Reconstructing consumer participation in evidence‐based health care: a polemic

Consumer participation in the evidence‐based health‐care movement is largely seen as important by those who promote evidence‐based health care but is surrounded by a range of competing discourses that variously critique medicine, nursing or health‐care systems; situate consumers as powerless players within systems characterized by controlling health professionals; or politicize the role of the consumer as activist and defender of patient rights. This paper explores these competing discourses and develops an argument that asserts that the social construction of the evidence‐based movement has rendered previously accepted terminology regarding the user or receiver of health services relatively meaningless. The result has been the ‘politicisation’ and ‘professionalisation’ of consumer participation and the time has come to reconstruct consumer participation in evidence‐based health care – from the generation of evidence to guideline development.     

Examining Antecedents of Health Insurance Literacy: The Role of Locus of Control,Cognitive Style,and Financial Knowledge

Today's consumer is expected to make health-care decisions that have serious implications for their welfare. However, a major barrier to these decisions is a basic lack of understanding of health insurance. A critical first step is to examine drivers of health insurance literacy and in turn offer interventions that can have a positive impact on consumer welfare. This article explores the relationship between relevant consumer psychographics, financial knowledge, and demographics with health insurance literacy. Results indicate that while demographics play a role, the degree to which consumers believe a situation or event is under their own control (i.e., locus of control), how they process information (i.e., cognitive style), and consumer's financial confidence (i.e., subjective knowledge) is a critical indicator of their health insurance literacy. Cluster analysis reveals three “faces” of health insurance literacy.     

The effect of activity identity fusion on negative consumer behavior

Negative consumer behavior is an important research topic as it explores consumer behaviors that threaten a brand's image and financial stability. However, prior research offers conflicting findings on whether a strong consumer‐brand relationship hurts or protects a brand after a market disruption or a brand transgression. To provide clarity on this issue, this work argues that disrupting the consumer‐activity relationship motivates consumers to reaffirm and protect their identity, thereby leading to negative consumer behavior. The data reveal that, after a brand‐initiated market disruption, consumers with high activity identity fusion are more likely to spread negative word‐of‐mouth, boycott the brand, and avoid repurchasing the brand in the future. Moreover, the data suggest that high brand identity fusion protects the brand during market disruptions; therefore, prior conflicting results may be due to the fact that the consumer‐activity relationship was not accounted for. Theoretically, this work establishes that consumers' relationship with their consumption activities has significant impacts on consumer behavior. Brand managers and marketers are urged to develop strategies that focus on strengthening the consumer‐brand relationship and not the consumer‐activity relationship.     

Consumers' waiting in queues: The role of first‐order and second‐order justice

Past research on queuing has identified social justice as an important determinant of consumers' waiting experiences. In queuing settings, people's perception of social justice is affected by whether the principle of first in and first out (FIFO) has been violated. However, even when service follows the FIFO principle, waiting time may still differ from one consumer to another for various reasons. For instance, a consumer who happens to arrive in the queue after a large group of people may have to wait longer than average. In this research, it is argued that, aside from and independent of the FIFO principle, consumers also care about whether everyone spends an approximately equal amount of time waiting before availing of the product or service. When consumers perceive that they have spent more time waiting than others and when they can attribute this injustice to the service provider, they will be less satisfied with the waiting experience. It is also proposed that adherence to the FIFO principle is a more salient concern to consumers (thus termed “first‐order” justice), and equal waiting time (”second‐order” justice) matters only when first‐order justice is not an issue. Three studies support the predictions. © 2008 Wiley Periodicals, Inc.     

‘I send the wife to the doctor’– Men's behaviour as health consumers

This paper explores men's behaviour and attitudes in relation to health matters. While there has been some practical and research progress in engaging with users of health services, there is less development in the area of engaging non‐users. In effect, all members of the society can be the consumers/users of health promotion, though not all are. This paper reports on the first stage of a wider project aimed at increasing the effectiveness of skin cancer awareness messages aimed at men. The project focuses on men over 50 from an area of socio‐economic disadvantage, since these men tend to have the lowest life expectancies in general, and the highest incidences of mortality for skin cancer both at a national and international level. The research was conducted through community‐based focus groups and while the sample was relatively, small it produced some interesting outcomes in terms of how this cohort audited and responded to public health promotion campaigns; how they perceive cancer and health issues in general; how they respond to health issues; and how they view both the public health service in Ireland and the ways health professionals relate to them. It confirms many theories about how men view their health and how they respond to health promotion campaigns. Among other points, it raises questions about the possible mixed benefits of testimonial‐based advertising. It also indicates that there may be further layers of complexity connected to identity, fatalism, problem solving and respectful treatment that have not been sufficiently articulated in the literature. It points to the need for greater engagement by service planners and providers with the needs of their target audience, which may require a more encompassing definition of service user.     

