Abstract

Self-care has enormous benefits to individuals and to the formal healthcare system, both by responding to consumer desire to take a stronger role in their own health, and by reducing unnecessary utilization of scarce professional healthcare resources. Understanding how consumers make decisions and what factors influence those decisions is critical to ensuring a holistic approach to maintaining a strong self-care environment.

Research reveals that there is a well-defined path that people follow in their quest for satisfactory health-related outcomes. Studies point to a process of exploration of health options once an individual recognizes a need to address a specific health concern. When a person decides to act, there are numerous inputs that guide their final decisions. The strongest influences on self-care decision-making come from the advice of physicians, friends, family and other health care professionals. Passive information sources such as advertising of products plays a role in creating awareness that a product exists with specific benefits, but it has low impact since it is not self-driven. The real search for a solution to a health concern begins when a person starts a self-driven search for information.

When a solution to a health need results in the acquisition and use of a health product for self-care, the success of that course of action becomes a highly influential element that can help people make choices in the future. When a product delivers the desired outcome, this successful experience becomes the baseline and there is a higher likelihood that the individual will recall that experience the next time the same need arises and will make the same decision.

The decision-making process that people employ to address a health need is considerably more deliberate than one might imagine. There are many influences on the final actions taken and they all are important to understanding how people behave in response to an identified health need.

Full paper

Key Influences on Self-Care Behavior

Self-care is the primary modality of health care throughout the world. In fact, studies report that 80 to 95 percent of all health problems are managed through self-care¹.

To paint a complete picture of how self-care is managed by individuals, it is important to understand the value that self-care provides to the health care system and to the people who choose to take a stronger role in managing their own health.

Broadly defined, self-care can mean many things, but within that larger domain, consumers can avail themselves of a wide variety of health products to assist in the prevention or management of self-treatable conditions. For example, smoking cessation is a behavior that can contribute immensely to the health of an individual as well as providing a benefit to the formal health care system and society more broadly. For those wishing to quit, they may choose a smoking cessation product. Health products intended for self-care play a valuable role in supporting consumer’s ability to manage their own health and thereby contribute substantially to the sustainability of health care.

A 2011 survey of United States primary care physicians, including internists and pediatricians² found that on average physicians believe that at least 10 percent of visits to their own offices ‘result from minor ailments which could be managed by the patient, including the use of over-the-counter medicines’. Health economists Paul A. London, Ph.D. and Daniel Shostak, M.P.H., M.P.P., concluded from this study that avoiding just half of the potentially unnecessary office visits to primary care physicians would save approximately 26.3 million appointments or $5.26 billion annually for the U.S. health care system.

The Consumer Decision-Making Process

The way that people search for, purchase and use products for self-care is highly influenced by the amount and type of information available about the choices to be made for either the management of self-treatable conditions or the maintenance of good health. In a traditional consumer decision-making process, people start from a position of either familiarity with a product and its attributes or they are faced with a new health consideration where they have no previous experience. In the case where someone is faced with a recurrent health need, the decision process is aided by past experience but the same considerations into the process are still present regardless of whether the person wants to find a solution to a novel health concern or one that they are familiar with. Graphically, the consumer-decision-making process is represented in Figure 1.

Figure 1. Influence on Behavior cycle

Awareness Phase

Every day, consumers are exposed to numerous information sources and advertising vehicles (broadcast, print, web sites, and social media) that convey basic product messages. This exposure does not mean that every viewer of an advertisement is interested in the products or that every exposure leads to a purchase.

A model for the utility of advertising as an awareness tool has been developed and tested to determine the factors that influence whether an ad message can effectively raise awareness to stimulate a further search process³. In this model, there are several complex conditions that must be satisfied before an advertisement can successfully inform the search process. The key findings of this research support the common-sense notion that attentiveness to advertising is fundamental to its utility. Attentiveness is driven by a person’s needs at the time they are exposed to an advertising message. The greater the need for a solution to a health issue, the greater the attentiveness will be to the message.

