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http://dergipark.gov.tr/ijhmt/ Doi Number: 10.31201/ijhmt.364494
Int Journal Of Health Manag. And Tourism 2018, 3(1), 1-22
IJHMT Editorial
THE IMPORTANCE OF WORD-OF-MOUTH COMMUNICATION ON HEALTHCARE MARKETING
AND ITS INFLUENCE ON CONSUMERS’ INTENTION TO USE HEALTHCARE
Maşide GÜRCÜ1*, Sezer KORKMAZ2,
PhD-Student, Gazi University Healthcare Management Department
Prof.Dr., Gazi University Healthcare Management Department
masidegurcu@hotmail.com
Abstract
This study aims, to determine the influence of word-of-mouth communication with regards to
the consumers’ purchase intention on healthcare. The empirical part of the study was conducted
with 430 consumers over the age of 18 living in Yozgat province. Questionnaire forms were
used to obtain data, which were analyzed through SPSS 22 package software for reliability
analysis, factor analysis, correlation analysis and regression analysis. It has been found that
68.1 % of the participants have recommendation on health care issue through word-of-mouth
communication. It has been seen that 95.8% of participants express satisfaction and 94.7% of
them express dissatisfaction on the use of health service. According to the results, references,
internet and social network are the first contact tools, and medical specialists along with those
who have already bought the service are the most effective source of information in regards to
health service consumption. It also shows that all of the sub-dimensions of word-of-mouth
communication have a positive influence on purchase intention.
Keywords: Word-of-Mouth Communication, Word-of-Mouth Marketing, Health Institution
Preference, Healthcare Preference, Purchase Intention
Internatıonal Journal Of Health Management And Tourism
International Journal Health Management and Tourism http://dergipark.gov.tr/ijhmt
GÜRCÜ, KORKMAZ 2
Introduction
Word-of-mouth communication has been used since people existed. However, the use of it in
the marketing sense is relatively new. These communications, which have been hardly
noticeable or ignored by businesses in the past, have become one of the most significant
marketing tools nowadays.
Word-of-mouth (WOM) communication is considered to be an important factor affecting
consumers' purchasing behavior. Especially recent studies show that many businesses have
discovered the effectiveness of this communication method. These studies also show that
marketing through word-of-mouth communication helps businesses to sell their products to
consumers effectively (Meiners, Schwarting and Seeberger, 2010).
Features such as interaction, rapidity and being lack of commercial concern, especially relation
with services with limited pre-purchase experience will probably make word-of-mouth
communication as one of the most effective sources of information to be able to understand
consumer choices in the future. In this sense, it can be said that word-of-mouth communication
is one of the most important factors affecting the decision process of consumer (East, Hammond
and Wright, 2007).
Consumers obtain information that will have an effect on their purchase intention from various
channels. The information about products and services can be obtained from other people or
sales staff through the relationship of people with their physical surroundings, mass media
(East, Hammond and Wright, 2007; Mookerjee, 2001). Today, especially mass media is an
integrated part of our lives and numerous information and advertisement messages are sent
from these tools during the day. The existence of many alternatives for the same or similar
products in the market environment causes consumers to turn to objective, independent and
reliable sources of information about consumption preferences (Cop and Gümüş, 2009; Özkan
and Yıldız, 2015). For consumers, purchase of certain products is more difficult than the others.
Prior to the purchase of tangible products, many have been standardized and have
comparatively easy-to-compare features. However, especially when it comes to services,
purchase process is more complicated.
It is inherently difficult to assess services compared to products prior to purchasing (Zeithaml,
1981). Moreover, perceived risk for services is higher. The higher the perceived risk, the greater
is the likelihood that the consumers tend towards word-of-mouth communication (Gabbott,
1991; Murray, 1991) and the decision to be taken will become significant (Dholakia, 1997).
The healthcare services sector is one of the leading sensitive sectors that incorporate the concept
of confidence between service provider and receiver because of its unique features. Consumers
are in the process of getting information from specialists, the ones who have consumed the
service before or from their closest people before the healthcare supplying. The main purpose
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GÜRCÜ, KORKMAZ 3
underlying the communications that the consumers have carried out in order to receive
information is usually assistance.
Word-of-mouth-oriented initial studies generally focus on new and concrete products (Arndt,
1967). The studies conducted in the following years inferred that word-of-mouth
communication is likely to have an influence on consumers’ purchasing processes in various
sub-branches of service sector (Bansal and Voyer, 2000; File, Judd, and Prince, 1992; Harrison-
Walker, 2001; Murray, 1991; Murray and Schlacter, 1990; Swanson and Hsu, 2011). One
common aspect of the studies is that consumers put forth word-of-mouth communication as a
basic source of information when they intent to make a purchasing decision in the service sector
(Harrison-Walker, 2001).
Conceptual Framework
Various studies made over the years have led to the formation of the literature that is used about
word-of-mouth communication today (Murray, 1991; File, Judd, and Prince, 1992; Bansal and
Voyer, 2000; Mookerjee, 2001; Harrison-Walker, 2001; East, Hammond and Wright, 2007).
