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Abstract
Objectives To identify consumers’ consciousness of health-friendly products and services (consumer reaction, purchase intention and willingness to pay more) and its association with sociodemographic characteristics and multidimensional health status.
Methods From March to May 2018, we administered questionnaires to 1200 individuals from the general Korean population asking about their perception of health-friendly labels, and if they would purchase such labelled products (foods, pharmaceuticals, etc) and services (purifying water, preventing air pollution, etc) at extra cost.
Results The participants placed a high value on the importance of mental, social, spiritual and physical health factors in terms of the company’s products and services with a score of about 8 out of 10 (range, 7.74–8.33). Most respondents (72.4%) said that they were interested in adopting health-friendly labels. When a health-friendly label is introduced (such as one by the Business for Social Responsiveness), 65.1% of the respondents said that they intended to purchase the product or service, while 6.8% said that they did not and 75.0% said that they were willing to pay extra for the health-friendly product or service. Multivariate logistic regression models showed urban residence, high education level and good social health to be significantly associated with positive attitudes towards health-friendly labels. People with high income, no religion or normal weight were more likely to say that they intend to purchase products and services with health-friendly labels. They also had a more positive attitude towards paying more for such products and services, as did people with good spiritual health.
Conclusion This study provides data that illustrate the importance of health-friendly products and services to the general population and companies.
- public health
- health services administration & management
- quality in health care
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Strengths and limitations of this study
Consumers nowadays are interested in whether a company cares about consumers’ health and wellness. Given such an increasing consensus, we proposed the concept of health-friendly management, and thereby aimed to better understand consumers’ perception of health-friendly labels and their purchase behaviour of health-friendly labelled products and services.
We propose here the concept of ‘health-friendly management’, which refers to the promotion of various healthful components, or the avoidance of harmful components, whether they affect the physical, mental, social or spiritual aspects of health.
However, since the current study is based on cross-sectional data, we could not conclude the causality between one’s attitude towards health-friendly labels and the intent to purchase health-friendly products or services.
Introduction
In 1948, the WHO Constitution defined health as ‘a state of complete physical, social, and mental well-being and not merely the absence of disease or infirmity’. In recent years, health has been viewed as having four aspects—body, mind, social and spiritual.1 Health is determined somewhat by genetics and medical care, but mostly by behaviour and social conditions. Healthcare policy, however, does not accommodate that observation.2 In the USA, for example, approximately 95% of the health budget goes to medical care services, while only 5% is allocated to population-based approaches for health improvement.3
There is an increasing awareness of the importance of social and environmental factors on health and that health is the responsibility of both the government and the private sector.4 Although current health policy focuses mainly on the role of the government, companies can play an important role in building a framework of health ecosystems.4 Just as companies can influence the health of employees and customers, they can also address corporate social responsibility (CSR). Usually, however, CSR efforts focus on philanthropy and are undertaken largely to meet legal requirements or avoid penalties.5 But CSR can have a more strategic role by using the company’s core systems to create business and express social value by addressing the issue of population health.4 6 According to Porter and Kramer, ‘The concept of shared values can be defined as policies and operating practices that enhance the competitiveness of a company while simultaneously advancing the economic and social conditions of the communities in which it operates’.6 7Some companies, such as PepsiCo,8 Qualcomm Incorporated,9 Walmart10 and General Electric,6 found new business opportunities that could prevent or solve specific health challenges.4 Overall, a few companies outside the food, beverage and agriculture industries are trying to improve customers’ health and wellness.4 Many sustainability and corporate responsibility programmes are ‘less bad’ rather than ‘good’.5
According to Business for Social Responsibility, consumers nowadays are interested in whether a company cares about their health and wellness, health-friendly product and service.4 For example, consumers can easily accept to buy innovative functional foods with health effects and increasing interest in health might drive a growth in demand for functional health foods with radical innovations.11 A famous example is the announcement Walmart made at the White House together with then-First Lady Michelle Obama. Walmart company would open 300 stores to serve the U.S. Department of Agriculture’s designated food desert areas to provide easy access to fresh, affordable and nutritious food to foster healthier communities.10 There is a significant stream of research covering health labelling and its impact on consumer choice.12–14 For example, frequent users of nutrition labels were less likely to consume unhealthy indicator foods13
Some studies of consumer purchase decision models indicate that consumer purchase intentions greatly depend on health and price consciousness and on a health label and they are uneven across different market segments and cultures.15–18 Although some studies have investigated the perception and purchase of organic products and eco-labels, few have investigated the same concept on health.17 19–21 Earlier studies have shown that consumer’s sociodemographic characteristics,20 22 such as age, sex, education and income, and their health status influenced their attitude towards health-friendly products and services (consumer reaction, purchase intention and willingness to pay more).17 18 20–27 Thus, in this study, we aimed to understand consumer perception of health-friendly labels and their purchasing behaviour of health-friendly labelled products and services, and to identify associated factors.