The same research by Huh et al. demonstrated that the utility of ads for consumer health products is highly related to cognitive (critical thinking) rather than affective (attitude) responses. This means that nonprescription medicine advertising prompts an evaluation of the product by consumers instead of spurring immediate purchase decisions. The authors conclude that OTC ads provide their value ‘by influencing consumers to first think about ad-delivered drug information and then evaluate those judgments’. The most common behaviors that are derived from seeing ads relate to further information seeking. The greatest frequency of reported actions prompted by a media message include communications with a health care professional or friends and relatives⁴.

In general, the real driver of the search process for self-care health solutions starts with the recognition of a health need and a desire to act on finding a solution to address that need. The self-care need may be satisfied in the form of a therapeutic option for an illness that can be self-treatable or it may be a desire to take some action to prevent or reduce the risk of illness. Regardless, the next stage of the search process is where desire to act starts to be converted to taking action to resolve the identified health need.

Need Recognition and Information Search

Once a person’s desire to act is stimulated, they more actively seek guidance in their evaluation of options. According to research by Court et al., two-thirds of the touch points during the information search phase involve consumer-driven information seeking⁵. These touch points involve resources such as advice from friends and family, doctors, pharmacists, web-based reviews, and past experiences.

Where a person has had a previous experience with the health concern, their past product choice has a significant impact on their decision for the current condition. Influences such as successful outcomes from the previous experience are powerful determinants of actions to be taken. However, several studies reveal that that experience can be further influenced by additional factors from numerous sources. Hill and Johnston⁶ found that people turn to many sources in their search process. The top three resources are the physician, family and friends, and the pharmacist. More importantly, these are also the top three most trusted information resources. It is at this point that advertising and other passive information tools are given much less weight in the evaluation process. In this study, product advertising is only trusted as a tool to assist in decision-making by 6% of the population. In a review of the effects of advertising on health behaviors, Koinig also found that advertising played a small part (also 6%) in the decision-making process for the selection of products intended for self-care⁷.

Another study from the United States8 also found that the doctor was the major influence on OTC and dietary supplement purchase and use (almost 4 out of 5 claim they are influenced by a physician). When asked, consumers indicated that they are primarily concerned about the safety of products and which ones are preferred. Seventy-two percent of respondents indicated that they check to determine if there are interactions to be concerned about and 52% want to know about side effects. Nearly half (46%) wish to determine if an OTC treatment is preferred to a prescription drug.

Consumers find that OTC advertising is focused more on information than ads for other categories of goods⁹. This multi-country analysis of consumer perceptions of advertising also noted that the messages are primarily focused upon the product attributes and relevance to health needs so that specific product recall is somewhat lower than other categories of advertised products. The authors state that ‘OTC ads communicate much more on a posture of service-provider than on a posture of product-seller. Consumers remember pieces of advice and solutions for small illnesses they heard in the ad, but they notice less the product name (or the brand itself) than in other sectors. To sum up, they see OTC ads as being helpful in their search process, at the opposite of ads that are seen to promote impulse purchase’.

A similar study in Japan¹⁰ showed that ‘product merit’ advertising is the most common focus for OTC advertisements. The authors note that ‘this is not too surprising as people purchase OTC drugs to solve a particular problem (i.e. ease symptoms)’. Since consumer health products are not considered to be impulse items, this focus on informational aspects of product attributes serves to inform those who may have an existing or future health need and serves as a useful awareness tool in the search process.

Evaluation of Alternatives

Once the individual decides that there is a need to act to address either a current condition or to act in a manner that can reduce the risk of illness, they gather information on the available options to deal with their health need. It is at this time that product alternatives arise from which they can choose. How they assess these alternatives depends upon the number of choices they have and their own selection criteria.

It is at this stage that people compare the various products that they have determined to be capable of solving the health needs that they intend to address. Criteria that guide the evaluation process can either be objective or subjective. The subjective aspects are often guided by the existing attitudes that an individual holds, while the objective process is a more systematic consideration of product attributes.

With respect to objective assessment of the options, a decision filter is employed where various product attributes are considered before deciding on purchase. In a cough and cold study that examined the filters used by people with cold symptoms, the results pointed to symptom relief as the primary consideration. With several products that could treat cold symptoms available, the next consideration was which brand would be preferred. Then attributes such as form (e.g. liquid or solid), flavor, size, and price are used to narrow the choices to where a single product is deemed to be appropriate for dealing with the identified health need¹¹.

