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Anti-consumption of public services: vacci(not)ion for Swine Flu

Anti-consumption of public services: vacci(not)ion for Swine Flu
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  Anti-consumption of publicservices: vacci(not)ionfor Swine Flu Melike Demirbag Kaplan  Department of Business Administration, Izmir University of Economics, Izmir, Turkey, and  Yusuf Cem Kaplan  Pharmacology and Clinical Toxicology, Izmir Atatu¨ rk Training and Research Hospital, Izmir, Turkey Abstract Purpose  – Anti-consumption is a new domain of research that deals with why individuals avoidconsumption of particular products. To date, research in this area is only confined to the rejection of goods,withnoevidencefromtheservicesindustry.Thepurposeofthispaperistoexploretheextentof anti-consumption behaviour for public health services, by deriving data from Swine Flu vaccinationresistance in Turkey. Design/methodology/approach  – The research employs a factor analysis method based on datacollected from 519 individuals. Findings  – Findings suggest that there is a strong anti-consumption attitude of the Turkish publictowards the service, and a major reason for avoidance was moral incompatibility, such that the publicbelieved that the vaccination served the interests of pharmaceutical companies and the government.Thefindingsalsorevealthatallthefactorspreviouslymentionedintheliteraturemaybeinvolvedintheanti-consumption of public health products. Originality/value  – This study suggests that public products, including public health services,arehighlysubjecttoanti-consumptionmovements,andpoliciesinvolvingsuchproductsshouldalsobeconsidered from this perspective in order to provide an increased welfare for the public. Keywords  Consumption, Public sector organizations, Health care, Diseases, Turkey Paper type  Research paper 1. Introduction Mostofthe consumerresearchstudiesfocus onthe factorsthatinfluence the choiceofaproduct or brand ( Lee  et al. , 2009b), as the practical implications of this information aremuch more attractive for businesses ( Dalli  et al. ,2006). However, the reasons that causeindividuals to not to consume have only started to attract attention in the recent years.This new field of research in consumer behaviour, which is coined with the term“anti-consumption”, enables the scholars and practitioners to comprehend reasons forconsumers’ avoiding a product and brand.Anti-consumption research has gained momentum in recent years, partly due to thechanges in consumers’ values leading to a resistance to certain products and brands.Such a resistance has urged scholars to examine reasons for consumers rejecting theseproducts, which reflects a deviance from traditional marketing research that generallyfocuses on factors leading to purchase behaviour ( Zavestoski, 2002a). Notably,the anti-consumption literature is still in its infancy and relevant studies in this domain The current issue and full text archive of this journal is available at www.emeraldinsight.com/2040-8269.htm Anti-consumption 353 Management Research ReviewVol. 34 No. 3, 2011pp. 353-363 q Emerald Group Publishing Limited2040-8269DOI 10.1108/01409171111116358  primarily focus on commercial goods and brands. On the other hand, research onanti-consumption attitudes towards public goods and services is literally nonexistent.However,itisevidentthattheconstructofanti-consumption,whichhasobviouslinkstoideological and moral values, should also be examined both for services and publicconsumption contexts.The main objective of this study is to investigate how anti-consumption behaviourcan address a public health service, the underlying factors that lead to such ananti-consumptionattitude,andtheircongruencewithexistingliterature.Tothisaim,thepaper empirically examines the Turkish Swine Flu Vaccination Case utilizing a surveydesignedtoassessthemagnitudeofresistancetowardsthevaccineandthemotivationsbehind this attitude. The organization of the paper is as follows: First, a review of literature on anti-consumption behaviour is presented, followed by the Swine Fluvaccination case in Turkey. Next, the methodology of the study is explained and thefindings are presented. The paper concludes with a through discussion of findings,particularly from a public services industry perspective. 