Struggles in optimal labelling: how different consumers react to various labels for genetically modified foods

The labelling of genetically modified (GM) foods is an important policy issue, as consumers' attitudes towards these foods appear to be quite sensitive to information about their potential benefits and risks. Because it is difficult for labels to differ across consumers, differences in reactions to label information could lead to conflicts across consumer groups or to different market outcomes. Using factor and cluster analysis, we uncover three consumer segments with different attitudes to the risks and benefits of GM foods. Our segmentation‐based analysis on consumer reactions to information points out important differences across consumers. Not only did we find differences across segments in how they view the credibility of GM‐related information, we also find differences in how information influences segments' perceptions of the product, and in their likelihood to buy.     

Action control,proxy control,and consumers' evaluations of the service exchange

This article adopts a consumer's point of view, and extends current literature that models the relationships between consumers' control perceptions, service providers' fair behaviors, and consumers' satisfaction with the exchange. Perceived control is disassembled into action and proxy control and their differential actions in the service exchange discussed. This article models, for the first time, the joint effects of perceived control and service provider behaviors on consumer satisfaction by explicitly connecting service‐provider fair behaviors to consumers' perceptions of control. The results from two repeated‐measures experiments provide support for the hypotheses. Specifically, a multivariate analysis of the data demonstrated main effects for the experimental manipulations on perceived control, perceived fairness, satisfaction, and behavioral intentions. An interaction effect between perceived control and perceived fairness was also evident in one experiment. Future research and managerial implications are discussed. © 2004 Wiley Periodicals, Inc.     

The effect of customer empowerment on adherence to expert advice

Customers often receive expert advice related to their health, finances, taxes or legal procedures, to name just a few. A noble stance taken by some is that experts should empower customers to make their own decisions. In this article, we distinguish informational from decisional empowerment and study whether empowerment leads customers to adhere more or less to expert advice. We empirically test our model by using a unique dataset involving 11,735 respondents in 17 countries on four continents. In the context of consumer adherence to doctors' therapy advice (patient non-adherence to doctor advice may cost about $564 billion globally to the pharmaceutical industry every year), we find that decisional empowerment lowers adherence to expert advice. The effect of informational empowerment varies predictably across cultures and is only universally beneficial when initiated by the customer. These findings have important implications for professional service providers.     

Attribution Effects of Time Pressure in Retail Supply Chain Relationships: Moving From “What” to “Why”

Retail supply chains must be responsive to consumer demand and flexible in adapting to changing consumer preferences. As a result, suppliers are often expected to deal with time pressure demands from retailers. While previous research demonstrates that time pressure can have longer term relational costs that reduce collaborative behaviors and overall relationship quality, this mixed‐methods study goes further by accounting for attribution effects to explain why the time pressure occurs. Specifically, supplier perceptions for the reason of time pressure being within or beyond a retailer's control, rather than time pressure itself, appear to have a stronger effect on relational outcomes. By investigating time pressure through the lens of attribution theory, this research opens a new inquiry of research that moves away from examination of outcomes themselves (the “what”), to examining “why” the outcome occurred.     

International transfer pricing and subsidiary performance: The role of organizational justice

International intrafirm trade is increasingly important in the global economy. Intrafirm transactions are governed by transfer‐pricing policies mandated by parent companies. Economic and accounting theories have long prescribed policies that maximize the parent company's short‐term profits but may have other, unintended outcomes. These outcomes are explored in a single‐case study. Based on this case study and organizational justice theory, a theoretical framework is developed to show how frequently used transfer‐pricing policies, through their impact on subsidiary managers' perceptions of justice, can significantly affect the subsidiary's strategic performance. First, the conditions under which transfer‐pricing policies can be perceived as procedurally, interactionally, or distributively unfair are presented. Second, it is proposed that those justice perceptions have an impact on subsidiary managers' commitment, trust in the parent company, neglect, ethical behavior, productivity, work quality, and compliance, and that the magnitude of this impact is moderated by the quality of relations between the parent company and subsidiary managers. Finally, it is predicted that such attitudes and behaviors may generate important agency and transaction costs that jeopardize the expected outcomes of international strategies of vertical integration. © 2009 Wiley Periodicals, Inc.     

