Examining the treatment choice when getting a cold

MINISTRY OF EDUCATION AND TRAINING
UNIVERSITY OF ECONOMICS HO CHI MINH CITY
VIETNAM

Examining the Treatment
Choice When Getting a Cold

By
DANG HOANG HAI TRUONG

MASTER OF ARTS IN DEVELOPMENT ECONOMICS
(SPECIALIZATION IN HEALTH ECONOMICS AND MANAGEMENT)

HO CHI MINH CITY, MAY 2015


MINISTRY OF EDUCATION AND TRAINING
UNIVERSITY OF ECONOMICS HO CHI MINH CITY
VIETNAM

Examining the Treatment
Choice When Getting a Cold

A thesis submitted in partial fulfillment of the requirements for the degree of

MASTER OF ART IN DEVELOPMENT ECONOMICS
(SPECIALIZATION IN HEALTH ECONOMICS AND MANAGEMENT)

Major: Economics
Code: 60310105
By

DANG HOANG HAI TRUONG
Academic Supervisor:
Dr. NAM KHANH PHAM
HO CHI MINH CITY, MAY 2015


CERTIFICATION STATEMENT
I guarantee data used in this thesis were truly collected through survey progress,
along with using legal documents.
The implications are withdrawn by the author from the experience of working, and
learning.

HoChiMinh city, 2nd May 2015

Dang, Truong Hoang Hai


Abstract
Wrong decision leads to wrong destination. We make choice at every action in our
life. There are a lot of decisions that are over our knowledge or experience.
Sometimes we need a convincer who knows better. However it is difficult for us to
judge whether his decision will lead to our expected outcome. He also does not
know what factors we are considering. That is the reason why sometimes we make
an irrational decision which is from other’s point of view. For a convincer, it is
important to understand decision factors of person who is convinced. In health
aspects, doctor-patient communication is significantly vital. For a health authority,
if he wants people to make a decision that benefit to the whole society, he also
should understand their elements of consideration. This thesis studies treatment
decision making of patients when they get a cold. Our survey shows that people
have three kinds of decision when they get a cold i.e. either “go to the doctor”, or

“self-medication” or “non-drug treatment”. This thesis examines the impacts of
psychological factors and socio-economic factors on each of the decisions. The
social pressure and patient’s perceived control factors do not have influence on the
decision. Females who have higher education are more likely to go to the doctor,
and who have high income are less likely to choose self-medication. We employed
the multivariate probit model to analyze the treatment choice and a factor analysis
to construct psychological variables which were developed from the Theory of
Planned Behavior. .


ACKNOWLEDGEMENTS
This thesis would not be completed without the backing and the encouragement of
important individuals. First, I would like to say thanks to my instructor, Dr. Pham
Khanh Nam, in spite of his busy schedule, he guided me to finish this dissertation.
Second, I would like to say my gratitude to my parents who encouraged me in hard
moments and their unconditional love.
Third, it would be a mistake if I did not make mention to my friends and my brother
who helped me to sharpen the questionnaire.
Finally, I express my gratitude to participants who play an important role in this
thesis through their collaboration to complete the questionnaire.


ABBREVIATIONS
Freq.

Frequency.

RUM

Random Utility Maximization

TPB

Theory of Planned Behavior.

VND

Vietnam dong.

WHO

World Health Organization.


Table of Contents
CHAPTER 1: INTRODUCTION…………..……………...…...……………….....1
1.1 Research problems.……………….…………………………………….1
1.2 Research objectives……………………………………..…………..…..2
1.3 Scope of study…………………………………………………………..3
1.4 The structure of the thesis……………………………………………....3
CHAPTER 2: LITERATURE REVIEW…………………………..……….….......4
2.1 Key Concepts…………………………..………….…...……….………4
2.1.1 Common health problems and common cold…….……………4
2.1.2 Patient choice and its special elements……….…………….....4
2.1.3 Patient belief………………..………………………………….4
2.1.4 Self-medication and economics of self-medication…………...5
2.1.5 Non-drug treatment……..……………………………………..6
2.1.6 Social capital…...…...…………………………………………6
2.2 Studies of socio-economic factors in health aspect………...………......7
2.3 Theory of Planned Behavior in Health Choice………………………..10

