Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion

Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion Perhaps you have been to a health fair sponsored by a local hospital in your community. Who benefits from such an effort? When you or your neighbors are screened for signs of illness (hypertension, for instance) or learn about available services, clearly the promotion benefits you, but what about the hospital? Having its name associated with “community service” benefits the institution. Any patients and/or clients the institution attracts may also result in some financial benefit, even if the organization is ostensibly “non-profit.” Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion In this Discussion, you will identify examples of promotion for social change in your community and analyze whether the promotion benefits the community, the organization, or both. To prepare for this Discussion: Review this week’s Learning Resources. Identify two local health care providers and identify an example of each organization’s effort in promoting a service or services as a form of positive social change. One of the organizations should be for-profit, the other, not-for-profit. POST A BRIEF DESCRIPTION OF HOW EACH ORGANIZATION’S PROMOTION FOSTERS SOCIAL CHANGE. THEN, EVALUATE HOW EACH ORGANIZATION’S MARKETING PROMOTION BENEFITS THE COMMUNITY AND HOW IT BENEFITS THE ORGANIZATION. FINALLY, FOR EACH EXAMPLE OF MARKETING PROMOTION YOU HAVE IDENTIFIED, ANALYZE WHETHER THE INTEREST OF THE COMMUNITY AND THE INTEREST OF THE ORGANIZATION ARE IN CONFLICT. BRIEFLY COMMENT ON HOW THE PROMOTIONS OF THE FOR-PROFIT AND NON-PROFIT ORGANIZATIONS DIFFER AND HOW THEY ARE SIMILAR. Support your work with specific citations from this week’s Learning Resources and/or additional sources as appropriate. Your citations must be in APA format. Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion resources_3.docx usw1_hlth_4115_fortenberryetal_2010_.pdf contentserver__11_.pdf contentserver__10_.pdf contentserver__9_.pdf : Evaluating Strategic Planning and Marketing/Summary Throughout this course, you have explored the values, vision, and mission for your organization. You performed the appropriate environmental assessment. You defined your organization’s goals and objectives, and you formulated and implemented a strategy you believe helps you achieve them. Now what? How do you know if it all worked as planned? This week, you will consider the fifth step to strategic planning and marketing: evaluation. A carefully considered and measurable evaluation allows an organization to determine how effective its efforts have been in achieving its goals. Evaluation allows the organization to identify weaknesses and highlight procedures and/or tools that may be useful and effective when applied in other circumstances. As you may discover, evaluation is not the end of the process, but a necessary step in a constant, continuous cycle of improvement for any organization. In this week’s Discussion, you will consider promotions of health care organizations that target social change. Using real-world examples, you will analyze whether these promotions benefit the organization, the community, or both. Learning Objectives Students will: Examine organizational marketing in the context of social change Evaluate strategic planning and marketing results . ——————————————————————————————————————– • • • Zuckerman, A. M. (2012). Healthcare strategic planning (3rd ed.). Chicago, IL: Health Administration Press. Chapter 9, “Making Planning Stick: From Implementation to Managing Strategically” Chapter 10, “The Annual Strategic Plan Update” Chapter 12, “Future Challenges for Strategic Planning and Planners” Is Billboard Advertising Beneficial for Healthcare Organizations? An Investigation of Efficacy and Acceptability to Patients John L. Fortenberry Jr., PhD, chair. Health Administration Department, James K. Elrod Professor of Health Administration, and professor of marketing. School of Business, Louisiana State University, Shreveport, Louisiana, and Peter J. McColdrick, PhD, Tesco Professor of Retailing, S4anchester Business School, The University of Manchester, Manchester, United Kingdom EXECUTIVE SUMMARY The healthcare industry is increasingly turning to billboard advertising to promote various medical services, yet little attention has been directed toward understanding the performance and policy implications of billboard advertising from the perspective of the patients targeted. Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion To shed light on this, we initiated a field experiment investigating the impact of an urgent care center’s billboard advertising campaign, colleaing primary data over a 32-day period at the center’s two clinics. Over the course of the billboard campaign, perspectives from 1,640 patients were collerted via questionnaire. Institutionally supplied business metrics were also monitored. Our principal findings indicate that billboard advertisements are noticed by patients, favorably viewed by patients, and effective across the sequence of steps leading to patient patronage. Enhancement of awareness exerts the most powerful influence on patronage, but the capacity to inform consumers is also highly significant. These effects are not limited to new patients, as many returning clients were made more aware of the clinics and were influenced by the campaign. The study offers insights for creative billboard treatments and campaign planning. Although effeas remained strong throughout the campaign, some degree of “wearout” was evident after three weeks, which suggests the need to rotate billboards frequently and to consider digital billboards. Corner tabs—small announcements sometimes placed in the corners of billboard advertisements—proved largely ineffective as a promotional device and may clutter the central messages. Given these findings, we believe healthcare institutions are justified in using billboards, as they perform effeaively and appear relatively free of controversy. Careful planning of creative billboard treatments and appropriate scheduling patterns are essential to maximize their communications potential. For more information on the concepts in this article, please contact Dr. Fortenberry at [email protected] 81 JOURNAL OF HEALTHCARE MANAGEMENT 55:2 MARCH/APRIL H ealthcare institutions and providers face serious dilemmas as communication with current and prospective patients becomes increasingly difficult (Fortenberry 2010). The prolifération of media options results in increasingly fragmented audiences (Andruss 2007; Moriarty, Mitchell, and Wells 2009). Clutter is now a serious problem in most advertising media, as vast numbers of messages compete for attention (Berkowitz 2006; Elliott and Speck 1998; Cratton 2006; Bloom 2003).Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion Information overload leads to highly selective attention, and technologies such as DVD recorders and ad-blocking software can reduce exposure to ads (Tellis 2004; Gritten 2007). A fiirther challenge is the shortening of attention spans, a trend to which text and Internet communication both caters and contributes (Obermiller 2002; Whaley 2006). 2010 of reaching 1,000 members of a targeted population with a given form of marketing communication (Moriarty, Mitchell, and Wells 2009; OAAA 2008), as indicated by comparative figures presented in Table 1. These characteristics give billboards significant advantages. These benefits have not been lost on the healthcare industry, which is now a large user of the medium (Berkowitz 2006; Managed Healthcare 1994). Despite extensive and increasing use, however, little is known about how billboards work, and academic research is scarce (Woodside 1990; Fortenberry and McGoldrick 2006; Taylor, Franke, and Bang 2006) and seemingly nonexistent for the healthcare industry. Civen increasing pressures for healthcare marketing officers to demonstrate a return on advertising expenditures (Eudes 2006; Berkowitz 2006; Thomas 2005), understanding if and how major types of media work is essential, Although all media possess strengths and weaknesses, billboards have a degree of immunity to the audience fragmentation, clutter, ad blocking, and attention span problems facing other media. Audience fragmentation is not an issue because the limited travel routes in given communities concentrate exposure of billboards to mass audiences. Additionally, technology that blocks billboard advertisements is currently not available. Billboard advertisements also enjoy a relatively clutter-free setting, as zoning ordinances limit their proliferation (Lamar Advertising 2008; OAAA 2008). Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion Because of their nature, billboard positioning and creative treatments have always assumed short attention spans. In addition, among the major media, billboards offer the lowest cost per thousand, a measure of the cost LITERATURE REVIEW The neglect of academic research on billboard advertising is often attributed to the costs involved with enacting field experiments, the preferred method for studying the medium (Woodside 1990; Bhargava and Donthu 1999; Fortenberry and McColdrick 2006). Laboratory experiments do not effectively replicate the externalities associated with billboards, such as motorist attention to the road, and other environmental distractions that take attention away from billboards. The extant literature focuses on four main categories: history, art, policy, and performance. Research on tbe history of billboard advertising focuses on the growth and 82 Is BILLBOARD ADVERTISING BENEFICIAL TOR HEALTHCARE ORGANIZATIONS? influence performance, as reported in a few performance-related studies discussed later. The policy category is perhaps the most developed ofthe four areas of the billboard literature. Substantial works mostly focus on the societal benefits or detriments associated with billboard advertising, and debates between proponents and opponents of the medium are commonplace (Taylor 1997). Billboard proponents