Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
Examining the Perceived Value of Health Care Consumers According to
the Gender Roles
Eda Yilmaz Alarcin* and Mert Uydaci**
The number of health institutions is increasing year by year in Turkey. In this case, it will be
more important as the time goes by how the service offered is perceived by the health care
consumers and how sensitively the consumers place an emphasis to perceived values
dimensions. In this research, whether the value health care consumers perceive according
to their sex and gender roles shows a difference for each perceived value dimension was
aimed to be tested. The sample size was calculated as 384, based on a significance level
of 0.05 and 416 questionnaire were collected. Questionnaire included sections about
socio-demographic information, health care consumption behavior, gender roles inventory
and consumer value dimensions. BEM Sex Role Inventory (BSRI) was used in measuring
gender roles. The independent samples t test was used in order to test whether there was
a significant difference in perceived value dimensions according to sex; the one-way
analysis of variance was used in order to test whether there was a significant difference in
perceived value dimensions according to gender roles. At the end of the study, it was seen
that persons who have different sex do not seem to distinguish about their value perception
for health care. Somehow, it was come to a conclusion that, the value that persons who
have different gender roles perceive offers a difference for each value dimension.
Respondents make decisions according to their gender roles rather than their sex.
Keywords: Perceived Value, Gender Roles, Consumer Behavior
1. Introduction
Intensity of competition between local firms and the international brands even in the globalized world,
increase in consumer awereness, the excessive number of messages that consumers are exposed,
variety of products and services, increasing the number of brand alternatives and experienced
technological developments increase the importance of positive value perceptions for the brands. In
Turkey where the contrubition of integrated marketing programs is recently understood for health
services, creating positive value towards health institutions will become even more important over
time.
In this context, the construct of perceived value has recently gained much attention from marketers
and researchers. Perceived value also plays important role in predicting purchase behavior and
achieving sustainable competitive advantage. However, in recent years it has been recognized that
consumer behavior is better understood when analyzed through perceived value. (Chen and Dubinsky
2003; Gallarza and Saura 2006).
The view of individual's decision-making based on gender roles rather than biological sex has led us
to research whether the importence given to perceived value dimensions is different according to the
gender roles. Having masculine, feminine, androgynous or undifferentiated gender role of the
individual may differ by the biological sex discrimination indicated as women and men. In this study,
whether perceived value dimensions for health services are different according to the sex and gender
roles is tested.
*Asst.Prof.Dr. Eda Yilmaz Alarcin, Health Management Programme, Faculty of Health Sciences, Istanbul University,
Turkey. Email: eyilmaz@istanbul.edu.tr Phone no: +90 212 4141500 Fax no: +90 212 4141515
**Prof.Dr. Mert Uydaci, Marketing Programme,Vocational School of Social Sciences, Marmara University, Turkey. Email:
muydaci@marmara.edu.tr Phone no: +90 216 3089348 Fax no: +90 216 414571
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Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
2. Literature Review
2.1. Gender Roles
Many researchers use the terms sex and gender interchangeably (Carver et al. 2013). Sex refers to
whether one is born a male or a female. It is a biologically based distinction. Gender refers to
personality traits, activities, interests, and behavior. Gender is a socially based distinction that we
label with the terms masculine, feminine, and androgynous (Beere 1990). The other definition is “the
beliefs people hold about members of the categories man or woman”. Many social psychological
studies have shown that these gender roles vary among different cultures and ethnic groups (Özkan
and Lajunen 2005). In the field of psychology, much research is conducted involving individuals‟
perceptions of gender roles, and behavioral as well as attitudinal correlates. Gender roles are cultural
expectations about what is appropriate behavior for each sex (Weiten et al. 2012; Holt and Ellis 1998).
Vafaei et al. (2014) submit that gender roles are often a self-perceived construct and are based on
how individuals identify themselves as masculine or feminine. Gender role, sometimes referred to as
an individual‟s psychological sex, has been defined as the fundamental, existential sense of one‟s
maleness or femaleness. Since gender is culturally derived, gender role is similarly rooted in cultural
understandings of what it means to be masculine or feminine. For many years, sex and gender were
thought to be inseparable—that is, men were masculine and women were feminine. But what
consumer behavior researchers, among others, recognized long ago was that some men were more
feminine than masculine while some women were more masculine than feminine. In the postmodern
culture in which we now live, this separation of gender from sex is even more apparent (Palan 2001).
Gender-role identification is the extent to which a male is masculine and a female is feminine.
Although different definitions of masculinity and femininity exist, masculine traits generally include
being independent, ambitious, assertive, and dominant and feminine traits generally include being
passive, being warm, lacking in leadership skills, and being dependent (Daigle and Mummert 2013).
In 1974, Bem developed the Bem Sex-Role Inventory (BSRI), an instrument used to measure gender
role perceptions. Bem (1979) emphasized the role of culture by defining the purpose of the Bem Sex
Role Inventory (BSRI) to assess the extent to which the culture‟s definitions of desirable female and
male attributes are reflected in an individual‟s self-description. The BSRI is a measure of masculinityfemininity and gender roles. It assesses how people identify themselves psychologically. Bem's goal
of the BSRI was to examine psychological androgyny and provide empirical evidence to show the
advantage of a shared masculine and feminine personality versus a sex-typed categorization (Askin
and Miman 2014).
