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7/28/2019 Dental Services Marketing - Do Market Segments Based on Usage Rate Differ in Terms of Determinant Attributes

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Journal of Services MarketingEmerald Article: Dental services marketing: do market segments based onusage rate differ in terms of determinant attributes?

Zhengyuan Wang, Swinder Janda, C.P. Rao

Article information:

To cite this document: Zhengyuan Wang, Swinder Janda, C.P. Rao, (1996),"Dental services marketing: do market segments based on

usage rate differ in terms of determinant attributes?", Journal of Services Marketing, Vol. 10 Iss: 4 pp. 41 - 55

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http://dx.doi.org/10.1108/08876049610124572

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THE JOURNAL OF SERVICES MARKETING, VOL. 10 NO. 4 1996, pp. 41-55 M CB UNIVERSITY PRESS 0887-6045 41

Introduction

Consumers form attitudes toward a product or service based on salient

beliefs about the product or service (dAstous and Dubuc, 1986; Miniard et

al., 1986). Alternative brands in the consideration set are viewed in terms of

the associated choice criteria. Choice criteria may include aspects such as

salient beliefs about product consequences, psychosocial consequences, or

value consequences (Peter and Olson, 1993). However, there could be

potentially a large number of choice criteria, typically product attributes,

which may be considered in a particular situation, but these attributes vary in

their relative contribution to the choice decision (Sinclair and Stalling,

1990). The attributes that contribute highly to choice have often been termed

as determinant attributes. The decision maker must perceive largedifferences in the alternatives under consideration in terms of an attribute,

for that attribute to be considered determinant (Myers and Alpert, 1968).

Bringing about a match between a marketers offering and needs of target

market segments is the essence of gaining a competitive advantage. In order

for marketers to achieve and sustain long-term competitive advantage, while

following the marketing concept (Kotler, 1988), they need to focus on

attributes that specific market segments value the most. Parasuraman et al.,

(1985) have pointed out that higher complexity of services relative to

tangible goods makes a matching of product offering with customer

expectations more challenging in the case of services marketing. Among

different types of common services, health care products may be even lessamenable to a matching of services offered with customer expectations. This

is because health care product offerings are often characterized by

complexity, inseparability, variability and customization (France and Grover,

1992).

Despite this difficulty, it is becoming increasingly imperative for

practitioners to develop and maintain a strategic fit between consumers

expectations of the health care offering, and the actual offering itself. This is

especially true for the dental care industry which has reached a plateau in

demand due to a decline in birth rate and significantly better oral hygiene

(Grove et al., 1994). At the same time, the number of dentists has increased

by 50 percent over the last decade (Bush and Nitse, 1992).

Since different market segments may prefer different sets of attributes when

patronizing a dentist, it becomes relevant for the practitioners to ascertain

what set of attributes are determinant attributes for each specific market

segment. Chakraborty et al. (1993) reviewed the dental service literature and

found that market segmentation was one area where prior research could be

extended. It is important for dentists to know whether different consumer

Dental services marketing: domarket segments based on usagerate differ in terms ofdeterminant attributes?Zhengyuan Wang, Swinder Janda and C.P. Rao

An execut ive summary

for m anagers and

execut ives can be

found at th e end of

thi s art ic le

Determinant attributes

A strategic fit neededbetween consumersexpectations and healthcare offerings

Segmented marketingstrategies


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42 THE JOURNAL OF SERVICES MARKETING, VOL. 10 NO. 4 1996

groups emphasize different determinant attributes so that dentists can

employ segmented marketing strategies. Thus, the purpose of this study wasto identify determinant attributes for selecting a general dental practitioner

and to examine whether determinacy scores differ across market segmentsbased on dental service usage rate.

