took note co-authors Ni Huang of the University of Houston C.T. of how participation on this platform impacted the social Bauer College of Business and Zhijun Yan of the School reputations of doctors. of Management and Economics at “These e-healthcare platforms allow Beijing Institute of Technology. Their patients to rate and review their “Providers who article, “Effects of Online-Offline Service physicians, much like Yelp or eBay do, Integration on e-Healthcare Providers: participated in which creates an accountability system A Quasi-Natural Experiment,” was where doctors are given scores these e-healthcare recently published in Production and depending on patient feedback,” Operations Management. says Yin. “They can also give a gift to

platforms saw positive

“We wanted to ask two main questions,” their physician if they choose to. The says Yin. “First, how do these value of the gift represents patient improvement in their e-healthcare platforms affect demand satisfaction.” for doctors in different channels, online professional reputations” After examining the data, Yin and her and offline? And second, how does team concluded that online/offline participation in these platforms impact the doctor’s service integration actually increased the number of social reputation?” consultations overall. However, the number of in-person To answer these questions, Yin and her team leveraged one prominent online healthcare platform in China. “We collected panel data from over 32,000 e-healthcare

visits decreased. “This decrease in offline demand is potentially due to the improved integration of a patient’s medical records,” Yin says. “Those traditional in-person visits seem to have been replaced by online appointments where doctors can more easily provide follow-up with their patients.” Also, the ability for doctors to examine patients and answer their questions remotely may reduce the need for in-person visits, freeing clinic and hospital resources for patients requiring more critical care. Another fascinating aspect of their research showed that healthcare providers who specialize in chronic illnesses experienced a higher increase in online demand and reputation and a lower decrease in in-person visits. Why? “Perhaps this is because the integration of online/ offline services on the platform better serves those chronic disease specialists who need to communicate more often with patients, synchronize medical records, track patient progress, manage treatment and measure outcomes more quickly,” says Yin. Their research has found that integrating online and offline visits is beneficial for patients with chronic illnesses,

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enabling them to build a long relationship with doctor and improving overall healthcare satisfaction. On the surface, these e-healthcare platforms appear to be mostly beneficial. However, there may be some unintended downsides. For example, while an online platform could potentially resolve shortages of medical care in regional areas, it might also hurt doctors who serve those smaller communities. “Doctors in the larger cities are typically seen as being more professional or experienced than doctors in smaller towns,” says Yin. “This might not be an accurate assumption, of course. But if patients are more likely to favor doctors in metropolitan areas it could have a negative impact on the practices and reputations of doctors in smaller communities.” So, the answer to the first question they wanted to

answer—how do these e-healthcare platforms affect a doctor’s online and offline demand?—was that it increased the total number of online consultations and reduced the number of in-person appointments. For the second question—how do these platforms impact doctor’s social reputations?—Yin and her team discovered that the impact was quite positive. “Providers who participated in these e-healthcare platforms saw positive improvement in their professional reputations,” says Yin. Overall, the increased demand for e-healthcare seems to be driven by positive outcomes for both doctors and patients alike. But moving forward there are still a variety of factors to consider as healthcare continues to move out of the doctor’s office and into the cyber-realm.

Haonan Yin PhD ’25 is interested in researching electronic healthcare, especially physician services, patient behavior and the operation of online health communities. She mainly uses natural experiments to explore the causal relationship between the external healthcare policy and user behavior on health websites. Yin received her master’s in management science and engineering from the Beijing Institute of Technology and her bachelor’s in information systems from the Qingdao University.

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Are You Too Popular? Unexpected Insights from Online Dating by Keith Giles

Market psychology can be the key to success when designing an online platform. As Professor Behnaz Bojd of The UCI Paul Merage School of Business puts it, “We need to recognize the differences between one-sided and two-sided matching markets. For example, e-commerce is a one-sided market, whereas labor markets are two-sided. Employers are looking to attract top talent and jobseekers are looking for the best companies. Both sides of the table need to agree to choose one another for the relationship to be successful.”


Together with Professor Hema Yoganarasimhan of the Foster School of Business at the University of Washington, Bojd set out to uncover some of the psychology behind two-sided marketplaces. “We wanted to examine the effect of a user’s popularity rating on their demand in a mobile dating platform,” says Bojd. They have published their results in an article, “StarCursed Lovers: Role of Popularity Information in Online Dating,” which is forthcoming from Marketing Science.