Both in psychology and in society at large, masculinity and femininity have long been conceptualized
as bipolar ends of a single continuum; accordingly, a person has had to be either masculine or
feminine, but not both. This sex-role dichotomy has served to obscure two very plausible hypotheses:
first, that many individuals might be "androgynous"; that is, they might be both masculine and
feminine, both assertive and yielding, both instrumental and expressive—depending on the situational
appropriateness of these various behaviors; and conversely, that strongly sex-typed individuals might
be seriously limited in the range of behaviors available to them as they move from situation to
situation (Bem 1974).
Bem (1974) was the first person who argued against the exclusive dichotomy of gender roles and
defined four gender roles: A person with high masculine and low feminine identification would be
categorized as „masculine‟, a person with high feminine identification and low masculine identification
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Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
would be categorized as „feminine‟, a person who had high identification with both characteristics
would be categorized as „androgynous‟, and finally a person who has low identification with both
dimensions would be considered „undifferentiated‟. She hypothesized that „androgynous‟ individuals
regardless of their biological sex, depending on the situational appropriateness can be instrumental
and assertive or expressive and yielding (Vafaei et al 2014).
The BSRI is a widely used instrument in psychology and other fields because it measures masculine
and feminine gender roles separately, is able to yield a measure of androgyny, and has adequate
psychometric properties (Holt and Ellis 1998; Askin and Miman 2014).
The adaptation of BSRI to Turkish society has been made by Kavuncu (1987). Kavuncu replaced the
characteristics considered not to comply with Turkish society with the other characteristics suggested
and reached a consensus, based on the evaluation of a group of professionals on the Turkish
translation of inventory. The validty and reliabilty studies of Turkish form of BSRI have brought to a
succesful conclusion. Kavuncu has also advised the short form of inventory (Dökmen 1999). BSRI
includes both a Masculinity scale and a Femininity scale, each of which contains 20 personality
characteristics. BSRI also includes a Social Desirability scale which contains 20 neutral
characteristics. Social Desirability scale, which is completely neutral with respect to sex, serves
primarily to provide a neutral context for the Masculinity and Femininity scales (Dökmen 1991). Social
Desirability scale was not used in this study.
2.2. Concept of Perceived Value
Perceived value has become a new strategic imperative for retailers; indeed, some authors have
contended that perceived value has, in some respects, superseded more narrowly defined concepts
such as quality and satisfaction (Sánchez-Fernández and Iniesta-Bonillo 2004). Perceived value has
been found to be a powerful predictor of purchase intention (Chen and Dubinsky 2003). The
importance of perceived value in relation to purchase intentions was documented in the early literature
but it is only in recent years that the concept of perceived value has received increasing attention. It is
suggested that perceived value can be enhanced by either adding benefits to the service or by
reducing the outlays associated with the purchase and use of the service (Tam 2004).
In fact, value is a key for gaining competitive advantage; it also has been seen as a definitive option to
improve a destination‟s competitive edge. Although the concept of value is old and particular to
consumer behavior, many authors have recognized a lack of interest in understanding and measuring
perceived value (Gallarza and Saura 2006). While the first determinant of overall customer
satisfaction is perceived quality, the second determinant of overall customer satisfaction is perceived
value (Cronin et al. 2000). From the point of view of marketing strategy, creating perceived value in
consumer marketing means meeting target customers‟ needs and increasing customer satisfaction.
Perceived value has been used extensively by market-oriented firms to differentiate themselves from
competitors (Chen and Dubinsky 2003).
The concept of perceived value, that marketing researchers have recently been trying to grapple with
and to study in greater depth, is stated as the essential result of marketing activities and is a first-order
element in relationship marketing (Sánchez-Garcia et al. 2006; Mathwick et al. 2001; Ulaga and
Chacour 2001). It has been emphasized by the authors that perceived value is a construct that has
attracted the attention of a number of researchers. They also point out one aspect that has been
assumed but little tested in the literature is that the valuation of a relationship is directly influenced by
the successive transactions taking place over time. In this context, the perceived value of a purchase
(transaction) is an antecedent of the quality of the relationship with an establishment (relationship).
For this reason relationship quality aims to measure the lifetime value of a customer, which is an
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Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
aspect that the Marketing Science Institute (MSI) highlights among its research priorities for the
coming years (Sánchez-Garcia et al. 2007).
It has been seen in perceived value oriented-studies that there are different marketing terms
representing “perceived value” are used and most of them have the same meaning. The terms that
are frequently used in the literature are stated as; “perceived value” (Zeithaml 1988; Sweeney and
Soutar 2001)”, “customer perceived value” (Grönroos 2010), “consumer value” (Holbrook 1999),
“customer value” (Holbrook 1996; Woodruff 1997; Parasuraman 1997; Anderson et al. 1993; Slater
and Narver 1994), “perceived customer value” (Chen and Dubinski 2003), “value” (De Ruyter et al.
1997), “perceived value for money” (Sweeney et al. 1999), “consumption value” (Tse et al. 1988;
Sheth et al. 1991), “acquisition and transaction value” (Grewal et al. 1998; Parasuraman and Grewal
2000), “value consciousness” (Lichtenstein et al.1990) and“service value” (Bolton and Drew 1991).
Numerous research studies have investigated this aspect in an articulate way but, to date, there has
been no univocal definition of the perceived value. More precisely, although different
conceptualizations exist in literature (client utility; benefits in relation to sacrifice; psychological price;
monetary value and quality), a prevailing approach is recognizable which is the one based on the wellknown Anglo-Saxon concept of value for money, or rather, on the trade-off between monetary price
and quality (Rigatti-Luchini and Mason 2010).
