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HEALTHCARE SERVICES CONSUMER BEHAVIOR IN THE LIGHT

OF SOCIAL NORMS INFLUENCE

Daniel Adrian GÂRDAN,
Spiru Haret University

postdoctoral student, Institute of World Economy-Romanian Academy
E-mail: danielgardan@yahoo.com

Iuliana Petronela GÂRDAN (GEANGU)
Spiru Haret University

postdoctoral student, Institute of National Economy-Romanian Academy
E-mail: geangupetronela@yahoo.com

Abstract

Healthcare services consumers’ behavior represents an multidimensional
concept, that implies the cumulative effects of different factors. The process of
consumption is very different and complex in the case of healthcare services
due to the nature of the needs and consumption motivations on one hand and
because of the complexity of the services itself on the other hand. Amongst the
factors that are influencing the consumer’s behaviour, the social ones
represent a particular type. In the case of healthcare services this is because
the social interactions of the patients can contribute to their own perception
regarding the post consumption satisfaction, or can influence the buying
decision in the first place. The influence of social factors can be analysed on
multiple layers – from the effect of the affiliation and adhesion groups to the
effect of social norms and regulations.

Keywords: social norms, affiliation groups, healthcare services,
consumer behavior

JEL Classification: I12, M31

Introduction

Social interactions are referring to generative relations that are capable to
induce changes at the level of perceptions and through these changes at the level of
consumer’s actions.

The analysis of consumption behavior or buying behavior can’t be done
without taking account of the fact that peoples find themselves all the time in a
evolutionary, historical and institutional context. From this point of view
interactions between individuals become very important.

The consumer behavior is influenced by a variety of factors both endogenous
and exogenous. This duality of the endogenous and exogenous influences upon the
consumer’s behavior create the picture that bring into evidence the evolution of the
social structures itself from the dawn of the civilization until present time. The

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human being cannot escape from the social framework present into his life from
childhood. At his turn, this social framework with all its institutions, social groups
etc, represents the effect of human activities, of choices and consumption acts
which individuals have usually.

From the healthcare services consumption perspective, these social
interactions attain new valences given by the specific of the healthcare services and
the needs which are behind consumption motivations.

The choices made by the healthcare services consumers, the behavior that is
related with influence groups are changing and contribute in the same time to the
evolution of medical system, of institutions that are regulating the provision of
these services. Thus, on a long run, the consumption processes will self-regulate
and the efficiency of provisions will rise towards a better serving of the social
interest. All the spectacular transformations at the level of nowadays medical
technology, last minute methods and treatments, are proving that the social needs
conjugated with healthcare individual needs have been shaped this field and are
continuing to shape it.

Social norms and their importance in the context of social factors

influence

Norms, in the most general sense are presenting as rules, pre-established sets
of decisions seeing as responses to the manifestation of social mechanisms. Thus a
fist definition of social norms points out that these are representing rules which
prescribe behaviors expected by a community or an institution. (Popescu-Neveanu,
P., 1978, p. 481)

The normative level presuppose the existence and manifestation of some
rules or formal norms, being as juridical nature or having a moral substrate and
also a series of informal constrains, developed along the society evolution and of
social inter-relations. The norms may have a mandatory character as it is the case
for juridical norms, or of social constraint as in the case of moral norms.

The social norms that are general appealing – the social norms that exists in a
field or another are credited with a high level of influence over the individuals’
behavior. The problem is, in what extent the social norms that are characteristic for
a minority of consumers, eventually for a social group are as much as striking
referring to the effect that they can determine upon the consumers behavior.

Thus in the social plan, each individual will assume a certain role, that is
suited to the status that he has. Thus during its development and maturation, the
individual will form a certain attitude regarding the roles and statues that he can
have at a social level.

His behavior, his personality will be reported to the social system of norms
and values. This system represents a mixture of cultural elements, anthropologic
ones, representative for the human civilization. The norms although they have a
constraint character, are still permissive in the same time, trying to develop a
equilibrium between the needs expressed by the individuals and the social

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requirements that are characteristics for a certain level of development of the
society in a particular moment in time.

The relations that are establishing between the juridical norms and the social
ones are presenting equivalence reports, without any kind of a “subordination”.
They are representing different aspects from the formal point of view regarding the
same reality – rules that are important for the proper functioning of the society.

The consumer behavior and the pressure of social groups

Individuals may define themselves as being members of a social predestined
category. They can learn or elaborate stereotypical norms for this category. Also
they receive a confirmation that certain behavior modalities based on these norms
are attributes specific to the defined social category (group), such as some learned
behaviors are expected or wanted and utilized as such in order to make the
differentiation between different social categories or belonging groups
(Neculau, A. (coord.), 1996, p. 370)

The individuals will become more and more integrated into the group, and
their behavior is becoming more and more similar with the other members.