Market Psychology As we’ve established, e-commerce represents a onesided market. Customers need a product, and they shop around until they find what they’re looking for. But the providers of goods and services do not need to evaluate their customers in advance. If a customer has a valid credit card, the transaction is approved.

the opposite gender from oneto-four in only 90 seconds. They see only limited info about each person—their picture, name, age, location and popularity rating—and matches are calculated using the triedand-true stable matching algorithm,” she says. “If I’m matched with Person A, I can decide if I want to send a message to them, and they can reply to my message or not.”

Surprising Results Knowing that a potential partner is popular should increase their appeal. Yet, the more popular someone was in the game, the less likely it was that another person might choose them.

As the game was played, volunteers rank-ordered Two-sided markets—like dating websites, college members of the opposite sex and are then matched admissions departments and job search sites—present based on a Stable Matching Algorithm. After the challenges that are matches were selected, not present in oneusers were allowed to “Knowing that a potential partner is popular sided markets. “There message and chat with are more than 2,000 their match after the should increase their appeal. Yet, the more dating apps out there game. “We quantified now that generate the causal effect of popular someone was in the game, the less likely over $3 billion a year a user’s popularity in revenue,” says Bojd. (or star-rating) on the it was that another person might choose them.” “Designing information rankings received systems that factor in during the game and the unique qualities of two-sided markets isn’t as easy the likelihood of receiving messages after the game,” as cutting and pasting features we find on e-commerce she says. “ Surprisingly, we found that popular users sites. We need to take the time to understand the received worse rankings during the game but received psychology of users in a two-sided market if we hope to more messages after the game.” avoid unintended consequences.” In other words, the results differed depending on the

The Games We Play In their study, Bojd and Yoganarasimhan examined a popular dating app and a game within the app where users could rank a set of four potential candidates based on limited information. As Bojd explains, the game works like this: “There are four women and four men in a virtual room and each person is asked to rank 12

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popularity ratings assigned to each person. “People were avoided more if they had 3 stars versus if they had a 2- or 1-star rating,” says Bojd.

Factoring in the Fear The results appear to go against common sense in some ways, with outcomes that often are the opposite of what one might assume. Why is this? “We link these


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results to the possibility of rejection that users may have feared,” says Bojd. “This fear seems to have led to strategic behaviors to minimize potential rejection.” People are used to referring to star ratings for products online. These ratings help them decide whether to purchase are not. The ratings systems on certain online dating platforms may be having the opposite effect. “Sometimes people like to approach popular people and other times they avoid it,” Bojd explains. “Popular people are physically attractive and have other desirable characteristics, but there are other factors in play. It’s not that some people don’t like attractive partners. Mostly it’s the fear of rejection that causes some to lower or strategically shade their expectations.”

Counting the Cost This fear of rejection in the online setting is a very real factor that designers in a two-sided matching market need to take under consideration. “Being online doesn’t seem to change the dynamic of approaching an attractive person,” she says. “The fear of rejection is still very much connected to the amount of mental and emotional energy that people invest. It’s very costly to approach someone you are likely to fail to attract.”

sided matching market may actually hurt and not help. Especially if there is a potential fear of rejection.” Bottom line: you can’t copy and paste a feature from other platforms. As Bojd warns, “The rating feature is ubiquitous in most one-sided matching platforms. But those ranking features might trigger different mechanisms and create unintended results in a twosided matching market.”

Final Thoughts “A lot of times when we try to estimate actual preferences in markets, we look at the stated preferences,” says Bojd. “But sometimes we need to disentangle strategic behaviors from the stated preferences to estimate the actual preferences. For examples outside the online dating world, let’s look at how schools process admissions. An average school may give admission offers to less-desirable students to play it safe and avoid waiting for the best students in the market to apply.”

Of course, people who are already attractive or have more self-confidence don’t struggle with these fears of rejection as much as others do. But for those who are designing an online dating platform it may be wise to reconsider using a rating system at all. “Amazon, Yelp and other one-sided matching platforms use ratings to drive sales.” says Bojd. “But a rating system in a two-

Behnaz Bojd is an assistant professor of information systems at The UCI Paul Merage School of Business. Bojd received her PhD in business administration (information systems) at the University of Washington, her M.Sc. in industrial engineering (operations research) at the University of Southern California and her bachelor’s degree in industrial engineering (industrial technology) at Iran University of Science and Technology. Her research focuses on measuring the causal effect of information technologies on consumer behavior. She has empirically examined the design of online platforms such as online weight-loss communities and online dating mobile apps.