The development of technology and the introduction of new means of communication have led
to a broader discussion of the concept of word-of-mouth communication, although considerable
progress has been made in the conceptual framework since the concept of word-of-mouth
communication was first discussed.
Word-of-Mouth Communication Concept
Word-of-mouth communication can be defined as informal, person-to-person communication
between a sender and a receiver which is not perceived commercially related to a product,
business or service. (Arndt, 1967; Anderson, 1998; Wangenheim, 2005).
Lampert and Rosenberg (1975) identified word-of-mouth communication as a speech about
product information between noncommercial people during a conversation. Richins (1983)
defines word-of-mouth communication as telling at least one friend, acquaintance or family
member about one’s personal experience of a product or business that has been actualized
satisfactorily or is not actualized.
In another definition, Liu (2006) expressed that word-of-mouth communication is the informal
conversation between consumers about products or services, and emphasized two significant
features that distinguish word-of-mouth communication from other sources of information such
as advertisements. One of these is that word-of-mouth communication is usually more
convincing and reliable, and the other is that it is more accessible via social networks.
Researchers working in the field of consumer behavior have found that various motivations are
effective on consumers in order to pass to positive and negative word-of-mouth communication
about products and services (Arndt, 1967; Trigg, 2011).
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GÜRCÜ, KORKMAZ 4
According to Sundaram, Mitra and Webster (1998), positive and negative word-of-mouth
process is an important source of motivation of self-sacrifice in evaluations. Arndt (1967), on
the other hand, expressed that the speaker has six possible motivations. These are “being well
informed”, “helpfulness”, “self-protection”, “personal attention”, “assisting with decreasing the
uncertainty” and “cognitive discordance”. In this process, every consumer has one or more
reasons that will require talking to other consumers about the product he purchased.
Furthermore, it is always not necessary for the initiator of the communication to be a consumer
who performs the purchase activity. Every consumer who needs a purchase can be found in the
position of being the initiator of these communications.
Types of Word-of-Mouth Communication
Word-of-mouth communication is the result of product experiences. These experiences are
often shared with others by consumers as positive and negative evaluations of the product they
meet (Susskind, 2002). The likelihood of buying a brand is expected to be affected by the
comparatively proportion of positive word-of-mouth communication and negative word-of-
mouth communication (East, Hammond and Lomax, 2008). There are two types of word-of-
mouth communication Positive and Negative.
Positive Word-of-Mouth Communication
Positive word-of-mouth communication can be defined as positive recommendations given
directly or indirectly to purchase a product. Negative word-of-mouth communication includes
disparagement about the product, rumor and personal complaint. Negative word-of-mouth
communication reduces the expected quality of communication while positive word-of-mouth
communication increases the expected quality (consumers' attitude towards a product) (Liu,
2006).
Positive word-of-mouth communication by satisfied and loyal customers is a source of free
advertisement. Therefore, businesses should try to broadcast positive word-of-mouth
communications by creating satisfied and loyal customers (Avcılar, 2005).
Surveys indicate that positive word-of-mouth communication helps to create a positive image
towards brand and business by decreasing the risks of communication (Dichter, 1966; Arndt,
1967). Word-of-mouth communication increases consumers’ purchase intention for innovative
products and decreases general promotion expenses of businesses (Holmes and Lett, 1977).
For this reason, it is necessary that marketing managers create a favorable environment for the
development and dissemination of positive word-of-mouth communication. In addition,
marketing managers must first understand how word-of-mouth communication is practiced in
the market and learn how to manage the process in the marketplace effectively (Sundaram,
Mitra and Webster, 1998).
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GÜRCÜ, KORKMAZ 5
Negative Word-of-Mouth Communication
Negative word-of-mouth communication is an unfavorable talk between consumers about their
experiences as a result of consumers failing to find the benefits that they expect from using any
products or services (Liu, 2006). Taking into consideration the public pressures on expressing
positive feelings, there is a widespread belief that a person who expresses negative feelings in
society is sincerer (Mezerski, 1982).
Consumers who are dissatisfied with the product or service they receive are often reluctant to
express their dissatisfaction to the business. Few consumers with courage actually act in
complaining. Some prefer to tell their family and friends through negative word-of-mouth
communication so as to pull their nerves rather than explaining businesses how to handle these
dissatisfaction and problems (Richins, 1983; Cheng, Lam and Hsu, 2006). There is a correlation
between participation levels of consumers in negative word-of-mouth communication and
satisfaction levels with the product or service they receive. Whereas consumers who are not
sufficiently satisfied with their products and services they use are the initiators of negative
word-of-mouth communication, satisfied consumers are not the initiators of negative word-of-
mouth communication (Cop and Gümüş, 2009).