frequently emphasize the medium’s ability to communicate information to travelers, deliver customers for advertisers, and increase road safety (Laible 1997; OAAA 2008). Billboard opponents, however, contend that billboard advertisements cause such undesirable consequences as aesthetic pollution (e.g., roadside clutter, excessive transmission of ambient light), environmental harm (e.g., damage to the environment when vegetation is removed to place roadside billboards), and motorist harm (e.g., billboard advertising distracts drivers and contributes to vehicular accidents) (Vespe 1997; Scenic America 2006). Some also claim that the preponderance of billboards that advertise harmful products in minority communities affects public health (Altman, Schooler, and Basil 1991; Hackbarth, Silvestri, and Cosper 1995). Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion The conflicting arguments of Laible (1997) and Vespe (1997) perhaps best illustrate this debate. One side asserts that the public likes billboards, and the other claims the public dislikes billboards, although it appears that the public is never actually asked for its perspective. Despite lengthy battles, this key question remains unanswered. TABLE 1 Comparative Costs of Various Media Cost per Ttiousand Media Television (prime lime) Magazine $30.45 • $25.93 Newspaper $12.24 Internet $11.25 $9.69 Radio Outdoor $3.62 Source: Information based on estimaces from media experts andOAAA(20U’)). development ofthe medium; works by Hendon and Muhs (1986) and Gudis (2004) are excellent examples. Although assumptions regarding billboard efficacy have clearly driven their development over the years, such performance considerations are not a focus of these historical accounts. They provide interesting accounts ofthe chronological development ofthe medium but do not analyze the performance characteristics or related matters that would be helpful in executive decision making. Within the art category, the literature focuses primarily on photographic collections of billboards; Fraser (1991) and Heon, Diggs, and Thompson (1999) are good examples. Such authors often present the winning entries from billboard artwork contests, providing readers with examples of creative efforts. This area ofthe literature tends to address creativity, rather than an ad’s ability to generate a marketing return on investment. However, there is clearly much scope for creative treatments to 83 JOURNAL OF HEALTHCARE MANAGEMENT 55:2 M A R C H / A P R I L 2 0 1 0 OBJECTIVES AND CONCEPTUAL FRAMEWORK The literature on billboard performance is clearly the least developed, and few academic studies have been published. However, this area is of great importance to institutions and media planners because they need a close understanding of the performance characteristics of billboards to make pmdent judgments regarding their use. Most of the work in this area has focused on recall—that is, the ability of a consumer to view an advertisement and remember its message and other relevant characteristics.Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion The studies of Hewett (1972), Fitts and Hewett (1977), King andTinkham (1990), and Osborne and Coleman (2008) indicate that billboards are capable of generating recall. The primary objective of this research is to gain insights into the performance characteristics of billboard advertising in the healthcare industry and thereby help institutions make more efficient media allocations. The sparse previous research in nonhealthcare settings indicates the following: Several authors have focused on how creative and spatial characteristics affect recall. Studies by Young ( 1984); Donthu, Cherian, and Bhargava (1993); and Bhargava, Donthu, and Caron (1994), for example, indicate that roadway positioning, size of text, use of color, and related characteristics affect consumers’ ability to remember billboard message content. A further element of the billboard performance literature focuses on the ability of billboards to drive sales, although the field experiments of Bhargava and Donthu (1999) are the sole independent contributions in this important area. The Outdoor Advertising Association of America (OAAA 2009) compiled case studies of billboard campaigns, and Taylor, Franke, and Bang (2006) surveyed management views regarding billboards. However, the efficacy of billboards remains seriously underresearched. • Billboards generate recall (Hewett 1972; Fitts and Hewett 1977; King and Tinkham 1990; Osborne and Coleman 2008). • Creative and spatial applications affect billboard advertising recall (Young 1984; Donthu, Cherian, and Bhargava 1993; Bhargava, Donthu, and Caron 1994). • Billboards can drive sales (Bhargava and Donthu 1999). We aim to assess the impact of billboards across what is known in the advertising literature as the hierarchy of effects, which is referred to herein as the patient patronage sequence—that is, the theoretical series of steps through which consumers travel as they move from initial awareness toward making a decision to act or buy. Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussionhe concept that people pass through a hierarchy or sequence of stages in their progression from awareness to action is well established in advertising (Tellis 2004), consumer behavior (Solomon 2007), psychotherapy (Prochaska and Norcross 1999), and social marketing (Velicer, Rossi, and Procbaska 1996). Knowledge relating to the efficacy of billboards at different stages in this sequence is of value to 84 Is BILLBOARD ADVERTISING BENEFICIAL FOR HEALTHCARE ORGANIZATIONS? healthcare providers. More specifically, we also test the efficacy of comer-tab promotions. Secondary objectives pertain to billboard policy matters relevant to the general debate (Taylor 1997) between proponents (Laible 1997) and opponents (Vespe 1997) of this advertising medium. Specifically, we measure whether patients view the medium favorably and consider billboards appropriate for marketing healthcare services to help resolve the issue of whether the public likes or dislikes billboards. A medium regarded as inappropriate or controversial could clearly be detrimental to new business and loyalty. Given the paucity of academic research on billboards in general and its absence in the healthcare context, the study further aims to close significant gaps in the literature on advertising and healthcare marketing. The study draws on two conceptual domains in examining the effects of billboards: first their efficacy in promoting healthcare establishments, and second, the perceived appropriateness of the medium for healthcare promotion. For the first domain, we draw from the literature on billboard performance and the wider literature on hierarchies and models of the effects of advertising and construct scales to measure effects on customer awareness, perceptions of informativeness, and influence on initial and return visits. For the second domain, we draw from a selection of the literature related to billboard policies, and then we measure attitudes of patients toward the medium and its appropriateness for healthcare advertising. Figure 1 shows the conceptual and analytical framework of the study, illustrating these two sets of influences on new or returning patient visits.Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion FIGURE 1 Conceptual Framework of the Study Efficacy: Promoting Healthcare Facility Patient Patronage Sequence Raising/ Creating Awareness Appropriateness: Attitudes Toward Billboards Billboard Policy Debates Conveying Relevant Information Appropriate for Health Advertising? Influencing Visits to the Facility: First Visit >>>> Return Visits 85 Overall Opinion of Medium OF HEALTHCARE MANAGEMENT 55:2 MARCH/APRIL ANALYTICAL PLAN AND METHODOLOGY 2010 The campaign represented a 133 gross rating point showing, which indicates daily exposure levels for the campaign at 133 percent of the population aged 18 years or older. This meant that people in this age group were typically exposed to the campaign more than once per day, given the number of billboards purchased. Willis-Knighton Health System purchased nine bulletins (14 X 48-foot billboards) and seven posters (12 x 24-foot billboards), and these were scheduled mainly in the month of October at a total cost of $25,411. Figure 2 shows the creative treatment, including a corner-tab invitation to telephone a “Flu Shotline.” This approach provided further opportunity to assess performance through direct monitoring of call volumes. To pursue these objectives, we designed and implemented a comprehensive analytical plan following the conceptual framework depicted in Figure 1. Field Experiment Following guidance regarding the preferred method for studying billboards, we developed an associated field experiment with the cooperation of a local healthcare provider. Specifically, our study tracked a 32-day billboard campaign by the Louisiana-based Willis-Knighton Health System promoting its Quick Care urgent care centers in Shreveport and Bossier City, an area with a population of around 260,000 (U.S. Census Bureau 2008). Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion Tbese centers were well suited to the investigation, as urgent care needs occur at any time and require a relatively short decision process, usually within the span of a typical billboard campaign. Furthermore, these centers had not been the focus of extensive advertising in the past. Questionnaire To assess the billboard advertising campaign, we developed a self-administered, three-section questionnaire that was distributed to patients on arrival at Quick Care. FIGURE 2 The Quick Care Billboard Advertisement Source: Reprinted with permission from Willis-Knighion Health System, Shreveport Louisiana. 