How do you feel today? Managing patient emotions during health care experiences to enhance well-being

Health care customers (patients) experience heightened emotions due to high stakes from risks to life, health, and well-being. Understanding and managing emotions during service experiences is an important area of inquiry because emotions influence customer perceptions, future intentions and behaviors. Yet despite its significance, research focusing on the impact of emotions on customer experiences remains fragmented, lacking a theoretically based conceptual framework. The authors attempt to fill this gap by addressing two important research questions contextualized in health care: (1) How can health care organizations better understand patient and family emotions during health care experiences? and (2) How should health care organizations use this understanding to design and better manage patient experiences to enhance patient well-being? The authors propose a new theoretically based framework on emotional responses following triggering events to enhance outcomes. Recommendations designed to enhance health care customer well-being are provided, as are directions to guide future work.     

The right to be heard and to be understood: a conceptual framework for consumer protection in emerging economies

In many emerging economies and developing countries, comprising consumers from different cultures and with varying degrees of sophistication (knowledge and skill) concerning consumer protection, the promotion of consumers' rights to develop a consumer‐oriented culture remains a very big challenge. One way of protecting the consumer, especially the consumer that has not been fully socialized to execute informed decisions when purchasing expensive durables, is by establishing a redress environment that would ensure fair redress as well as an understanding and appreciation of the consumer. Manufacturers and retailers are often not aware of the performance failures that consumers experience concerning their products because many people do not communicate their dissatisfactions to them. However, unless and until manufacturers and retailers fully comprehend their customers' complaint behaviour, their reasons for engaging in specific complaint behaviour and the reasoning (cognitive processes) and emotional processes behind their behaviour, they will not recognize the link between complaint handling and customer loyalty and profits. The purpose of this paper was to develop a theoretical conceptual framework that would enable consumer scientists, consumer consultants, consumer behaviour researchers and those with the responsibility of handling consumer complaints to explore and understand consumer complaint behaviour in its entirety. We argue that, to be able to establish and manage a redress environment that is characterized by an understanding of the specific consumer as well as by effective complaint behaviour handling, it is of the utmost importance that the manufacturer, retailer, consumer consultant and all those that work with consumers' complaints understand the entire complaint process, including the underlying cognitive and emotional processes as well as the consumer's post‐complaint perception of justice and his/her satisfaction with the complaint handling. It is also important to understand the role that consumer‐, product‐ and redress environment‐related variables play in consumer complaint behaviour. The consumer who blames the retailer for the problem and who probably feels angry about the situation and decides to complain will expect redress. From a consumer's viewpoint, complaint‐related justice is, however, not only a matter of economic calculus but also a matter of procedure and interaction. We therefore argue for a holistic approach where consumer complaint behaviour is addressed in its entirety. Practical suggestions that could enhance customer satisfaction are given for manufacturers, retailers and those who deal with consumers' complaints.     

An evaluation of consumer participation in hospital breast services

Community expectations and research demonstrate that consumers play an important role in shaping services for women with breast cancer. Consumer contribution has been mandated recently in Victoria, Australia, to ensure the inclusion of consumer involvement in the planning and decision‐making processes within health organizations. As part of the redevelopment of breast services in Victoria, Southern Health has been funded to plan local improvements to care co‐ordination for women diagnosed with breast cancer in the southern metropolitan area of Melbourne. The establishment of effective consumer participation in breast services is an integral aspect of this project and a range of initiatives has been undertaken to achieve meaningful consumer involvement including the appointment of a consumer advisor; appointment of staff with extensive knowledge in women's health and community development to the project; establishment of a consumer reference group; and plans made to improve the receptivity of health service systems to consumer input. A preliminary evaluation of this ongoing project has indicated that a productive role for consumers in service practice review and policy and planning activities has been established and some change and engagement of staff has occurred. There is still work to be done to promote the involvement of a wider range of health professionals and to increase the level of trust between consumers and staff.     

Effects of voice assistant recommendations on consumer behavior

The present study compares the influence of text-based recommendations; traditionally known as online consumer reviews, and the influence of voice-based recommendations provided by voice-driven virtual assistants on consumer behaviors. Based on media richness theory, the research model investigates how voice versus text modality influences consumers' perceptions of credibility and usefulness, as well as their behavioral intentions and actual behaviors. In addition, the study analyses if these relationships vary based on the type of product and compares the influence of masculine and feminine voices. Two studies were conducted using between-subjects experimental designs, partial least squares-structural equation modeling, and logistic regression. The core finding is that voice-based recommendations are more effective than online consumer reviews in altering consumer behaviors. In addition, the first study showed that the influence of recommendations on behavioral intentions is mediated by consumers' perceptions of their credibility and usefulness. The second study confirmed, in a realistic setting, that voice-based recommendations affect consumer choices to a greater extent. Recommendations for search products and provided by males are also found to be more effective. These results contribute to the voice assistant and e-WOM literature by highlighting the effectiveness of voice-based recommendations in predicting consumer behaviors, confirming that credibility and usefulness are key factors that determine the influence of recommendations, and showing that recommendations are more effective when they focus on search products.     