The group can be defined as being a human ensemble that has members that
are having interactions ruled by some pre-established norms.

We can find, in the relevant literature different types of social groups taking
into account the type of interactions between the individual member and the whole
group.

From a marketing perspective, within social groups it can be outlined the
adhesion groups and reference groups (Armstrong, G., & Kotler, P., 2012). The
adhesion group is represented by the group that has a direct influence and an
individual that can be a part of it, will transform himself from the point of view of
all aspects regarding his social development at a particular moment in time –
family, the professional team, political unit, local community etc.

The reference group, according to Hyman can be defined as a group of
which an individual will report himself as an actual active member or a future one.
(Hyman, H.H., 1960, p. 383-396). The reference group will influence or will
determine the behaviors and attitudes of those that are identifying with it, in a
differentiated way, certain persons can be a reference group in a particular field and
other persons in another field.

Thereby, an individual can be part simultaneously from more different
reference groups, taking account his interests and the complexity of social life
involvement.

Each reference group will be determinative for certain values, attitudes etc,
specific elements that will leave their mark upon the behavior of its members.

Taking account of the typology of individuals, the period of time that has
passed from the first identification with the group and the relations within the
group, we can see a greater or lesser influence of the social norms associated with
the group upon the actual buying or consumption behavior.

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Thus, scholars have determined that we can have “social” type buyers or
“solitary” type buyer.

The social type buyer will have as a tendency a behavior centered on
relationship with the other members and as a result they may be able to buy more
products. (Anić, I.D., & Radas, S., 2006, p. 733). Starting from the same type of
mechanism it can be observed a different type of behavior in case of couples that
have babies compared with the ones that doesn’t have.

One of the most well-known types of membership group is represented by
the family. The family will have a very complex influence upon the consumer’s
behavior from the point of view of different aspects: the life stage of the family, its
cultural type, etc. From the point of view of the life cycle stage, the quality and the
dynamic of the interactions between individual and the family it can be very
different from stage to stage (Wells, W.D., & Gubar, G., 1966, p. 355-363). The
cultural type of the family is a factor that also contributes to the behavior of its
members and the relationship between them. The analysis reveals a patriarchal type
family on one hand and an egalitarian type family on the other. Each cultural type
is developing its own kind of relationship between members, with social roles that
have different characteristics and positions. We can enumerate: initiator,
influencer, decider, buyer or user (Cant, M.C., Strydom, J.W., Jooste, C.J., &
Du Plessis, P.J., 2009, p. 87).

As a conclusion we may state that individuals tend to adopt life styles that
are common with their social group and modify them according to some standards,
as much as they grew older. Also they will develop a kind of pattern starting from
the norms incorporated within their behavior and this will lead to the possibility of
consumption optimization (Starr, M.A., 2009, p. 25-49).

Practical implications for dental healthcare services consumer behavior

The influence of social factors upon the dental healthcare services consumer
behavior is undoubtedly obvious, because a healthcare type service has a complex
consumption motivation behind and deep emotional involvement of the consumers.

Different research has revealed that there are notable differences between
consumption habits of women to men or married people to unmarried or separated
people. Thus the people that are engaged in a more fruitful social life (women or
married people) have a greater consumption volume than the persons that are single
or do not imply themselves in multiple social relationships (Tchicaya, A., &
Lorentz, N., 2014, p 1-14).

One of the author’s previous qualitative research made on dental medics at
the level of Bucharest town has pointed out also information’s regarding the
perception of doctors upon the influence of social factors.

Thus the doctors have appreciated that the influence of the family as a social
group is prevalent, many of the respondents considered that more female patients
have a greater impact upon their husbands regarding the dental healthcare services
consumption than the opposite. Also doctors believe that apart from the influence
of husbands or spouses, there is an influence from an opinion leader from a

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particular group or from a person emotionally closer to the patients. Another
interesting topic was related to the fact that persons who have had very bad dental
diseases or even surgical interventions are exposed to the negative image from the
others and have problems with the social integration at the workplace. This shows
that the construction of the self-image of individuals is based on a great extent on
the perception and image of the others about them, and the social capability of a
person to integrate within different groups is depending on the way in which that
person is capable to find equilibrium between the two – internal and external
perceptions.

Another authors” quantitative web based research suggested that the pressure
of social groups upon the consumers behavior is nuanced because respondents have
declared in a lesser extent to renounce to a medical dental treatment just in order to
be in line with the friends or family members opinions. This shows that, even if the
influence from social groups exists, a special situation can be met when the power
of self-motivations is very high, and these motivations are related to the health
status of the individuals.