This paper first reviews the extant literature in order to determine the

attributes considered relevant by consumers while patronizing a generaldental practitioner. Based on the review of literature and four focus group

interviews with dental service consumers, 18 attributes are then identified to

be included in this study. Data pertaining to the importance of each of theseattributes and the perceived differences among the various dental care

providers on each attribute are collected from a nationwide sample ofconsumers. Using a determinant attribute approach, the data are then

analyzed to obtain a smaller set of determinant attributes. Eight suchattributes are isolated, and multiple discriminant analysis conducted to

establish differences in attribute consideration among three a priori marketsegments based on usage rate (i.e. heavy, medium and light users of dental

care services).

Literature review

Extensive work in the area of customer satisfaction with services has

focussed on health care in general (Aday et al., 1980), and dental servicesin particular (e.g. Gopalakrishna and Mummalaneni, 1993). Prior researchrelating to dental services has identified relevant factors considered by

patients when first choosing a dentist (e.g. Barnes and Mowatt, 1986; Hill

et al., 1990), and factors influencing customer satisfaction with dental care

services (e.g. Gopalakrishna and Mummalaneni, 1993). McAlexander et al.(1994) have pointed out that patient satisfaction with dental care and

assessment of overall service quality contribute to intentions to patronize adentist. Recent research (Motes et al., 1995) has attempted to uncover

differences between patients search for specialized versus routine dentalcare.

In general, the primary attributes considered by consumers when choosing adental practitioner, or subsequently evaluating the quality of service can begrouped into three general categories:

(1) Those related directly to provision of the core service offering itself, e.g.quality of service, professional competence, attitude of dentist and the

support staff, methods of pain control, etc.

(2) Those concerned with aspects other than the core service offering, e.g.location, parking facilities, office atmosphere, etc.

(3) Consumers may also base their decisions on the reputation of the dentist

and the use of advertisements. The perceived reputation could bebrought about through word-of-mouth recommendations from friends

and family or through advertising.

Past studies have explored one or more of the above factors. These studies

are now elaborated in the following sub-sections.

Attributes related to core service offering

These factors include characteristics inherent in the service offering,

including aspects related to the dentist, the support personnel and the serviceoffering itself. They have been found to be very important for evaluation of

Relevant factors when

choosing a dentist

Three general categoriesof primary attributes


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THE JOURNAL OF SERVICES MARKETING, VOL. 10 NO. 4 1996 43

dental services. Past research has found service quality to be a highly

emphasized attribute in patronizing a dentist (Hawes and Prough, 1988;

Sanchez and Bonner, 1989). Bush and Nitse (1992) found quality to be of

very high importance irrespective of whether consumers patronize private or

retail dental centers. Consumers also confer high importance to factors such

as courtesy and competence (both technical and professional) of the dentist

(Crane and Clarke, 1988; Gopalakrishna and Mummalaneni, 1993). Several

other relevant intrinsic attributes uncovered by past research include aspects

such as sensitivity of dentist, personality and attitude of dentist, attitude of

support personnel, and personal attention provided (Barnes and Mowatt

1986; Chakraborty et al., 1993; Crane and Lynch, 1988; Dolinsky and

Caputo, 1990; Hawes and Prough, 1988). Fee charged for dental service has

been found to be a moderate determinant of satisfaction in some studies

(Chakraborty et al., 1993; Gopalakrishna and Mummalaneni, 1993; Hawes

and Prough, 1988; Hill et al., 1990). Other relevant attributes include the

sensitivity of the dentist, personality and attitude of the dentist, attitude of

support personnel, personal attention provided, methods of pain control, and

availability of emergency services (Barnes and Mowatt, 1986; Chakraborty

et al., 1993; Crane and Lynch, 1988; Dolinsky and Caputo, 1990; Hawes

and Prough, 1988).

Attributes other than those related to core service offeringThese attributes have been found to be of varied importance in the past

literature. One of the attributes found consistently to be very important is

office atmosphere and appearance including neatness, seating comfort,

magazine selection and music (Andrus and Buchheister, 1985; Chakraborty

et al., 1993). Other such attributes identified in the past literature include

waiting time for appointment, ease of making appointments, fee payment

plans, location of dentist, and attractiveness of office and facilities

(Chakraborty et al., 1993; Gopalakrishna and Mummalaneni, 1993; Hawes

and Prough, 1988).

