HEALTH RISK PERCEPTIONS AND PATIENTS BEHAVIOUR

Dr.M.Arul, MBA., Ph.D., Professor, Department of Business Administration, Annamalai University, Annamalainagar. A.Arockiaraj, Ph.D, Research Scholar, Manonmaniam Sundaranar University. Address for communication : A.Aroc iara!, "#" $ast Street, panic an uppam % post, Panruti & '#( )#' Mo*ile + ,,('-----) $.mail : aro iara!)-+yahoo.co.in Intro uction Ris has *een studied from many different perspectives: economic, psychological and consumption. $conomists and insurers define ris in terms of a company, country, or instrument defaulting /i.e., not follo0ing through on a promised or e1pected return2 see Mc3adden ),,,4. 3inance defines ris in terms of the volatility of price around a mean /Shefrin5##64. Statisticians thin of ris in terms of uncertainty, or a pro*a*ilistic assessment of the li elihood of an event occurring versus not occurring 0ith this usage common in the *ehavioural decision theory literature as 0ell /7vers y and 8ahneman ),(94. Because of the multi.dimensional nature of ris , methods for studying and o*serving its effects have varied 0ithin and across paradigms and disciplines. :ealth ris has *een as the perception of the su*!ective li elihood of the occurrence of a negative event related to health for a person or group of people over a specified time period. IMPORTANCE O! STUD"IN# HEALTH RISK PERCEPTIONS :ealth ris perceptions are important to study *ecause they are theoretically interesting, managerially relevant, and have consumer 0elfare and pu*lic policy implications. 7he domain of health provides a rich set of constructs that allo0 a consumer researcher to e1amine larger theoretical ;uestions such as: ). <hat is the interplay of the cognitive and affective systems in the construction of ris estimates= 5. <hat factors moderate the lin *et0een !udgments li e ris perceptions and :ealth related *ehaviour= ". Do individuals differ in the manner in 0hich they process information and ma e= >udgments= 7he rest of this chapter is organi?ed as follo0s: <e integrate several e1tant approaches to studying health ris and propose a conceptual model of the antecedents and conse;uences of health ris perceptions. <e place the e1tant research in the health domain in our proposed frame0or , 0ith the effect of perceived ris on patient@s *ehaviour. In$%rt !i&ur% ' a(out )%r% ANTECEDENTS O! CONSUMER PERCEPTIONS O! RISK 7he antecedents of health ris perceptions in the e1isting literature can *e classified into five ma!or types of psychological factors: motivational, cognitive, affective, conte1tual, and individual differences.

Moti*ational !actor$ A variety of factors and *iases in the domain of health ris s may *e attri*uted to motivational factors. Motivational factors are inherently intert0ined 0ith perceptions of health ris . 7hree primary phenomena highlight the motivational factors affecting health ris perceptions: self. positivity /or unrealistic optimism4, social desira*ility, and self.control. An summary, self.positivity, social desira*ility and self control are three motivational factors that affect the perceptions and report of a person@s o0n health ris . 7he model proposes that the e1tent to 0hich they e1ist is a function of individual and conte1tual differences. A++%cti*% !actor$ Affective factors play a role in terms of people@s a*ility to deal 0ith negative events or information. People might anticipate and e1perience the negative affective conse;uence of considering health ris s. An the conte1t of processing health message information in the domains of s in cancer and se1ually transmitted diseases, Bloc and 8eller /),,64 demonstrated that information that highlights negative conse;uences of contracting a disease is more persuasive 0hen there are cues in the message that induce in.depth processing. Bn the other hand, 0hen the information is *eing processed only in a shallo0 manner, the valence of the information presented did not affect persuasion. 3or e1ample, :ighlighting negative conse;uences may lead to feelings of fear, 0hich may decrease the persuasiveness of an appeal /8eller and Bloc ),,'4 Co&niti*% !actor$ 3eldman and Cynch@s /),--4 accessi*ility.diagnosticity frame0or help us understand ho0 the different pieces of information that are salient to a consumer at a given time might influence the ind of ris related cues that come to mind. 7hey predict that D/a given Piece of information4E0ill *e used as an input to a su*se;uent response if the former is accessi*le and if it is perceived to *e more diagnostic than other accessi*le inputsF Cont%,tual !actor$ Bne of the *etter studied conte1tual sources of information to ma e responses is the ;uestionnaire itself /Bic art ),,"4, including the manner in 0hich ;uestions are framed, the order in 0hich they are as ed, the response alternatives used to elicit their responses and other incidental information in the ;uestionnaire that ends up serving an informative 3unction rather than the pure recording function for 0hich it 0as intended. 7he cognitive aspects of survey methodology literature sho0s that the manner of construction of a ;uestionnaire affects the reports elicited, and can, in turn, affect later responses /see Sudman et al. ),,6 for a revie04. In i*i ual Di++%r%nc%$ 7here are many individual difference varia*les that may also account for systematic differences in ris perceptions *et0een groups of individuals. Depressive 7endency: Bne of the fe0 groups of people 0ho have *een sho0n to not have the self.positivity *ias is depressives. 7heir ris estimates are more realistic than the average