Purchase Decision

Unlike most consumer purchases, decisions about health are more complex and often there are numerous determinants that affect the final decision. One of the largest influences on a decision about health actions occurs at the moment a person faces a decision to select a product from the store shelves.

Aker and colleagues examined the steps consumers take when they are seeking a consumer health product in a retail environment¹². They found that consumers in the final stages of making a product choice are guided by signage and to some extent familiar brands. They start by looking for helpful signage (94%) that will lead them into the area where they will find health products. They then look for category-specific signage (89%) that relates to their symptoms or needs and finally they narrow the search to familiar brands (56%) and other product attributes such as price (14%).

People who aren’t familiar with a specific product for the condition they are seeking to treat most often choose to seek out a pharmacist’s advice prior to making the purchase decision. In an Australian report¹³ the vast majority (69.9%) of people indicate that they always seek a pharmacist’s advice prior to an initial purchase of a new medicine. It is generally agreed that the main reason why pharmacists are sought for their advice is that they are seen as trustworthy, creating a strong sense of confidence in the recommendations they provide for treating self-manageable ailments¹⁴. This trust and confidence may be owing to a perceived impartiality. When it comes to advertising influences on pharmacist recommendations, some studies report that the recommendations made are based solely on therapeutic considerations and are not influenced by advertising¹⁵.

This finding was reinforced by another Australian study looking at the influence of advertising on health actions undertaken by consumers for self-care products¹⁶. The effects of commercials were found to drive the search for a product where an existing illness was already identified. In this experiment, the test subjects were provided with an ad message while the control group was not.

In both cases, consumers would most likely seek a pharmacist’s advice about the product (64.6% for the test group and 58.9% for the control). This would indicate that an ad may slightly increase the likelihood of seeking a pharmacist’s advice but reinforces the generally high reliance on the pharmacist in the search process. But there was another interesting observation. Where there was no awareness of a nonprescription product (the control group), the likelihood of a doctor visit was higher while the test group was more likely to see a pharmacist. In either case the ad propelled the search process further when there was an identified need. Increased attention to ads for a nonprescription product may favor the use of a pharmacist’s advice in the next stage along the consumer purchase decision pathway.

post-Purchase behavior

It is important to note that positive outcomes from the use of a chosen product are dependent on its proper use. Various studies have examined the use of products for self-medication and found that the level of adherence to label instructions is strong¹⁷.

In a study done in the United Kingdom, adherence to label instructions was very high with 90% of people saying that they read the label carefully before using the product for the first time¹⁸. Similarly, A U.S. study¹⁹ found that ‘An overwhelming majority of Americans say they are generally very cautious when they use nonprescription medications. Most people say they take necessary precautions, such as reading directions before taking a product for the first time (95%), reading labels to choose appropriate OTC medicines (89%), and reading about possible side effects and interactions (91%)’.

Consequently, it is not surprising that people tend to use the products they select successfully and that this contributes to brand satisfaction and intention to re-purchase when the same need arises. Not only does the successful outcome create a positive influence on future purchases, it also results in people making recommendations to friends and family for similar health needs.

Conclusion

The influences on the consumer’s decision-making process are numerous and the process itself is sophisticated relative to how purchase decisions are made for many other consumer goods. Advertising and other product information sources play a role in creating awareness of self-manageable conditions and available solutions for self-care health needs. Such low involvement approaches to making the consumer aware of product availability are helpful in the early stages of the consumer search process.

The primary sources of information that people use are recommendations of health professionals and friends or family members. Internet searches and other information sources contribute to the decision-making process and consideration of their treatment possibilities. During the evaluation stage of the decision process, many people will elect to do nothing. However, choosing to purchase a product to deal with their health concern is often a course of action and the selection of a particular product becomes more focused as the person takes the finals steps to purchase a product from the retail shelf.

The decision-making process that people employ to address a health need is considerably more deliberate than one might imagine. There are many considerations to the final actions taken and they all are important to understanding how people behave in response to an identified health concern.

Correspondence to: David Wendland: dave_wendland@hamacher.com or David Skinner: David.Skinner@Heuristix.ca