CHAPTER – I

If you can’t explain it simply, you don’t understand it well enough

– Albert Einstein

1.1 INTRODUCTION
The American Marketing Association (AMA) has defined consumer behaviour as,
“The dynamic interaction of affect and cognition, behaviour, and the environment by
which human beings conduct the exchange aspects of their lives.”

Consumer Behavior
Consumer Behaviour is the study of how individuals, groups, and organizations
select, buy, use and dispose of goods, services, ideas, or experiences to satisfy their
needs and wants. It helps us to know when, why, how, and where people do or do not
buy a product, or a service. It blends elements from psychology, sociology, social
anthropology and economics. It attempts to understand the buyer's decision making
process, both individually and in groups. Armstrong, (1991) says that a consumer
plays three distinct roles such as user, payer and buyer. A consumer‟s buying
behaviour is influenced by cultural, social, and personal factors. The object of the
study of consumer behaviour is to provide conceptual and technical tools to enable the
service provider to apply them for both profit and non-profit organizations.

The study of Consumer Behaviour (CB) is very important to the service providers
because it enables them to understand and predict buying behaviour of consumers.
Consumer research is the methodology used to study consumer behaviour; it takes
place at every phase of the consumption process: before the purchase, during the
purchase, and after the purchase of the service.

“Consumer behaviour refers to the actions and decision processes of people who
purchase goods and services for personal consumption.” (Peter D. Bennett, ed.
Dictionary of Marketing Terms, 2nd ed. 1995).

1
Consumer behaviour refers to “the mental and emotional processes and the observable
behaviour of consumers during searching, purchasing and post consumption of a
product or service.” (James F. Engel, Roger D. Blackwell and Paul W. Miniard,
“Consumer Behaviour” 1990). How consumers make decisions to spend their
available resources such as money, time and effort on consumption and use-related
items is the subject of consumer behaviour study.

Development of Consumer Behaviour Field

For a variety of reasons, the study of consumer behaviour is developed as an
important and separate branch in marketing discipline. The history of consumer
behaviour shows that scholars of marketing had observed that consumers did not
always behave as suggested by economic theory. Marketing researchers involved in
studying the buying behaviour of consumers soon appreciated the fact that though
there were many similarities, consumers were not all alike. Other important factors
that contribute to the development of consumer behaviour as a marketing discipline
include increased environmental concerns, interest in consumer protection, growth of
services marketing, opening up of international arcades and the development of
computers and sophisticated techniques of analysis. Consumer behaviour is a multi-
disciplinary field which draws its concepts from several fields of study.

Disciplines involved in the study of Consumer Behaviour

It is in fact a subset of human behaviour and it is often difficult to draw a distinct line
between consumer-related behaviour and other aspects of human behaviour. The
discipline of consumer behaviour has borrowed heavily from concepts developed in
other disciplines of study such as psychology, sociology, social psychology, cultural
anthropology and economics.

Psychology is the study of the individual, which includes motivation, perception,

attitudes, personality and learning theories. All these factors are critical to an
understanding of consumer behaviour and help us to comprehend consumption related
needs of individuals, their actions and responses to different promotional messages
and services and the way their experiences and personality characteristics influence
their choices.

2
Sociology is the study of groups. When individuals form groups, their actions are
sometimes quite different from the actions of those individuals when they are
operating alone. The influences of group memberships, family and social class on
consumer behaviour are important for the study of consumer behaviour.

Social psychology is a combination of sociology and psychology. It studies how an

individual operates in a group. It also studies how they respect the opinion of peers,
reference groups, their families and also the influence on individuals in their
consumption behaviour.

Cultural anthropology is the study of human beings in society. It explores the

development of core beliefs, values and customs that individuals inherit from their
family members, which influence their purchase and consumption behaviour. It also
studies sub-cultures and helps to compare consumers of different nationalities and
cultures.

Economics: An important aspect of the study of economics is the study of how

consumers spend their funds, how they evaluate alternatives and how they make
decisions to get maximum satisfaction from their purchases.

Despite the fact that consumer behaviour as a field of study is relatively of recent
origin, it has grown enormously, has become a full-blown discipline of its own.
Organisations had to engage in extensive marketing research to identify unsatisfied
consumer needs. In this process, marketers learnt that consumers were highly
complex as individuals and had very different psychological and social needs, quite
apart from their survival needs. They also discovered that needs and priorities of
different consumer segments differed significantly.

1.2 Study of Consumer Behaviour

The study of consumer behaviour helps service provider to understand consumers‟
needs so as to recognize the potential for the trend of development of change in
consumer requirements and new technology. And also to articulate the new facet in
terms of the consumers‟ needs so that it will be accepted well.

3
Consumer behaviour has two aspects: the final purchase activity which is visible to us
and the decision process which may involve the interplay of a number of complex
variables not visible to us. In fact, purchase behaviour is the end result of a long
process of consumer decision-making.

The study of consumer behaviour is quite complex, because of many variables

involved and their tendency to interact with and influence each other. These variables
are divided into three major sections that have been identified to have the most
important general influences on Consumer Behaviour.

Figure: 1.1 - Consumer Behaviour Modelling

(Consumer Psychology / Behaviour)

Source: Sandhusen, Richard L.: Marketing (2000)

Engel, James F., Kollat, David T. and Blackwell, Rodger D. (1968) Consumer Behavior, 1st ed. New
York: Holt, Rinehart and Winston 1968.
Philip Kotler, Kevin Lane Keller, Abraham Kosh, MithileshwarJha – Marketing management- A south
Asian perspective, Published by, DorlinKindersely (India)Pvt.Ltd.2009.

4
- External Environmental Variables Influencing Behaviour
These are the factors controlled by external environment. The following forms the
basis of external influences over the mind of a consumer.
 Culture, and Sub-culture
 Social Class, and Social Group
 Family, and Inter-Personal Influences
 Other Influences (which are not categorised by any of the above six,
like geographical, political, economical, religious environment, etc.).

- Individual Determinants of Behaviour

Major individual determinants of Consumer Behaviour are portrayed. These are the
human mind and its attributes. These variables are personal in nature and they are
influenced by the above set of external factors and in turn influence the way
consumers proceed through a decision making process regarding products and
services. They are:
 Personality and Self-concept
 Motivation and Involvement
 Perception and Information Processing
 Learning and Memory
 Attitudes.

- The Consumer Decision Making Process:

The buying decision comes as a result of the complex interaction of the external
factors and the personal attributes.