Zeithaml (1988) reports considerable heterogeneity among consumers in the integration of the
underlying dimensions of perceived value (Sinha and DeSarbo 1998). Zeithaml (1988, p. 14) found
that, though consumers have different conceptions about perceived value, it can be captured in one
overall definition: “Perceived value is the consumer‟s overall assessment of the utility of a product
based on perceptions of what is received and what is given”. Essentially, value represents a trade-off
of salient get and give-components, which are perceived as benefits and sacrifices, respectively
(Chen and Dubinsky 2003; Gallarza and Saura 2006; Nasution and Ardin 2010).
Although perceived value often has been defined as a trade-off of quality and price, several marketing
researchers have noted that perceived value is a more obscure and complex construct, in which
notions such as perceived price, quality, benefits, and sacrifice all are embedded and whose
dimensionality requires more systematic investigation (Sinha and DeSarbo 1998; Kim 2002; Chen and
Dubinsky 2003). On the one hand, perceived value is understood as a construct configured by two
parts, one of benefits received by the customer (economic, social and relationship) and another of
sacrifices made (price, time, effort, risk and convenience) (Sánchez-Garcia et al. 2007)
According to Woodall (2003), perceived value is stated as any demand-side, personal perception of
advantage arising out of a customer‟s association with an organization‟s offering, and can occur as
reduction in sacrifice; presence of benefit (perceived as either attributes or outcomes); the resultant of
any weighed combination of sacrifice and benefit (determined and expressed either rationally or
intuitively); or an aggregation, over time, of any or all of these. Woodruff (1997) expands the concept
of perceived value and describes it as a source of competitive advantage (Chen and Dubinsky 2003).
According to Woodruff (1997), perceived value is “a customer's perceived preference for and
evaluation of those product attributes, attribute performances, and consequences arising from use
that facilitate (or block) achieving the customer's goals and purposes in use situations.” Parasuraman
(1997) emphasize that perceived value occurs in consumers‟ mind regarding a product or service in
consequence of assessment of benefits and costs that consumers perceived.
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Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
2.3. Perceived Value Dimensions
According to different authors, recently an approach based on the conception of perceived value as a
multidimensional construct has been gaining ground (Kim 2002; Eggert and Ulaga 2002; Yang and
Peterson 2004; Huber and Morgan 2001; Snoj et al. 2004; Gallarza and Saura 2006). This approach
allows us to overcome some of the problems of the traditional approach to perceived value,
particularly its excessive concentration on economic utility (Sanchez-Garcia et al. 2007; Cengiz and
Kirkbir 2007; Sanchez et al. 2006; Snoj et al. 2004). In general, the authors who study the concept of
value as a multidimensional construct agree that two dimensions can be differentiated: one of a
functional character and another of an emotional or affective type (Fandos-Roig et al. 2009).
Considering all of these, single item scale does not address the concept of perceived value, since it is
constructed with multiple dimensions. Therefore, measuring multiple components of perceived value
has been recommended by many researchers (Lee et al. 2007).
Zeithaml (1988) conceptualize perceived value with two dimensions as “benefit” and “sacrifice” which
are seen in Table 1 (Zeithaml 1988; Cronin et al. 2000; Mcdougall and Levesques 2000; Tam 2004;
Anderson et al. 1993; Lapierre 2000; Lichtenstein et al. 1990; Grönroos 2010).
Table 1. Zeithaml‟s Perceived Value Dimensions
Dimensions
Description
Benefit
The benefit components of value include salient intrinsic attributes,
extrinsic attributes, perceived quality, and other relevant high level
abstractions.
The sacrifice components of perceived value include monetary prices
and nonmonetary prices such as time, energy and effort.
Sacrifice
Sweeney and Soutar (2001) has defined perceived value dimensions which are “emotional value”,
“functional value- performance/ quality”, “functional value- price/ value for money” and “social valueenhancement of social self- concept”, as it is seen in Table 2.
Table 2. Sweeney and Soutar‟s Perceived Value Dimensions
Dimensions
Description
Emotional Value
The utility derived from the feelings or affective
states that a product generates
Functional
Value The utility derived from the perceived quality and
(Performance/ Quality)
expected performance of the product
Functional
Value The utility derived from the product due to the
(Price/ Value for Money)
reduction of its perceived short term and longer term
costs
Social
Value The utility derived from the product‟s ability to
(Enhancement of Social
enhance social self-concept
Self- Concept)
Woodall (2003) presend perceived value dimensions as “exchange value”, “intrinsic value”, “use
value” and “utilitarian value”. Stated perceived value dimensions are found in Table 3.
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Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
Dimensions
Exchange
Value
Intrinsic Value
Use Value
Utilitarian
Value
Table 3. Woodal‟s Perceived Value Dimensions
Description
Exchange value is object-based, and primarily influenced by the
nature of the object and the market in which it is offered. The
subject, however, has an influence on the process of ascribing
value as he/she can either accept, reject and/ or negotiate the
value that is offered.
Intrinsic value is object-based, and is perceived as the object
and subject interact (before, or during consumption).
Use value is subject-based, and is also perceived as the object
and subject interact (during, or after consumption).
Utilitarian value is subject based, and can be identified at the
point when intrinsic and/or use-value are compared with the
sacrifice the subject is required to make in order to experience
those forms of value.