In general, most studies in the area of dental services marketing have found

attributes related to core service offering to be very important. Attributes

such as location, parking facilities, hours of operation and office atmosphere

have been found moderately to minimally important as choice criteria (e.g.

Chakraborty et al., 1993; Hawes and Prough, 1988).

Several previous studies have included advertising as one of the criteria

which may influence consumers choice of a dentist. Consumers perceive

advertising as less important than the other factors outlined above (Bush

and Nitse, 1992; Chakraborty et al., 1993; Crane and Lynch, 1988).

However, advertising plays an important role in creating awareness about

different options available for dental care (Hite et al., 1988), and can also

provide useful information pertaining to various dental care attributes(Sanchez and Bonner, 1989). Hite et al. (1988) found that consumers

perceived advertising as playing a very constructive role in providing

information about attributes pertinent to making a thoughtful dentist choice

decision. Advertising also assumes importance because of its potential

power to influence consumers beliefs about various dental service

attributes. In addition, advertising may affect the overall reputation or

image of a dentist.

Office atmosphere

Advertising mayinfluence customerchoice


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Method

Selection of attributes and formulation of questionnaire

Eighteen attributes were included in this study based on the past literature,

and a series of four focus group interviews with typical consumers of dental

services. Attributes pertaining to the core service offering included in the

study were quality of service, professional competence, personality and

attitude of dentist, attitude of support personnel, fee charged for services,

methods of pain control and availability of emergency services. Attributes

not pertaining directly to the service offering were location, parking

facilities, hours of operation, fee payment plans, ease of making

appointments, office atmosphere, nonrequirement of appointments, waitingtime before treatment and services available on Saturdays. Finally,

reputation of dentist and use of advertisements were the last two attributes

examined in the present study.

The 18 attributes outlined above were included in the questionnaire, and

arranged in alphabetical order. Each questionnaire consisted of three

sections. In the first section, respondents were asked to rate the importance

of each attribute when patronizing a general dental practitioner. A six-point

rating scale was used for this rating task, where 1 corresponded to least

important and 6 corresponded to most important. In the second section,

respondents were asked about their perceptions of how various alternative

general dental practitioners differed in terms of each of the 18 attributes.This rating task also involved a six-point rating scale where 1 corresponded

to very little differences and 6 corresponded to very large differences. The

third section asked respondents about demographic information.

Research design and data collection procedures

The research design involved the survey method. The responses to the

questions were obtained through a nationwide mailing of questionnaires.

This procedure was considered appropriate in this context because it

provided an opportunity to obtain geographically disperse responses at a

reasonable cost within a reasonable time (Davis and Cosenza, 1988).

Mailing lists of households across the USA were obtained from a reputed

mailing list vendor. The initial mailing of questionnaires was followed by asecond mailing after three weeks. Only heads of household who had either

personally been to, or accompanied another member of household to a

general dental practitioner in the last year were asked to complete the

questionnaire. Altogether 1,889 questionnaires were mailed, out of which

460 consumers responded with usable responses. This is a response rate of

24 percent. Although the response rate is low, it can be considered

satisfactory in this context since no financial incentives were provided to the

respondents (Kanuk and Berenson, 1975; Yu and Cooper, 1983). Since the

chi-square tests of early respondents versus late respondents indicated no

statistically significant differences at the 0.05 level in terms of such

demographic and socio-economic characteristics as age, household size and

household income, there seemed to be no serious nonresponse bias in thedata collected for the study.

Sample description

The sample of 460 respondents were heads of households. The majority of

the respondents were between 36 years and 65 years (67 percent of

respondents), 17 percent were over 65 years, and 16 percent below 35 years.