The consumer dissatisfaction with the service may have a permanent impact on reducing both
the business image and the business sales (Richins, 1983). Negative word-of-mouth
communication leads to weakening of business reputation and financial standing by keeping
away potential buyers from thinking about a particular brand or product or making a positive
evaluation (Holmes and Lett, 1977; Lee and Cranage, 2014). So, though negative word-of-
mouth communication turns into a positive and strong weapon for businesses due to its
reliability and crossbench, negative comments can have devastating influences on businesses
(Silverman, 2007).
The Correlation Between Word-of-Mouth Communication and Purchase Intention
The main reason why consumers seek information in the purchase decision process is to reduce
perceived risk and uncertainty (Bronner and Hoog, 2011). Arndt, who was one of the first
researchers to state that word-of-mouth communication is influential on consumer behaviors,
investigated the possibility of being affected by the benefits of these communications of people
who have purchase intention and utilization of word-of-mouth communication about the
product in 1967. Arndt examined the comments that participants receive from others on a new
food product and their responses to these comments. He concluded that the ones who have
purchase intention and preparation have a higher probability of receiving word-of-mouth
communication which will benefit them compared to others.
Factors Affecting the Purchase Intention
The best way to facilitate the consumer's decision-making process is that a reliable "mentor
encourages the consumer to use the product, that is, spreading through word of mouth”. The
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GÜRCÜ, KORKMAZ 6
main reason why marketing managers look for ways to influence the decision process is to
increase business profit (Silverman, 2007). Factors affecting the purchase intention are outlined
below.
Perceived Risk: According to Schiffman and Kanuk (2004), consumers show many
purchase behaviors that they never know about their consequences and perceive
constant risk throughout each purchase process. The risks that consumers face during a
purchase process are financial risk, performance risk, physical risk, psychological risk,
social risk and time risk.
Personal Information Sources: Consumers refer to individuals (such as friends,
experts) and non-personal sources (such as mass media) during the purchase process of
products or services. Consumers tend to trust their personal resources for various
reasons in a service purchase process (Zeithaml, 1981).
Opinion Leaders: Opinion leaders are amongst the most influential people in spreading
the market knowledge through word-of-mouth communication. People who inform
surrounding consumers when they need information or without knowledge are
considered opinion leaders. These people have expertise in particular issues, they want
to be seen as sources of information by consumers and as the people who are consulted
with (Katz and Lazarsfeld, 1955).
Means of Communication: Consumers use traditional word-of-mouth communication
and electronic word-of-mouth communication (e-WOM) as well as mass
communication tools during purchase decision-making process. While traditional word-
of-mouth communication is the source of traditional interpersonal communication,
electronic word-of-mouth communication refers to consumer comments on the internet
about products and services (Bronner and Hoog, 2011).
Use of Word-of-Mouth Communication: Word-of-mouth communication is an
important market phenomenon that provides consumers with the information to make
purchase decisions (Laczniak, DeCarlo and Ramaswami, 2001). Martin and Lueg
(2013) have shown that word-of-mouth communication is effective on both attitude and
intent.
Tie Strength: In word-of-mouth communication recommendation, sources can be
categorized according to the closeness of the relationship between the decision maker
and the recommendation sources, or in other words the ‘tie strength’ (Godes and
Mayzlin, 2004; Duhan, Johnson, Wilcox and Harrel, 1997). The more the sharing
between consumers and word-of-mouth communication source and the stronger the tie
between them, the stronger is the impact on the consumer (Bansal and Voyer, 2000;
Özkan and Yılmaz, 2015).
Sender’s Expertise in Communication: Some researchers interpret resource expertise
as a combination of education, ability and experience (Baber et al., 2015). Expertise can
be explained as the ability of the source to give the exact information in general terms.
Information sent by the expert source is expected to have a convincing influence on
receiver. If the word-of-mouth communication sender occupies a highly ranked position
in terms of education and experience, receiver can be said to have the expertise in terms
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GÜRCÜ, KORKMAZ 7
of the buyer's point of view. A person who wishes to receive information through word-
of-mouth communication believes that the knowledge he gained from an expert source
in the field that he wants to receive information is a huge benefit for him (Bansal and
Voyer, 2000).
Receiver’s Expertise in Communication: The expertise of a person apart from those
working on the scientific and technological field can be described as acquiring skills
through systematic procedures related to his own standards of education. People tend to
confuse expertise with experience and stereotype an expert person as an experienced
person (Baber et al., 2015). The influence of word-of-mouth communication knowledge
on receivers will be low or high, depending on whether the receiver's expertise is low
or high (Herr, Kardes and Kim, 1991). The level of receiver’s expertise influences not
only his purchase intention but also receiver's risk perception and whether he will seek
the knowledge of word-of-mouth communication. The greater receiver’s expertise, the
less active referral to word-of-mouth communication, the level of perceived risk about
the service, and the influence of word-of-mouth communication on purchase decisions
(Bansal and Voyer, 2000).