By means of a multi-dimensional procedure, Sanchez et al. (2004) have developed a scale of
measurement of the perceived value of a purchase. On the basis of Sheth et al. (1991), and the
PERVAL scale by Sweeney and Soutar (2001) Sánchez-Garcia et al. (2007) have developed the
GLOVAL scale which measures the perceived value of a purchase, including not only the
establishment but also the product purchased there, widening the scope of the PERVAL scale (Cengiz
and Kırkbir 2007; Sánchez-Garcia et al. 2007). Sánchez-Garcia et al. (2006) conducted the survey on
tourists who buy tourism packages. The dimensions of scale which is discussed in this research can
be seen below:
Table 4. Sánchez et al.‟s Perceived Value Dimensions
Description
Functional value of the It can be stated as a customer‟s perception regarding
travel agency: installations installations‟ location, structure and so on.
Dimensions
Functional value of the
contact personnel of the
travel
agency:
professionalism
Functional value of the
tourism
package
(quality)
Functional value price
It can be stated as a customer‟s perception regarding
contact person‟s advices, knowledge about the job
and products/ services, professionalism etc.
It can be stated as a customer‟s perception regarding
product/ service quality, performance and how it is
served.
It can be stated as a customer‟s perception regarding
the price of served service/ product or whether the
price is the main criterion etc.
Emotional value of the It can be stated as a customer‟s perception regarding
purchase
how a customer feels in the service point, motivation
of contact person etc.
Social value of the It can be stated as a customer‟s perception regarding
purchase
social approval and gaining reputation etc.
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Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
The other perceived value dimensions in the literature can be seen in Table 5.
Author (s)
Table 5. Other Perceived Value Dimensions in the Literature
Dimensions
Holbrook
(1999; 1996)
Sheth et al. (1991)
Al-Sabbahy et
(2004)
Sin et al. (2001)
Extrinsic Value (Efficiency, Excellence, Status, Esteem)
Intrinsic Value (Play, Aesthetics, Ethics, Spirituality)
Functional Value, Social Value, Emotional Value,
Epistemic Value, Conditional Value
al. Acquisition Value, Transaction Value
Aesthetic Value, Instrumental Value, Social Value
Patriotic Value
Jensen and Hansen Harmony,
Excellence,
Emotional
Stimulation,
(2007)
Acknowledgement, Circumstance Value
De Ruyter et al. Emotional Value, Practical Value, Logical Value
(1997)
Grewal et al. (1998) Perceived Acquisition Value, Perceived Transaction Value
Kantamneni
and Core Value, Personal Value, Sensory Value, Commercial
Coulson (1996)
Value
Parasuraman
and Acquisition Value, Transaction Value, In-use Value,
Grewal (2000)
Redemption Value
Tse et al. (1988)
Aesthetics, Instrumental: Basic Needs, Social: Acceptance
and Instrumental: Higher Level Needs, Social: Morality,
Simple, Fit My Status, Social: Trendiness, Value
Babin et al. (1994)
Hedonic Value, Utilitarian Value
Butz and Goodstein Expected Value, Desired Value, Unanticipated Value
(1996)
3. The Methodology and Model
The purpose of this research is to investigate if the value that health care consumers perceive about
health care is making a difference, firstly according to sex and secondly according to gender role. The
first purpose has been tested by “independent samples t test” and the second purpose has been
tested by “one-way analysis of variance”.
The population of the research is the health care consumers living in Istanbul. As all those who live in
Istanbul can be health care consumers, sampling size has been determined over Istanbul. According
to TUIK data (www.tuik.gov.tr), the population of Istanbul is 14,377,018.- as of 2014. Confidence
interval is 95 %, sampling error is ± 5 % has been calculated as (d=0.05) and n=384.
Young persons have been aimed mostly in the research. It is because, when older persons apply to
health institutions, they are accompanied by a young relative. Besides, it has been seen that older and
low-educated persons are unwilling to respond the questionnaire during the research.
Questionnaire has been used as data collection method in the research. While making the
questionnaire form, “BEM Sex Role Inventory” has been referred to in determining the gender roles
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Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
and Sanchez et al. (2006)‟s Gloval Scale has been referred to in determining perceived value items.
The questionnaire form has been put into practice with health service customers selected as simple
sampling between 18th and 30th December 2014 in Taksim, Bakırköy and Kadıköy by face-to-face
interview. 416 appraisable questionnaire forms have been gained. According to the result of extreme
value analysis, 24 of the forms have been omitted from the analysis and 392 ones have been
evaluated.
For the evaluation of understandability and reliability of the questions in the questionnaire form, the
pilot questionnaire has been put into practice with 50 persons appropriate to sample mass and
necessary corrections have been made according to the received results.
It has been tried to be tested if the value that the questionnaire respondents perceive about the health
care according to their sex and gender roles is distinguishing or not. As seen in Figure 1, the model
research includes variable groups as „perceived value‟, „sex‟ and „gender roles (BEM Sex Role
Inventory)‟. In order to test the purposes of the research, the established hypotheses have been listed
as follows:
H1a = Functional value perceptions about the health care of the health care consumers who have
responded to the research do not make a significant difference according to sex.
H1b = Social value perceptions about the health care of the health care consumers who have
responded to the research do not make a significant difference according to sex.
H1c = Emotional value perceptions about the health care of the health care consumers who have
responded to the research do not make a significant difference according to gender.