-Post Purchase Decision:

• After the purchase, the consumer might experience dissonance that stems from
noticing certain disquieting features or hearing favourable things about other
services and will be alert to information that supports his or her decision.
• Psychological discomfort caused by inconsistencies among a person‟s beliefs,
attitudes, and actions
• Varies in intensity based on importance of issue and degree of inconsistency

5
 • Induces a “drive state” to avoid or reduce dissonance by changing beliefs,
attitudes, or behaviors and thereby restore consistency.
 Cognitive Dissonance:
The consumer thinks upon the following aspects:
1) Did I make a good decision?
2) Did I buy the right product or service?
3) Did I get a good value?
Service providers are frequently uncertain about the variables that are at play
influencing and affecting consumers. Sometimes this occurs because they don‟t
clearly understand the extent of variables that might have an influence. Sometimes
some variables are not directly observable. Other times variables are known to the
service providers but their exact nature and relative strength of influence is not
apparent. In these circumstances, it is useful to understand the above mentioned
concepts and how the consumers behave, so that their decision making process can be
predicted to a reasonable extent. The human mind being as complex as it is, the
understanding of the buying behaviour of the consumers becomes a continuous
activity of application of various theories and concepts.

1.3 Consumer behaviour model:

It describes various factors that influence on ultimate consumer buying behaviour,
specifically with reference to Indian consumer.

The Engel – Kollat – Blackwell Model:

This model talks of consumer behaviour as a decision making process in the form of
five steps (activities) which occur over a period of time. Apart from these basic core
steps, the model also includes a number of other related variables grouped into five
categories. The five steps (activities) involved in the decision process stage are briefly
explained hereunder:
(1) Problem Recognition: The consumer will recognize a difference between his
or her actual state and what the ideal state should be. This may occur on
account of external stimuli. It may be noted that the consumer must perceive a
sufficiently large discrepancy between actual and ideal states in order to be
activated, recognize a problem and find a way to solve it.

6
(2) Information Search: Initially the information available with the consumer
may be consistent with the beliefs and attitudes held by him or her. While
being involved in an information seeking or search stage, the consumer will
try to gather more information from various sources. These sources could be
personal or friends or neighbours or mass communication media. The
information processing takes place in various stages. The individual gets
exposure of the stimuli which may catch his or her attention, be received and
stored or retained in memory. This method of information processing is
selective in nature and the consumer will accept the information which is
conclusive to what is perceived by them.

(3) Alternative Evaluation: Now the individual will evaluate the alternatives.
The methods used for evaluating the various alternatives will depend on the
consumers underlying goals, motives and personality. The consumer also has
certain (predetermined) beliefs about the various alternatives in terms of the
characteristics associated with it. Based on these beliefs the consumer will
respond either positively or negatively.

(4) Choice: The consumer‟s choice will depend on his or her intention and
attitude. The choice will also depend upon normative compliance and
anticipated circumstances.

Normative compliance relates to the extent to which the consumer is

influenced by other people like friends, family members etc. Thus normative
compliance and anticipated circumstances will attempt to influence the
individual. The person‟s choice of the product / service can also be dependent
on the sensitivity of the individual to handle unanticipated circumstances like
losing the job, funds diverted for another urgent cause etc.

At this stage, a purchase decision is likely to occur unless when confronted by

unanticipated circumstances. In case of the latter occurring, it may act as a
barrier to the purchase decision.

7
(5) Outcome: The outcome may be either positive or negative. If the end result is
positive, the outcome will also be positive. Conversely, if there is dissonance,
that is, a feeling of doubt experienced by the consumer, about the choice made
by him or her, the outcome will not be positive. Now the consumer will search
for more information to support his or her choice.

The above mentioned Engel-Kollat-Blackwell model has taken into

consideration a large number of variables which influences the consumer. The
model has also emphasized on the conscious decision making process adopted
by a consumer. The model is easy to understand and is flexible, that is, it
recognizes that a consumer may not go through all the steps always. This is
because in case of repeat purchases the consumer may bypass some of the
steps. One limitation of this model is the inclusion of environmental variables
and general motivating influences, but not specifying the effect of these on the
buyer behaviour.

1.4 Consumer buying behaviour process

Buyer behaviour is an extremely important and complex subject for any organization.
At the same time, it is important to appreciate that there is no unified, tested, and
universally established theory on this subject. Consumer remains an enigma and
her/his mind is viewed as a black box. Before organizations can develop presentation
strategies, they must understand what factors influence buying behaviour and how
they make purchase decisions to satisfy their needs and wants. Understanding buyer
behaviour and “knowing consumers” are not that simple. It is almost impossible to
predict with one hundred percent accuracy how consumers will behave in a certain
situation. Consumers are moved by a complex set of deep and subtle emotions. Their
behaviour results from deeply held values and attitudes, their perceptions of the world
and their place in it, from common sense, impulse, or just plain whimsy.

“Consumer behaviour refers to the mental and emotional processes and the
observable behaviour of consumers during searching, purchasing, and post
consumption of a product or service.” (Satish K. Batra and S. H. H. Kazmi).

8
Buyer behaviour has two aspects: the final purchase activity visible to any observer
and the detailed or short decision process that may involve the interplay of a number
of complex variables not visible to anyone. Actual purchase is just one activity, but
the process is initiated several steps prior to a purchase and often progresses beyond
consumption. In fact, purchase behaviour is the end result of a long process of
consumer decision-making, influenced by many variables.

Figure: 1.2 – Various factors influencing Consumer Behaviour

Source: Marketing Management, Kotler, Keller, Pearson Education, Inc., 2009

The term „consumer‟ is used both for personal consumers and organisational
consumers and refers to two different kinds of consuming entities. The personal
consumers make use of products or services either personally or for their dependants.

9
Figure: 1.3 – Internal Factors affecting Consumer Behaviour

Source: Marketing Management, Kotler, Keller, Pearson Education, Inc., 2009

Figure: 1.4 – Factors affecting Consumer Behaviour

Source: Marketing Management, Kotler, Keller, Pearson Education, Inc., 2009

10
Social factors
Social factors refer to forces that other people exert and which affect consumers‟
purchase behaviour. These include culture and subculture, roles and family, social
class, and reference groups.

Culture and Subculture

Culture influences consumers through the norms and values established by the society
in which they live. It is the broadest environmental factor that influences consumer
behaviour. The impact of culture is automatic and almost invisible and its influence
on behaviour is usually taken for granted. Culture not only influences consumer
behaviour but also reflects it. It is a mirror of both the values and possessions of its
members. Cultures are not static but evolve and change slowly over time.