86 Is BILLBOARD ADVERTISING BENEFICIAL I-OR HEALTHCARE ORGANIZATIONS? The first section focused on performance aaoss the patient patronage sequence. The study context limited questionnaire length and precluded the use of multi-item scales. However, Rossiter (2002) and Bergkvist and Rossiter (2007) show that single-item scales can perform equally well for objects “easily and uniformly imagined,” such as billboards. After first establishing whether the respondent bad noticed the billboards, a seven-point scale adapted from Havlena and Craham (2004) measured change in awareness levels. A scale of advertising informativeness was built on a concept developed by Ducoffe ( 1995) and Smit and Neijens (2000). For a later stage in the patient patronage sequence, an extent of influence scale was adapted from Cilly and colleagues (1998). The second section focused on the billboard policy debate, and patients were asked about the degree to which they view billboards to be appropriate for marketing healthcare services and about their overall view of billboards. Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion The seven-point scale, which ranged from 1 = very negative to 7 = very positive, was adopted from Krosnick, Judd, and Wittenbrink (2005). This section addressed the debate about whether consumers like or dislike billboard advertisements, and it appears to be the first academic study, either within or outside the healthcare sector, that seeks consumer perspectives. The third section included a series of demographic inquiries, which permitted us to investigate potential trends and patterns associated with specific patient groups and subgroups. Questionnaire development included two focus groups, and furtJier qualitative methods helped to interpret the results. Sample Over the course of the campaign, 2,380 patients came to one of the two Quick Care locations for treatment. Of these, 1,640 participated in the survey, yielding a response rate of 68.9 percent. Table 2 summarizes the demographic characteristics of respondents, which TABLE 2 Summary of Respondent Characteristics (N = 1,640) Characteristic Respondent Income ($) Under $10,000 18.2 $10,000-524,999 20.9 $25,000-$39,999 23.9 $40,000-$54,999 15.4 $55,000-$84,999 13.2 $85,000 and over 8.5 Mean income $37,644 Gender Male 37.0 Female 63.0 Age Under 18 years 18-29 years 25.8 3 … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion

Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion Perhaps you have been to a health fair sponsored by a local hospital in your community. Who benefits from such an effort? When you or your neighbors are screened for signs of illness (hypertension, for instance) or learn about available services, clearly the promotion benefits you, but what about the hospital? Having its name associated with “community service” benefits the institution. Any patients and/or clients the institution attracts may also result in some financial benefit, even if the organization is ostensibly “non-profit.” Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion In this Discussion, you will identify examples of promotion for social change in your community and analyze whether the promotion benefits the community, the organization, or both. To prepare for this Discussion: Review this week’s Learning Resources. Identify two local health care providers and identify an example of each organization’s effort in promoting a service or services as a form of positive social change. One of the organizations should be for-profit, the other, not-for-profit. POST A BRIEF DESCRIPTION OF HOW EACH ORGANIZATION’S PROMOTION FOSTERS SOCIAL CHANGE. THEN, EVALUATE HOW EACH ORGANIZATION’S MARKETING PROMOTION BENEFITS THE COMMUNITY AND HOW IT BENEFITS THE ORGANIZATION. FINALLY, FOR EACH EXAMPLE OF MARKETING PROMOTION YOU HAVE IDENTIFIED, ANALYZE WHETHER THE INTEREST OF THE COMMUNITY AND THE INTEREST OF THE ORGANIZATION ARE IN CONFLICT. BRIEFLY COMMENT ON HOW THE PROMOTIONS OF THE FOR-PROFIT AND NON-PROFIT ORGANIZATIONS DIFFER AND HOW THEY ARE SIMILAR. Support your work with specific citations from this week’s Learning Resources and/or additional sources as appropriate. Your citations must be in APA format. Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion resources_3.docx usw1_hlth_4115_fortenberryetal_2010_.pdf contentserver__11_.pdf contentserver__10_.pdf contentserver__9_.pdf : Evaluating Strategic Planning and Marketing/Summary Throughout this course, you have explored the values, vision, and mission for your organization. You performed the appropriate environmental assessment. You defined your organization’s goals and objectives, and you formulated and implemented a strategy you believe helps you achieve them. Now what? How do you know if it all worked as planned? This week, you will consider the fifth step to strategic planning and marketing: evaluation. A carefully considered and measurable evaluation allows an organization to determine how effective its efforts have been in achieving its goals. Evaluation allows the organization to identify weaknesses and highlight procedures and/or tools that may be useful and effective when applied in other circumstances. As you may discover, evaluation is not the end of the process, but a necessary step in a constant, continuous cycle of improvement for any organization. In