2.4 Review of empirical studies...…………………………………………11
2.5 Literature review conclusion………………………………………….12
CHAPTER 3: RESEARCH METHODOLOGY………...……………………..…13
3.1 Analytical framework……………………………………………….…13
3.2 Measurement of variables...…………………………………………...15
3.2.1 Qualitative process…………………………………………...15
3.2.2 Quantitative process………………...………………………..18
3.2.2.1 Indirect measure of the Theory of Planned Behavior…….18
3.2.2.2 Direct measure of the Theory of Planned behavior.............21
3.2.2.3 Socio-economic…………………………………………...22
3.3 Econometric Models…………………………………………………..22
3.4 Variable description…………………...……………………………....24
3.5 Research strategy ……………………………………………………...29


3.5.1 Setting………….…………………………………………….29
3.5.2 Sampling technique and sample size…………………………30
3.5.3 Data collection process……………………………………….30
3.5.4 Data analysis…………………………………………………31
3.5.5 Data framework…..…………………………………………..31
CHAPTER 4: RESEARCH RESULTS………..………………..….…..………...32
4.1 Overview of Vietnamese health environment…………………..……..32
4.2 Descriptive statistics……………………………………….…………..32
4.2.1 Psychological factors statistic……………………..…………33
4.2.1.1 Attitude………………………..…………………….33
4.2.1.2 Subjective norm…………………………………….36
4.2.1.3 Perceived behavioral control………………..………37
4.2.2 Socio-economic statistic……………………………………...38
4.2.2.1 Demographic variables……………………………...38
4.2.2.2 Descriptive social capital variables…………………40

4.2.2.3 Descriptive risk variables…………………………..41
4.3 Regression results……………….……………………………………..42
4.3.1 Theory of Planned Behavior……………..…………………..42
4.3.1.1 Indirect measure…………………………………….42
4.3.1.2 Direct measure……………………………………...49
4.3.2 Socio-economic factors…………………..…………………..51
CHAPTER 5: CONCLUSIONS AND POLICY IMPLICATIONS……...............55
5.1 Conclusions……....…………………………..…………………......…55
5.2 Policy Implications……………………..……………….……....……..56
5.3 Other suggestions…….………….…………………….……..………..57
5.4 Limitation……………..…………………………………..…………..58
REFERENCES.………………………………………………….…..…………..59
APPENDIX A………..…………………………………………………………..64
APPENDIX B…………………………………………………..……….….……71


LIST OF FIGURES
Figure 1. Model of the study……………...………………………..……………..13
Figure 2. Data framework…………………………………………...…………….31
Figure 3. The income and the choice………………………………………...…....39
Figure 4. The gender and the choice……………………………………...……….40
Figure 5. The social group adherence and the choice…………………………..…42
LIST OF TABLES
Table 1. Theories of socio-economic in health aspect…………….……………….9
Table 2. Salient belief items……………………………………………………….18
Table 3. Variables definition………………….…………………………………...25
Table 4. The statistical results of the choice……………………….………………33
Table 5. The attitude and the choice…………….……………..…………………..35
Table 6. The subjective norm and the choice……………………..………………..37
Table 7. The perceived behavioral control and the choice…………………………38

Table 8. Descriptive demographic variables……………………………………….38
Table 9. Joint social group……………………….………………………………...40
Table 10. Description of trust…………….………………………………………...41
Table 11. Risk attitude description……………….………………………………...41
Table 12. Factor analyses and Cronbach’s alpha of the indirect measure…….…...43
Table 13. Multivariate probit regression of indirect measure………………….…..47
Table 14. Factor analyses and Cronbach’s alpha of the direct measure…………...49
Table 15. Multivariate probit regression of direct measure……….………………50
Table 16. Factor analyses and Cronbach’s alpha of the socio-economic………….51
Table 17. Multivariate probit regression of socio-economic……….……………...52