H1d = Functional value of the personnel (professionalism) perceptions about the health care of the
health care consumers who have responded to the research do not make a significant difference
according to sex.
H2a = Functional value perceptions about the health care of the health care consumers who have
responded to the research do not make a significant difference according to gender role.
H2b = Social value perceptions about the health care of the health care consumers who have
responded to the research do not make a significant difference according to gender role.
H2c = Emotional value perceptions about the health care of the health care consumers who have
responded to the research do not make a significant difference according to gender role.
H2d = Functional value of the personnel (professionalism) perceptions about the health care of the
health care consumers who have responded to the research do not make a significant difference
according to gender role.
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Proceedings of 7th Annual American Business Research Conference
23 - 24 July 2015, Sheraton LaGuardia East Hotel, New York, USA, ISBN: 978-1-922069-79-5
Figure 1. Research Model
Perceived Value
4. The
Functional Value
Gender
Social Value
Emotional Value
Gender Roles
Functional Value of Personnel
(Professionalism)
Perceived Value
Findings
Demographic Characteristics of the Research Respondents
Frequency and percentage distributions about the socio-demographic characteristics of the research
respondents have been given in Table 6. According to this, 43.1 % of the research respondents are
between 21 and 30 years old; 66.3 % are women; 77.8 % are single; 75.2 % are university educated;
62 % are students and 33.2 % have an income between 2,001.- and 3,000.- TL.
As one of the limitations of the research, older and low-educated persons were unwilling to respond
the questionnaire during the application of the questionnaire forms, so those who have responded
have become younger and educated.
Table 6. Demographic Characteristics
Description
Age
≤ 20
21 to 30
31 to 40
41 to 50
51 to 60
≥ 61
Sex
Female
Male
Frequency
Percent
142
169
43
26
9
3
36.2
43.1
11.0
6.6
2.3
0.8
260
132
66.3
33.7
Description
Frequency
Percent
Education
Grade School
High School
University
Postgraduate
18
53
295
26
4.6
13.5
75.2
6.7
Marital Status
Single
Married
305
87
77.8
22.2
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Proceedings of 7th Annual American Business Research Conference
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Monthly Net Income
of the Family
≤ 1000 TL
10012000 TL
2001- 3000 TL
3001- 4000 TL
4001- 5000 TL
5001- 6000 TL
6001- 7000 TL
≥ 7001 TL
35
127
130
63
18
10
2
7
8.9
32.4
33.2
16.1
4.6
2.6
0.5
1.8
Occupation
Unemployed
Self Employed
Housewife
Student
Worker
Official
Contract
Employee
Retired
49
22
18
243
19
16
15
10
12.5
5.6
4.6
62.0
4.8
4.1
3.8
2.6
Health Care Consumption Preferences of the Research Respondents
When health care consumption preferences of the research respondents are investigated, it is seen
that majority of the respondents (61.7 %) have preferred to receive health care from Public Hospitals.
The ratio of those who have not preferred university hospitals (76 %) is more that those who have
preferred (24 %). The ratio of those who have preferred District Polyclinic, Community Health Center,
Physician‟s Private Office, Medical Center and Private Hospitals has become lower than those who
have not preferred. In this case, it can be said that the respondents have preferred to receive health
care mostly from Public Hospitals and the ratio of preference for the other health institutions is low.
When the research respondents‟ social security has been evaluated, it has been seen that majority is
under 4A cover with a ratio of 60.5 %. These results have been shown in Table 7.
Table 7. Health Care Consumption Preferences
Description
Frequency Percent
Public Hospital
Yes
242
61.7
University Hospital
No
298
76.0
District Polyclinic
No
370
94.4
Community Health Center
No
319
81.4
Physician‟s Private Office
No
379
96.7
Medical Center
No
372
94.9
Private Hospital
No
275
70.2
Social Security
4A
237
60.5
4B
62
15.8
4C
48
12.2
Private Health Insurance
17
4.3
Green Card
8
2.0
None
20
5.1
Distributions about the Gender Roles
BEM Sex Role Inventory has been referred to in order to determine the gender roles of the research
respondents. Respondents have replied how the statements which took place in femininity and
masculinity scales described themselves between „1- I do not agree at all‟ and „7- I exactly agree‟. As
seen in Table 8, the ratio of masculine gender role of the respondents is 20.2 %; the ratio of feminine
gender role is 15.8 %; the ratio of androgen gender role is 16.1 % and the ratio of undifferentiated
gender role is 48%. When the research respondents‟ sex distributions are investigated, the majority is
woman but as for the distributions about gender roles, it is seen that the lowest group is feminine.
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Proceedings of 7th Annual American Business Research Conference
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Table 8. Distributions about the Gender Roles
Gender Roles
Frequency Percent
Masculine
79
20.2
Feminine
62
15.8
Androgynous
63
16.1
Undifferentiated
188
48.0
When the distribution of the sex of the respondents is investigated according to the gender roles, only
22.3% of women are feminine but 12.7 % of them are masculine; 16.5% of them are androgen and
48.5 % of them seem to have undifferentiated gender. 35 % of men are masculine; 3 % are feminine;
15 % are androgen and 47 % of them seem to have undifferentiated gender. These results have been
shown in Table 9.
