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 Table of Contents  
Year : 2015  |  Volume : 3  |  Issue : 5  |  Page : 6-11

Identification of behavior change methods in social marketing for countering induced demand in health system

1 Social Determinants of Health Research Center, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
2 Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication29-Oct-2015

Correspondence Address:
Rahele Samouei
No. 67, Talar Neighborhood, Jey Street, Baharestan Town, Post code: 8199939637, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-9019.168570

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The goal of social marketing is to change social behaviors in order to benefit the target audience and society as a whole have various applications in health care system. Social marketing sometimes uses behavior change methods in order to achieve its goals. Therefore, this study aims to identify behavior change methods in social marketing used for countering induced demand in health care system. This study was carried out using survey method and by searching relevant keywords in scientific texts, dissertations and Persian and English websites. The most important sources of information in this study included Irandoc, SID, Noormags, Springer, Science direct, and Emerald websites. The keywords used in searches were “Social marketing,” “Induced demand,” and “Theories of behavior.” The useful articles were selected after reading the abstracts and full text of the articles. In order to change the attitude of target audience about induced demand, theory of planned behavior change, BASNEF model, and the health belief of procede – proceed were investigated and the effect of each of their factors on behavior change and induced demand was determined. Among these factors, the attitude was determined to be the most important factor in behavior change. Based on the findings of this study, using social marketing models especially precede – proceed model can be useful for reducing induced demand.

Keywords: Health system, induced demand, social marketing, theories of behavior

How to cite this article:
Fathian N, Jafari M, Heidari ZH, Samouei R. Identification of behavior change methods in social marketing for countering induced demand in health system. Int J Health Syst Disaster Manage 2015;3, Suppl S1:6-11

How to cite this URL:
Fathian N, Jafari M, Heidari ZH, Samouei R. Identification of behavior change methods in social marketing for countering induced demand in health system. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2021 May 15];3, Suppl S1:6-11. Available from: https://www.ijhsdm.org/text.asp?2015/3/5/6/168570

  Introduction Top

In the last 30 years, the costs of healthcare sector have greatly increased in most countries.[1] There are several factors behind this increase in costs and these factors not only increase the cost of health systems but also lead to a phenomenon called induced demand.[2]

Induced demand is the unnecessary services or care provided for healthcare clients that are associated with the exercise of power by healthcare providers.[3]

The consequences of induced demand include increase in cost of health sector and the resulting pressure on general budget, reduced efficiency,[4] creating baseless worries in patients, patient confusion, family problems, lack of trust in treatment team, reducing the fairness in healthcare services, reduced efficiency of healthcare system, reduced service quality, baseless spreading of new technologies, financial consequences for healthcare system, accessibility challenges, wrongful resource allocation, ignoring the main services, lack of real health services in public health centers, the profit seeking relation between patient and doctor aimed to profit the doctor, and other such consequences.[5],[6]

New strategies are needed in order to control induced demand and among these strategies, those that eventually result in changes in behavior and attitudes are the most important ones. In the meantime, social marketing was introduced as the last and latest concept among five marketing philosophies.[7] According to Andersen concepts and techniques of commercial marketing can be used for creating various changes in the society [8] with the slight difference that social marketing aims to sell behavior and not products to the target audience.[9]

Given the fact that the basis of social marketing is changes in behaviors and attitudes of target audience and since the effectiveness of these methods is confirmed;[10],[11],[12],[13] social marketing sometimes makes use of behavior change models and various theories.[7] Some of these theories include health belief theory, the theory of planned behavior, BASNEF, and precede – proceed theory.

The basis of health belief theory is on the motives behind people's actions and emphasizes that people's perceptions can lead to motivation and different behaviors.[14] This means that people only respond to health messages when they perceive the adverse effects and dangers of the situation in their lives (perceived threat) and then pay attention to behavior change messages. It is in this situation that interventions and educational programs are effective.[15] On the other hand, according to the theory of planned behavior, the most important factor in determining behavior is behavioral intentions.[14] These behavioral intentions are the results of attitudes, mental norms, and perceived behavior controls.[15] BASNEF model is the most comprehensive model for “behavioral study,” “behavior identification,” and “creating new behaviors” in the society.[16] According to this model people behavior in a certain way when they have an attitude leading to that behavior, other people and present rules (mental norms) approve of the behavior, and empowering and enabling factors encourage that behavior.[17]

Precede – Proceed model also includes executive procedures such as social evaluation, epidemiological investigation of behaviors and environment, educational and ecological investigation, executive evaluation and design of intervention, implementation, procedure evaluation, and investigating the evaluation results.[18]

Despite the differences between the aforementioned models, they all follow the similar goal of creating behavioral changes in their target audience.

Siouki et al. reported that use of planned behavior theory is essential for improving the attitude and understanding of high school students in order to avoid dangerous behavior.[19] Tramm et al. reported that Precede – Proceed model is a strong framework for nursing researchers in order to improve the health of cancer survivors.[20] In another study, the effect of nutrition education program based on BASNEF model on improving the eating habits of students was confirmed.[21] Sharifirad et al. also reported that health belief structures are useful for improving the health situation of diabetic patients.[22]

The results of various studies confirm the effective role of social marketing and aforementioned models and templates in creating behavior change in various areas of health care. In this study, induced demand that is one of the important and effective concepts in healthcare is investigated, controlled, and confronted using different social marketing models. Therefore, the main goal of this study is to use various social marketing models in order to reduce induced demand in the healthcare system.