1

CHAPTER 1: INTRODUCTION
1.1 Research problems:
In a big picture, there is an unbalanced diversity among hospitals. There is a very
common situation that in central hospitals, such as Cho Ray hospital, hospital overload
is the serious trouble that causes two patients have to share one bed. However in the
others hospital, like district hospitals or private hospitals, there are usually free beds as
a result of lacking of patients.
The ability of “downstream” hospitals, by doubting not only about technique ability but
also service ability could damage deeply in patient’s belief. Even when they can
completely cure the common diseases, people still want to stay away and move to
higher level hospitals.
There is information asymmetry between the patients and medical staffs. For instance,
patients do not know whether drugs they are using are good or bad for their health and
also do not know which are the good sides and which are the drawbacks of the
medicine services that they are consuming as well as the opportunity cost they have to
pay when they could get to other hospitals or choose to not experience in medical care.

Moreover, until now in medicine area, for a certain health problem, we still do not have
powerful measure tools to predict which doctor, or drug, is better and completely
guarentee for a positive outcome. There are chances existing, chances for getting cured,
and chances for complication. The result is mostly on individual basis, which one
experiences himself as a patient or who know the patient, don’t know thoroughly about
the situation. In this lack of information and uncertainty environment, individual seems
to make a choice between various solutions by their feeling and belief.
Health is a vital matter for each individual. Good health allows us to live and work
more efficiently and positively. Bad health on other hand could negatively affect people
attitude and productivity. That is the reason why an increase in level of citizens’ health
can improve the productivity, GDP, research, or education so that the social community
can be enhanced in all areas. In the other side of the coin, when a health problem


2

appears, it is important to find a suitable method which can cure the disease with
appropriate cost, not only be measured by money, but also by time, career, health,
relationship, etc.
This thesis stays focused on in aspect how health’s belief impacts on health decisionmaking. In order to explain this relationship, common cold is used as a common health
problem. Common cold’s nature is a popular health problem and patients have many
choices.
The author believes that investigation of this event could lead to a new insight,
especially in Vietnam, a country that lacks of health behavior research. Moreover,
successful explanation of this relationship provides a suggestion on communication
with patient. Since talking with doctor takes a main part in making patients satisfy
(Bensing 1991; Maguire & Pitceathly 2002), and health decision-making is based on
belief, this thesis will become a milestone for healthcare practice.

1.2 Research objectives:

The overall aim of this research is to analyze the impacts of socio-economic factors and
psychological factors on treatment choice when getting a cold.
Specially, based on the Vietnam’s health environment, the specific objectives of this
research are to:
1. Measure psychological factors in three dimensions: attitude, subjective norm, and
perceived behavioral control.
2. Examine the relationship between psychological factors and treatment choice, i.e. go
to the doctor, self-medication, and non-drug treatment.
3. Examine the relationship between socio-economic factors (demographic, social
capital, and risk attitude) and treatment choice i.e: go to the doctor, self-medication, and
non-drug treatment.


3

1.3 Scope of study:
This study compares the causes of treatment decision-making: go to the doctor, selfmedication, and non-drug treatment. To be specific, the subjective of research is
common-cold, a common health’s problem that patients have many solutions. Data are
received by survey method. The location and time to survey is district 3, from April to
May, 2015. Collected data have been analyzed by multivariate probit model.
Data have been collected by cluster sampling method. District 3 citizens who are at
ages from 18 to 80 are selected.

1.4 Structure of the thesis:
The thesis is divided into five chapters. Chapter I is the introduction that presents the
research problem, as well as research objectives and scope of study. Chapter II is the
literature review which defines concepts, provides theoretical background, and
discusses empirical related studies. Chapter III is the methodology which gives the
method of study, including analytical framework, measurement variables, qualitative
progress and variable definition. After data are analyzed, the result of study appears at

chapter IV. Chapter V is the conclusions and political implications.