Table 9. Distributions of Female and Male According To Gender Roles
Masculine
Feminine
Androgynous
Undifferentiated
Frequency %
Frequency %
Frequency %
Frequency %
Female 33
12.7 58
22.3 43
16.5 126
48.5
Male
46
35
4
3
20
15
62
47
Reliability Analysis
Cronbach Alpha coefficient has been referred to for the measurement of the BSRI which took place in
the questionnaire and the measurement of the reliability of perceived value scale. Feminine scale and
masculine scale under BSRI have been analysed separately. The 0.793 value of the analysis result
applied to 20 variables which took place in feminine scale and the 0.826 value of the analysis result
applied to 20 variables which took place in masculine scale have been considered to be reliable.
Analysis applied to 24 variables for the reliability of the perceived value scale has shown that the
scale is reliable. Somehow, when a variable which has risen alpha coefficient has been omitted from
the scale, the analysis has been repeated and the 0.884 value has shown that the scale is reliable.
Factor Analysis
Factor analysis has been applied to the perceived value scale in the research. „Varimax Rotation‟ has
been used to make factor structure simple and to make its comment easy. For the factor analysis
applied to the perceived value scale, the variables under the factor load 0.500 have been omitted from
the analysis and it has been repeated. According to Kaiser-Meyer-Olkin (KMO) sampling adequacy
result gained as a result of factor analysis applied to 18 variables scale, sampling size has been found
sufficient (0.883). The analysis has been continued with Bartlett test significance value 0.000. At the
end of the analysis, four factor groups have been gained. These factors explain 67.212 % of the total
variance.
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Proceedings of 7th Annual American Business Research Conference
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Table 10. Factor Analysis Results Belonging To The Perceived Value Scale
Items
Factor Loadings
F1
It is important for me that health institution to be
spacious, modern and clean.
It is important for me that health institution to be
neat and well organized.
It is important for me that service which I purchased
from health institution to be well organized.
It is important for me that personnel working in
health institution to know their job well.
It is important for me that the quality of the service
which I purchased from health institution to be
maintained throughout.
It is important for me that purchasing health service
to improve the way others perceive me.
It is important for me that using health institutions‟
(brands) services to has improved the way others
perceive me.
It is important for me that people who take service
which I purchased to obtain social approval.
It is important for me that health institutions‟
(brands) services to be used by many people that I
know.
It is important for me to be comfortable with the
service I purchased.
It is important for me that the personnel not to
pressure me to decide quickly.
It is important for me that the personnel to give me
a positive feeling.
It is important for me that the personnel to be
always willing to satisfy my wishes as a customer,
whatever product/ service I wanted to buy.
It is important for me to feel relaxed in the health
institution.
It is important for me that personnel working in
health institution to be a good professional and to
be up-to-date about new items and trends.
It is important for me that personnel working in
health institution to know the services which the
institution offers.
It is important for me that the result of the service
which I purchased from health institute to be as
expected.
It is important for me that the advices of personnel
working in health institution to be valuable.
Rotation Sums of Squared Loadings
(% of Variance)
Cronbach's Alpha
F2
F3
F4
.872
.761
.749
.746
.652
.924
.910
.836
.812
.727
.659
.656
.621
.595
.759
.639
.607
.586
20.563
17.785
14.648
14.215
.892
.906
.783
.740
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Proceedings of 7th Annual American Business Research Conference
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First factor group is „functional value‟; second factor group is „social value‟; third factor group is
„emotional value‟; and fourth factor group is „functional value of personnel (professionalism)‟. The
results of factor analysis belonging to the perceived value scale have been shown in Table 10.
The factor groups gained in this study have been evaluated with the dimensions which took place in
Sanches et al.‟s (2006) study. While six dimensions have been mentioned in their study, four
dimensions have been gained about the perceived value for health care consumers in our study.
Besides, when distributions of the items under the dimensions have been investigated, similarities and
differences have been met. While the items under „social value‟ and „emotional value‟ dimensions
have been distributed as similar as Sanchez et al.‟s, the items under „functional value‟ and „functional
value of personnel (professionalism)‟ dimensions have shown differences from the reference study. It
has been seen that, especially under the „functional value‟ in the reference study, the item :„it is
important for me that personnel working in health institution to know their job well‟ is under „functional
value of personnel (professionalism)‟; the item under „quality‟ dimension: “it is important for me that
service which I purchased from health institution to be well organized‟ and „it is important for me that
the quality of the service which I purchased from health institution to be maintained throughout‟ have
been distributed. While the item: „it is important for me that the result of the service which I purchased
from health institute to be as expected‟ has taken place under „quality‟ dimension in the reference
study but under „functional value of personnel (professionalism)‟ in our study. „Quality‟ and „price‟
dimensions which were listed among the perceived value dimensions by Sanchez et al.‟s could not be
gained in this study about health care consumers.
Difference Tests
It has been tested by independent samples t test if it is different according to the sex for each
dimension of the value that research contributor health care consumers perceive. Test results have
been shown in Table 11.
Functional value perception does not show a significant difference according to the sex. The
distribution is homogeneous for “sig=0.430 >0.05” value when Levene test results are investigated.
H1a hypothesis has been accepted since p value 0.417 is bigger than 0.05. Social value perception
does not show a significant difference according to the sex. The variances of both group are equal for
“sig=0.900 > 0.05” value according to the Levene test results. H1b has been accepted since p value
is 0.305 > 0.05. Emotional value perception does not show a significant difference according to the
sex. The distribution is homogeneous for “sig=0.478>0.05” value according to Levene test results.