2. Literature review  2.1 Anti-consumption Anti-consumption is a new domain of research that deals with why individuals avoidconsumption of particular products. Anti-consumption, by nature, is an essentialcomponent of marketing and can be defined as “a behaviour against consumption”(Craig-Lees, 2006; Lee et al. ,2009c).However, anti-consumptiondoes not merelyrefer tothe behaviour of not choosing a product due to better alternatives, but it reflects“a resistance to, distaste of, or even resentment of consumption” ( Zavestoski, 2002a).Inthiscontext,ananti-consumptionattitudemayassumeavarietyformsrangingfromactivebehaviours,suchasboycottingorvoluntarysimplification,tomorepassiveones,such as avoidance of a particular brand, a product, or a product category in general( Hogg  et al. , 2009). While still in its infancy, the current domain of anti-consumptionresearch compromises three broad areas which examine the factors leading toanti-consumption behaviour, the forms of anti-consumption, and the consequences of itfor consumers and producers. Of these, a review of anti-consumption motivations isessential to this study.Theliteraturesuggeststhatconsumersmayavoidabrandoraproductforanumberof reasons. First, some consumers may resist the consumption culture and try to minimizeconsumption,referredtoas“voluntarysimplicity”.Zavestoski(2002b) definesvoluntarysimplicity as a “system of beliefs and a practice, [ . . . ] centred on the idea that personalsatisfaction, fulfilment, and happiness result from a commitment to the nonmaterialaspects of life”. Voluntary simplifiers, therefore, tend to restrict their consumption infavourofasimplerlife,astheybelievethatthemajorityofcommercialproductsareinfactunnecessary, and are likely to express a heightened sensitivity to environmental andsocialissuesaswellasapreferencefornaturalproducts(Craig-Lees,2006;Craig-LeesandHill,2002;Klein etal. ,2004 ).Second,consumersmayavoidsomeproductsorbrandsduetoincongruencewithexpectations,self-identityormoralvalues,ascategorizedbyLee et al. (2009c ), who define the first category as experiential avoidance, where the consumersavoid a brand due to a negative experience. While experiential avoidance is defined asentailing a previous involvement with the product, Lee  et al.  (2009a) further expandedtheir model to cover anticipated unpleasant experiences and named this category MRR34,3 354  as deficit-value avoidance (DAV), where the consumers perceive a product to representan unacceptable cost to benefit trade-off. Thirdly, consumers may also avoid a brandbecause they are unable or unwilling to identify with, which leads to identity avoidance(IA). Such incongruence with the self-identity may arise when the product reflects anundesired self or a negative reference group ( Hogg, 1998; Hogg and Banister, 2001;Ogilvie, 1987; Sandıkcı and Ekici, 2009). Finally, moral avoidance (MA) is motivated byideological incompatibility, and in this case, consumers reject a brand due to political orsocio-economical values. These may include an ideological orientation that clashes withthebrand’spolicies( Lee etal. ,2009c )animositytowardsthecountryofsrcin( Klein,2002;Russell and Russell, 2006), or a belief that consuming foreign products is unpatriotic(Sandıkcı and Ekici, 2009). This category of avoidance may also overlap with themoral values that result in voluntary simplification behaviour ( McDonald  et al. , 2006 ).While Lee  et al. ’s (2009a, c) categorization is designed to describe avoidance of brands;itcanbeextendedtoproductsorproductcategoriesinpractice,includingpublicservices( Piacentini and Banister, 2009). Notably, the literature on the anti-consumption of publicservicesisonlyrecentlyemerging,includingthepioneeringpaperofLeeandMale(2010)on the anti-consumption of vaccines, particularly focusing on the possible reasons whysome parents resist vaccination of their children.  