We propose here the concept of ‘health-friendly management’, which refers to the promotion of various healthful components, or the avoidance of harmful components, whether they affect the physical, mental, social or spiritual aspects of health.
To eliminate factors that may impair health, it is necessary for health-friendly products and services to meet safety regulations through quality control of raw materials, minimisation of harmful elements or the improvement of mental, social and spiritual health. Health-friendly management, thus, deals with health-friendly products and services as a corporate responsibility. From our literature review, we hypothesised that consumer’s demographic characteristics such as education and income and their health status might influence their attitude towards health-friendly products and services (consumer reaction, purchase intention and willingness to pay more) figure 1.17 18 20–27
The conceptual model for how demographic and health behaviours and health status are related to consciousness of health-friendly products and services.
Methods
Patient and public involvement
Data were collected from a broader general Korean population targeted in the survey. First, the survey was conducted with the general population aged 20–70 years and residing across 17 major cities and local districts from March to May 2018. In each major city and local district, all participants were recruited taking the age and sex strata by region into account and applying probability proportion-to-size sampling in accordance with the 2016 Korean census. We used a probability-proportional-to-size technique for sample selection to select a representative national sample, particularly when the sample groups differ in size.28 Among 4000 eligible persons, 1200 people (30% response rate) of them responded to the self-reported questionnaire in the presence of the interviewer who could provide further explanation on the study. This method is widely used by trained research assistants who administered a semistructured, self-reported questionnaire. The World Research Co. (Seoul, Korea) conducted the survey. All recruiters provided informed consent.
Measurement
The survey items were formulated on the basis of published studies.29–32 Accordingly, these three items were generated: (1) How would you feel about companies when you see their health-friendly labelled products or services?28 The participants could respond with one of the following: ‘They are trustworthy’, ‘They care about consumers’ health’, ‘The cost is high’ or ‘No special feeling’. (2) Would you prefer the health-friendly labelled products or services to others not so labelled?28 31 (5-point Likert scale with 1, not at all; 2, a little; 3, moderate; 4, quite a bit and 5, very much) (3) Would you be willing to pay more for the health-friendly labelled product or service? If so, how much more compared with the label-free product price?’29–31 (1, no more; 2, <5%; 3, 5%–10%; 4, 11%–15%; 5, 16%–20% and 6, >21%) (figure 2). To measure the impact of different aspects of health status on health-friendly consciousness, we assessed the respondents’ health on the basis of a holistic point of view.1 The items measuring physical, mental, social and spiritual health status were applied as follows (0=not at all helpful, 10=very helpful): ‘Physical health is the state of having normal physical strength, without diseases and injuries. What do you think about your physical health status?’ ‘Mental health is the state of being mentally stable, being able to overcome stress. What do you think about your mental health status?’ ‘Social health is the state of having good social relationships, carrying out one’s work properly. What do you think about your social health status?’ ‘Spiritual health is the state of adding meaning to life through volunteering, religious experiences and meditation. What do you think about your spiritual health status?’ In addition, we measured general health status with the following question: ‘Considering your physical, mental, social, and spiritual health status, what do you think about your health status in general?’ All the items used a 5-point Likert scale with ‘excellent’, ‘very good’, ‘good’, ‘poor’ and ‘bad’.