Receiver’s Actively Sought Communication: Actively seeking for a word-of-mouth
communication message also includes the acquiring process. There is an active and
independent participation between sender and receiver during the word-of-mouth
communication process. The conversation in word-of-mouth communication starts with
the desire of the person who needs information. The act of seeking for word-of-mouth
communication is a significant element of the process. The consumer has already
prepared for the message as he voluntarily joined the process. Actively sought
information will be more effective than the one which is not sought actively (Bansal and
Voyer, 2000).
Word-of-Mouth Marketing in Healthcare Services
In the 1970s, when marketing was first incorporated to the healthcare field, as well as there
were forecasts that word-of-mouth communication would collapse and traditional marketing
tools would supersede giving recommendation to each other and counseling, it was not as it
was expected. It has been seen that efficacy and strength of human contact is more goal-oriented
and influential than traditional marketing whether from a person, via voice and internet channels
or rating sites (Weiss, 2014). In this context, healthcare services are among service sub-
branches of which contact rating is at maximum.
In addition, the increasing interest of consumers in the selection of healthcare services in recent
years has significantly increased the healthcare market and consumers have become active
decision makers for the first time. For this reason, marketing in healthcare has become the basis
for clinics and the financial success of health institutions of all sizes (Corbin, Kelley and
Schwartz, 2001). Consumers need more word-of-mouth communication and recommendation
so as to find a qualified physician or health professional compared to other sectors (Uzunal and
Udyacı, 2010).
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GÜRCÜ, KORKMAZ 8
In terms of patients, persons whom they consulted are valuable for verifying information,
understanding options, seeking information and reducing time lost in healthcare services
Recommendations are particularly more significant provided that they come from a reliable
source (Dobele and Lindgreen, 2011).
That word-of-mouth communication or recommendations are esteemed highly leads to
increased sharing of information about health services between people. These recommendations
will both facilitate to abolish the information asymmetry in the healthcare services for health
care system and be a tool for health providers to realize the exact value of patients as well
(Dobele and Lindgreen, 2011).
Traditional patient-doctor relations are based on face-to-face communication and physical
contact. With the emergence of information age, a new model has appeared in which consumers
of health information, such as patients, academics, researchers and doctors, can use the internet
to receive and send online health recommendation. Not only geographical distances have not
become a barrier to access expertise, also patients have the opportunity to be able to share
experiences with others under similar circumstances (Samuel, 2011).
Chaniotakis and Lymperopoulus (2009) examined the correlation between word-of-mouth
communication, satisfaction and the quality of service in health services and concluded that
quality of service has influence on word-of-mouth communication and satisfaction. Another
study intended for exploring the value of recommendations given through word-of-mouth
communication in health services showed that the information that mothers obtained from other
mothers about children is perceived as reliable. In the same study, mothers expressed that word-
of-mouth communication decreased the information search concern and time (Dobele and
Lindgreen, 2011). Kitapci, Akdogan and Dortyol, (2014) examined the correlation between
service quality, word-of-mouth communication and purchase intention in public healthcare
sector. In the study, customer satisfaction was found to be closely associated with word-of-
mouth and repurchase intention.
Although there is a rich literature on word-of-mouth communication, it can be said that the
studies in our country are still in its infancy. However, the number of studies examining the
relationship between health services and word-of-mouth communication in not only national
but also international literature is very small. It is believed that all of the studies that will
evaluate the relationship between word-of-mouth communication and health services from
different angles will contribute to the literature significantly.
Methodology
Problem of the Study
Whether word-of-mouth communication has an influence on the purchase intention of the
healthcare consumer, if so, the level of this influence and the possibility of using word-of-mouth
communication service in the healthcare marketing constitute the problem of this research.
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GÜRCÜ, KORKMAZ 9
Purpose, Model and Hypotheses of the Study
This study generally aimed to determine the expertise of the person who is recommended in the
healthcare consumption, the expertise of sender, the risk of healthcare purchase, the power of
the tie strength between receiver and sender, and the influence of the acquired information on
the purchase intention of the person. The model of the study is shown in Figure 1.
Figure 1. Research Model
Hypotheses of the study are as follows:
H1: Receiver’s Expertise Influences Purchase Intention Positively.
H2: Sender’s Expertise Influences Purchase Intention Positively.
H3: Perceived Risk Expertise Influences Purchase Intention Positively.
H4: Tie Strength Expertise Influences Purchase Intention Positively.
H5: The Correlation between Perceived Risk and Receiver’s Expertise Influences Purchase
Intention.
The Scope of the Study and Sampling
The scope of the study refers to healthcare consumers over the age of 18 living in Yozgat city
center with a population of 85, 679. The data of the study were collected between 12.01.2016 -
04.23.2017 by face-to-face interview based on survey method with individuals over 18 selected
by simple random sampling method in Yozgat province. The sample size assigned for the study
is 382. A total of 500 survey forms were distributed to increase the reliability of the study and
due to the possibility of incorrect / incomplete feedbacks. Of these, 450 were answered and a
total of 430 questionnaires among them were used as data sets for statistical analysis.
