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Date:         Fri, 19 Jun 2009 07:39:22 -0400
From:         "BROWN, STEVEN" 
Subject: Q Bibliography: Hughner & Kleine on theories of health
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Hughner, Ren=E9e Shaw, & Susan Schultz Kleine (2008, December).  Variations=
 in lay health theories: Implications for consumer health care decision mak=
ing.  Qualitative Health Research, 18(12), 1687-1703.

Abstract.  Wide variations in how contemporary consumers think about health=
 and make health care decisions often go unrecognized by health care market=
ers and public policy decision makers. In the current global environment, p=
revailing Western viewpoints on health and conventional biomedicine are bei=
ng challenged by a countervailing belief system forming the basis for alter=
native health care practices. The ways American consumers once thought abou=
t health have changed and multiplied in this new era of competing health pa=
radigms. Our study provides empirical evidence for this assertion in two wa=
ys. First, it demonstrates that in the current environment consumers think =
about health and health care in a multiplicity of very different ways, lead=
ing to the conclusion that we should not classify health care consumers as =
either conventional or alternative. Second, the results provide clues as to=
 how individuals holding diverse health theories make health care decisions=
 that impact health behaviors, treatment efficacy, and satisfaction judgmen=
ts.

Ren=E9e Shaw Hughner  is an assistant professor of mark=
eting at Arizona State University in the Morrison School of Management and =
Agribusiness, Mesa, Arizona, USA.  Susan Schultz Kleine  > is an associate professor of marketing at Bowling Green=
 State University College of Business Administration in Bowling Green, Ohio=
, USA.

Although their abstract does not say so explicitly, Q methodology is centra=
l to this study. Administered to a P set of n=3D35 individuals, the Q sampl=
e (N=3D63) was structured in part in terms of the professional biomedical p=
aradigm on the one hand and a variety of alternative and unconventional vie=
ws on the other.

The first of six lay factors was least conventional in orientation and was =
distinguished from the others by embracing views such as "I would prefer to=
 be treated by an alternative approach such as herbals or homeopathy than b=
y conventional medicine."  Interpretation of this as well as the other fact=
ors is well fortified with comments taken from post-sorting depth interview=
s.

The second factor emphasizes life-style issues but also sides with professi=
onal expertise:  "Technical expertise and knowledge is far more important i=
n a doctor than personal qualities."

The third factor was comprised of busy professionals who really had no time=
 for illness; their philosophy was therefore one of plugging away and maint=
aining a positive attitude:  "As long as I keep going, I tend not to get si=
ck- keeping busy doesn't allow one to have the time to get sick!" and "The =
power of a positive outlook or attitude can prevent sickness."

Factor 4, even more so than 2, has unbridled confidence in all aspects of c=
onventional biomedicine and the medical profession:  "Medical doctors (MDs)=
 are the primary health experts and authorities" and  "I rely on my doctor =
to take care of my health; that's what he or she gets paid for."  Faith in =
pharmaceuticals is also in evidence:  "When I'm not feeling well, I prefer =
that my physician write me a prescription so that I can recover more quickl=
y."

By way of contrast, the fifth factor carries a spiritual and religious comm=
itment: "Spiritual commitment is essential to optimal health," "I believe t=
hat maintaining good health includes meditation or prayer," and "Faith-heal=
ing can restore wellness."

Whereas the previous factor associates health with religion, the sixth fact=
or goes one step farther and attributes both health and illness to divine i=
ntent:  "God works in mysterious ways-health and sickness is part of the di=
vine plan-meant for a reason."  This factor does not rely on prayer to cure=
 illness, however; rather, "Having regular contact with a physician is the =
best way to avoid illness" and "When it comes to medical treatment, patient=
s should always follow their doctor's advice."

The subtitle of this article emphasizes "consumer health care decision maki=
ng," but consumer behavior often has a way of spilling over into political =
decision making.  As reported in some Ohio newspapers this morning, state l=
egislation was proposed yesterday that would levy criminal charges on paren=
ts and guardians who would rely on prayer rather than doctors as the only t=
reatment of sick children (http://www.recordpub.com/news/article/4611172). =
 Such legislation seems especially aimed at factor 5, and whereas factor 4 =
might be least ambivalent about supporting this legislation, the above resu=
lts suggest that the other factors (except for 5) would at least provide li=
ttle opposition if not outright support.  What the results reveal is the di=
verse motivational base of those who would likely support the proposal.  It=
 also helps explain why the author of the House Bill, in implicit recogniti=
on of factor 5, was quick to point out the limits of the bill:  that it is =
not intended to impinge on adults' decisions for themselves and that it "is=
 not attempting to discredit religious institutions that practice spiritual=
 healing"; rather, that "this legislation is designed to eliminate faith-ba=
sed healing as the only method of treatment for minors with physical or men=
tal illness."  Savvy politicians are usually intuitively aware of the Q fac=
tors that exist, if only in shadowy outline.  Q methodology frequently remo=
ves the shadows.