Of the households, 25 percent had annual income greater than $30,000; 26

Attributes used in aquestionnaire

The survey method

Sample demographics


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percent of households had incomes less than $15,000 and 49 percent of

respondents had annual household incomes between $15,000 and $30,000.

Forty-five percent of the households had two members. Three-member and

four-member households each comprised 19 percent of the sample; only 9

percent of sample households had greater than four members, and 8 percent

had only one member. Seventy-one percent of the households pay for dental

services by cash or check, whereas 25 percent pay by insurance. The

remaining 4 percent pay by other methods.

The determinant attribute approach

According to multi-attribute attitude models in consumer behavior (see Lutzand Bettman, 1977; Sheth and Talarzyk, 1973; Wilkie and Pessemier, 1973

for a general review) the salience of, as well as beliefs about, an objects

attributes must be considered in evaluating attitude toward the object.

Salience refers to the potential influence that an attribute or evaluative

criterion exerts during the alternative evaluation process. Salient attributes

which actually affect the evaluation process are known as determinant

attributes (Alpert, 1971; Engel et al., 1993; Myers and Alpert, 1968).

The notion of determinant attributes is consistent with the idea that an

attribute may be important to a consumer, but if the consumer feels that

alternative products are equal with regard to that attribute, then the

attribute is not considered a determinant factor in consumer decisionmaking. Take airline travel as an example. An airlines safety record is

obviously important to passengers. However, because most passengers

perceive all major airlines as providing relatively safe travel, safety is not

a deciding factor in most airline choice decisions. Determinant attribute

analysis is a technique which can assist marketers in understanding

which product attributes most determine choice behavior. Prior research

has used the technique to identify factors determining consumer store

choice (Bearden, 1977; Lumpkin et al., 1985), bank selection (Anderson

et al., 1976; Sweitzer, 1975), data terminal acquisition (Moriarty and

Reibstein, 1986), and forest products purchase decisions (Sinclair and

Stalling, 1990).

Analysis procedures

Following earlier studies with determinant attribute analysis (e.g. Moriarty

and Reibstein, 1986; Sinclair and Stalling, 1990), the current study adopted

the dual question method to identify determinant attributes for selecting

general dental practitioners. Attribute determinacy scores were developed

based on importance rating and a rating of attribute variability among dental

service providers. A final set of determinacy scores was derived by

multiplying, for each attribute, the importance rating by the perceived

difference rating. As noted by Moriarty and Reibstein (1986), different

respondents may use different intrinsic importance scales such that a rating

of 4 represents high importance to one person and low importance to

another. To overcome this potential bias, each respondents ratings (bothimportance and difference ratings) were normalized with a common mean of

6 prior to the calculation of the determinacy score (Bass and Wilkie, 1973;

Moriarty and Reibstein, 1986). Normalization was performed by subtracting

from each rating the mean of all 18 attribute ratings of that person and then

adding the constant of 6 so that the normalized ratings had a positive value.

Since the purpose of the research is to uncover the perceived relative

determinacy of the dental service attributes as opposed to their absolute

The potential influence ofan attribute

Determinant attributeanalysis

The dual questionmethod


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determinacy, no information loss occurs during this normalization process

(Moriarty and Reibstein, 1986).

Because both the importance and difference ratings were centered around the

value of 6, the resultant determinacy scores were centered about the value of

36. Thus, a determinacy value greater than 36 indicated that the attribute

played a relatively more important role in the decision-making process.

Likewise, a determinacy score lower than 36 indicated a less important

factor. Column four in Table I (under the heading of total) ranks the 18

attributes according to their average determinacy score across the total

sample of all 460 respondents. Results shown in Table I are consistent withthose found in previous studies (e.g. Bush and Nitse, 1992; Chakraborty et

al., 1993; Crane and Lynch, 1988; Gopalakrishna and Mummalaneni, 1993).