DEMOGRAPHIC
VARIABLES
TIE STRENGTH
PERCEIVED RISK
RECEIVER’S
EXPERTISE
SENDER’S
EXPERTISE
PURCHASE
INTENTION
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GÜRCÜ, KORKMAZ 10
Instruments
The article titled "A Dyadic Study of Interpersonal Information Search" by Gilly et al. (1998)
and the article titled "Word of Mouth Processes within a Services Purchase Decision Context"
by Bansal and Voyer (2000) provide the basis for the model proposed in this study. These
studies have benefited substantially in composing the scale. Expressions in the study were
evaluated with 7 point Likert scale. "1-Strongly disagree, 2- Disagree, 3- Somewhat disagree
4- Neither agree nor disagree, 5- Somewhat agree, 6- Agree, 7- Strongly agree" form.
Data Analysis
The obtained data were processed through statistical analysis using the SPSS 22 program. The
result of the Kolmogorov-Smirnov test showed that the scale did not come from the normal
distribution. However, as taking exclusively this information into consideration would give a
faulty result. The descriptive statistics of the normality test were examined and the mean and
median values were found to be close to each other. Kurtosis (0.57) and Skewness (-0.70) scales
are between -1 and +1. It can be said that these values in question do not deviate much from the
normal distribution on these scales basis. For this reason, parametric tests were deemed
appropriate. Data are subjected to reliability analysis, descriptive statistics, factor analysis,
correlation analysis and regression analysis.
Findings
The data obtained from the survey questionnaire were evaluated statistically and the findings
were interpreted.
When the reliability coefficient of the scale of influence of word-of-mouth communication on
the purchase intention of healthcare service consisting of 19 items is examined, it is seen that
Cronbach's Alpha values of the scale are calculated as 0.878. In accordance with this
information, the reliability coefficient calculated for the scale indicates that the scores obtained
from the scale are "highly reliable".
As a result of factor analysis, it has been found that the influence of word-of-mouth
communication on healthcare service purchase intention scale was 5-factor and the statement
rate of the total variance of this 5 factor was 65.342%. The first factor (Sender’s Expertise)
expresses 33.39% of the total variance, the second factor (Purchase Intention) expresses %10.70
of the total variance, the third factor (Receiver’s Expertise) expresses 8.98%, the fourth factor
(Perceived Risk) expresses %6.87% of the total variance, the fifth factor (Tie Strength)
expresses 5.41% of the total variance.
The data regarding the personal information of the participants are displayed in Table 1.
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GÜRCÜ, KORKMAZ 11
Table 1. Findings Regarding the Personal Information of the Participants
Gender
f
%
Educational Status
f
%
Female
223
51,9
Primary or Secondary Education
184
42,8
Male
207
48,1
Undergraduate-Graduate
214
49,8
Total
430
100
Postgraduate
32
7,4
Age
f
%
Total
430
100
18-24
91
21,2
Household Income Status
f
%
25-34
112
26,0
1.300 TL and less
62
14,4
35-44
118
27,4
1.301 TL-2.000 TL
104
24,2
45-54
61
14,2
2.001 TL-3.000 TL
84
19,5
55 and over
48
11,2
3.001 TL-4.000 TL
91
21,2
Total
430
100
4.001 TL-5.000 TL
43
10,0
Marital Status
f
%
5.001 TL-10.000 TL
46
10,7
Married
284
66,0
Total
430
100
Single
146
34,0
Total
430
100
When the demographic features of the 430 respondents were examined, from the total of
participants, it was seen that 51.9% of them were female and 48.1% were male. When the age
of the participants was examined, 21.2% were in the age range of 18-24 years, 26.0% in the 25-
34 age range, 27.4% in the 35-44 age range, 14.2% in the 45-54 age range, and 11.2% of those
55 years and over. When examined in terms of marital status, the number of participants who
expressed being married (66.0%) was higher than the ones who express being single (44.0%).
According to the educational status, it is determined that 15 (3.5%) of the participants were not
literate. In statistical analyzes, this group was included in the first or secondary education group,
which is a higher group, due to fewer number. Thus, it was determined that 42.8% of them were
in the education level at primary or secondary education level, 49.8% were undergraduate-
graduate and 7.4% were in post-graduate education. 14.4% of the participants had household
income less than 1.300 TL, 24.2% of them had between 1.301-2.000 TL, 19.5% of them had
between 2.001-3.000 TL, 21.2% of them had between 3.001-4.000 TL, 10.0% had between TL
4.001-5.000. 11 participants (2.6%) were found to have over 10.000 TL. In statistical analyzes,
this group was included in a subgroup of 5.001-10.000 TL group because of fewer number.
Thus, 10.7% of the participants were in the group of 5.001TL-10.000 TL.
Participants were asked what type of health institution they preferred when they needed a health
service. Participants replied it as state hospital (52%), private hospital (23.5%), university
hospital (20.9%) and other answers respectively. It was seen that 13 people who marked the
other option gave health center or family physician response.
Participants were asked what type of word-of-mouth communication channel through which
they would get recommendation when they needed a healthcare service. They stated that they
preferred to use face-to-face (68.1%), telephone (17.0%), online (14.0%) and other (9.0%)
respectively. None of the participants who marked the other option stated what channel it was.