2.2 The healthcare industry and 2009 Swine Flu pandemic The healthcare industry holds a unique position for consumer research, particularly duetotwomainreasons:First,theindustryisoneofthemajorsectorsoftheserviceindustryboth in developed and developing countries ( Baltacioglu  et al. , 2007). In 2009, healthcareconsumed8.9percent ofthe GDPacross the organisationfor economic co-operation anddevelopment (OECD) countries with the USA (16 per cent), France (11.0 per cent), andSwitzerland(10.8percent)beingthetopthree(OECD,2009).Developingcountriesexhibita similar increasing trend in healthcare expenditures, and this increase is expected tosurpassexistingratiostoGDPinnearfuture,particularlyduetotheagingpopulationandtechnological advances (Cutler and Sheiner, 2001). Another significant characteristic of thehealthcareindustryisthatmosthealthspendingisfundedbypublicsourcesglobally,ashealthcareinvolvesanumberofeconomicalandethicalissuesthatdonotexistforotherindustries( Rice,2001 ).Thepublicfinancingofhealthcareservicesreachesto73percentforOECDcountriesonaverage,anditishigherthan80percentinsomecountriessuchasSweden and Denmark (OECD, 2009). Given these figures, it is not surprising thatgovernmentalpublichealthpoliciessignificantlyinterveneintheprovisionofhealthcareservices, which results in direct involvement in critical decisions, such as the number of providers or the quality of service. From a consumer behaviour perspective, suchintervention of the government in the healthcare industry isvery likely to influence howtheseservicesareperceivedbythecustomers,i.e.thesociety.Inthiscontext,thepositiveor negative evaluation of a public healthcare service may depend on the politicalorientation of the individual, as consumption is also an expression of political ideology( Crockett and Wallendorf, 2004; Ozalp and Zwick, 2008). These characteristics of thehealthcare industry have clearly contributed to the management of the 2009 Swine Flupandemic worldwide, as examined in the following sections of this paper.Swine Flu, which is caused by a novel H 1 N 1  strain of Influenza A virus, wasconsidered as the most important pandemic disease threat to world’s population by2009-2010, witha fast inter-personal transmission ( Gatherer, 2009). Fatalcomplications Anti-consumption 355  of the disease usually resulted from severe pneumonia and acute respiratory distresssyndrome,yet multi-organandrenalfailure alsoledtodeath inrarecases(Sinha, 2009).While antiviral agents might be administered for chemoprophylaxis and treatment,vaccine against H 1 N 1  was considered to be the most efficient approach to thedisease( Petrosillo et al. ,2009 )However,duringtheSwineFlupandemicof2009,severalconcerns regarding the vaccine arose on a global scale, which have hindered theimplementation of vaccination programs.ThedebateoncurrentSwineFluvaccinestemmedfromtwomainquestions.Thefirstquestion addresses the safety and efficacy of the vaccine, as rapid development andapprovalofthevaccineprovokeddebateovertheadequacyofclinicalstudies.Memoriesof previous events also have prompted this question since a vaccination programconducted in response to the emergence of swine influenza in Fort Dix in 1976 led to532 cases of Guillain-Barre syndrome and 32 deaths. A total of 40 million civilianvaccinations were carried out before the vaccine was withdrawn ( Marks and Halpin,1980 ).The second question related to the determination of risk groups. Although theAdvisory Committee on Immunization Practices identified the initial target groups forimmunization with Swine Flu vaccine as pregnant women, caregivers for infants agedless than six months, health-care and emergency medical services personnel, personsaged from six months to 24 years, and persons aged 25-64 years with chronic diseases(CDC, 2010), in practice, a significant dispute has arisen on the coverage of these riskgroups, particularly fuelled by the media and political organizations.  2.3 The case of Swine Flu vaccination in Turkey UponthenewsoftheSwineFluoutbreakinMexicoandWHOraisingSwineFluPandemicAlerttoLevel4bytheendofApril2009,theTurkishgovernmentpromptlyreactedtotheissueby placing thermal cameras at the major internationalairport of Turkey,as well asproviding a quarantine room and ambulance transport to a prearranged state hospital(   Haber7  ,2009).EarlyinMay2009,theMinistryofTurkishHealthalsosetupacallcentrefrom which public could obtain information regarding protection, the course of diseaseand treatment. Shortly after, on 16 May, the first Swine Flu case was reported, a USAcitizen,whoonentrytotheairport,hasbeendetectedbythermalcameras(   Hurriyet  ,2009).One month later, the government declared that ten million citizens would be vaccinatedagainstfluatnocost.BymidJune,55citizenshadbeendiagnosedwiththediseaseandbythe end of August 2009 the number had risen to 411 (   Milliyet  , 2009).September2009beganwithastatementfromtheMinistryofHealthhighlightingtheimportance of vaccination, but as the month passed, the intensity of the debate on