Subcultures exist within a given dominant culture. Culture is viewed as consisting of

basic patterns of behaviour that exist within a society at national level. Within this
broad culture, one can easily distinguish relatively more homogeneous and fairly large
groups that follow the dominant cultural values but also have other quite distinct
beliefs, values, customs, and traditions that set them apart from the larger cultural
mainstream. These represent the subcultures that may be based on religion, region,
ethnic groups, language, age, gender, and many other differences.

Roles and Family

All of us occupy some positions within family, groups, organizations etc. A role
refers to a set of functions and activities that an individual in a particular position is
supposed to perform, based on one‟s own and others‟ expectations. An individual
may have several roles and sets of expectations placed on her/his behaviour. He can
be a son, husband, father, employee, friend, etc. These different roles influence a
person‟s general as well as buying behaviour.

11
 Figure: 1.5 - Joint Decision Making Process

Source: Putnam and Davidson (1987), David and Rigaux (1974), Consumer Behaviour, WILEY- India
Edition, Martin Evans, Ahmad Jamal, Gordon Foxall, Philip Kotler, Kevin Lane Keller, Abraham
Kosh, MithileshwarJha – Marketing management- A south Asian perspective, Published by,
DorlinKindersely (India)Pvt.Ltd.2009. http://www.slideshare.net/ajaykumarta/ajaykumartaunit-2-
consumer-behavior

Figure: 1.6 – Family Decision Proces

Source: Consumer Behaviour, Ninth Edition, SchiffmanandKanuk; Copy right by Prentice hall,
http://www.slideshare.net/rainbowlink/family-social-class-life-cycle
http://www.consumerpsychologist.com/cb_Family_Decision_Making.html

A person‟s changing roles in family life cycle very significantly influence buying
behaviour.

Social Class
Many people like to think (and say) that all people are created equal. However, in all
societies there are some people who are ranked higher than others. Social class can be
viewed as a range of social positions in a society. „Social class defines the ranking of
people in a society into a hierarchy of distinct status classes; upper, middle and lower,
so that the members of each class have relatively the same status based on their power
and prestige.‟

12
Social class means societal rank, which is one‟s position relative to others on one or
more dimensions valued by society. Social class is based on demographic variables
that others in society aspire for and hold in high esteem. These characteristics
precipitate unique behaviours. Social classes range from the lower to the upper. Those
with few or none of the socio-economic factors desired by society represent lower
class, while persons who possess many of the socio-economic characteristics desired
by the society constitute upper class. Individuals in different social classes tend to
have different consumption patterns.

Figure: 1.7 - Social Class Results from Socio-economic Factors

Source: Kotler and Armstrong, 2012, Page, 137 ; https://kimthuynh.wordpress.com/reflections/factors-

impacting-consumer-buyer-behavior/

Social class is often measured in terms of social status. Subjective values set by a
society determine the ideal types of people in that society. Important factors that
determine the status in most societies include: authority over others; political,
economic, military, or religious power; ownership of property, income, occupation,
lifestyle and consumption patterns, education; public service, ancestry and
connections. Social class influences people and they may develop and exhibit
common behavioural patterns. They may have similar desires, attitudes, preferences,
and possessions.

Reference Groups
A reference group refers to a group of people with whom an individual identifies
herself/himself and the extent to which that person assumes many values, attitudes, or
behaviours of group members. Almost all of us have several reference groups such as
family, school or college related groups, work groups, etc. Nearly the entire spectrum

13
of consumer behaviour takes place within a group setting. In addition, groups serve as
one of the primary agents of consumer socialization and learning and can be
influential enough to induce not only socially acceptable consumer behaviours but
also socially unacceptable and even personally destructive behaviours. The degree of
group influence depends on an individual‟s sense of identity, value systems, strength
of involvement with the group and tendency of accepting influence of reference
group. Reference groups may influence both consumption decision as well as the
service choice.

Psychological factors
Psychological factors are internal to an individual and generate forces within that
influence her/his purchase behaviour. The major forces include motives, perception,
learning, attitude, and personality.

Motivation
This refers to the driving forces within an individual produced by a state of tension
caused by unfulfilled needs, wants, and desires. Individuals strive to reduce this
tension through some appropriate behaviour that they expect will satisfy their needs.
Much depends on individual thinking and learning in selecting the goals and the
patterns of behaviour that they believe will satisfy their needs. Whether an
individual‟s need is fulfilled leading to reduction of tension depends on the course of
action the individual takes.
Figure: 1.8 – Motivation Process

Source:Model of the Motivation process, Copyright 2010, Pearson Education, Inc, Publishing as
Prentice hall http://www.slideshare.net/ashapakki/asha-cb

14
Consumers, at any given time, are generally influenced by a set of motives rather
than just one motive. The strength of an individual‟s motives may vary at different
times and occasions. Many of the needs of an individual remain dormant for long
periods. The arousal of any particular set of needs at any given time point gets
triggered by an individual‟s physiological condition, emotional or thinking processes
or due to situational factors.

Perception
Perception is the process by which an individual selects, organizes, and interprets
stimuli into a meaningful and coherent picture of the world. Stimuli may include
services, products, packages, brand names, advertisements and commercials, etc.
Perception is an individual process and depends on internal factors such as an
individual‟s beliefs, experiences, needs, moods, and expectations. Perception is also
influenced by the characteristics of stimuli such as the context in which it is seen or
heard.

Learning
Learning is viewed as a relatively permanent change in behaviour occurring as a
result of information or experience, both direct and indirect. Schiffman and Kanuk
have defined consumer learning as: “The process by which individuals acquire the
purchase and consumption knowledge and experience they apply to future related
behaviour.” There are two basic approaches to learning: (1) Behavioural approach,
and (2) Cognitive learning approach. The emphasis of behavioural learning is on
external environmental stimuli, which are responsible for eliciting the behaviour and
minimize the importance of internal psychological processes. Behavioural learning
considers stimulus - response relationship as leading to learning, and cognitive
learning is based on the premise that learning also occurs as a result of mental
activity.

Attitudes
An attitude is an enduring organization of motivational, emotional, perceptual, and
cognitive processes with respect to some aspect of our environment. In the context of
consumer behaviour, Schiffman and Kanuk have defined attitude as “a learned
predisposition to behave in a consistently favourable or unfavourable way with

15
respect to a given object.” Attitudes are viewed as quite important object in the
evaluation process, and can be favourable or unfavourable feelings and behavioural
inclinations. Research supports the assumption that attitudes strongly affect consumer
behaviour.