4

CHAPTER 2: LITERATURE REVIEW
2.1. Key Concepts:
2.1.1 Common health problems and common cold:
Everyone wants to live a healthy life, and want to recover from disease. However, there
is usually not only one option to solve the problem. Specially, in common health
problems, people have more solutions than in serious health events.
Common cold is a common health problem mostly because of virut. From patient’s
point of view, Mayo Clinic’s definition is suitable. According to Mayo Clinic, healthy
adults are expected to have a few cold each year, and most people recover from a
common cold in about a one or two weeks. Sign and symptoms include runny or stuffy
nose, cough, and mild fatigue. Not all cases need to see a doctor and these patients only
seek medical attention when getting high temperature fever. Fever is accompanied by
sweating, chills, and a cough with colored phlegm, severe sinus pain.
2.1.2 Patient choice and its special elements:
Patient choice as Community Pharmacy Standards of Practice declared in 2015, relates
to rights, which is that no one can enter into agreement with any person, who limit a
patient’s choice of pharmacy, excepts as required or permitted under the bylaws.
Dixon et al. (2010) gave evidence that the patient valued the ability to make choice.
They also had evidences that patient rely on their own or others’ experience to inform
their choice.
There are different points of patient and doctor when comparing to normal buyers and
firms. Dixon et al. (2010) also argued that patients do not act as normal consumers, they
cannot test the product before consuming or even after having consumed it. It is also
hard for patients to find out relevant information to their condition, and they place trust
on the provider. Externalities are also an important factor in health aspect.

2.1.3 Patient belief:
As mentioned before, patients have to place their trust on the providers. Therefore, the
concept of patient belief is necessary to join the thesis.


5

Groot and Steg argued that general belief may affect a wide range of behaviors (Groot
and Steg, 2007:3), that means we need to explore belief to research behavior and health
decision-making.
Mostly because of the asymmetric information, patients choose health solutions mainly
based on their belief. Because belief is the psychological state in which an individual
holds a proposition or premise to be true ( Passos et al., 2013:1). Knowing each
patient’s health beliefs is the key feature of the new doctor- patient encounter. This may
lead to a negotiated treatment plan to which both patient and doctor can adhere
(Vermiere et al., 2001:400). This empirical research impresses the important role of
understanding patient’s belief to help them improve their health behavior.
There are a lot of theories that study the relationship between belief and decision.
Among them is the Theory of Planned Behavior (TPB). Moreover, there have been a lot
of meta-analyses and reviews of TPB. In Armitage work in 2001, he concluded “TPB is
a useful model for predicting a wide range of behaviors and behavioral intentions.”
(Armitage and Conner, 2001:340) or Armitage’s another argued in the next two years,
“At present, the theory of planned behavior is arguably the most dominant model of
attitude-behavior relations”. (Armitage and Christain 2003:5).
2.1.4 Self-medication and economics of self-medication:
This thesis combines psychological factors and socio-economics factors to explain
treatment decision-makings: go to the doctor, self-medication or non-drug treatment.
In a study in Jordan about self-medication (Yousef et al.,2007:24), Yousef said selfmedication is a concept which belongs to self-care and can be defined as consuming
medicines without the advice of physician for diagnostic, or treatment. As the result of

World Self-Medication Industry, Self-medication is popular in both developed and
developing countries.
Self-medication is an important matter in healthcare aspect. It also was defined as the
consuming of patient without physician’s advice or on the advice of pharmacist or on
his own decision (Yousef et al., 2007:24). Patients usually use self-medication to solve


6

their normal health problems. World Self-Medication Industry also declared: “Selfmedication is the treatment of common health problems with medicines”. On the other
hand, “Most of the self-medication was involved with headache and fever, cough and
cold” (Verma, 2010:60), which related to the sign and syndrome of common cold.
The reason why patients choose to use self-medication method is its benefits. Selfmedication users save their time and money, compared to professional care users
(Chang et al., 2003:721). However, self-medication users increase risks of drug induced
and/or drug-resistant strains (Chang et al., 2003:721).
There are many studies that discovered the link between self-medication and socioeconomic (Afolabi, 2012). Among them is the study of Chang et al. (2003). They built
a RUM model of self-medicating behavior of consumers who balance the advantages
and disadvantages of self-medication. Their theory formulates the connection between
income, health insurance and self-medication decision.