In terms of determinacy, attributes related to core service offering such as

quality of service, professional competence, reputation, personality and

attitude of dentist, attitude of support personnel, and fee charged for services

were most relevant factors for choosing a dental practitioner, followed by

attributes other than those related to core service offering such as hours of

operation, location, parking facilities, ease of making appointments, office

atmosphere, and so on. Advertising was perceived as the least determinant

attribute when patronizing a dental practitioner.

Note that mean determinacy scores under the heading of total sample in TableI represent average determinacy scores across the entire group of observations.

Certain subgroups may thus differ from the averages. Average determinacy

scores provide a relative ranking of each dental service attribute, but do not

provide a test of differences across the three usage segments (i.e. heavy,

medium and light users of dental care services). Heavy users in this study are

defined as those who go to a dentist every six months or more often. Similarly,

medium users visit a dentist once a year. Light users are those who visit a

dentist, on an average, of less than once a year. To examine differences among

heavy, medium and light users of dental care services, both canonical

discriminant analysis and multivariate analysis of variance (MANOVA) were

employed. The 18 dental service attributes were used as discriminating

variables with dental service usage used as the grouping variable. Canonicaldiscriminant analysis was performed to identify linear combinations of

variables that best discriminate among the groups and to uncover

interrelationships among predictor variables (Dillon and Goldstein, 1984). In

order to detect overall differences in vectors of mean scores for the 18

attributes across the three usage segments, the MANOVA procedure was

deemed appropriate. Statistically significant MANOVA results were followed

up with univariate ANOVAs (Hair et al., 1992). Whenever univariate F-tests

were statistically significant, Tukeys honestly significant difference (HSD)

tests were then conducted to highlight differences in mean determinacy scores

across the three usage segments (Hair et al., 1992).

ResultsTable I summarizes the results of both MANOVA and canonical

discriminant analysis. The overall MANOVA test was statistically

significant (Wilks = 0.734, F(36, 880) = 4.09,p < 0.0001), indicating that

heavy, medium and light users of dental services placed different levels of

importance on the set of 18 dental service attributes. By examining the

univariate ANOVA (F-test) results, one can identify those individual

attributes where differences existed among the three types of users. Among

Canonical discriminantanalysis and MANOVAwere used

Eleven attributesexhibited groupdifferences


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Standardizeddiscriminantload

ings

Meandeterminacyscores

F=value/

Dentalservice

Total

A:heavyuser

B:m

ediumuser

C:lightuser

p-value

Tukeys

attributes

FunctionI

FunctionII

(460)a

(153)a

(178)a

(129)a

(2,457)b

HSDc

Qualityofservice

0.021

0.250

50.53

49.41

50.18

52.41

2.88/0.06

NS

Professionalcompetence

0.085

0.271

49.38

47.23

49.11

52.63

9.86/0.00

C>A;C>B

Reputation

0.135

0.303

49.23

49.53

48.27

50.49

1.70/0.18

NS

Personalityandattitudeofd

entist

0.018

0.266

46.32

44.86

45.66

49.04

7.10/0.00

C>A;C>B

Attitudeofsupportpersonne

l

0.034

0.028

42.79

41.64

42.15

44.98

4.71/0.01

C>A;C>B

Waitingtimebeforetreatment

0.136

0.338

40.15

40.35

40.79

39.01

1.13/0.32

NS

Availabilityofemergencyservices

0.023

0.352

39.88

38.95

38.83

42.34

6.48/0.00

C>A;C>B

Feechargedforservices

0.235

0.205

39.55

39.25

38.89

40.67

1.27/0.28

NS

Feepaymentplans

0.078

0.079

36.08

36.40

35.99

35.85

0.12/0.88

NS

Methodsofpaincontrol

0.070

0.087

35.08

33.12

34.60

37.60

6.36/0.00

C>A;C>B

Hoursofoperation

0.143

0.334

33.02

33.79

34.05

30.52

5.53/0.00

C

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