Personality
Personality refers to a dynamic concept that describes the growth and development of
an individual‟s whole psychological system, which looks at some aggregate whole
that is greater than the sum of the parts. Personality is the dynamic organization
within the individual of those psychological systems that determine his unique
adjustment to environment. There seems to be much controversy regarding the exact
nature of personality. However, the concept of personality is viewed as very real and
meaningful as personality characteristics help us describe and differentiate between
individuals. Most authorities seem to be in general agreement that personality of an
individual is made up of her/his inherited characteristics and the interactions with
environment and moderated by situational conditions. It is the composite total
outcome of an individual‟s psychological makeup, motives, beliefs, attitudes, habits,

Personal factors
Personal factors include those aspects that are unique to a person and influence
purchase behaviour. These include demographic factors, lifestyle, and situational
factors.

Demographic Factors
Demographic factors include individual customers‟ age, gender, education,
occupation, income, marital status, family size, etc. These characteristics affect the
purchase and consumption behaviour of persons. Demographic considerations have
given rise to broad ways of looking at arcades, such as child arcade, teenage arcade,
youth arcade, women arcade, men arcade and senior citizen arcade. Similarly, the
income angle: low-income group, middle-income group, high-income group, and dual
income households. In general, income affects purchases because it determines how
much people can afford to spend. Buyer behaviour also varies among urban and rural
consumers in conjunction with other characteristics such as education and income. It
is believed that consumers with common demographic characteristics behave in

16
relatively similar manner and tend to have similarity in many aspects, such as product
and service preferences. Demographic characteristics may affect purchase behaviour
during specific stages of purchase decision process. In the present scenario, a person‟s
age and income may affect the number and types of information sources used.
Younger generation in cities, with resources, use the Internet to search a variety of
information. The effect of occupation and education is also seen on consumer buying
behaviour. Educated consumers seek more information and better quality services and
products.

Lifestyle
Lifestyle is an indicator of how people live and express themselves on the basis of
their activities, interests and opinions. Lifestyle dimensions provide a broader view of
people about how they spend their time, the importance of things in their
surroundings, and their beliefs on broad issues associated with life, living and
themselves. To some extent, people determine their own life styles, but the pattern is
also influenced by demographic factors and personality.

Situational Factors
Situational influences are temporary conditions or settings that occur in the
environment at a specific time and place. Based on Russell W Belk‟s study,
situational influence refers to all those factors particular to a time and place that do
not follow from a knowledge of personal (intra-individual) and stimulus (choice
alternative) attributes and that have a demonstrable and systematic effect on current
behaviour.

1.5 Consumer Decision - Making Process

Consumer decision-making generally involves five stages: Problem or need
recognition, information search, alternatives evaluation, purchase, and post-purchase
evaluation.

Problem Recognition
Purchase decision-making process begins when a buyer becomes aware of an
unsatisfied need or a problem. Problem recognition is a critical stage in consumer
decision-making process because without it, there is no deliberate search for
information.

17
The process of problem recognition combines some highly relevant consumer
behaviour concepts such as information processing and the motivation process. First
of all, consumers must become aware of the problem through information processing
arising as a result of internal or external stimuli. This leads to motivating consumers;
they are aroused and activated to engage in some goal directed activity (purchase
decision-making). This kind of action in response to recognizing problems and
finding solutions to problems depends on the magnitude of the discrepancy between
the current state and the desired or ideal state and secondly, the importance of the
problem for the concerned consumer. The discrepancy and/or importance should be of
sufficient magnitude to start the purchase process. Without perception of a problem
by the consumer, there is no recognition of an existing problem and hence there is
actually no need to engage in the process of decision-making. Since the consumer
does not perceive any discrepancy between her/his current state and the desired state,
the current state for the concerned consumer is apparently quite satisfactory and does
not need decision-making. It is important to appreciate that it is actually the
consumer‟s perception of the actual state that stimulates problem recognition and not
some “objective” reality. Also, the relative importance is a critical concept in several
purchase decisions because almost all consumers have budgetary or time constraints.

Figure: 1.9 - Stages in Consumer Decision Process

Source: Philip Kotler, Kevin Lane Keller, Abraham Kosh, MithileshwarJha – Marketing management-
A south Asian perspective, Published by, DorlinKindersely (India)Pvt.Ltd.2009.

18
Routine problems are those where the difference between actual and desired state is
expected to be felt and would call for immediate solution. Both routine and
emergency problems stimulate purchases of goods and services with a minimum time
lag between purchase and actual consumption. Emergency problems are possible but
are unexpected and necessarily need immediate solutions. For example, say a
consumer meets an accident while on his/her way to office, gets injured and the
vehicle is badly damaged. In such an emergency, she/he needs a quick solution to
reach a hospital‟s emergency room.

Information Search
After problem or need recognition, consumers generally take steps to gather adequate
information to select the appropriate solution. Information search refers to what
consumer surveys in her/his environment for suitable information to make a satisfying
purchase decision. Problem recognition is an ongoing process for consumers and they
use internal and external searches to solve these problems. Consumers may also be
involved in ongoing search activities to acquire information for possible future use.
No sooner does a consumer recognizes a problem, than she/he in a reflexive manner
first thinks or tries to remember how she/he usually solves this kind of problem. The
recall may be immediate or occur slowly as a result of conscious effort. This recall
from long-term memory might produce a satisfactory solution in case of many
problems, and no further information search is likely to occur.

In case of high involvement purchases, the relative importance of external

information search tends to increase. In general, the type of information sought by a
consumer depends on what she/he already knows. If the consumer possesses little
knowledge about available alternatives, the tendency is to learn about the existence of
alternatives and after acquiring sufficient information, to redirect efforts towards
learning more about the attributes of available alternatives to develop suitable
evaluative criteria and evaluate them. Purchase decisions of this type involving
perceived risk, extensive information search, and serious evaluation efforts are called
extended decision-making.

19
Sources of external information include:
• Relatives, friends, neighbours, and Chat groups.
• Professional information from handouts, pamphlets, articles, magazines,
journals, books, professional contacts, and the Internet.
• Direct experience through trial, inspection, and observation.
• Marketer initiated efforts

Alternatives’ Evaluation
Consumers‟ evaluative criteria refer to various dimensions; features, characteristics
and benefits that a consumer desires to solve a certain problem.

