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Espacios. Vol. 37 (Nº 17) Año 2016. Pág. 10

Factors influencing dental surgeons when choosing a low involvement dental material

Fatores que influenciam o Cirurgião-dentista na escolha de um material odontológico de baixo envolvimento

Ana Paula Taboada SOBRAL 1; Sergio Sousa SOBRAL 2; Pamella de Barros MOTTA 3; Sandra Kalil BUSSADORI 4; Lara Jansiski MOTTA 5

Recibido: 22/02/16 • Aprobado: 24/03/2016

Conteúdo

1. Introdução

2. Theoretical References

3. Methodology

4. Analysis of results

5. Conclusions/Final considerations

References

1. Introdução

Competition in the dental market motivates companies to invest more and more in new products. With this, professionals are faced with several options of brands and products and, most of the time, they are indecisive when confronted with so many alternatives. This is especially true for new graduates, who nearly always use products with which they became familiar in the academic realm in their practices. Professionals that want more information and knowledge will seek out continuing education and specialization courses; it is in these courses that dental surgeons learn about and recognize the variety of brands and products. 

In light of this, what leads a dental surgeon to choose a certain product or a certain brand? What will be the most important and determining factor during the decision process: brand, price, recommendation of a shaper of opinion, recommendation of a professional colleague, use during a particular course, availability or cost-benefit?

According to Morita et al. (2010), in 2008 the number of dental surgeons registered with Brazil's National Dentistry Board (CFO, its acronym in Portuguese) was 219,575. The state of São Paulo has the most professionals (72,508), with 24,797 dentists in the municipality of São Paulo. Regarding dental schools, in 2008 there were 197 active dental courses in Brazil.

The website for the CFO – Brazil's National Dental Board (http://cfo.org.br/servicos-e-consultas/servicos-e-consultas/downloads/, accessed on 21, August 2015) states that 272,090 dental surgeons were registered as of March 2015. Using this information, we know that the number of dental surgeons grew by 52,515 in 7 years. The state of São Paulo continues to have the most professionals of any state in Brazil, with 82,524. The number of dental schools grew in 2015 to 220 institutions.

Considering the niche that dental surgeons represent in Brazil and the lack of clearer information on this topic, this paper is aimed at assessing the consumer profile of the dental surgeon, identifying aspects that are valued in deciding on which dental material to choose.

2. Theoretical References

2.1 Marketing Stimuli, Marketing Mix or Integrated Marketing

The terms Marketing Stimuli, Marketing Mix or Integrated Marketing are used to define the set of marketing tools that the company uses to achieve its Marketing goals. These tools were classified into four broad groups, called the four P's of marketing: price, product, place (distribution channels) and promotion (marketing communications). Marketing activities also influence the consumer purchase process through the elements of the marketing mix (Churchill Jr and Peter, 2000; Kotler and Keller, 2006a).

According to Arruda et al. (2014), the Marketing Mix paradigm has dominated thinking and influenced the marketing strategy theory ever since it was created in the early 1960s. Starting in the 1990s, relationship marketing researchers began to challenge its bases, questioning its simplistic nature and the usefulness of building value for the customer through long-term relationships. As relationship marketing began to take shape theoretically, it become clearer that the Marketing Mix paradigm is related to mass marketing and its transactions. Long-term consumer relationships, as well as formation and management of strategic alliances have required a break, resulting in a paradigm shift. Although many approaches have arisen in recent years in this sense, in relevant marketing surveys, none has been able to remove the Marketing Mix from its paradigmatic position.                                                                                                       

2.1.2 Consumer Behavior

Consumer behavior is defined as activities directly involved in obtaining, consuming and disposing of products and services, including the decision-making processes that come before and after these actions (Engel et al., 2000).

According to Mowen et al. (2003), orientation towards marketing includes the viewpoint that the industry is a process of customer satisfaction, rather than of production of goods. An industry is created by a customer and this customer's needs, and not from a patent, raw material or ability to sell. A company's recognition can only exist insofar as it satisfies the needs and wants of the consumer, making the study of consumer behavior essential.

Studies on consumer behavior are oftentimes focused on the purchase process and on the variety of forces shaping this process. According to (Kotler and Keller, 2006b), it is influenced by four kinds of factors: cultural, social, personal and psychological.

A purchase process usually goes through the following stages: problem recognition, information search, evaluation of alternatives, purchase decision and post-purchase behavior (Kotler and Keller, 2006b).