It can be pointed out, that also at the level of this quantitative research, even
if there was a measurement of the patient’s opinions, these are similar with the
ones of the doctors related with importance of self-image and the others persons
perceptions.

Consumption motivations related to dental healthcare services may have as a
basis a complex body of thought related to the self-image perceptions and the
social status importance. There are different types of dental provisions that are
complementary to the basic interventions that have merely a medical – clinical
purpose. We can refer to the dental aesthetic procedures, rhinestones fitting etc.,
procedures that are intended to fulfill other type of needs than the normal ones. We
talk about the self –image construction or reconstruction, and the display of a
certain status.

This type of consumption is a Veblevian type, directed to the social status
enforcement through a conspicuous consumption.

ACKNOWLEDGMENT
This paper has been financially supported within the project entitled

“Horizon 2020 – Doctoral and Postdoctoral Studies: Promoting the National
Interest through Excellence, Competitiveness and Responsibility in the Field of
Romanian Fundamental and Applied Scientific Research”, contract number
POSDRU/159/1.5/S/140106. This project is co-financed by European Social Fund
through Sectorial Operational Programme for Human Resources Development
2007-2013. Investing in people!

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References

• Anić, I.D., & Radas, S. (2006). “The impact of situational factors on purchasing
outcomes in the Croatian hypermarket retailer”, Ekonomski pregled, 57(11), p. 730-752.

• Armstrong, G., & Kotler, P. (2012), Marketing: An Introduction (11th Edition),
New Jersey: Prentice Hall.

• Cant, M.C., Strydom, J.W., Jooste, C.J., & Du Plessis, P.J. (2009). Marketing
management, Fifth edition, Cape Town: Juta Academic.

• Hyman, H.H. (1960). “Reflections on reference groups”, Public Opinion
Quarterly, 24(3), p. 383-396.

• Neculau, A. (coord.) (1996). Psihologie socială. Aspecte contemporane, Iaşi:
Polirom.

• Popescu-Neveanu, P. (1978). Dicţionar de psihologie, Bucureşti: Editura Albatros.
• Starr M.A. (2009). “Lifestyle conformity and lifecycle saving: a Veblenian

perspective”, Cambridge Journal of Economics, 33(1), p. 25-49.
• Tchicaya, A., & Lorentz, N. (2014). “Socioeconomic inequalities in the non-use of

dental care in Europe”, International Journal for Equity in Health, 13(7), p. 1-14,
http://www.biomedcentral.com/content/pdf/1475-9276-13-7

• Wells, W.D., & Gubar, G. (1966). “Life cycle concept in marketing research”,
Journal of Marketing Research, 3(4), p. 355-363.

The purpose of this assignment is to critique a peer-reviewed article regarding consumer behavior.

http://anale.spiruharet.ro/index.php/economics/article/view/1512/pdf

(The article is also attached)

During this assignment, assume the role of a peer reviewer who is reviewing the article for a journal. Select an article from a peer-reviewed journal within the scope of consumer behavior (e.g., global marketing, services, pricing). Begin your research by using the GCU Library or an electronic database search. The article must be published within the last 5 years. Write an article review of 750-1,000 words that addresses the following:

1. A general overview of the article. Include an opening paragraph stating the full APA formatted reference for the article you chose. Give a brief overview of the following: thesis of the article, hypothesis, research design methods, conclusions, and recommendations.

2. Relationship to course. How does this article relate to the knowledge within this course? How does it relate to the textbook? (This course is Marketing Management) the book is: A Framework for Marketing Management.

3. A critical analysis. Did the process make sense? Was enough information given to determine if results were valid? Were the statistics clear and did they support the results? Were the results generalizable to a wider population than the sample subjects?

4. A value assessment. Based on the conclusions, what value exists in the article for a future manager in the real world?

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

RUBRIC IS AS FOLLOWS:

20.0%

20.0%

5.0%

5.0%

Article Overview			20.0%	Overview includes an opening paragraph, and a clear overview of the thesis of the article, including pieces such as hypothesis, research design methods, conclusions, and recommendations from author.
Relationship to Course	10.0%	Includes a clear and thorough connection between article and course materials.
Critical Analysis	Critical analysis includes a compelling and thorough report of the process used, validity of results, use of statistics, and the ability to generalize to a larger population.
Value Assessment	Value assessment includes a clear and thorough take on the value presented from the article on the real world.
Argument Logic and Construction	1 5.0%	Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
Mechanics of Writing (includes spelling, punctuation, grammar, language use)			5.0%	Writer is clearly in command of standard, written, academic English.
Paper Format (use of appropriate style for the major and assignment)	All format elements are correct.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)	Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
Total Weightage	100%