To evaluate different alternatives in the evoked set, the consumer examines services,
products or brands against-the desired set of criteria, and also those that are not
desired. Consumers use either attitude-based choice that involves the use of general
attitudes, impressions, beliefs, intuition, or heuristics and form overall preferences
about the services, or attribute-based choice that requires the knowledge of specific
attributes at the time of choosing a service by comparing each service alternative on
specific attributes.

This attribute-based choice process is cumbersome and time consuming. Generally,

the importance of an optimal decision is related to the value.

Purchase Decision
Now that the consumer has evaluated the different solutions and services, products
available for respond to his/her need, he/she will be able to choose the service that
seems most appropriate to his/her needs. Then proceed to the actual purchase itself.
The decision will depend on the information and the selection made in the previous
step based on the perceived value, features and capabilities that are important to
him/her. But his/her Consumer Buying Decision Process and his/her decision process
may also depend or be affected by such things as the quality, experience, availability,
policy or good terms and conditions etc.

20
Post-Purchase Action
Consumers‟ favourable post-purchase evaluation leads to satisfaction. Consumers
choose a service because they perceive it as a better overall choice than other
alternatives that were evaluated while making the purchase decision. They expect a
level of performance from their selected item that can range from quite low to quite
high. Expectations and perceived performance are not independent and consumers
tend to perceive performance in line with their expectations. After using the product,
service, the consumer will perceive some level of performance that could be
noticeably more than the expected level, noticeably below expectations, or match the
expected level of performance. Thus, satisfaction with a purchase is basically a
function of the initial performance level expectations, and perceived performance
relative to those expectations. Consumers engage in a constant process of evaluating
the services and products purchased. In case of certain purchases, consumers
experience post-purchase dissonance. This occurs as a result of the consumer
doubting her/his wisdom of a purchase. Consumers experience post-purchase
dissonance because making a relatively longer commitment to a selected alternative
requires one to forgo the alternative not purchased. One may expect, a positive post-
purchase evaluation results in satisfaction and the negative evaluation causes
dissatisfaction. In case the consumer‟s perceived performance level is below
expectations and fails to meet the expectations, this will definitely cause
dissatisfaction, thus the consumer is also likely to initiate complaint behaviour and
spread negative word-of-mouth. The consumer generally experiences satisfaction
when the performance level meets or exceeds the minimum performance
expectations. Similarly, when the performance level far exceeds the desired
performance level, the consumer will not only be satisfied but also will most likely be
delighted.

1.6 Hospital Service (Concept of Service)

The increasing interest in the services sector has been accompanied by considerable
disagreement as to what constitutes a service. Many authors have sought to develop
definite descriptions of a service, yet no adequate and agreeable definition emerged.

21
According to Philip Kotler ―any activity or benefit that one party can offer to another
that is essentially intangible and does not result in the ownership of anything. Its
production may or may not be tied to a physical product.”

Service has a number of unique characteristics that make them so different from
products. The distinguishing feature of a service is that its intangible aspect is
dominant, and makes them distinct from products. Services cannot be separated from
the service provider. The human elements are very much involved in providing and
rendering services and this makes standardization a very difficult task to achieve.
Services are highly variable.

Hospital as a Service Organization

The overall process which involves hospital business is service. There is nothing
which is tangible, which can be physically touched or verified and which is not
perishable. Organizations engaged in hospital business provide a wide variety of
services like providing beds, complete nursing to the patients or providing equipment
for diagnosing all sorts of ailments, arranging transportation in the form of
ambulances, catering services, etc., to the individuals.

The main objective of a hospital is to provide services against specific ailments. In

view of the definition given by Ykeshel Hasenfield and others, we notice that efforts
of hospitals are directed towards maintaining and improving the well-being of the
persons who come to the hospital for any reason whatsoever. These organizations
improve the well-being of the patients in many ways. For example, prosperity of the
country is directly proportionate to the health of the people living in the society.
Hospitals are playing a vital role in maintaining the well-being of the people.

While pointing to services, Yakeshel Hasenfield and others have touched upon
another important characteristic of services, that of 'input' and 'output', but unlike
manufacturing organizations where input is in the form of raw materials, here both
input and output are human beings only. The difference between human beings as
input and human beings as output is the changed behavior of human beings after
availing some service, or the satisfaction that they get which is reflected in their
output. This definition fits in very well in the services offered by healthcare

22
organizations. It is only the guidance which is given and facilities which are provided
in the form of beds, tests, local transportation, and nursing care. All these services a
person get satisfaction which is the output. Moreover, hospitals satisfy all
characteristics of service organizations in so far as the facilities provided by
healthcare organizations cannot be physically touched but they can simply be fit.
They are in the form of an organized system which makes the provision of service
possible on time and effective. A hospital has a network of medical services,
paramedical services, clinical services, catering services to facilitate patient
satisfaction. These organizations also have contacts throughout the world with leading
hospitals and practitioners to provide updated facilities to the users. The services
cannot be stored. It is also true with services provided by hospitals that their expertise
cannot be stored. They are perishable. If one is not hiring them, they get useless for
the day. When the services cannot be stored they cannot be transferred too. One can
say that all that hospital services are linked with other supplementary services.

Healthcare set up in India

Health care services are becoming more significant today than ever before in India.
Along with the growth of the industry and services, the demand for health care is also
increasing. India has perhaps the world„s largest community based tradition of
indigenous system of medicine. In health care services, hospitals play an important
role. The development of health care facilities is influenced not only by opening of
hospitals and healthcare centers; but also by their administration and management. If
hospitals and health care centers are managed properly, there is an expression in the
medical care that all the facilities can be provided even at the least possible
investment.

The traditional concept of managing the hospital services cannot serve our purpose,
like corporate management. The hospital management also insists on time- honored
structural transformation in the management cadre. The application of modern
marketing principles would pave the way for rationalizing the services, standardizing
the services offered, optimizing the fee structure, and promoting the services with the
help of sophisticated communication devices. This would open doors for channeling
the services. In developing countries like India the cases of marketing paucities are
found in almost all the corporate hospitals.

23
The healthcare industry in recent years has restructured its service delivery system to
survive in an unforgiving environment that has resulted from maturation of the
industry, reduced funding and increased competition. The restructuring has focused
on finding effective ways to satisfy the needs and desires of the patients. Consumer
satisfaction is a basic requirement for healthcare provider because, the satisfaction
related to quality of healthcare is provided by hospitals. Satisfaction is important
where patients and institutional healthcare service buyers make decisions on their own
selections.