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Hughner, Renée Shaw, & Susan Schultz Kleine (2008, December). &n=
bsp;Variations in lay health theories: Implications for consumer health car=
e decision making.  Qualitative Health Research, 18(12), 1687-1=
703. 



Abstract.  Wide variations in how contemporary consumers think =
about health and make health care decisions often go unrecognized by health=
 care marketers and public policy decision makers. In the current global en=
vironment, prevailing Western viewpoints on health and conventional biomedi=
cine are being challenged by a countervailing belief system forming the bas=
is for alternative health care practices. The ways American consumers once =
thought about health have changed and multiplied in this new era of competi=
ng health paradigms. Our study provides empirical evidence for this asserti=
on in two ways. First, it demonstrates that in the current environment cons=
umers think about health and health care in a multiplicity of very differen=
t ways, leading to the conclusion that we should not classify health care c=
onsumers as either conventional or alternative. Second, the results provide=
 clues as to how individuals holding diverse health theories make health ca=
re decisions that impact health behaviors, treatment efficacy, and satisfac=
tion judgments.



Renée Shaw Hughner <renee.shaw@asu=
.edu> is an assistant professor of marketing at Arizona State Univer=
sity in the Morrison School of Management and Agribusiness, Mesa, Arizona, =
USA.  Susan Schultz Kleine <skleine@BG=
SU.EDU <skleine@BGSU.EDU> > i=
s an associate professor of marketing at Bowling Green State University Col=
lege of Business Administration in Bowling Green, Ohio, USA.



Although their abstract does not say so explicitly, Q methodology is centra=
l to this study. Administered to a P set of n=3D35 individuals, the =
Q sample (N=3D63) was structured in part in terms of the professiona=
l biomedical paradigm on the one hand and a variety of alternative and unco=
nventional views on the other.  



The first of six lay factors was least conventional in orientation and was =
distinguished from the others by embracing views such as “I would pre=
fer to be treated by an alternative approach such as herbals or homeopathy =
than by conventional medicine.”  Interpretation of this as well =
as the other factors is well fortified with comments taken from post-sortin=
g depth interviews.



The second factor emphasizes life-style issues but also sides with professi=
onal expertise:  “Technical expertise and knowledge is far more =
important in a doctor than personal qualities.”



The third factor was comprised of busy professionals who really had no time=
 for illness; their philosophy was therefore one of plugging away and maint=
aining a positive attitude:  “As long as I keep going, I tend no=
t to get sick— keeping busy doesn’t allow one to have the time =
to get sick!” and “The power of a positive outlook or attitude =
can prevent sickness.”



Factor 4, even more so than 2, has unbridled confidence in all aspects of c=
onventional biomedicine and the medical profession:  “Medical do=
ctors (MDs) are the primary health experts and authorities” and  =
;“I rely on my doctor to take care of my health; that’s what he=
 or she gets paid for.”  Faith in pharmaceuticals is also in evi=
dence:  “When I’m not feeling well, I prefer that my physi=
cian write me a prescription so that I can recover more quickly.”



By way of contrast, the fifth factor carries a spiritual and religious comm=
itment: “Spiritual commitment is essential to optimal health,” =
“I believe that maintaining good health includes meditation or prayer=
,” and “Faith-healing can restore wellness.”



Whereas the previous factor associates health with religion, the sixth fact=
or goes one step farther and attributes both health and illness to divine i=
ntent:  “God works in mysterious ways—health and sickness =
is part of the divine plan—meant for a reason.”  This fact=
or does not rely on prayer to cure illness, however; rather, “Having =
regular contact with a physician is the best way to avoid illness” an=
d “When it comes to medical treatment, patients should always follow =
their doctor’s advice.”



The subtitle of this article emphasizes “consumer health care decisio=
n making,” but consumer behavior often has a way of spilling over int=
o political decision making.  As reported in some Ohio newspapers this=
 morning, state legislation was proposed yesterday that would levy criminal=
 charges on parents and guardians who would rely on prayer rather than doct=
ors as the only treatment of sick children (http://www.recordpub.com/news/article/4611172).  Such legislation seems especially aimed at factor 5, and whereas =
factor 4 might be least ambivalent about supporting this legislation, the a=
bove results suggest that the other factors (except for 5) would at least p=
rovide little opposition if not outright support.  What the results re=
veal is the diverse motivational base of those who would likely support the=
 proposal.  It also helps explain why the author of the House Bill, in=
 implicit recognition of factor 5, was quick to point out the limits of the=
 bill:  that it is not intended to impinge on adults’ decisions =
for themselves and that it “is not attempting to discredit religious =
institutions that practice spiritual healing”; rather, that “th=
is legislation is designed to eliminate faith-based healing as the only met=
hod of treatment for minors with physical or mental illness.”  S=
avvy politicians are usually intuitively aware of the Q factors that exist,=
 if only in shadowy outline.  Q methodology frequently removes the sha=
dows.




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