2.1.5 Non-drug treatment:
WHO (1994) argued not all health problems need drug to recover. Along with drug
treatment, non-drug treatment is used in many health problems: Pain control,
hypertension, Acute Diarrhea with mild dehydration in child, open wound, etc.
(Yurdanur 2012; Institute for Quality and Efficiency in Health Care 2011; WHO 1994;
Medical Protection Society 2012) and promised many benefits. For common cold
treatment, non-drug treatment also plays an important role. It is the first line treatment
(Lousianaphamacists update).
Furthermore, non-drug treatment has many strong points such as reducing number of
drug misusers, drug abusers, waiting time, improving access to medicine for necessary

patients.

2.1.6 Social capital
Putnam (2001) in his article Social Capital defined that social capital is networks and
the associated norms of reciprocity that have value.


7

Pherson et al. (2013) found out that family and community social capital are important
in health aspect. Another empirical research came from Pampel, F. et al. (2010). They
declared that socio-economics can affect the incentives or motivations for healthy
behavior.
Social factor also plays an important part of socio-economic theories (Svendsen and
Sorensen, 2006). A review of socio-economic theories and the components are
necessary because this thesis’s objective is to examine the relationship between socioeconomic and treatment decision-making.

2.2 Studies of socio-economic factor in health aspect:
Social capital:
Rocco and Suhrcke’s (2012) research declared three mechanisms of social capital for
the determinants of individual health: the increasing in accessing to relevant health’s
information, the providing of informal healthcare and support in health problems, and
finally, well-organized, connected groups are more effective in lobbying in the political
economy mechanism. In additional, Grootaert et al., (2004) argued that social capital
should include the trust in people, and the adherence to any social group.
Demographic characteristics:
Belief is a core aspect to explain behavior. However, kinds of patient also affect the
selection and therefore health status. For example, patients with high education
demonstrated in Korsh’s work are more likely to express their fears and hopes to have a
better chance (Korsh et al., 1968:14). Similar to Korsh, Mocan and Altindag pointed

out the relationship between health and education “this positive relationship between
education and health is robust whether one analyzes aggregates (e.g., mortality or
morbidity rates ) or micro units (e.g., individual’s self- reported health status, or sick
days)” ( Mocan and Atindag, 2013:1). Another research that came from Korean, Shin
and Kang explored health behaviors, and examined health behaviors in relation to
demographic factors (Shin and Kang, 2014:1)
Risk attitude:


8

There is a connection between risk perceived and behavior, as well as decision making.
Health belief model, which was created by U.S Public Health Service in 1950s,
indicates that when a person perceives chances of risk, they are more likely to prevent it
from happening. Therefore risk attitude has a role to the behavior. Szrek et al. (2012)
predicted actual risk behavior in the domain of health. They argued that different
persons perceive different risks.
Rormann (2002) also believes that people are different in risk attitude.
Therefore the diversity of people’s behaviors and decision making depends on their
risk- taking propensity.


9

Table 1. Theories of socio-economic in health aspect:
Theory/ Research

Author(s)

Is Social Capital Good

Rocco and Suhrcke

for your Health?

(2012)

Measuring Social
Capital
Gaps in Doctor-Patient
Communication
Education, cognition,
health knowledge, and
health behavior

Grootaert (2004)

Kosch (1968)

Mocan & Altindag

Elements of socioeconomic used
Social Capital

Social Capital
Demographic characteristics

Demographic characteristics

(2013)

Health Behaviors and
Related Demographic
Factors among Korean

Shin & Kang (2014)

Demographic characteristics

Adolescents
A comparison of risktaking propensity
measures. Judgment

Szrek et al. (2012)

Risk attitude

and Decision Making
Risk Attitude Scales:
Concepts and
Questionnaires
Source: Thesis’s Author

Rormann (2002)

Risk attitude


10

2.3 Theory of planned behavior (TPB) in Health Choice:
To understand clearly patient belief, as well as to measure psychological factors and
examine its impact on treatment decision making, this dissertation is based on the
theory of planned behavior, a theory about the connection between belief and behavior
(Ajzen, 1991).
A lot of empirical studies have been using TPB to discover the behavior, such as
Knowlden et al. (2012) predicted the sleep intentions and behaviors, Ziadat (2014)
applied TPB in Jordanian Tourism, and Rhodes (2008) learned the behavioral physical
activity.
TPB is also effective in prediction and intervention of health behavior, as Darker
announced