The purchase process begins when the buyer recognizes a problem or need. When a need is recognized, the consumer tends to look for information. Sources of consumer information are split into four groups: personal sources (family, friends, neighbors, acquaintances), commercial sources (advertisements, salespersons, representatives, packaging, displays), public sources (means of mass communication, consumer rating organizations) and experimental sources (handling, examination, use of product) (Kotler and Keller, 2006b).

According to (Lopes and Da Silva, 2011), global trends lead us to reflect on the emergence of a new behavioral model.  The consumer's incessant search for innovations, the greater level of information and of involvement regarding products acquired, in the face of less asymmetry in information, significantly driven by the use of the internet as a means for consumer relations and exchange of consumer experiences, in conjunction with the growing interest in matters related to environmental conservation are just some of the behavioral phenomena that should be part of the new propositions that are part of modern consumer behavior.

2.2 Study on purchase decision factors

According to the researcher, one of the biggest questions during the analysis of consumer behavior is what leads the consumer to choose a certain product: Which factor, what attribute is essential to choosing a certain product? One of the factors assessed during the purchase decision process is the product's attributes, which may vary depending on the degree of consumer involvement with the product to be purchased.

2.2.1.1 Product attributes

For (Tibola et al., 2004), an attribute is what identifies the product, what the product has/possesses; it is the adjectives and/or properties that together form a set of attributes that give the product a reference.

Attributes are aspects or characteristics of an object and vary widely in the importance they have for consumers. The importance of the attribute is the evaluation of one person as to the significance of an attribute for a specific good or service (Mowen et al., 2003).

 During the purchase decision process, the consumer buys different product options capable of satisfying needs. The consumer selects, integrates and evaluates information related to the brands of products to reach a decision. Information on brands is classified into two general categories of attributes: extrinsic and intrinsic (Zeithaml, 1988).

2.2.2 Degree of involvement with the purchase

The main attributes of consumer involvement during the purchase decision process were summarized by (Popadiuk, 1993) as follows:

- High involvement: tendency to look for information on products and brands; sharper perception by the consumer; information processed in a decision sequence in various stages; contradictory answers cause increased counter-arguments; difficulty causing changes in attitudes; communication messages should be more intellectually elaborate, tendency towards greater brand loyalty; post-purchase dissonance; information obtained from other people, influence of social status.

- Low involvement: search for general information without major mental elaborations in the analysis of the purchase process; tendency not to refute information received; greater probability of change to attitude; process of communication with repetition of the message as a determining factor to persuasion; purchase of the brand could occur because of routine, no post-purchase dissonance; little influence by other people.

In the study (Furtado and Franco, 2011), it was found that the same attributes can have different influences on the consumer's purchase decision, even when dealing with the same product and the same public. Based on the study, this is firstly because of the strength of internal reasons seems more consistent. The variables mentioned, between the lines in the responses, by indicating the main factors, were: significant recognition of values, trust and satisfaction; unrelated to material rewards and marketing actions. Secondly, because most of the reasons are built by the consumer herself through recognition. All of this is leveraged by the low involvement of pharmaceutical products, allowing for a reduced information search stage.

2.3 History of dentistry in Brazil

In colonial times, only those that underwent examination by the "premedicato," a court located in the capital of the kingdom with deputies in the hereditary captaincies and Portuguese colonies in Africa, were entitled to exercise medicine. The decisions of the premedicato were based on information supplied by its deputies, with this body granting the applicant the title of surgeon, nurse and bloodletter (Russo et al., 2000).

The first references to dentists in Brazil date to the XVII century, in a royal charter dated November 9, 1629. Curiously, the first person to be mention as an expert in teeth was Tiradentes. At this time, the book by Pierre Faucard (1678-1761), a French dentist considered the father of modern dentistry, was already known. His main work, "Le Chirurgien Dentiste," published in 1746, was the cornerstone of clinically-based dentistry and marked a new stage in dental history (Russo et al., 2000).

 Medical education began in Brazil in 1808, through an initiative of Dom João VI. Yet, the art of dentistry was only incorporated into medical education after 1850, with the reform of the Jobim Council. At that time, nearly all of the dentists were Portuguese barbers. In 1850, a qualifying diploma was required and the School of Medicine of Rio de Janeiro established the first exam for aspiring dentists (Russo et al., 2000).