thisissueincreased. Atthe beginningofOctober, the MinistryofHealthdeclaredthat fundsequivalent to  e 220 million have been reserved for 43 million doses of the vaccine(Ayvaz, 2009), and vaccination process would be held by government organizationsrather than the pharmacies. Debate over vaccination peaked during this month as themedia, politicians and nongovernmental organizations have taken conflicting attitudestowards the issue. The dispute over the vaccine focused on three aspects in particular,the adjuvants used in the vaccine, short and long-term adverse effects, and whether thegovernmentdeliberatelysetouttoserveitsownsupporters’bestinterestsbyimportingamassiveamountofvaccines.Untilthispoint,only11SwineFludeathshaveoccurredinTurkey(  CNN Turk ,2009).Thevaccinationbeganon7November;howeverthedemand MRR34,3 356  was relatively low even in the healthcare workers. By January 2010, the death tollreached 415 (   Ntvmsnbc , 2010).Nevertheless, at the same time, only four million doses of the vaccine wereadministered, which led the government to cancel the procurement of 33 of the total43 million doses (  Ozgenc , 2010). Meanwhile, agencies reported that several otherEuropean governments, including those of France and Germany, cancelled theprocurement or delivery of as many as one hundred million doses of the vaccine due tolow public demand (   Radio France Internationale , 2010; Shirbon, 2009).As previously noted, anti-consumption research is currently limited to commercialgoods, particularly due to the fact that it is a new area of study. In this context, theanti-consumptionattitudestowardsservicesappeartobeasignificantliteraturegap.Thisstudy empirically examines the anti-consumption behaviour of the society for a specificcase,namelytherejectionoftheSwineFluvaccinationserviceinTurkeyduringlate2009. 3. Methodology For this research, the initial procedure included the development of scale items forassessing the anti-consumption attitude and the underlying motives, which utilized aGoogle.com keyword search for “What do you think about Swine Flu vaccination?” and“WillyouundergoSwineFluvaccination?”Thefirst30websitesforeachkeywordsearch,mainly bulletin boards, were content analyzed for positive and negative reactions of thepublic,andemergingthemesweredesignatedinto19scaleitems.Theitemswereratedon5-point Likert scales, rangingfrom1,completelydisagree;to5,completelyagree,whereascore closer to five represented a stronger anti-consumption attitude. In order to avoidbias, seven of the statements were framed in a positive manner towards vaccinationand were randomly distributed throughout the questionnaire. These positively phrasedstatements were reverse coded for the analysis. The reliability analysis for the scalegenerated a Cronbach Coefficient Alpha score of 0.85, which is satisfactory as theminimum level of internal consistency is stated to be 0.70 (Nunnally, 1978).The 19-item-scale was then developed into a survey, including seven other questions tocollect data on demographics and political orientation. Political orientation was consideredan important variable for the research as public woes remarkably noted a “misdeed of thegovernment” and assessment was based on the votes of the respondents during the recentelections in Spring 2009. Interestingly, the content analysis did not yield any concernsregarding the specific ingredients that may be contained within the vaccine, such as swineDNA, which turned out to be a serious issue in some other Muslim populations (Benson,2009). A possible reason to this may be the solid support to the vaccination by the AKP(JusticeandDevelopmentParty)government,whichisconsideredpro-Islamistbythemost,and hence a likely pressure on the media to refrain from such debates. The survey wasself-administered online and conducted during the first two weeks of December 2009employingaconveniencesample.Inordertoreachalargeandreliablesample,thehyperlinkofthesurveywebsitewaspostedonthreebulletinboardsincludingalargevarietyoftopicswith a very high traffic, where the number of members for each bulletin exceeded 120,000. 4. Findings A completed 519 questionnaires were returned and analyzed. A total of 47.6 per cent of participantswerefemale,51.3percentwereinthemiddle-incomeclass,and17.3percenthold a high school degree, while 59.7 per cent were university graduates. The mean age Anti-consumption 357
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