“This extended TPB has been generally supported as a framework for

developing and testing such intervention [health intervention]” (Darker et al., 2009:16).
Other academics adopt a similar position, such as Baban and Cracium in their review
“it [TPB] states how these constructs should be operationalized, which makes the
design of behavior change interventions easier” (Baban and Craciun, 2007: 5).
TPB is a standard theory about belief that a lot of studies are using to explain behavior,
Groot and Steg declared that studies based on the TPB scarely examined more general
behavioral determinants, such as values or general beliefs (Groot and Steg, 2007:3).
Cognitive structure is the collection of beliefs that individuals consider an objective and
how these beliefs are constructed in memory ( Alba and Hutchinson, 1987)
Belief: Belief could be recognized as the information that people have about behavior:
its likely outcome, the normative judgment of others, and the likely ability to its
performance (Ajzen, 1991 ).
Ajzen and Fishbein (1991) created a great theory to determine elements of people’s
action based on belief, (named theory of planned behavior). According to them,
behavior is a result of three factors.
The first is belief about the likely outcome of the behavior (behavioral belief) and the

evaluations of these outcomes, that both create the attitude.


11

The second is belief about the normative expectations of others (normative belief) and
the motivation to comply with these expectations, these two factors combined to
become subjective norm.
The final one is belief about the present of factors that may facilitate or impede
performance of the behavior (control belief) together with belief about the perceived
power of these factors, to become perceived behavioral control.
The attitude, the subjective norm and the perceived behavioral control are three forces
for people’s behavioral intention, and they lead to actual behavior.
Moreover, unlike other factors, perceived behavioral control plays an important role to
the actual behavior.

2.4 Review of empirical studies:
Theory of planned behavior shows out the method to predict and intervene human
behavior (Ajzen,1991) in many areas, such as healthcare (Arbour-Nicitopoulos et al,
2009), teaching (Jeong and Block, 2011), risk (Turchik and Gidycz, 2012).
For the predicting health behavior purpose, Gerend and Shepherd (2012) use both the
theory of planned behavior and the health belief model to predict human papillomavirus
vaccine uptake. The result was that the theory of planned behavior outperforms the
health belief model in the purpose of predicting the behavior. Another research
predicting the TPB firstly concern about the attitude. Aladjem (2010) via two essays
with 135 individuals in essay 1and 131 individuals in essay 2 had said out the
connection between attitude and the product involvement on judgment and choice.
The second element of TPB is the norm. We can find it out from studies that use
extended technology acceptance model in testing the impact of between subjective
norm and e mail usage (Mutlu and Ergeneli, 2012), or theory of planned behavior to

determine the contribution of moral norm on behavior of HPV vaccination (Ilona et al.,
2011).


12

And last but not least, perceived behavior belief is a component that makes TPB
special. Kraft et al. (2005) operated a study that exploring the construction of perceived
behavioral control. They discovered the important role of controllability in predicting
behavior. This research also suggested that measuring perceived behavioral control by
means of perceived difficulty.
Martin et al. (2010) discovered the impact of perceived behavioral control on the
control of gambling behavior. Research discovered that college students are more likely
to be vulnerable to gambling problem. Authors implicate that to decrease gambling
activity of college students, increasing student’s perception of their ability to control
gambling is necessary.
Chang et al. (2003) used World Bank’s Living Standards Measurement Survey of
Vietnam’s data, 1997-1998 to develop self-medicating behavior’s model. They
discovered that self-medication is an inferior [good] at high incomes levels and a
normal [good] at low income levels. In the other hand, besides the young male group,
the data’s result showed up that there is a negative impact of income on pharmacy visit.
2.5 Literature review conclusion:
This dissertation uses the psychological and socio-economic approach to examine the
treatment choice, using common cold as common health problem to investigate
patient’s belief and their treatment decision. In order to reach the aim, this dissertation’s
framework mainly applies the TPB, a theory which successes in explaining wide range
of behaviors. According to the theory, human behavior is guided by three kinds of
beliefs: beliefs about the likely consequences of the behavior, beliefs about the
normative expectations of others, and beliefs about the presence of factors that may
facilitate or impede performance of the behavior. On the other hand, health behavior

and health status are also controlled by demographic factors.
Socio-economic is another main component for treatment choice. Its empirical studies
suggest that there is a connection between income factor and treatment choice.