Private Healthcare
The healthcare industry in India has been emerging as one of the biggest service
sectors. The Indian healthcare provider needs to be benchmarked to international
standards to provide quality service to the patients and to meet their expectations.
What patients experience, and what they think of that experience, should also matter
to health care planners, policy makers, and managers, because that experience, as
much as the technical quality of care, will determine how people use the health care
system and how they benefit from it.

The patient centered approach is widely advocated, but implementation in practice is

limited and related to characteristics of both doctors and patients. Some aspects of
patient centeredness may have important benefits for patients: improved
communication can improve satisfaction and biomedical outcomes, Involving patients
in partnership can have benefits without increasing their anxiety and with the potential
to reduce adverse outcomes connected to prescribing (Little Paul, et. al., 2001). In the
broadest terms, understanding the consumer behaviour process and bringing about a
patient-centered care is essential.

Hospitals
A hospital is the most complex and dynamic institution of our society. The main
objective of a hospital is to provide health services to all people, at all times at
affordable costs. A modern hospital is considered a highly scientific and complex
medical institution much different from its age old concept of a poor house where
people left their incurable and dying relatives. (World Health Organization, Expert
Committee on Hospital Administration, 1968)

24
An in-patient, on the other hand, is "admitted" to the hospital and stays overnight or
for an indeterminate time, usually several days or weeks (though some cases, such as
coma patients, have been in hospitals for years). Treatment provided in this fashion is
called inpatient care. The admission to the hospital involves the production of an
admission note. The leaving of the hospital is officially termed discharge, and
involves a corresponding discharge note. Healthcare Professionals (HCP) are persons
licensed and qualified with education, training, certification, to provide health care.
“Health professionals” are highly skilled workers, in professions that usually require
extensive knowledge including university-level study leading to the award of a first
degree or higher qualification. This category includes physicians, physician assistants,
dentists, registered nurses, pharmacists, physiotherapists, optometrists, and others
(World Health Organization, 2006).

Role of Hospitals
The role of hospitals and hospital administration has been broadened in the modern
era as the life expectancy has gone up. People expect that all kinds of diseases can be
eased out or controlled by the hospitals. Thus, hospitals have become a place of high
expectations and everyone looks to it for help in times of distress. That the hospital
has a noble purpose expressed in the phrase promotion of health and welfare of the
people cannot be disputed. Hospital Administration is an activity to secure better
output through optimum utilization of inputs.

It is said that each hospital has an image of its own, a tempo of work and emotional
atmosphere peculiar to its traditions, its community of staff and patients. The nature
of staff relationship directly influences the staff-patient relationships. It is for this
reason that there is different working atmosphere in different hospitals. Some
hospitals enjoy a good reputation and others not so good. The patients and the hospital
environment are interested only in the ultimate quality of effective health care, which
is an important factor in the inputs of a good health care delivery system. In this way
all the efforts are directed to achieve a good health care output thereby, providing
good quality health care, which will go a long way in creating excellent patient-
hospital relationship.

25
With the growing community consciousness, expectations about the hospitals‟
performance also rises. Hospitals are being reoriented from just being centres for
medical care and treatment to be more community oriented. There is now a greater
pressure of work, for really over-worked hospital personnel due to steep rise in
population and the various types and serious nature of the ailments. Medicine is still
not reaching up as an exact science in spite of the great advances in bio-chemical
science. It is imperative for doctors, nurses and paramedical personnel to exhibit
utmost precaution, care, judgment and skill in dealing with patients while treating
them, balancing the relative risk of the disease with the risk involved in the use of
drugs, surgery or diagnostic procedures, apart from the cost benefit considerations.

Skills of Care Providers

Understanding the needs and wants of the patients to bring about patient satisfaction
is the need for the hour. This includes not only learning about the sicknesses and
symptoms, but also their environment, beliefs, dietary habits, risk factors, and social
and psychological function. Through effective patient-centered communication,
doctors are able to understand the patient‟s perspective. This forms a collaborative
partnership that actively promotes patient involvement in decision making, ultimately
leading to better outcome and satisfaction.

In addition to the physicians, another important cog in a health care set up are the
nurses. Patients willingly seek care because their needs exceed their capacity for self-
care and patients will experience a heterogeneous response to illness. The nurse must
be able to show a caring presence via communication and other manifestations,
approach the patient as an individual, have the necessary skills and competencies and
be able to deviate from established norms, if necessary. Through this process, the
nurse is able to provide effective care, minimize the erosion of individual (patient)
identity, address complexity and broaden the explanatory perspectives of illness.

Expectations
By means of the increasing community awareness, prospects about the hospitals‟
performance are also rising. Hospitals are being reoriented from just being centres for
medical care and treatment to be more community oriented. It is imperative for health
care personnel to exhibit utmost precaution, care, judgment and skill in dealing with

26
patients while treating them, harmonizing the virtual risk of the disease with the risk
involved in the use of drugs, surgery or investigative processes, apart from the charge
benefit deliberations.

1.7 Exploration of consumers' behaviour in choosing hospital

Demands of high quality and service on medical care are brought up in consumers'
mind. Nowadays, hospital operating environment is getting more and more
competitive. Therefore, how to take the advantage of competitiveness is the need of
the hour. It is important to catalogue consumers' behavior in choosing hospitals
(Arjun Murti, et al. 2014).

As health care services get more competitive, health care practitioners and academic
researchers are increasingly interested in exploring how patients perceive quality
before building up their satisfaction levels and generating behavioural intentions.
Hospitals today are increasingly realizing the need to focus on service quality as a
measure to improve their competitive position. Customer based determinants and
perceptions of service quality therefore play an important role when choosing a
hospital. It is significant to examine and measure the quality of services and its
outcomes (patient‟s satisfaction and behavioural intentions) provided by private
hospitals. The development of a comprehensive scale for measuring service quality,
patient satisfaction and behavioural intentions is obligatory for the current health care
scenario. The results establish a direct influence of service quality on behavioural
intentions, and the mediating role of customer satisfaction on influencing behavioural
intentions. Service quality and patient satisfaction are found to be strong drivers of
behavioural intentions in the context of health care services in India. Studies are vital
to analyze the suitability of service quality to improve customer satisfaction and in the
process to know the positive impacts on behavioural intentions in the health care
setting (Wan-I Lee. Et al, 2008).