H1c has been accepted since p value is 0.194 > 0.05. Functional value of personnel (professionalism)
perception does not show a significant difference according to the sex. The distribution is
homogeneous for “sig=0.065>0.05” value according to Levene test results. H1d has been accepted
since p value is 0.455 > 0.05.
It has been seen that perceived value dimensions do not show a significant difference according to
the sex.
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Proceedings of 7th Annual American Business Research Conference
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Table 11. Independent Samples T Test Results of Perceived Value Dimensions According To Sex
Description
N
Mean
Std.Dev. df
T
p
Hypothesis
Functional Value
390
.812
.417
H1a accepted
Female
260 6.79
0.57
Male
132 6.74
0.53
Social Value
390
-1.026 .305
H1b accepted
Female
260 5.04
1.77
Male
132 5.23
1.74
Emotional value
390
1.302
.194
H1c accepted
Female
260 6.50
.76
Male
132 6.40
.74
Functional
Value
of
390
.748
.455
H1d accepted
Personnel
(Professionalism)
260 6.54
.62
Female
132 6.49
.76
Male
Whether the value for each dimension the research respondents perceive about health care shows a
difference according to gender roles has been tested by one way analysis of variance. Firstly, group
variances are not equal because p value 0.000 is lower than 0.05 gained at the end of Levene test as
a result of analysis functional value dimension. Therefore, Welch and Brown-Forsythe tests have
been applied. P value 0.000 and 0.05 has been gained smaller at the end these two tests. According
to this result, it can be said that functional value perceptions about health care of respondents who
have different gender roles show differences. Tamhane Post Hoc Test has been used to identify
which gender roles have caused this difference. According to the test result, undifferentiated ones
constitute gender role which have the lowest functional value perceptions. H2a hypothesis has been
rejected. Analysis results have been shown in Table 12.
Table 12. One-Way Analysis of Variance Results of Functional Value Perception According To
Gender Roles
Statistic
df1
df2
Sig.
16.042
3
388
.000
Levene
7.110
3
185.243
.000
Welch
16.382
3
318.238
.000
Brown- Forsythe
(I) gender role
(J) gender role
Mean Difference (I-J)
Std.Error
Sig.
Masculine
Feminine
-.01531
.03637
.999
N: 79
androgynous
-.00410
.03661
1.000
Mean: 6,8911
undifferentiated
.25603(*)
.05902
.000
feminine
masculine
.01531
.03637
.999
N: 62
androgynous
.01121
.04069
1.000
Mean: 6,9065
undifferentiated
.27135(*)
.06164
.000
androgynous
masculine
.00410
.03661
1.000
N: 63
feminine
-.01121
.04069
1.000
Mean: 6,8952
undifferentiated
.26013(*)
.06178
.000
undifferentiated
masculine
-.25603(*)
.05902
.000
N: 188
feminine
-.27135(*)
.06164
.000
Mean: 6,6351
androgynous
-.26013(*)
.06178
.000
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Proceedings of 7th Annual American Business Research Conference
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For p value 0.000 gained as a result of Levene test for the analysis made to show whether social
value perceptions about health care of the research respondents distinguish according to gender
roles, Welch and Brown-Forsythe tests have been applied. P 0.000 value has been gained at the end
of the tests. According to this result, it can be said that respondents‟ social value perceptions about
health care show differences according to different gender roles. H2b has been rejected. According to
the results of Tamhane Post Hoc Test, androgynous and feminines have higher social value
perceptions than masculines and undifferentiated ones. The results of the analysis have been shown
in Table 13.
Table 13. One-Way Analysis of Variance Results of Social Value Perception According To Gender
Roles
Statistic
df1
df2
Sig.
6.537
3
388
.000
Levene
10.959
3
160.256
.000
Welch
9.227
3
277.818
.000
Brown- Forsythe
(I) gender role
(J) gender role
Mean Difference (I-J)
Std.Error
Sig.
Masculine
feminine
-.98224(*)
.27041
.002
N: 79
androgynous
-.83836(*)
.30120
.036
Mean: 4,8323
undifferentiated
.03973
.25351
1.000
feminine
masculine
.98224(*)
.27041
.002
N: 62
androgynous
.14388
.26057
.995
Mean: 5,8145
undifferentiated
1.02196(*)
.20358
.000
androgynous
masculine
.83836(*)
.30120
.036
N: 63
feminine
-.14388
.26057
.995
Mean: 5,6706
undifferentiated
.87808(*)
.24299
.003
undifferentiated
masculine
-.03973
.25351
1.000
N: 188
feminine
-1.02196(*)
.20358
.000
Mean: 4.7926
androgynous
-.87808(*)
.24299
.003
Whether the emotional value perceptions of the research respondents about health care shows a
difference according to gender roles has been tested by one way analysis of variance. P value is
0.000 gained as the result of Levene test. P value 0.000 has been gained in Welch and BrownForsythe tests applied because of the first test. So, H2c hypothesis has been rejected. Emotional
value perceptions show a significant difference according to the respondents‟ different gender roles.
According to Tamhane Post Hoc test results, feminines respect value more than undifferentiated
ones; androgenes respect value more than undifferentiated ones and masculines for emotional value
perception. The result of the analysis has been shown in Table 14.
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Proceedings of 7th Annual American Business Research Conference
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Table 14. One-Way Analysis of Variance Results of Emotional Value Perception According To Gender
Roles
Statistic
df1
df2
Sig.