  Methods Top

This study was carried out using survey method and by searching scientific texts, dissertations and websites for related keywords. The most important Persian websites used in this study include SID, Noormags, Irandoc, and MagIran while websites such as Google Scholar, PubMed, Science Direct, Springer, and Emerald were the main source for English articles. Keywords used in searches were “Social marketing,” “Induced demand,” and “Theories of behavior change.” Using these keywords, a total of 20 English and 30 Persian articles were retrieved and investigated. After investigating the abstract and methodology section of each article, irrelevant articles were eliminated and then the relevant information were extracted from the full texts of the articles, summarized and categorized.

  Results Top

The answer to the main research question about the methods for behavior change in social marketing in order to confront induced demand is shown in [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Figure 1: Theory of planned behavior for countering induced demand[2],[5],[24],[25],[26],[27]

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Figure 2: Theory of health belief for countering induced demand[2],[5],[24],[25],[26],[27]

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Figure 3: Theory of Precede – Proceed for countering induced demand

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Figure 4: BASNEF theory for countering induced demand[5],[24]

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  Discussion Top

In order to investigate the social marketing methods used in behavior change and countering induced demand, various theories such as BSANEF, Precede – Proceed, planned behavior and health belief, and the effect of each theory in reducing induced demand in health system were investigated.

In this regard, Meshki used the theory of Precede – Proceed and Health locus control theory in order to improve mental health of the patients [23] and Poor et al. made use of planned behavior theory in a social marketing framework in order to improve the number of volunteers for blood donation and reported that this theory is effective in changing people's behavior.[7]

The results of this study showed that all important theories emphasize the individual's attitude toward his behavior and consider personal attitude to be the most important factor affecting people's behaviors. Mental norm is another factor that affects people's behavior. In some theories such BASNEF and planned behavior, this factor in directly considered but in other theories such as health belief and Precede – Proceed model, this factor (in case of induced demand) is embedded among the behavior barriers because an individual's mental norms sometimes increases induced demand and can be considered among the factors that contribute to increased demand. In other words, two factors of personal attitudes and mental norms are the most important factors in creating behaviors in all investigated models. However, it is necessary to remember that although these two factors are necessary for certain behaviors, they are not sufficient for these behaviors to happen, often needing the presence of other factors. This is more important when some of the factors affecting behaviors such as induced demand are not controllable by individuals and are instead induced by social or political situations of the society.

Later, various models were evaluated in order to determine the best model for reducing induced demand. Although it might seem that health belief model is a suitable model for behavioral studies, since this model only emphasizes on internal factors and considers behavior to be affected by internal factors and an individual's perception and also since this model does not offer a suitable evaluation for new behaviors, it can be considered an incomplete model. In this regard Sharifirad et al. reported that the health education program based on this model that was implemented for osteoporosis prevention in girls' high schools showed favorable results.[22]

The theory of planned behavior also lacks evaluation and does not consider barriers against new behavior and seems inadequate for the reason of this study. Among the two remaining models (BASNEF and Precede – Proceed), although BASNEF theory is the most comprehensive behavior theory and is considered to be a augmented version of Precede – Proceed theory, special features of Precede – Proceed model such as a more practical approach, having most factors necessary for implementation of a successful intervention program such as comprehensive study of previous behavior and evaluation steps, carefully investigating the reasons behind current behaviors and comprehensive nature, means that Precede – Proceed model is a better model for the goal of this study. Of course Precede – Proceed model also has shortcomings and removing these problems can improve the efficiency of the model. One of the shortcomings is the fact that Precede – Proceed model mostly concentrates on factors resulting in previous behaviors and tries to change the behavior while paying less attention to factors necessary for creating new behaviors (such as educational channels, cooperation with other organizations in order to achieve better success). Therefore, it is suggested for this model to be used along with social marketing mix in order to achieve the best efficiency because creating policies and cooperation with other organizations are necessary for stabilization of new behaviors. [Table 1] shows a summary of some necessary components of behavior change in various models [Table 1].
Table 1: Various theories about behavior change component

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  Conclusion Top

Social marketing is one of the methods used in order to change the attitude and behavior of target audience. On the other hand, induced demand is one of the most important and controversial subjects in health economy and one of the reasons for an increase in healthcare costs in recent years. Therefore, induced demand has gained increased attention in recent years and decreasing it can be helpful to health sector. Among various behavior models, Precede – Proceed model due to the detailed description of stages necessary for creating a new behavior, and reasons for previous behavior is the best model for reducing induced demand. However, this model does not consider the prerequisites for behavior change and education and therefore, it is better to implement this model along with a social marketing mix in order to consider the prerequisites (education location, advertisement methods, costs, etc.) and try to maintain the new behavior. Finally, this study uses the survey method and, therefore, the results presented here are the results of studies by other researchers.


This article is the result of research projects approved by the Isfahan University of Medical Sciences. We would like to thank it.

Financial support and sponsorship

Isfahan University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.[27]

  References Top

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1]

This article has been cited by
1 Main Factors Leading to Supplier-Induced Demand in Iran: A Comprehensive Review
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Health Scope. 2020; In Press(In Press)
[Pubmed] | [DOI]


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