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GÜRCÜ, KORKMAZ 12
People who participated in the survey were asked about sharing status of their satisfaction /
dissatisfaction with the healthcare they received. 95.8% of the respondents said they would
share it with others when they were satisfied with the health service they received while 94.7%
of them said they would share it with others if they are dissatisfied with the health service they
received.
In the study, the effectiveness of the communication tools to which the consumers have applied
for information about the preference of healthcare service has been investigated. For this
purpose, pre-determined potential communication tools are expected to be ranked according to
priority order. The weighted average was used in the calculation of this ranking and the results
are shown in Table 2.
Table 2. Distribution of Effectiveness of Referable Communication Tools for Healthcare
Services Preferences by Priority Order
Communication
Tools
Priority Level
Weight
Priority
Order
1
2
3
Total
%
References
238
66
46
892
34,57
1
Internet
120
164
66
754
29,22
2
Social Networks
15
88
161
382
14,81
3
TV-Ads.
41
71
47
312
12,09
4
Written Media
11
30
81
174
6,74
5
Radio
5
11
29
66
2,56
6
Total weight = “1. degree frequency x3+2. degree frequency x2+ 3. degree frequency
x1” .
When the ranking of the communication tools that the participants apply to obtain information
on health services preference is examined, it is seen that references are 34.57%, internet is
29.22% and social networks are 14.81%. This fact indicates that healthcare consumers' first
preference as source of information is personal information sources. Although the references
are placed on the top, it is seen that the use of internet and social networks as a source of
information also occupy an important position as a result of the expansion of technological
facilities and widespread usage of them.
Priority order of the sources affecting the purchase decision that the consumers applied in the
selection of the healthcare service was investigated in the survey. For this purpose, pre-
determined potential sources are expected to be ranked according to priority order. The
weighted average was used in the calculations related to this ranking, and the results are shown
in Table 3.
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GÜRCÜ, KORKMAZ 13
Table 3. Distribution of Resources Affecting the Purchase Decision in the Selection of a
Healthcare Service by Priority Order
Resources
Priority Level
Weight
Priority
Order
1
2
3
Total
%
Medical specialist
207
109
46
885
34,30
1
Previously bought services
114
114
70
640
24,81
2
Own idea
53
75
108
417
16,16
3
Family
37
74
90
349
13,53
4
Friends
11
28
69
158
6,12
5
Relatives
8
30
47
131
5,08
6
Total weight = “1. degree frequency x3+2. degree frequency x2+ 3. degree frequency x1”
When the order of priority of the sources affecting the purchase decision of participants is
examined, medical specialists and service purchasers occupy the top position with a score of
34.30% and 24.81% respectively. The fact that information asymmetry in healthcare services
affects people's health service consumption process considerably.
The Pearson’s Correlation coefficient results, which determine the correlation between
receiver’s expertise and purchase intention, are shown in Table 4.
Table 4. Results of the Pearson’s Correlation Coefficient Results Determining the Correlation
Between Receiver’s Expertise and Purchase Intention
Receiver’s expertise
Purchase intention
Receiver’s expertise
r
1
,263**
p
,000
Purchase intention
r
1
p
When Pearson Correlation coefficient results were examined to analyze the correlation between
receiver's expertise and purchase intention, there was a weak positive correlation between
receiver's expertise and purchase intention (p <0.01) (0.20 <r <0.40) (r = 0.263). In other words,
it has been determined that the perception of purchase intention may increase if there is an
increase in the perception of receiver's expertise. Vice versa is also true.
The results of the Regression Analysis intended for testing the influence of receiver's expertise
on the purchase intention are shown in Table 5.
International Journal Health Management and Tourism http://dergipark.gov.tr/ijhmt
GÜRCÜ, KORKMAZ 14
Table 5. Results of Regression Analysis Intended for Testing the Influence of Receiver's
Expertise on Purchase Intention
Purchase
Intention
Constant
R2
Corrected
R2
F
Significance
F
Standardized
Beta
t
value
P
value
Receiver’s
Expertise
4,017
0,069
0,067
31,799
0,000
0,263
5,639
0,000
When the results of the regression analysis are examined receiver’s expertise seems to have a
significant influence on the purchase intention. Explanatory value of the model pertained to the
influence of receiver’s expertise on purchase intention has been determined as 6.7%. The
receiver's expertise has been found to have a positive influence of 26.3% on the purchase
intention (at a level of 0.05 significance). The regression model is as follows.
Purchase Intention=4,017+0,263*Receiver’s expertise
In the correlation and regression analysis performed, receiver's expertise has been inferred to
have a positive influence on the purchase intention (H1 has been accepted).
The Pearson’s Correlation coefficient results which determine the correlation between the
sender's expertise and the purchase intention, are shown in Table 6.