17.342
3
388
.000
Levene
15.043
3
184.039
.000
Welch
17.098
3
333.883
.000
Brown- Forsythe
(I) gender role
(J) gender role
Mean Difference (I-J)
Std.Error
Sig.
Masculine
feminine
-.19114
.08923
.188
N: 79
androgynous
-.26574(*)
.08997
.022
Mean: 6.5089
undifferentiated
.24929
.10114
.084
feminine
masculine
.19114
.08923
.188
N: 62
androgynous
-.07460
.06597
.836
Mean: 6.7000
undifferentiated
.44043(*)
.08054
.000
androgynous
masculine
.26574(*)
.08997
.022
N: 63
feminine
.07460
.06597
.836
Mean: 6.7746
undifferentiated
.51503(*)
.08136
.000
undifferentiated
masculine
-.24929
.10114
.084
N: 188
feminine
-.44043(*)
.08054
.000
Mean: 6.2596
androgynous
-.51503(*)
.08136
.000
Whether the functional value of personnel (professionalism) perceptions of the research respondents
about health care shows a difference according to gender roles has been tested. P value 0.000 has
been gained as a result of Levene test. Group variances are not homogeneous for this variable.
Because of this result, Welch and Brown-Forsythe tests have been applied and p value 0.000 has
been gained. Since the p value gained is smaller than 0.05, H2d hypothesis has been rejected. It can
be said that professionalism value perceptions of the respondents who have different gender roles
show differences. According to Tamhane Post Hoc test, undifferentiated ones respect value for
professionalism value perceptions less than respondents with the other gender roles. The result of the
analysis has been shown in Table 15.
Table 15. One-Way Analysis of Variance Results of Functional Value of Personnel (Professionalism)
Perception According To Gender Roles
Statistic
df1
df2
Sig.
3
388
.000
Levene
10.784
3
175.084
.000
Welch
10.649
3
337.494
.000
Brown- Forsythe
11.882
(I) gender role
(J) gender role
Mean Difference (I-J)
Std.Error
Sig.
Masculine
feminine
-.04333
.09179
.998
N: 79
androgynous
-.16782
.08786
.302
Mean: 6.6139
undifferentiated
.25754(*)
.09048
.029
feminine
masculine
.04333
.09179
.998
N: 62
androgynous
-.12449
.07779
.510
Mean: 6.6573
undifferentiated
.30088(*)
.08074
.002
androgynous
masculine
.16782
.08786
.302
N: 63
feminine
.12449
.07779
.510
Mean: 6.7817
undifferentiated
.42536(*)
.07623
.000
undifferentiated
masculine
-.25754(*)
.09048
.029
N: 188
feminine
-.30088(*)
.08074
.002
Mean: 6.3564
androgynous
-.42536(*)
.07623
.000
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Proceedings of 7th Annual American Business Research Conference
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5. Summary and Conclusions
In this research, whether the value health care consumers perceive according to their sex and gender
roles shows a difference for each perceived value dimension has been aimed to be tested. The
findings gained are that when the value perceptions which do not show differences are analyzed
according to the sex factors, it is seen that they show a difference according to the gender roles. It can
be submitted that this is an important finding for the marketing studies to be conducted in future.
When thought that the researches made in marketing field on health care consumers especially in
Turkey are limited, this research can be considered to be a leading study for further ones.
Sex element seems to be insufficient in explaining the emphasis placed on the perceived value
dimensions according to the research findings. Respondents make a decision according to their
gender roles rather than their sex. So, it will be useful to determine which gender role the target
market have while trying especially to create a positive value perception and establishing marketing
programmes for health care consumers. When the respondents‟ frequency distributions grounded on
sex, it is seen that the majority is women. Upon determination of the gender roles, it is seen that the
majority of the respondents have undifferentiated gender role and feminines have a percentage of
only 15.8 within all the respondents. The percentage of those who has feminine gender role within
women is at the level of 22.3 percent. These results show that discrimination upon gender roles rather
than man and woman can be more useful for social researches.
When the health care and health institutions are discussed, it can be said that masculines are focused
on the functional value perception such as orderliness, cleanliness, providing good service and on the
characteristics to create a professionalism value perception such as personnels‟ knowledge level, their
following new developments and being good professionals. In addition to these characteristics,
feminines and androgynous place emphasis for the elements to create an emotional value perception
such as feeling comfortable in health institutions, feeling good about the personnels and a social value
perception such as, finding acceptance and reputation. Undifferentiated ones constitute those who
have low value perception for all dimensions.
The statement „I am a virtuous one‟ taking place in sex role inventory has been reacted by some
respondents. This situation can be concerned with the perception that the concept „virtue‟ is
connected with sexualism in Turkey. That the statement „I am a virtuous one‟ takes place in feminine
scale can be evaluated as a supportive indicator for this connection.
The findings gained about the perceived value dimensions show differences from the reference
article. According to this, while the perceived value dimensions are being constituted by „functional
value‟, „functional value of personnel (professionalism)‟, „quality‟, „price‟, „emotional value‟ and „social
value‟ in the reference article of Sanchez et al.‟s (2006); four dimensions have been gained in this
research applied to health care consumers in Turkey: „functional value‟, „social value‟, „ emotional
value‟ and „functional value of personnel (professionalism)‟. Besides, the items constituting the said
dimensions have allocated differently in this study. Therefore, some other studies can be done to test
the validity of the perceived value dimensions for health care consumers and Turkey.
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