13

CHAPTER 3: RESEARCH METHODOLOGY

3.1 Analytical framework
Figure 1. Model of the study
PSYCHOLOGY
Attitude
Subjective Norm
Perceived Behavioral
Control

TREATMENT
CHOICE
Go to the doctor
Self-Medication

SOCIO-ECONOMICS
Demographic
Characteristics
Social Capital
Risk Attitude
Source: Thesis’s Author

Non Drug Treatment

14

Theory of planned behavior:
Attitude:
Attitude is analyzed as patient’s thoughts about the outcome and benefit of the
treatment choice.
This research analyzes the patient’s attitude by asking them if their treatment is an
effective or an ineffective, and how can they evaluate.
Subjective norm:
Subjective norm is analyzed as patient perceives the social pressure to perform or not
perform their behavior.
Patient’s subjective norm could be analyzed by asking them what would their important
referents agree or not agree about their choice.
Perceived behavioral control:
Perceived behavioral control is analyzed as how easy or difficult patient evaluate, and it
is depended on patient’s experience as well as their prediction about the obstacle
toward the behavior.
This research analyzes the patient’s perceived behavioral control by investing if they
have enough time, or money, or can be able to access to treatment method, or they
would perceive control over the treatment period.
Socio-economic factors:
Socio-economic includes demographic characteristic, social capital and risk behavior.
The demographic characteristics consist of gender, age, education, married, family, and
income.


15

Social capital: social capital is measured by three factors, did or did not attend in a
social group one year ago, the trust in people surrounding, and the trust in people from
different careers.
Risk attitude: Trend to take risk.
Treatment choice:
Patient’s treatment choices are their solutions when getting a cold. They are “go to the
doctor”, self-medication, and non-drug treatment.
Patient’s choice is analyzed by asking them choose their treatment method.
Psychological factors and socio-economic factors are two components that patients
consider to make choice when they get a cold.
3.2 Measurement of variables:
3.2.1 Qualitative process:
According to Ajzen (2010), TPB variables could be calculate through direct or indirect
measure. In order to collect material for indirect measurement, the author asks for
salient beliefs. Model salient beliefs can provide the basis for constructing a standard
question (Ajzen, 2010). Salient beliefs when coping with common cold problem have
been elicited to salient behavioral outcome, salient normative references, and salient
control factors.
Before asking for the salient beliefs, it is necessary to ask their choice when they get a
cold.
Salient behavioral outcomes:
a. What do you believe are the advantages of your choice when you get a cold?
b. What do you believe are the disadvantages of your choice when you get a cold?
Salient normative beliefs:


16

a. Are there any individuals or groups who would approve of your choice when you get
a cold?

b. Are there any individuals or groups who would disapprove of your choice when you
get a cold?
c. Are there any individuals or groups who would likely to choose the same to your
choice when you get a cold?
d. Are there any individuals or groups who would unlikely to choose the same to your
choice when you get a cold?
Salient control beliefs:
a. What factors or circumstances would enable you to do your choice when you get a
cold?
b. What factors or circumstances would make it difficult or impossible for you to do
your choice when you get a cold?
Results of the pilot study:
The pilot result has been classified. Then the author has withdrawn the most chosen
items.
Generally, the participants have 3 choices: go to the doctor, self-medication, non-drug
medication.
The pilot study collected 21 samples. Among them average sickness times per year is 3,
in range from 1 to 10. Two-thirds are married. Their old age is from 21 to 69, with
mean value are 31. Almost have insurance. Nearly a half of them choose change life
style without using drug solution. One-fifth wants to go to the doctor. Their referents
focus on family, friends, co-workers and medical staffs. The elements that they mainly
consider are fast and slow recovery, drug side effect, and time saving. Almost dislike