October 25, 1884 marks the start of dentistry in Brazil, which is when Decree 9.311 established the Dentistry course at the Schools of Medicine of Rio de Janeiro and Bahia. A trade institution was created in 1889, entitled: Institute of Dental Surgeons of Rio de Janeiro. In 1900, Coelho e Souza rose to prominence with his monumental work: the Dentistry Manual, which many generations of dentists studied, and in 1905, the Free School of Dentistry was founded in Rio de Janeiro (Russo et al., 2000).

 According to (Silva and Sales-Peres, 2007), Dentistry underwent various stages until reaching the professional structure it has today. With this being the case, dental professionals were to be educated according to the National Curricular Guidelines for Dentistry (2002): "professional with a generalist, humanist, critical and thoughtful education, to act at every level of healthcare, based on technical and scientific rigor. Trained in the exercise of activities related to the oral health of the population, based on ethical and legal principals and on the understanding of the social, cultural and economic reality of the means thereof, with action aimed at transformation of reality to the benefit of society."

2.4 Dental materials

Historically, a wide variety of materials were used for replacement of dental structures. Dental materials belong to one of the following classes: metal, ceramic, polymer or composites. Usually, polymers, cements and composites are used as restorative and preventive materials (Anusavice et al.,2013).

The type of dental material that will be analyzed in this paper are materials frequently used in the dental practice, for which the decision to buy is a routine one and which have a low degree of involvement in purchase.

3. Methodology

3.1 Type of Research

Exploratory research is a type of research where the main goal is provision of criteria about the situation-problem faced by the researcher and its comprehension. Exploratory research is characterized by flexibility and versatility in relation to methods (Malhotra, 2001).

Exploratory research is aimed at learning about the topic or problem of research in perspective; because of this, it is appropriate in the early stages of investigation, when familiarity, knowledge and understanding of the phenomenon are, usually, insufficient or inexistent on the part of the researcher (Mattar, 2000).

This study is aimed at learning about the factors that influence the decision to purchase dental products and may be classified as exploratory.

In relation to the method, research can be qualitative and quantitative. Qualitative research identifies the presence or absence of something, while quantitative research seeks to measure the degree to which something is present. There are also methodological differences: in quantitative research, data are obtained from a large number of respondents, generally using numeric scales, and are submitted to formal statistical analyses; in qualitative research, data are gathered through open-ended questions (when on questionnaires), group interviews, in-depth individual interviews and projecting testing. It is possible for there to be quantitative and qualitative questions in the same research and in the same instrument for collecting data (Malhotra, 2001; Mattar, 2000).

In an effort to identify the factors influencing the decision-making process of the dental surgeon in relation to purchase of dental materials, this study will use the quantitative method.   

3.2 Population

Population is the sum of all elements sharing some common set of characteristics, shaping the universe for the purpose of the marketing research problem (Malhotra, 2001).

The population chosen for this study is Dental Surgeons (students and teachers) that attend continuing education and specialization courses at an Institution located in the West Zone of the city of São Paulo.

3.3 Sampling

A sample is a subgroup of elements in a population selected to participate in a study (Malhotra, 2001).

Sampling techniques can be generically classified as probability and nonprobability sampling. Probability sampling is where each element of the population has the same chance of being included in the sample. Nonprobability sampling trusts in the person judgment of the researcher, and not on the chance of selecting sample elements. The researcher may arbitrarily or consciously decide on elements to be included in the sample. Nonprobability samples can offer good estimates of the characteristics of the population, but they do not allow for an objective evaluation of the precision of results. Nonprobability sampling techniques can be divided into: convenience sampling, judgmental sampling, ad hoc quotas and snowball sampling (Malhotra, 2001).

The sampling technique chosen for this study was nonprobability convenience sampling.

3.4. Preparation for collection of information

After planning the research project and having defined the problem and objectives and having chosen the research types and methods and data collection methods, the form should be drafted to collect data, which will be called a questionnaire for quantitative research and a script for qualitative research. A questionnaire is structured when it has a logical sequence of questions that cannot be modified and does not contain insertions by the interviewer. When the objectives of research are explained in the questionnaire, it is considered undisguised (Santos and Barros, 2002).

The Likert scale, proposed by Rensis Likert in 1932, is a scale where respondents are asked not only if they agree or disagree with the statements, but to also state their degree of agreement / disagreement. Each response cell is given a number that reflects the direction of the respondent's attitude in relation to each statement. The total score of each respondent's attitude is found by tallying the scores for each statement (Mattar, 1999).