Table 6. Pearson’s Correlation Coefficient Results Determining the Correlation Between
Sender's Expertise and Purchase Intention
Sender’s expertise
Purchase intention
Sender’s expertise
r
1
,486**
p
,000
Purchase intention
r
1
p
When the Pearson’s Correlation coefficient for analyzing the correlation between sender's
expertise and the purchase intention is examined, there is a positive moderate relationship
between sender's expertise and the purchase intention (p <0.01) (0.40 <r <0.60) r = 0.486). In
other words, when sender's perception of expertise has increased, the perception of purchase
intention may increase. Vice versa is also true.
Regression analysis results intended for testing the effectiveness of sender's expertise on the
purchase intention are shown in Table 7.
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GÜRCÜ, KORKMAZ 15
Table 7. Regression Analysis Results Intended for Testing the Effectiveness of Sender's
Expertise on the Purchase Intention
Purchase
Intention
Constant
R2
Corrected
R2
F
Significance
F
Standardized
Beta
t
value
P
value
Sender’s
Expertise
3,109
0,236
0,234
132,216
0,000
0,486
11,499
0,000
When the results of the regression analysis are examined, it is seen that sender's expertise has a
significant influence on the purchase intention. The explanatory value of the model pertained
to the influence of sender’s expertise on purchase intention has been determined as 23.4%.
Sender's expertise has been found to have a positive influence of 48.6% on the purchase
intention (at a level of 0.05 significance). The regression model is as follows.
Purchase Intention=3,109+0,486*Sender’s expertise
In the correlation and regression analyzes performed, sender’s expertise has been inferred to
have a positive influence on purchase intention (H2 has been accepted).
The Pearson’s Correlation coefficient results which determine the relationship between
perceived risk and purchase intention are shown in Table 8.
Table 8. The Pearson’s Correlation Coefficient Results Determining the Correlation Between
Perceived Risk and Purchase Intention
Perceived risk
Purchase intention
Perceived risk
r
1
,550**
p
,000
Purchase intention
r
1
p
When Pearson’s Correlation coefficient results were examined to analyze the correlation
between perceived risk and purchase intention, it was found that there was a positive moderate
correlation between perceived risk and purchase intention (p <0.01) (0.40 <r <0.60) (r = 0.550).
In other words, when the perceived risk perception increases, it is determined that the perception
of purchase intention may increase. Vice versa is also true.
The results of the Regression Analysis intended for testing the influence of perceived risk on
purchase intention are shown in Table 9.
Table 9. Regression Analysis Results Intended for Testing the Influence of Perceived Risk on
Purchase Intention
Purchase
Intention
Constant
R2
Corrected
R2
F
Significance
F
Standardized
Beta
t
value
P
value
Perceived
Risk
2,196
0,302
0,301
185,320
0,000
0,550
13,613
0,000
International Journal Health Management and Tourism http://dergipark.gov.tr/ijhmt
GÜRCÜ, KORKMAZ 16
When the results of regression analysis are examined perceived risk appears to have a
significant influence on the purchase intention. The explanatory value of the model pertained
to the influence of perceived risk on purchase intention has been determined as 30.1%. The
perceived risk has been found to have a positive influence of 55% on the purchase intention (at
a level of 0.05 significance). The regression model is as follows.
Purchase Intention= 2,196+0,550*Perceived Risk
In the correlation and regression analysis performed, the perceived risk has been inferred to
have a positive influence on purchase intention (H3 has been accepted).
The Pearson’s Correlation coefficient results which determine the correlation between the tie
strength and purchase intention are shown in Table 10.
Table 10. Pearson Correlation Coefficient Results Determining the Correlation Between Tie
Strength and Purchase Intention
Tie strength
Purchase intention
Tie strength
r
1
.251**
p
.000
Purchase intention
r
1
p
When the Pearson’ Correlation coefficient results for the correlation between tie strength and
purchase intention are examined, there is a positive strong correlation between tie strength and
purchase intention. (p <0.01) (0.20 <r <0.40) (r = 0.251). In other words, it has been determined
that purchase intention perception may increase when there is an increase in tie strength
perception. Vice versa is also true.
The results of the Regression Analysis intended for testing the influence of tie strength on
purchase intention are shown in Table 11.
Table 11. Regression Analysis Results Intended for Testing the Influence of Tie Strength on
Purchase Intention
Purchase
Intention
Constant
R2
Corrected
R2
F
Significance
F
Standardized
Beta
t
value
P
value
Tie
Strength
4,396
0,063
0,061
28,899
0,000
0,251
5,376
0,000
When the results of regression analysis are examined it seems that the power of tie strength has
a significant influence on purchase intention. Explanatory value of the model pertained to the
influence of tie strength on purchase intention has been determined as 6.1%. Tie strength has
been found to have a positive influence of 25.1% on the purchase intention (at a level of 0.05
significance). The regression model is as follows.
International Journal Health Management and Tourism http://dergipark.gov.tr/ijhmt
GÜRCÜ, KORKMAZ 17
Purchase Intention=4,396+0,251*Tie strength
In the correlation and regression analysis performed, the tie strength has been inferred to have
a positive influence on purchase intention (H4 has been accepted).