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Research Abstracts Latest Published Work by Merage School Faculty Members March 2021 - June 2021

Accounting Abstracts Professors Ben Lourie & Terry Shevlin Title: “Employee Turnover and Firm Performance: Large-Sample Archival Evidence” Co-authors: Qin Li (recent PhD graduate) and Alex Nekrasov (former Merage School faculty) Accepted at: : Management Science (Journal on Financial Times Top 50 list)

Professors Ben Lourie & Terry Shevlin Title: “Employee Turnover and Firm Performance: Large-Sample Archival Evidence” Co-authors: Qin Li (recent PhD graduate) and Alex Nekrasov (former Merage faculty) Accepted at: Management Science (Journal on Financial Times Top 50 list)

Professor Radhika Lunawat Title: “Financial Reporting and Moral Sentiments” Co-authors: Timothy Shields and Gregory Waymire Accepted at: Journal of Accounting and Economics (Journal on Financial Times Top 50 list)

Professor Terry Shevlin Title: “How Does the Market for Corporate Control Impact Tax Avoidance? Evidence from International M&A Laws” Co-authors: Jinshuai Hu and Siqi Li Accepted at: Review of Accounting Studies (Journal on Financial Times Top 50 list)

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Professor Terry Shevlin Title: “Measuring Corporate Tax Rate and Tax Base Avoidance of U.S. Domestic and U.S. Multinational Firms” Co-authors: Niklas Lampenius and Arthur Stenzel Accepted at: Journal of Accounting and Economics (Journal on Financial Times Top 50 list)

Professor Chenqi Zhu Title: “The Disciplinary Effect of Social Media: Evidence from Firms’ Responses to Glassdoor Reviews” Co-authors: Svenja Dube Accepted at: : Journal of Accounting Research (Journal on Financial Times Top 50 list)

Finance Abstracts Professor Zheng Sun Title: “Does Mutual Fund Illiquidity Introduce Fragility into Asset Prices? Evidence from the Corporate Bond” Co-authors: Hao Jiang, Yi Li and Ashley Wang Accepted at: Journal of Financial Economics (Journal on Financial Times Top 50 list)

Information Systems Abstracts Professor Behnaz G. Bojd Title: “Star-Cursed Lovers: Role of Popularity Information in Online Dating” Co-author: Hema Yoganarasimhan Accepted at: Marketing Science (Journal on Financial Times Top 50 list)

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Professor Siew Hong Teoh Title: “Non-Audit Services in Audit Committee Interlocked Firms, Financial Reporting Quality and Future Performance” Co-authors: Linna Shi and Jian Zhou Accepted at: Journal of Accounting, Auditing and Finance

Marketing Abstracts Professor Emeritus John Graham Title: “Planting Orange Trees in Twenty Cultures: The Practice of International Negotiation” Co-authors: Mehdi Mahdavi and Navid Fatehi-Rad Accepted at: Negotiation Journal

Professor Emeritus John Graham Title: “Finding Potential Speed Bumps and Pitfalls in Buyer-Seller Negotiations in Twenty Cultures” Co-author: Mehdi Mahdavi and Navid Fatehi-Rad Accepted at: Negotiation Journal

Professor Emeritus John Graham Title: “Planting Orange Trees in Twenty Cultures: The Practice of International Negotiation” Co-author: Mehdi Mahdavi and Navid Fatehi-Rad Accepted at: Negotiation Journal

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Professor Connie Pechmann Title: “Is this Product Easy to Control? Liabilities of Using Difficult-to-pronounce Product Names” Co-authors: James Leonhardt PhD ‘13 Accepted at: Organizational Behavior and Human Decision Processes (Journal on Financial Times Top 50 list)

Strategy Abstracts Doctoral Candidate Mojtaba Hosseini Title: “Robust-stochastic Models for Profit Maximizing Hub Location Problems” Co-authors: Gita Taherkhani and Sibel A. Alumur Accepted at: Transportation Science

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