The instrument created to collect data was a questionnaire based on the Likert Scale.

3.5. Field procedures and collection of information

The sample used was selected based on convenience sampling and was made up of Dental Surgeons (students and teachers) that attend continuing education and specialization courses at an Institution located in the West Zone of the city of São Paulo. The instrument used to collect data was a questionnaire of closed questions based on the Likert Scale. Sixteen statements were created where respondents to which respondents could agree completely, agree, neither agree nor disagree, disagree or disagree completely.

Information was obtained through face-to-face interviews, where the author approached dental surgeons that were walking through the facilities of the Institution located in the West Zone of São Paulo, applying the questionnaire to those that agreed to answer the questions.

Collection of information was done by the author, over 3 days and at different times of day. Interviews were given to 70 dental surgeons, of which 51 were students and 19 were teachers.

3.6. Procedures for field research analysis

Field research analysis primarily followed use of descriptive statistics, description of data and, later, reflection regarding this data, always looking for a relationship with the theoretical reference found in the study.

Data found through questions was structured into a chart, where this same data was related to the number of dental surgeons that took part in the study and the percentage of the data obtained.

To facilitate data analysis, a key was used with the following meanings:

DT: Disagree Completely

D: Disagree

NDNC: Neither Agree Nor Disagree

C: Agree

CT: Agree Completely

4. Analysis of results

Of the dental surgeons that participated, 54% are women and 46%, men. Distribution by gender is balanced, creating no significant variance in relation to the distribution of responses by gender.

A comparison of the distribution of dental surgeons interviewed shows that 72% are students of courses given at the Institution in the West Zone of São Paulo and 28% are teachers. This difference is understandable, since there are more students than teachers that attend the institution researched.

To facilitate assessment of the responses to the 16 questions, the data were gathered in Figure 1 and Figure 2 – Data Summary.

Figure 1 – Data Summary, questions 1 to 7

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Figure 2 – Data Summary, questions 8 to 16

After analyzing the results found in the survey, some factors and attributes were found to stand out when choosing a low involvement dental material. The quality attribute, which is an abstract and intangible attribute, can be seen as a highly relevant attribute when choosing a low involvement dental material, based on the statement  "The quality of a dental material is the most important characteristic of the material," which had 90% agreement.

This degree of agreement corroborates the results found by (Espinoza & Hirano, 2003), where abstract/intangible attributes are at a higher level in the value hierarchy and, with this, they are closer to the psychological characteristics of consumers and are considered the most important attribute from the consumer standpoint.

In his research, Hohl (1999) also found that the quality attribute was considered very important to 82.8% of consumers when it comes to a low involvement product.

A paper by (de Mello et al., 2013) showed that buyers see quality as one of the most decisive criteria when making a purchase.

 Another factor that had a high degree of agreement was Cost-Benefit. The statement "Cost-Benefit influences the decision to purchase dental material" had agreement by 89%. This indicates that Cost-Benefit is also one of the factors considered when choosing a low involvement dental material.

The result found with Cost-Benefit reinforces the theoretical reference, showing that the consumer is looking for certain benefits in the choice of the product; moreover, each product is seen as a set of attributes with different capacities to delivery benefits to fulfill the consumer's need. Consumers pay more attention to attributes that provide the sought after benefits (Kotler and Keller, 2006b).

Once the consumer feels that he has enough information to make a decision, he evaluates the alternatives based on the attributes considered as relevant and that meet his expectations (Pires et al., 2015).

 The statement "Use of a specific dental material during the class makes me interested in buying it" had 83% agreement, followed by the statements: "Visits by promoters to the practice to publicize new materials is a factor I consider during purchase," with 74%; "Recommendation of dental material by a colleague in the profession is a factor influencing purchase of the material," with 72%; "I like to receive information and promotions on dental materials by mail, e-mail or telephone, since this helps me to choose new products," with 68%; "Explanatory folders on dental materials have an influence on the choice of the product," with 62%; "Recommendation of a dental material by an opinion-shaper gives the product more credibility," with 60%; and "I like ads for dental materials in industry magazines," with 54%.

Analysis of these statements backs the theoretical reference that after recognizing the problem, interested consumers tend to look for information from different sources: personal, commercial, public and experimental (Kotler and Keller, 2006b).