population, a term referred to as Ddepressive realismF /cf. Alloy and A*ramson ),(,2 8eller, Cip us, and Rimer, 5##52 see Ac ermann and DeRu*eis ),,) for a revie04. Depressives are less prone to self.positivity as they vie0 their life and future in negative terms /Bec , ),'(, ),('4, have lo0 self.esteem /Gerrard et al., 5###4, 0ith their ris )5 estimates reflecting pessimism /versus an a*solute ris level4 and self.negativity /versus another person2 8eller, Cip us and Rimer, 5##54. Cin et al /5##"a4 sho0ed that optimists are less li ely to update self.estimates of controlla*le events 0hen provided 0ith *ase.rates, 0hile pessimists incorporate *ase.rates into their !udgments for all events. CONSE-UENCES O! RISK PERCEPTIONS Ris perceptions can play t0o ma!or roles: Bn the one hand, they can *e highly correlated 0ith *ehaviour, such that 0hen one *elieves that one is at ris , and then engages in more preventative, precautionary, and healthy *ehaviour. 7his is the role of ris perceptions as a mediator to *ehaviour. Relatedly, there are several factors that guide 0hen ris mediates *ehaviours and 0hen this lin *et0een ris and *ehaviour *rea s do0n. Bn the other hand, there could *e other factors that interact 0ith ris perceptions, and determine 0hat ind of *ehaviours might *e affected *y the ris perceptions. 7his is the role of ris perceptions as a Moderator. Bur model emphasi?es the need to understand the persuasive conse;uences of ris elicitation. :ence, it is important to understand 0hen ris 0ould mediate health *ehaviours and 0hat ind of *ehaviours 0ould *e influenced. Ri$k a$ a Mo %rator o+ B%)a*ioural Con$%.u%nc%$ 7he lin *et0een ris and *ehaviour can also *e analy?ed from the perspective of the different forms that the ris might ta e for the consumer. <e defined ris as negatively. valence li elihood assessment that an unfavoura*le event 0ill occur in an a*stract 0ay. 3rom a consumer standpoint, this ris could manifest in many different domains or forms. 3or instance, the ris could *e related to performance of a test or treatment or health product, or it could *e financial, physiological, or psycho.social. 7he form the ris ta es for the consumer can govern ho0 it influences decisions or *ehaviours, and 0hat interventions may *e effective in eliciting healthy *ehavioural patterns. 7hese forms of ris may*e associated 0ith the health pro*lem itself or 0ith preventiveHcorrective *ehaviours. 7he e1tent to 0hich !udgments of ris translate into corrective *ehavioural conse;uences depends on *oth, the ris s associated 0ith the health pro*lem, as 0ell as the ris related to the corrective *ehaviour/s4. Most e1isting models of health psychology discussed earlier endorse the importance of studying the ris .*ehaviour lin . :o0ever, their conceptuali?ation of ris is mostly uni dimensional. Bur model recogni?es that ris may manifest in several forms and these different forms of ris may lead to distinct *ehavioural outcomes. Related to the notion of distinct *ehavioural outcomes, the e1isting models of health psychology do not discriminate *et0een various types of *ehavioural outcomes that may result from ris evaluation. An our model, 0e rely on previous mar eting research /Rogers ),'52 ),-(4 to identify a variety of different consumer decisions or *ehaviours that may occur due to ris evaluation. An the follo0ing section, 0e discuss the effects of different types of ris s and ho0 they affect a variety of consumer decisions. Ie1t, 0e discuss ho0 different forms of ris could affect the consumer decision.ma ing in different situations and ho0 interventions can *e designed to strategically influence the ris *ehaviour lin in specific situations.