Proportions about participants’ idea about health-friendly labelled products or services. (A) Consumer reaction about health-friendly labelled products or services. (B) Purchase intention for health-friendly labelled products or services. (C) Willing to pay more for the health-friendly labelled products or services.
In addition, the respondents were asked which subscales of each health aspect they considered important for the pursuit of a company’s health-friendly products or services. They were given the subscales of four health aspects (five subscales each) and asked to rate the importance of each on a scale of 0–10. The respondents’ sociodemographic and health information we collected included age, sex, residence, religion, marital status, education, monthly income, job status, body mass index (BMI), comorbidities and smoking experience.
Statistical analysis
Using descriptive statistics for the sociodemographic variables, we calculated the mean±SD scores of the importance of the impact of the four health factors (physical, mental, social and spiritual) for corporations that made health-friendly products or services. To test the reliability of the the variables of health-friendly activities, we estimated Cronbach’s α, which is a measure of internal consistency of patient responses. Then we performed univariate analyses to measure sociodemographic correlates for each aspect of health consciousness (consumer reaction, purchase intention and willingness to pay more). For the sociodemographic factors significantly associated with univariate analysis, we performed multiple regression analyses to examine the independent association with more positive health consciousness. The sociodemographic variables were included in univariate analyses based on the literature reviews17 18 20–27 and screening potentially element associated with the health consciousness. We also compared the proportions of health consciousness using a χ2 test to evaluate the impact of five categories of health status (physical, mental, social, spiritual and general health). In all analyses, we determined two-sided p values and considered a p value <0.05 to be significant. In final model, we used the factors that were determined to be significant in univariate analyses to examine the association between the sociodemographic variables, health status and those of more positive health consciousness. We conducted three multiple regression analyses using the hierarchical/stepwise method for factors significantly associated with univariate analysis to identify the independent and best predicted variables for participants’ consciousness of health-friendly product/services. We used this analytical approach because of concerns of multicollinearity. We conducted a univariate analysis with the aim of screening potentially existing elements to learn from existing data and draw implications. Therefore, univariate analysis was not a meaningful thing in itself, but a step to build a model for the final multivariate analysis. As a result, the final multivariate analysis results were meaningful and the researchers evaluated it. We also performed a sensitivity analysis by further calibrating the age-square along with the age variable in the multivariate analysis, confirming that most results were maintained. In the case of income variables, obtained and analysed in a categorical manner without logarithmic conversion of income variables, there are no problems caused by extreme values. We considered p<0.05 as statistically significant and reported results as the OR with a 95% CI. We used SAS V.9.3 software (SAS Institute) for all analyses.
Results
Sociodemographic characteristics of the participants
Table 1 shows sociodemographic characteristics of the 1200 survey participants. The mean age±SD of the study participants was 46.97±14.18 years.
Sociodemographic characteristics of participants
Factors that are important for the health-friendly activities of companies to affect consumers’ four aspects of health
The respondents evaluated the mental, social, spiritual and physical health factors incorporated into products or services highly. Table 2 shows the scores for the various aspects of the four factors. All values of the variables of the health-friendly activities showed high reliability, with good internal consistency (Cronbach’s α range, 0.89–0.91).
Mean and SD of the company’s health-friendly activities that have a significant impact on consumers’ health (0=not at all helpful, 10=very helpful)
Acceptance of health-friendly label and intent to purchase its products or services
Most respondents (72.4%) said that they were interested in adopting the health-friendly label, evaluating the companies' health-friendly activities in various areas. In detail, 36.5% of the respondents believed that the companies thought about consumers’ health, and 35.9% felt that they could believe the label claims and purchase the products or services. When a health-friendly label is introduced by a company, 65.1% of the respondents said that they intended to purchase the product/service, 6.8% said that they did not and 75.1% said that they were willing to pay more for it (figure 2).
Association of demographic characteristics and health status with health-friendly label, intent to purchase its product/services and willing to pay extra price, univariate logistic analysis
Tables 3 and 4 show the association of demographic characteristics and health status with consciousness of health-friendly products and services, intent to purchase the product or services and willingness to pay a higher price for them. As for the domain of consumer reaction, five demographic variables (young age, place of residence, religion, education and higher BMI) and two types of health status (good mental health and social health) were statistically significant.