For the dental surgeons interviewed, the experimental source (handling, examination and use of the product) was considered a relevant factor when choosing a low involvement dental material; while the statement related to this source had a degree of agreement of 83%. Other sources are also considered by the dental surgeons interviewed, in the following order of importance: person source (colleague in the profession, shaper of opinion), commercial source (information by mail and e-mail, explanatory folders) and public source (industry publications).

In a study by (da Rosa, 2012), a significant relation was found between the salesperson's qualifications and experimentation of products; in other words, when the consumer trusted in the publicity, there was a higher likelihood to try the products. A significant relationship was also found between experimentation and purchase behavior, with 76.8% of the sample evaluated trying some product before buying.

The surgeon dentists interviewed were indifferent in relation to the following statements: "Materials featuring published scientific papers are better than others;" "An established brand is synonymous with the quality in dental material;" "Imported dental materials are better than domestic dental materials;" and "I always trust in a dental material recommended by a teacher."   This could suggest that these factors are not decisive when choosing a low involvement dental material

Based on the literature, these statements fall under salient attributes, which are those attributes that consumers are able to perceive as present in a certain product, brand, company or institution. Salient attributes function as a whole set of attributes perceived by a particular consumer public without, however, possessing any degree of importance or determination in the product purchase process. These attributes are admittedly found in a certain product or brand for a specific group (Alpert, 1971).

The low price attribute was not found to be fundamental when choosing a low involvement dental material. And when the statement "Between low price and quality, low price is essential" was analyzed, the degree of disagreement was 74%. This confirms that for the dental surgeons interviewed, the quality attribute is more relevant when choosing a low involvement dental material.

In his research, Hohl (1999) found that the price attribute was considered very important to 42.2% of those interviewed for a low involvement product. Also, (De Carli et al., 2002) found that although the price attribute is an important factor, it was not considered a decisive factor in choosing the product researched. The study therefore corroborates the latter's idea.

In light of the results found in research by Milan et al. (2014), a similarity was found between the behavior of an end consumer with the organizational buyer, who appreciate good service, attractive prices and products and/or services delivered on time and with quality.

The statement "Dental Vendors know how to correctly recommend dental material" had 61% disagreement. This indicates that the recommendation of a material by a dental salesperson is not one of the factors considered by the dental surgeons interviewed when choosing a low involvement dental material.

The dental salesperson falls under the commercial source of information and, according to the literature, commercial sources usually play an informative role (Kotler and Keller, 2006b). That is why this was not considered by those interviewed to be a decisive factor when choosing the material.

5. Conclusions/Final considerations

This study sought to discover which factors influence dental surgeons during the process of deciding to purchase a low involvement dental material. The study was able to fulfill all of the objectives proposed, finding that the quality attribute can be considered a determining attribute in the choice of a low involvement dental material. It also found that the information search is a very important stage for the dental surgeons interviewed, since they consider all sources for finding information to be fundamental, with the experimental source being the main source. On the other hand, they were indifferent to the low price attribute.

Dental material companies should strive to satisfy their consumers' needs by finding quality products; investing in publicity (for instance, publicizing materials on clinical tables in undergraduate, continuing education and specialization courses), so that professionals have the chance to use these materials; and allowing dental surgeons to learn about products through promoters, explanatory folders and ads in industry magazines. It should also be considered that low price was not found to be a fundamental attribute in the choice of dental material and, oftentimes, professionals prefer to pay a little more for a quality product. This can be reinforced by the cost-benefit factor, which was found to be important in the field research when choosing a low involvement dental material.

This paper posed limitations, since it was an exploratory study whose sample technique was nonprobability convenience sampling. Within its limitations, this study was able to recognize some factors and attributes considered by the dental surgeons in the sample studied when choosing a low involvement dental material. The author suggests performing a new study using probability sampling and that this topic be studied more in-depth, since consumer behavior is an inexhaustible and always current topic.

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1. Mestranda em Gestão em Sistemas de Saúde. Universidade Nove de Julho; São Paulo; Brasil anapaula@taboada.com.br
2. Cirurgião-dentista. Universidade Nove de Julho; São Paulo; Brasil sss@uol.com.br
3. Cirurgiã-dentista. Universidade Estadual de Campinas; Piracicaba; Brasil pamellamotta@terra.com.br

4. Pós-doutora em Odontopediatria. Universidade Nove de Julho; São Paulo; Brasil sandra.skb@gmail.com

5. Doutora em Saúde Coletiva. Universidade Nove de Julho; São Paulo; Brasil larajmotta@terra.com.br