1.8 Need for the study

The need for the study therefore, is to identify the expectations of the patients from a
healthcare set up. Patients are usually satisfied with the technical quality of care they
receive. But somewhere in the process, their individuality is lost sight of; their
personal and subjective needs remain unmet. Healthcare set up is still complex to

27
understand, to take appropriate decisions regarding different treatment modalities,
patient care, facilities etc... Similarly, the expectations of the patients from a health
care service are not clearly known. There is still a gap which exists in terms of
healthcare delivery. In the current scenario a patient centered approach is vital in a
hospital while providing medical services. It is important for any health care set up to
analyze the consumer behaviour pattern in order to understand the needs of the
patients and to recognize the potential for development and to bring about an
integrated care. Consumer Behaviour is quite complex, because of many variables
involved and their tendency to interact and influence each other. Keeping the various
parameters of cognitive process and consumer behaviour in mind an approach
towards satisfying the patient expectations through an integrated care has to be
articulated. There is scarcity of information especially with regard to the patient
expectations and the managerial tenets to achieve the same, so that it could be
implemented in a healthcare set up particularly here in India. This vast area of health
care service expectations of patients has neither been empirically examined nor have
the data been catalogued. Being a student of management specifically exposed to
hospital and health systems management, it is felt that there is an urgent need to
explore not only the highways of the subject but the by lanes and alleys of the
healthcare service expectations of patients to bring about an integrated care and
patient delight.

1.9 Area of the Study

The present study was conducted in four multispecialty corporate hospital in Chennai.
The four multispecialty hospitals were; i) Apollo Hospital ii) Billroth Hospital iii)
Mehta‟s Hospital and, iv) Fortis Malar Hospital. The study was conducted with
inpatients. After obtaining formal permission from the authorities of the hospital,
questionnaires were distributed to the inpatients of wards such as General Medicine
(Adults and Children), General Surgery (Adults and Children). Both the primary and
secondary data obtained forms the basis for this study. The empirical findings of the
present study will aid corrective measures and improvements to be implemented
forthwith and lead to better patient satisfaction.

28
1.10 Statement of the Problem
This study mainly focuses on the perception of the patients with regard to their
expectations during healthcare delivery in terms of treatment modalities, patient care,
facilities, administrative and supportive aspects from selected corporate hospitals. It
has been articulated based on the important consumer behaviour aspects like
Demographics, Individual determinants of behaviour (such as Learning and memory,
Motivation, Attitudinal aspects, Perception and Information processing), Decision
process, Post purchase determinants and Post purchase decision. Thus the patient
expectation during healthcare delivery has been identified as the key aspect for the
study.

1.11 The aim of the Study

The main aim of the study is to assess the Consumer behaviour process with special
reference to patients of corporate hospitals in Chennai city, with regard to the aspects
of Consumer behaviour process such as Individual determinants of behaviour,
Decision process, Post purchase determinants and post purchase decision.

1.12 Methodology
Data for the study has been collected through a structured questionnaire. The present
study was conducted at four multispecialty corporate hospitals in Chennai for the
inpatients. The requisition letters and mails were sent to 12 corporate hospitals in
Chennai for conducting the study. Out of the 12 corporate hospitals approached, 4
hospitals gave permission to collect responses from the inpatients. After obtaining
formal permission from the authorities of the hospital, questionnaires were distributed
to the inpatients of wards such as General Medicine (Adults and Children), General
Surgery (Adults and Children). The study is based on both the primary and secondary
data obtained.

The questionnaire had been specifically developed for the study. A detailed
questionnaire was prepared in both English and Tamil with questions arranged
systematically and worded in a simple manner to facilitate easy understanding. The
questions were designed on five point scale, multiple choice, open ended type and yes
or no type. The questions were spread out into five sections, each section forming a
parameter in the questionnaire. The design of the structured questionnaire is guided

29
by the objectives. Most of the questions are closed questions. Apart from the
demographic details, the questionnaire contained 95 objective type statements. A
rating scale with five response alternatives was used to measure the perception in
relation to the statement given; in particular the Likert scale has been used.
Alternative responses like „Very poor’, ‘Poor’, ‘Satisfactory’, ‘Good’, and ‘Very
good’ are applicable for some set of questions and „Strongly disagree’, „Disagree’,
‘Neither agree nor disagree’, ‘agree’ and „strongly agree’ for rest of the questions.
Questions were framed without changing the meaning of each item. The requisite
ethical clearance was obtained from Sri Ramachandra University (Ethics committee)
and the pilot study was conducted in order to refine and validate the process of data
collection using questionnaire. Questions related to each item was reviewed,
discussed and modified accordingly.

The content validity and verification of the instrument was done by distributing the
questionnaires to experts like senior level doctors involved in patient care, and
experienced researchers, statisticians. 10 – 20 experts were asked to provide their
suggestions and comments for improvising the study aspects. The questionnaire was
also distributed to 120 patients (30 patients in each of the hospital), the data was
collected and analyzed to have an overview about the study and to know the
reliability. The reliability of the instrument was checked using the statistical tool
named Cronbach‟s Alpha, which is the most conjoint means of testing internal
constancy of the items, using the SPSS package.

The primary data was collected through well-defined questionnaire which was
administered to a pre-determined sample at four of the corporate hospitals. The
researcher visited the hospitals, explained the study information and consent was
obtained from the patients. Majority of the respondents could fill the questionnaire on
their own, but for few respondents who had difficulty the researcher explained the
questionnaire and obtained the responses. In case of children being the patient, the
parent (mother/father) was the respondent/informant and filled the questionnaire. The
selected hospitals were visited for data collection from December 2013 to July 2014
for a period of 8 months (2 months duration in each hospital). Formal permission and
approval was obtained from the selected hospitals before collecting primary data. The
secondary data was obtained from journals, books and reports.

30
The questionnaire was distributed to a total of 600 inpatients from the four
multispecialty corporate hospitals using stratified sampling technique. The data
collected through questionnaires was tabulated and analyzed by applying appropriate
statistical tools such as Reliability Analysis, Descriptive Analysis, Confirmatory
Factor Analysis, Inferential Analysis, Correlation Method, Regression Analysis, One-
way ANOVA, and t test. The data had been subjected to statistical analysis using the
SPSS (Version 18) package and AMOS (Version-18).

1.13 Limitations
 The study is limited to four corporate hospitals in Chennai city.
 The study is limited to inpatients and does not attempt to analyse other
departments such out patients, aspects of trauma or other emergencies.
 All the aspects related to consumer behaviour with regard to choosing a
hospital may not have been dealt with during this study.

1.14 Operational Definitions

Patient: A person under medical or surgical treatment; correlative to physician or
nurse.