Performance ris :is the li elihood that the treatment 0ill not perform as per prior consumer e1pectations, or that another alternative treatment may perform *etter than the chosen one. 3inancial ris is the perceived li elihood associated 0ith not getting the e1pected return /financial, utilitarian or hedonic4 on a financial outlay /e.g., the price of the 7reatment4. 7ypically, the higher the initial cost of a )6 treatment, the greater the financial ris and the lo0er the li elihood of trying, adopting or repeating the treatment. 7he high cost of medications and the high percentage of the under.insured or uninsured in the US and other countries ma e it pertinent for consumer researchers to e1amine the e1tent to 0hich financial ris considerations in see ing diagnosis and treatment are a factor that inhi*it consumer from <ishing to recogni?e their actual level of ris . An other 0ords, if a person no0s that sHhe cannot afford the treatment for AADS, then sHhe may prefer to not *e diagnosed and may strategically underestimate herH his ris of contracting AADS to maintain positive mental health as argued *y 7aylor and Bro0n /),--4. Physiological ris is the set of *eliefs that underta ing a product or service may cause harm /e.g., 0hen introduced many consumer *elieved that micro0aves could lead to cancer and 0ere hesitant a*out *uying them4. Given that health ris almost al0ays has a physiological aspect, and its testing can fre;uently *e invasive /e.g., *lood tests, 1.rays, mammograms etc.4, as can its treatment /e.g., side effects of medications4 understanding the factors that inhi*it people from *eing tested, starting treatment, and continuing treatment is ey to understanding the psychology of health ris . :ighlighting actual ris s, and de*un ing common myths, as 0ell as highlighting *enefits 0ill allo0 consumers to ma e informed health related choices. Psycho.social ris is the *elief that using a product or service 0ill cause a reduction in the psychological 0ell *eing or the social status of the consumer. Psychological ris can lead consumers to shut.do0n, deny ris , or delay ta ing preventive action. 3or e1ample, consumers might find treatments that involve trading off *et0een t0o important attri*utes /e.g., trade.off involving safety, Cuce ),,-4 emotionally difficult and this might discourage them from ta ing preventive action. Ris perceptions involving self. positivity highlight the importance of mental 0ell.*eing and usually have a psycho.social Jomponent. 7he most common psycho.social ris that has *een studied is that of coping and social support mechanisms. A systematic *ias in perceptions of a*solute or relative levels of any of these forms of ris can lead to no optimal purchases, decisions, and *ehaviours. An this chapter, 0e focus on one type of ris perception: health ris s. :ealth.ris perceptions em*ody physiological, performance, psycho.social, and financial ris in a single construct. 7hus, not only are they interesting to e1amine from the point of vie0 of pu*lic policy and social 0elfare, they also provide a theoretically interesting construct incorporating the many facets of consumers@ ris perceptions. Most of the e1tant 0or in mar eting has e1amined ho0 ris perceptions are formed, and ho0 these can assist in getting consumers to try preventive courses of action. 7he lin s to the other later *ehaviours in the various stages of consumer decision.ma ing chain are a rich future source of en;uiry. <hat strategies are effective to get people to stay on a course of action= <hat are the primary reasons for their dropping out & is it fears of failure or fear of success= <hat is needed to get consumers to encourage others=

7he relationship *et0een memory and perception is crucial. <e often rely on our memory of procedures and our recollection of ho0 0e performed tas s 0hen 0e underta e 0or . :o0ever, if our recollection is inaccurate, decisions that 0e ma e a*out safety ris s, Based on 0hat 0e remem*er and recognise, may also *e fla0ed. T)% link (%t/%%n ri$k 0%rc%0tion an (%)a*iour <e ma e decisions every day2 consciously or unconsciously, on ho0 0e are going to *ehave. Ket ma ing a decision is a difficult cognitive process. At involves the amalgamation of various sources of information. $ven 0hen 0e are a0are of all the contri*uting aspects, individual differences and perceptions influence our decision.ma ing and the resulting *ehaviours /:illson, 5##94. A mis!udgement of ris may lead to inappropriate decisions and an unsafe *ehaviour or human error & ris perception is a critical antecedent of at.ris *ehaviour. 7he lin *et0een ris perception and *ehaviour is t0o directional. Ris perception can influence *ehaviour and vice versa, ris y *ehaviour may cause an affective reaction. Jonsumers differ 0ith respective amount of ris they are 0illing to incur in a given situation. An general, the notion of Ris comprises t0o components namely the uncertainty of an outcome and the importance of negative conse;uences associated 0ith the outcome of a choice. 7he concept of Perceived Ris involves *oth the Perceived uncertainty of outcomes and the Perceived severity of negative conse;uences. Andividuals may vary 0ith respect to *oth components. At differs from situation to situation. Many studies have sho0n that consumers perceive different facets or components of Ris and that their Predictive value for total Ris and Ris Reducing *ehaviour depends very much on the product class. Social, financial, institutional and Performance ris may *e Perceive independently of one another as they can arise from different inds of sources. 7he influence of Perceived Ris on consumer decision ma ing may *e different in situation that are dominated *y different type of Ris . An the conte1t of hospital, consumers perceive them as ris y *ecause the performances of these services are uncertain and un no0n compare to products. $fficient service offering creates uni;ue customer e1perience 0hich 0ould ma e the consumers to use the hospital services. Luality of health care has *ecome a concern for patients. Patients increasingly e1pect more from health services and compare their e1periences 0ith their perception. :ence Perceived Ris can also reduce purchase *ehaviour *y underta ing additional information searches. Patients have many different associations 0ith their *ehaviour. Bne class of association of satisfaction 0hich can *e seen as a patients overall favoura*le or unfavoura*le evaluation of the hospital. Brand affect is another association *y the patients to0ards the hospital. Brand affect is the potential to elicit a positive emotional response from the average consumers and it can serve as a means to reduce Ris . 7here is a General agreement that in situation 0ith high customers@ involvement the decision ma ing process is more comple1. 7hus trust as the 8ey factor for reducing the comple1 of decision ma ing process. Af a patient trust 0ith the hospital name that li ely to reflect positive *ehavioural intention to0ards the hospital. Coyalty as important conse;uences of trust has *een conceptuali?ed either as *ehavioural intention to0ards the hospital or as an actual pattern of purchase *ehaviour. 7here is also agreement that trust only e1ist in an uncertain and Ris y environment. 7rust is only relevant in situation of uncertainty. :aving only limited cognitive resources availa*le, consumers see to reduce the uncertainty and comple1ity of *uying process *y applying mental shortcuts. Bne effective

