USING THE MEANS-END CHAIN APPROACH TO MAP CONSUMER DECISION MAKING: THE CASE OF NATURAL HEALTH PRODUCTS

Purpose: To use the means-end chain approach to understand the role of scientific evidence in consumer self-selection of natural health products (NHPs). 

Method: The means-end chain (MEC) approach is a novel way to explore medical decision-making by focusing on the relationships between product attributes, their associated consequences, and personal values (ends).  Personal values are assumed to ultimately drive consumption decisions. The sample was comprised of 25 participants with self-reported osteoarthritis (OA). Thirteen had consumed NHPs with scientific evidence of efficacy for OA (glucosamine or chondroitin) only, while 12 had consumed NHPs which lacked scientific evidence of efficacy for OA in addition to, or in place of, glucosamine or chondroitin.  Interviews started with identifying salient product attributes. Using the laddering interview technique, these were then linked with associated consequences and underlying values. After interviews were transcribed and coded, the resulting data were entered into MECAnalyst©.  Based on an implication matrix that records all links mentioned in the interviews, hierarchical value maps (HVM) were generated to identify attribute-consequence-value chains that dominate the decision-making processes.

Result: The dominant decision-making chain used by our participants started with an endorsement of a product by someone they trusted (e.g., health care provider, friend/family) who often described that NHPs had few (or no) side effects.  Believing the product would have fewer side effects, consumers were more likely to take the product and then reported experiencing reduced pain, enabling increased daily activity, improved physical and emotional health, and ultimately a better quality of life.  Scientific evidence was a product attribute mentioned by about half of our participants as impacting their NHP choices.  Participants in the two scientific evidence categories had similar decision-making dominant chains; however, participants using only NHPs with scientific evidence of efficacy recalled more information from others they trusted that was related to the effectiveness and mechanism of action of NHPs.

Conclusion: Scientific evidence plays a role in consumer decision-making; however, the endorsement of a trusted individual appears to have the greatest impact on decision-making.  The laddering technique linked to the MEC approach enables a graphical representation of patients' cognitive decision-making structure. This method offers a richer and more insightful characterization of the relationship between underlying values impacting decision-making than is offered by existing direct and indirect preference elicitation methods.