Patient Care giver / Patient Attender: A caregiver is an unpaid or paid person who
helps another individual with impairment with his or her activities of daily living.
A lay individual who assumes responsibility for the physical and emotional needs of a
nother who is incapable of self-care.

In-patient: A patient who is admitted to a hospital or clinic for treatment that requires
at least one overnight stay.

Healthcare Provider: An individual who provides health services to health care

consumers (patients).

Hospital: The WHO defines hospital as “an integral part of a social and medical
organization, the function of which is to provide for the population, complete
healthcare both curative and preventive and whose out-patient services reach out to
the family in its home environment.”

31
Corporate Hospitals: Corporate hospitals can be defined as private for-profit
hospitals (as opposed to charitable hospitals) offering general or specialist tertiary
level care (e.g. cardiac care). They are different from others hospitals because of their
private corporate limited status.

Healthcare Professionals: A person who by education, training, certification, or

licensure is qualified to and is engaged in providing health care.

Learning: It is the act of acquiring new, or modifying and reinforcing,

existing knowledge, behaviors, skills, values, or preferences and may involve
synthesizing different types of information

Memory: The power or process of remembering what has been learned, something
that is remembered, the things learned and kept in the mind.

Motivation: Internal and external factors that stimulate desire and energy in people to
be continually interested and committed to a job, role or subject, or to make an effort
to attain a goal.

Perception: Perceptions vary from person to person. Different people perceive

different things about the same situation and the meanings might change for a certain
person. One might change one's perspective or simply make things mean something
else.

Attitude: A predisposition or a tendency to respond positively or negatively towards

a certain idea, object, person, or situation. Attitude influences an individual's
choice of action, and responses to challenges, incentives, and rewards (together called
stimuli).

Cognition: Cognition is a group of mental processes that includes attention, memory,

producing and understanding language, learning, reasoning, problem solving and
decision making. Cognition is typically assumed to information processing in a
participant‟s or operator‟s mind or brain. Cognition is a faculty for the processing of
information, applying knowledge, and changing preferences.

32
Cognitive: Psychological processes involved in acquisition and understanding of
knowledge, formation of beliefs and attitudes, and decision making and problem
solving. They are distinct from emotional and volitional processes involved in
wanting and intending.

Cognitive Processes: Cognitive processes are the mental processes used by an

individual to learn and retain information.

Consumer Behaviour: Consumer Behaviour is the study of how individuals, groups,

and organizations select, buy, use and dispose of goods, services, ideas, or
experiences to satisfy their needs and wants. It helps us to know when, why, how,
and where people do or do not buy a product, or a service.

Decision Process: In psychology, decision-making is regarded as the

cognitive process resulting in the selection of a belief or a course of action among
several alternative possibilities.

Consumer Decision Process: The buyer decision process is the decision-making

process used by consumers regarding market transactions before, during, and after the
purchase of a good or service. More generally, decision-making is the
cognitive process of selecting a course of action from multiple alternatives.

Consumer Decision Behaviour: The processes, by which consumers identify their

needs, collect information, evaluate alternatives and make the purchase decision.
These actions are determined by psychological and economical factors, and are
influenced by environmental factors such as cultural, group and social values.

Post Purchase Decision Behaviour: Post-purchase behaviour involves all the

consumers‟ activities and the experiences that follow the purchase. Usually, after
making a purchase, consumers experience post-purchase dissonance.

Cognitive Dissonance: It is also called as post-purchase dissonance. The consumer

thinks upon the following aspects like, did I make a good decision? Did I buy the
right product or service? Did I get a good value?

33
Post purchase satisfaction: Satisfaction is a function of the closeness between
expectations and the perceived performance. If performance falls short of
expectations, the consumer is disappointed; if it meets expectations, the consumer is
satisfied; if it exceeds expectations, the consumer is delighted. These feelings make a
difference in whether the consumer purchases the service again and talks favourably
or unfavourably about it to others. The larger the gap between expectations and
performance, the greater the dissatisfaction.

Post purchase actions: If the consumer is satisfied, he or she is more likely to

purchase the service again. The satisfied consumer will also tend to say good things
about the brand to others. On the other hand, dissatisfied consumers may abandon or
may not return back to the particular service provider

Empirical Study: Empirical research is a way of gaining knowledge by means of

direct and indirect observation or experience. Empirical evidence (the record of one's
direct observations or experiences) can be analysed quantitatively or qualitatively.
Through quantifying the evidence or making sense of it in qualitative form, a
researcher can answer empirical questions, which should be clearly defined and
answerable with the evidence collected (usually called data).

Healthcare Services: Health care (or healthcare) is the diagnosis, treatment, and
prevention of disease, illness, injury, and other physical and mental impairments in
humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry,
nursing, pharmacy, allied health, and other care providers. It refers to the work done
in providing primary care, secondary care and tertiary care, as well as in public health.
Access to health care varies across countries, groups and individuals, largely
influenced by social and economic conditions as well as the health policies in place.

Health care systems: These are organizations established to meet the health needs of
target populations.

34
1.15 Chapter Organization of the Study
The study is organized into the following five chapters.
1. CHAPTER I - INTRODUCTION – This chapter introduces‟ the background,
fundamentals, trend in consumer behaviour process and its significance in health care
set up. It also deals with the need for the study, statement of the problem, area of the
study, aim of the study, the methodology, about the analysis and also the limitations
faced in the study.

2. CHAPTER II - REVIEW OF LITERATURE – This chapter explains the existing

literature relating to the study. The literature includes the articles and books published
in the area of Consumer Behaviour, Individual determinants of Behaviour, Decision
process, Post purchase determinants and Post purchase behaviour, Patient‟s
Perception, Patient‟s satisfaction, Doctor-Patient Relationships, Patient-centered care,
Quality Healthcare, and studies relating to the Structure Equation Model.

3. CHAPTER III - METHODOLOGY – This Chapter discusses the methodology

used to determine the Consumer behaviour process of the patients in the hospital and
a detailed picture of population and sample, pilot study, data collection, the survey
design, the questionnaire, its components.

4. CHAPTER IV – ANALYSIS and INTERPRETATION – This chapter discusses

the statistical analyses used for testing hypotheses and the details of the results, which
are the outcomes of various statistical techniques, which are presented in the form of
tables, charts, etc.

5. CHAPTER V - CONCLUSION – This Chapter deals with conclusions based on the

research work carried out and the results obtained comprising a summary of all the
findings, conclusions and recommendations as also areas for further research.

35