From social capital to informal power: A qualitative exploration of cancer care inequalities in Morocco

Abstract

BACKGROUND: Cancer patients are not merely passive recipients of care. Some, especially those with extensive experience or strong engagement in their therapeutic journey, develop informal forms of influence that operate outside institutional boundaries. This study explores these dynamics by analyzing how informal power is exercised by cancer patients and how it reshapes care relationships, particularly when there is an over-reliance on personal networks to navigate formal health care systems . MATERIALS AND METHODS: This qualitative study draws on thematic analysis of clinical observations and semi-structured interviews conducted in multiple hospital settings in the Fez-Meknes region. The analysis is grounded in a sociological framework combining concepts of relational legitimacy, social capital, and empowerment to explain how informal power emerges and is recognized in care contexts. RESULTS: Patients with experiential knowledge or broad social networks often support peers, offer therapeutic advice, or mediate interactions with healthcare professionals. Though informal and non-institutionalized, this influence impacts clinical decisions, team dynamics, and patient group organization. However, access to this form of power remains unevenly distributed, reinforcing existing social inequalities. CONCLUSION: Informal patient power is a double-edged resource for health professionals. While it can foster patient autonomy and enhance clinical collaboration, it also raises ethical challenges. Institutional acknowledgment and ethical regulation— such as clear protocols, interdisciplinary mediation mechanisms, and training programs for healthcare workers —are needed to balance personal initiative with equity and organizational fairness.