The Pearson Correlation coefficient results which determine the correlation between receiver's
expertise and perceived risk are shown in Table 12.
Table 12. Pearson’s Correlation Coefficient Results Determining the Correlation Between
Receiver's Expertise and the Perceived Risk
Receiver’s expertise
Perceived risk
Receiver’s expertise
r
1
0,367
p
,000
Perceived Risk
r
1
p
When Pearson Correlation coefficient results were examined to analyze the correlation between
receiver's expertise and perceived risk, a weak positive correlation was found between
receiver’s expertise and the perceived risk (p <0.01) (0.20 <r <0.40) (r = 0.367).
The results of the Regression Analysis intended for the influence of the correlation between the
perceived risk and receiver’s expertise on purchase intention are shown in Table 13.
Table 13. Regression Analysis Results Intended for the Influence of the Correlation between
Perceived Risk and Receiver’s Expertise on Purchase Intention
Purchase
Intention
Constant
R2
Corrected
R2
F
Significance
F
Standardized
Beta
t
value
P
value
Model 1
2,355
0,226
0,224
125,073
0,000
0,476
11,184
0,000
When the results of the regression analysis are examined the correlation between the receiver’s
expertise and the perceived risk seems to have a significant influence on purchase intention.
The explanatory value of the model pertained to the influence of perceived risk and receiver’s
expertise on purchase intention has been determined as 22.4%. Receiver's expertise has been
found to have a positive influence of 47.6% on the purchase intention (at a level of 0.05
significance). The regression model is as follows.
Purchase Intention=2,355+0,476*Receiver’s expertise+ perceived risk
The correlation between perceived risk and receiver's expertise has been found to have a
positive influence on purchase (H5 has been accepted).
International Journal Health Management and Tourism http://dergipark.gov.tr/ijhmt
GÜRCÜ, KORKMAZ 18
In the correlation and regression analysis performed, the correlation between perceived risk and
receiver’s expertise has been concluded that it has a positive influence on the purchase
intention.
Results and Discussion
The word-of-mouth communication method, which has now become a topic of research in many
fields, has begun to attract attention of the health sector in recent years. Especially in Turkey as
well as in many parts of the world, the fact that health providers have to comply with legal
restrictions on advertising and publicity causes them to have difficulty in informing consumers
about the services they offer. Apart from this, health institutions are basically business entities
and carry out business activities. For this reason, they are in competition with other businesses
under difficult economic conditions. Whether public or private healthcare providers, they need
to realize marketing activities.
That satisfied people are initiator of positive word-of-mouth communication while dissatisfied
ones are initiator of negative word-of-mouth communication is concluded. Because of the fact
that a negative opinion the initiator of which is an unsatisfied consumer may spread in an
unobtrusive and uncontrollable manner, it is necessary for healthcare institutions to be aware
of the complaint of the patient. Solving problems and a more encouraging patient-hospital
communication for positive recommendation should be paid attention so that negative word-of-
mouth communication does not occur initially.
In the investigations made, it has been seen that the most effective source in selecting the
healthcare institution is medical specialists and the receivers who had already consumed the
service while the most effective communication tool is references. The Internet and social
networks are in a position that can be called a sine qua non. It can be expressed that the more
active use of references, internet and social networks in promoting the health institution
compared to the traditional communication tools will be more effective for the consumers to be
aware of the services. Also, using these tools together rather than focusing on one will increase
the expected effectiveness. The healthcare institution should accept every consumer as a
volunteer delegate, present real consumer experiences in promotional campaigns, and choose
opinion leaders from health professionals and consumers.
Compared to traditional promotion tools the use of word-of-mouth communication will both
provide cost advantage and stronger influence on the consumer. Businesses that have included
word-of-mouth communication in integrated marketing communication will be able to gain a
significant competitive advantage against their opponents.
In the research, it has been concluded that word-of-mouth communication affects consumers'
purchase intention. The effect of all sub-dimensions of word-of-mouth communication
(receiver's expertise, sender's expertise, perceived risk and tie strength) on purchase intention
was found to be influential on the purchase intention.
International Journal Health Management and Tourism http://dergipark.gov.tr/ijhmt
GÜRCÜ, KORKMAZ 19
This research is limited to the province of Yozgat. It is known that word-of-mouth
communication can affect the purchase process in different cultural structures. For this reason,
different results can be reached in the studies to be done in different provinces and regions. The
influence of word-of-mouth communication is significant issue not only in the preference of
hospital but in the usage proportion in certain branches that provide services in the hospital and
in purchase process as well. For instance, in some branches where experience and privacy are
fundamental, such as gynecology, urology, and even in some branches where advertising and
promotion are sometimes not possible due to the social structure, influences of word-of-mouth
communication can be stronger compared to branches such as dermatology, internal medicine
and radiology. In subsequent studies, researchers are addressed to study the influence of word-
of-mouth communication on the purchase process in different provinces and in certain
branches.
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