Univariate analysis of correlation of participants’ consciousness of company’s health-friendly activities with demographic and health behaviours
Univariate analysis of correlation of participants’ consciousness of health-friendly product/services with health status
Significantly related to the domain of purchase intention were social health status as well as the demographic factors of age, religion, education, monthly income and BMI. In addition, significantly associated with additional payment intention were the demographic factors of younger age, education, monthly income and BMI, as were physical, mental, spiritual and general health status.
Multivariate logistic regression models for factors associated with health-friendly labels, intent to purchase its product or services and willingness to pay for the higher price
Multivariate logistic regression models show that the consumers residing in urban areas, highly educated and having good social health status showed a more positive reaction to health-friendly labels. Respondents with a higher income level, normal BMI and no religion were more likely to express an intention to purchase products and services with a health-friendly label, whereas no health status was significantly associated with that intent. In addition, factors such as higher education, higher income level, normal BMI and good spiritual health were associated with having a more positive attitude towards paying extra for products and services with health-friendly labels (table 5). Significant correlations in some univariate analyses such as age, physical, mental and general health status have lost significance in multivariate analysis, which may be due to correlation and confounding between variables.
Multivariate analyses* of participants’ consciousness of health-friendly products/services with sociodemographic variables and health status
Discussion
This study provides a better understanding of the importance to consumers of products or services that provide physical, mental, social and spiritual health. In addition, this study suggests the need for a health-friendly certification mark or label recognised by the general population. Our findings suggest that consumers are demanding health-friendly products and services and are willing to pay the extra cost involved.
Companies’ marketing activities can play a significant role in raising the public awareness of health.4 Business for social responsibility, a global non-profit organisation working to build ‘a just and sustainable world’, confirmed that member companies support the idea that they can strengthen the health and wellness of their customers and the public. About 90% of the companies agree that they can help strengthen the health of their consumers, while about 75% agree that they can help strengthen public health.4 Shared value models may represent the next evolution of capitalism.7 In the USA, for example, Kaiser Permanente partnered with Home Box Office, the National Institutes of Health, the Centers for Disease Control and Prevention, the Institute of Medicine and the Michael & Susan Dell Foundation and launched public health campaigns addressing the obesity epidemic.33 Moreover, companies can partner with local governments to encourage healthy lifestyles or habits. For the National Salt Reduction Initiative, for instance, more than 100 state and local health authorities and national health organisations partnered with many companies to reduce the amount of sodium in packaged and restaurant foods (https://www1.nyc.gov/site/doh/health/health-topics/national-salt-reduction-initiative.page%23national-salt-reduction-initiative).
Our findings showed that consumers with higher education or who lived in an urban area had a more favourable attitude towards health-friendly labels and that non-religious, high-income or normal-weight consumers had intentions to purchase products and services with health-friendly labels. This study showed that people with higher education, high income or normal weight had a positive attitude towards paying more for products and services with health-friendly labels. However, other studies had inconsistent findings between demographic characteristics and purchase intention towards green products.20 22 Our finding that consumers with good health status would be cautious about products and services with a health-friendly label and expressed willingness to pay more for them are consistent with the finding that health consciousness is an important factor that influences the purchase of organic foods.17 18 23 24 Our results seem to be consistent with the finding that eco-label and the value of green products had the strongest positive influence on green product purchase intention and were associated with the willingness to pay more for environmentally certified products, the eco-label or the energy label.21 22 25–27
These studies imply that most consumers perceive the health-friendly label as important when purchasing products or services. Emphasising the health-friendly label of products or services accredited by reputable organisations would help to build reliability and awareness among consumers, but the products and services would be more expensive than conventional products and services,21 22 and that could negatively influence purchasing. Thus, managers are challenged with the need to produce high-quality products and services at affordable prices.21
To integrate health-friendliness into its value chain and culture, companies can start by meeting social needs through products or services that serve the unserved or underserved.6 7 16 It can motivate employees to strengthen the health of their customers through daily actions and business decisions. Companies can use key performance indicators and report them in their sustainability report in a comprehensive and transparent way.4
Many companies, however, would struggle when trying to integrate a health and wellness agenda into their value chain. Many CEOs cite a lack of recognition from the financial market as a barrier to achieving their sustainability goals.34 But it is necessary to focus not only on preventive and holistic health, but also on return on investment. Stakeholders from managers, employees, investors, consumers, community organisations and government should form a consensus that companies should try to contribute to consumer and public health through a mission that goes beyond mere profit. ‘The purpose of business is to serve society, through the provision of safe, high quality products and services that enhance our well-being, without eroding our ecological and community life-support systems ultimately’.5 The government should also consider ways to assist these companies through tax breaks or their health insurance premium cuts.4
Although the scope of this study is so broad that all products and services and health are also very broadly defined across four different domains, consumers think that corporate products or services have very important impact not only on their physical health, but also on mental, social and spiritual health and there was no difference in importance among the four different domains of health. It might be crucial to develop measure to evaluate the health-friendly activities of corporates across four different domains of health in an objective and reasonable manner and to apply ‘health-friendly label’ to the products and services of corporates.