Trait superstition and consumer behavior: Re‐conceptualization,measurement, and initial investigations

The authors propose that superstitions are employed as a heuristic device and that they influence a variety of consumer behaviors. Previous research has assessed superstition by investigating specific superstitious beliefs. The present research advances the literature by developing a general measure of a propensity to be superstitious. In a two‐study sequence, a new measure of trait superstition is developed and a nomological net of its consequences and antecedents identified. Study 1 employed a sample of 322 student responses to investigate the influence of trait superstition on traditional superstitious behaviors, such as keeping good‐luck charms. Study 2 employed a sample of 1158 consumer panel respondents to investigate the influence of trait superstition on consumer activities in which outcomes are uncertain and are likely to be influenced by chance. The studies reveal that after accounting for a set of antecedents, trait superstition is predictive of a wide variety of consumer beliefs, such as beliefs in astrology and in common negative superstitions (e.g., fear of black cats). In addition, a general predisposition to be superstitious leads to enduring dispositions to gamble, participate in promotional games, invest in stocks, forward superstitious e‐mails, keep good‐luck charms, and exhibit sport fanship. Theoretical contributions and managerial implications are also discussed. © 2009 Wiley Periodicals, Inc.     

Embedding consumer culture in health and social care education – a university office's perspective

Health and social care services are changing – and this change is radical. Service user and carer involvement has been a key aspect of health and social care policy for a number of years. In terms of the National Health Service (NHS), this has been significantly strengthened by the report ‘High Quality Care for All’. The NHS will no longer be a monolith dictating what services it offers. It is beginning to take seriously the views of its consumers: the patients, service users and carers. The NHS is starting to put the patient experience at the centre of everything it does, and its regulators are asking for evidence of public and patient involvement. This process may yet prove to be one of the NHS' greatest challenges as it transforms to prioritize the consumer viewpoint. Social care, though further down the line in relation to involvement, is now responding to the relatively new personalization agenda. This paper will consider what the university sector can do to embed the consumer and service culture within the education of health and social care professionals. It looks at the challenges of involvement and required culture change, highlighting the key points to address in the early and middle stages of involvement from a university office's perspective. It includes examples of consumer involvement in teaching, assessment and the selection of students and how their input is starting to make a difference. Finally, the paper outlines what is needed in a development office to establish and support effective service user and carer involvement on health and social care courses in higher education. The article concludes by acknowledging that there is much more work that needs to be done in this field to embed the work of a development office, but that early steps have been promising.     

Making compassion count: equal recognition and authentic involvement in mental health care

Compassionate care within mental health services is often taken for granted as something that can be made visible and authentic. However, recent government reports and policy suggest that we are far from providing compassionate care and may be more focused upon risk and surveillance. This paper will discuss the visibility of compassionate care and explore outcomes that consumers and practitioners could measure in practice. Separating the fact from fiction within compassionate care will make authentic involvement practices more visible and open to discussion around consumer collaboration. In a qualitative analysis of a small study with mental health consumers, compassion was found to be a major factor in whether consumers became more involved in their own health care. Demonstrating compassionate care may therefore also demonstrate consumer participation and engagement. This paper will argue that compassionate care can be observed in the relationships between practitioners and consumers that are collaborative and use presence and persistence as methods of practice. Emancipatory practices can be made more visible in mental health care in order to make compassion measurable and to encourage consumer participation and engagement.     

Affective and Cognitive Components of Attitudes in High‐Stakes Decisions: An Application of the Theory of Planned Behavior to Hormone Replacement Therapy Use

Consumers are increasingly encouraged to take charge of high‐stakes decisions such as those regarding medical treatments. However, the important inputs into overall evaluations of risky and important behaviors, such as undergoing medical therapy, are not well understood. The purpose of this research is to study the interplay of cognitive and affective factors in determining consumer attitudes and intentions toward high‐stakes decision behaviors. This is done in the context of consumer choices regarding medical treatments, and specifically, the decision to use (or not to use) hormone replacement therapy (HRT). Overall, both affective and cognitive responses are found to be independent significant predictors of attitude toward HRT use. Moreover, the results support an extended version of the theory of planned behavior model that is useful in predicting consumer's intentions to engage in high‐stakes decision behaviors, such as using HRT. These findings have implications for the design of decision support systems and behavioral change interventions.