mental shortcut is trust 0hich can serve as a mechanism to reduce the comple1ity of human contact in situation 0here people have to hope 0ith uncertainty. Conclu$ion 7he Perceived Ris is a one of the most important 3unction for the patients on their *ehaviour. An this research the researcher has empirically analyse the effect of Perceived ris of patients@ *ehaviour. At can *e assumed that Perceived ris influenced on satisfaction of *rand trust, *rand affect, purchase loyalty, attitudinal loyalty. RE!ERENCES Agra0al, Iidhi, Geeta Menon and >ennifer Aa er /forthcoming4, DGetting $motional a*out :ealth,F >ournal of Mar eting Research. Bic art, Bar*ara, Geeta Menon, Ior*ert Sch0ar? and >ohnny Blair /),,94, D7he Use of Anchoring Strategies in the Jonstruction of Pro1y Reports of AttitudesF, Anternational >ournal of Pu*lic Bpinion Research, ' /94, "(6."(,. Bloc , Cauren G., and Punam A. 8eller /),,64, D<hen to Accentuate the Iegative: 7he $ffects of Perceived $fficacy and Message 3raming on Antentions to Perform a :ealth Related Behavior,F >ournal of Mar eting Research, "5 /May4, ),5.5#". Davis, :arry C., Stephen >. :och and $. 8. $aston Ragsdale /),-'4, DAn Anchoring and Ad!ustment Model of Spousal Predictions,F >ournal of Jonsumer Research, )" />une4, 56."(. 3lin, R., Mearns, 8., 3leming, M., % Gordon, R. /),,'4. Ris perception and safety in the offshore oil and gas Andustry. :ealth and safety e1ecutive *oo s. A*erdeen: :MSB. Mahes0aran, Duraira! and >oan Meyers.Cevy/),,#4, M7he Anfluence of Message 3raming and Assue Anvolvement,M >ournal of Mar eting Research, 5( /August4, "').'( Raghunathan, Ra!agopal and Kaacov 7rope /5##54, D<al ing the 7ightrope Bet0een 3eeling Good and Being Accurate: Mood as a Resource in Processing Persuasive Messages,F >ournal of Personality and Social Psychology, -" /"4, 6)#.656. 7aylor, Shelley $. /),,-4, D7he Social Being in Social Psychology,F in Daniel Gil*ert, Susan 3is e, % Gardner Cindsey /$ds.4, 7he :and*oo of Social Psychology, Ie0 Kor : McGra0. :ill, 69.,-. >ohnson, B.B. /),,"4. Advancing understanding of no0ledge@s role in lay ris perception. ris : Assues in :ealth and Safety, 9, )-,.5)5. Morro0, P.J., % Jrum, M.R. /),,-4. 7he effects of perceived and o*!ective safety ris on employee outcomes. >ournal of Nocational Behaviour, 6", "##. ")". <illiams, S.<., % <ong 7.S. /),,,*4. Mood and organisational citi?enship *ehaviour: 7he effects of positive affect on employee organisational citi?enship *ehaviour intentions. >ournal of Psychology: Anterdisciplinary and Applied, )"", '6'.''-.

Figure 1. Proposed Research Frame work:

Trust 1

Trust 2

Trust 3

Trust 4 Recom mendati on Purchas e Loyalty

Brand Trust $R

#R

SR PR

Perc eive d Risk

Patients Satisfaction

Willin to Revisit

Brand Affect

Attitudina l Loyalty

A!1

"R A!2

Affect 1

Affect 2

Affect 3