This study had some limitations. The first is that it was conducted in Korea and the findings might not apply to other populations. Second, in the present study, we applied probability proportion-to-size sampling taking into account the age and sex strata with the 2016 Korean census. Although we could not perform inverse probability weighting techniques due to lack of information of non-responder and, therefore, a concern of selection bias remains, the sociodemographic characteristics of the study participants included in the present study (n=1200) were similar to those of the Korean population with regard to age (20–29 years: 16.2%, 30–39 years: 17.7%, 40–49 years: 20.8%, 50–59 years: 19.9%, ≥60 years: 25.5% in the present study; 20–29 years: 15.9%, 30–39 years: 16.4%, 40–49 years: 19.6%, 50–59 years: 20.2%, ≥60 years: 27.9% in the Korean population) and sex (men: 49.3%, women: 50.7% in the present study; men: 49.9%, women: 50.1% in the Korean population), suggesting low possibility of selection bias and confirming representative sampling. Third, the response rates of the subjects were low, so the results might not be generalisable. Fourth, since this is a cross-sectional study, we could not attribute causality between attitudes towards health-friendly labels and intent to purchase health-friendly products or services. Further studies are needed to examine the associations. Fifth, almost all respondents would automatically agree with the questions in our survey and we did not address the gap between attitudes and behaviour. Sixth, our hypothesis that consumer’s demographic characteristics might influence their attitude towards health-friendly products and services have the limitation of study design. Especially educated people tend to give socially desired responses in surveys, that is to say that they would prefer health-friendly products and be willing to pay more for them. Therefore, discrete choice modelling (choice-based conjoint analysis) would be more suitable method to find out the preferences of features and products to simulate market and create optimal products.
Seventh, we did not treat the questions of trustworthiness and care about consumer health as separate questions. Therefore, it is hard to interpret how one feels about companies when seeing health-friendly products or services. Eight, we arbitrarily used the categories to assess willingness to pay more and did not test other categories. It would be helpful to see how sensitive the results are to the use of other categories in further studies. Finally, it is also a limitation that the respondents’ use of health-friendly products or knowledge of such products was not asked at all in the survey although these factors might explain the attitudes towards the products. Further studies are needed to examine the associations of the consumers’ use of health-friendly products or knowledge of the products with attitude towards health-friendly products and services.
Acknowledgments
The corresponding author YHY and co-author JAS thank BK21 plus program through the National Research Foundation (NRF) for financial support.
Footnotes
Contributors YHY participated in the design of the study, provided financial supports and study materials, collected and assembled the data, interpreted the analyses, participated in the sequence alignment and drafted the manuscript. JAS participated in its design and coordination, conducted data analyses, participated in the sequence alignment and drafted the manuscript. YK, SL and K-NK participated in the design of the study, performed the statistical analysis and helped to draft the manuscript.
Funding This work was supported by a Seoul National University Research Grant in 2016 (800-20170241).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval The Institutional Review Board (IRB) at Seoul National University Hospital approved the study protocol, and all participants provided informed consent. All participants from each of the Seoul National University Hospital provided written informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.