this week’s Discussion, you will consider promotions of health care organizations that target social change. Using real-world examples, you will analyze whether these promotions benefit the organization, the community, or both. Learning Objectives Students will: Examine organizational marketing in the context of social change Evaluate strategic planning and marketing results . ——————————————————————————————————————– • • • Zuckerman, A. M. (2012). Healthcare strategic planning (3rd ed.). Chicago, IL: Health Administration Press. Chapter 9, “Making Planning Stick: From Implementation to Managing Strategically” Chapter 10, “The Annual Strategic Plan Update” Chapter 12, “Future Challenges for Strategic Planning and Planners” Is Billboard Advertising Beneficial for Healthcare Organizations? An Investigation of Efficacy and Acceptability to Patients John L. Fortenberry Jr., PhD, chair. Health Administration Department, James K. Elrod Professor of Health Administration, and professor of marketing. School of Business, Louisiana State University, Shreveport, Louisiana, and Peter J. McColdrick, PhD, Tesco Professor of Retailing, S4anchester Business School, The University of Manchester, Manchester, United Kingdom EXECUTIVE SUMMARY The healthcare industry is increasingly turning to billboard advertising to promote various medical services, yet little attention has been directed toward understanding the performance and policy implications of billboard advertising from the perspective of the patients targeted. Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion To shed light on this, we initiated a field experiment investigating the impact of an urgent care center’s billboard advertising campaign, colleaing primary data over a 32-day period at the center’s two clinics. Over the course of the billboard campaign, perspectives from 1,640 patients were collerted via questionnaire. Institutionally supplied business metrics were also monitored. Our principal findings indicate that billboard advertisements are noticed by patients, favorably viewed by patients, and effective across the sequence of steps leading to patient patronage. Enhancement of awareness exerts the most powerful influence on patronage, but the capacity to inform consumers is also highly significant. These effects are not limited to new patients, as many returning clients were made more aware of the clinics and were influenced by the campaign. The study offers insights for creative billboard treatments and campaign planning. Although effeas remained strong throughout the campaign, some degree of “wearout” was evident after three weeks, which suggests the need to rotate billboards frequently and to consider digital billboards. Corner tabs—small announcements sometimes placed in the corners of billboard advertisements—proved largely ineffective as a promotional device and may clutter the central messages. Given these findings, we believe healthcare institutions are justified in using billboards, as they perform effeaively and appear relatively free of controversy. Careful planning of creative billboard treatments and appropriate scheduling patterns are essential to maximize their communications potential. For more information on the concepts in this article, please contact Dr. Fortenberry at [email protected] 81 JOURNAL OF HEALTHCARE MANAGEMENT 55:2 MARCH/APRIL H ealthcare institutions and providers face serious dilemmas as communication with current and prospective patients becomes increasingly difficult (Fortenberry 2010). The prolifération of media options results in increasingly fragmented audiences (Andruss 2007; Moriarty, Mitchell, and Wells 2009). Clutter is now a serious problem in most advertising media, as vast numbers of messages compete for attention (Berkowitz 2006; Elliott and Speck 1998; Cratton 2006; Bloom 2003).Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion Information overload leads to highly selective attention, and technologies such as DVD recorders and ad-blocking software can reduce exposure to ads (Tellis 2004; Gritten 2007). A fiirther challenge is the shortening of attention spans, a trend to which text and Internet communication both caters and contributes (Obermiller 2002; Whaley 2006). 2010 of reaching 1,000 members of a targeted population with a given form of marketing communication (Moriarty, Mitchell, and Wells 2009; OAAA 2008), as indicated by comparative figures presented in Table 1. These characteristics give billboards significant advantages. These benefits have not been lost on the healthcare industry, which is now a large user of the medium (Berkowitz 2006; Managed Healthcare 1994). Despite extensive and increasing use, however, little is known about how billboards work, and academic research is scarce (Woodside 1990; Fortenberry and McGoldrick 2006; Taylor, Franke, and Bang 2006) and seemingly nonexistent for the healthcare industry. Civen increasing pressures for healthcare marketing officers to demonstrate a return on advertising expenditures (Eudes 2006; Berkowitz 2006; Thomas 2005), understanding if and how major types of media work is essential, Although all media possess strengths and weaknesses, billboards have a degree of immunity to the audience fragmentation, clutter, ad blocking, and attention span problems facing other media. Audience fragmentation is not an issue because the limited travel routes in given communities concentrate exposure of billboards to mass audiences. Additionally, technology that blocks billboard advertisements is currently not available. Billboard advertisements also enjoy a relatively clutter-free setting, as zoning ordinances limit their proliferation (Lamar Advertising 2008; OAAA 2008). Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion Because of their nature, billboard positioning and creative treatments have always assumed short attention spans. In addition, among the major media, billboards offer the lowest cost per thousand, a measure of the cost LITERATURE REVIEW The neglect of academic research on billboard advertising is often attributed to the costs involved with enacting field experiments, the preferred method for studying the medium (Woodside 1990; Bhargava and Donthu 1999; Fortenberry and McColdrick 2006). Laboratory experiments do not effectively replicate the externalities associated with billboards, such as motorist attention to the road, and other environmental distractions that take attention away from billboards. The extant literature focuses on four main categories: history, art, policy, and performance. Research on tbe history of billboard advertising focuses on the growth and 82 Is BILLBOARD ADVERTISING BENEFICIAL TOR HEALTHCARE ORGANIZATIONS? influence performance, as reported in a few performance-related studies discussed later. The policy category is perhaps the most developed ofthe four areas of the billboard literature. Substantial works mostly focus on the societal benefits or detriments associated with billboard advertising, and debates between proponents and opponents of the medium are commonplace (Taylor 1997). Billboard proponents frequently emphasize the medium’s ability to communicate information to travelers, deliver customers for advertisers, and increase road safety (Laible 1997; OAAA 2008). Billboard opponents, however, contend that billboard advertisements cause such undesirable consequences as aesthetic pollution (e.g., roadside clutter, excessive transmission of ambient light), environmental harm (e.g., damage to the environment when vegetation is removed to place roadside billboards), and motorist harm (e.g., billboard advertising distracts drivers and contributes to vehicular accidents) (Vespe 1997; Scenic America 2006). Some also claim that the preponderance of billboards that advertise harmful products in minority communities affects public health (Altman, Schooler, and Basil 1991; Hackbarth, Silvestri, and Cosper 1995). Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion The conflicting arguments of Laible (1997) and Vespe (1997) perhaps best illustrate this debate. One side asserts that the public likes billboards, and the other claims the public dislikes billboards, although it appears that the public is never actually asked for its perspective. Despite lengthy battles, this key question remains unanswered. TABLE 1 Comparative Costs of Various Media Cost per Ttiousand Media Television (prime lime) Magazine $30.45 • $25.93 Newspaper $12.24 Internet $11.25 $9.69 Radio Outdoor $3.62 Source: Information based on estimaces from media experts andOAAA(20U’)). development ofthe medium; works by Hendon and Muhs (1986) and Gudis (2004) are excellent examples. Although assumptions regarding billboard efficacy have clearly driven their development over the years, such performance considerations are not a focus of these historical accounts. They provide interesting accounts ofthe chronological development ofthe medium but do not analyze the performance characteristics or related matters that would be helpful in executive decision making. Within the art category, the literature focuses primarily on photographic collections of billboards; Fraser (1991) and Heon, Diggs, and Thompson (1999) are good examples. Such authors often present the winning entries from billboard artwork contests, providing readers with examples of creative efforts. This area ofthe literature tends to address creativity, rather than an ad’s ability to generate a marketing return on investment. However, there is clearly much scope for creative treatments to 83 JOURNAL OF HEALTHCARE MANAGEMENT 55:2 M A R C H / A P R I L 2 0 1 0 OBJECTIVES AND CONCEPTUAL FRAMEWORK The literature on billboard performance is clearly the least developed, and few academic studies have been published. However, this area is of great importance to institutions and media planners because they need a close understanding of the performance characteristics of billboards to make pmdent judgments regarding their use. Most of the work in this area has focused on recall—that is, the ability of a consumer to view an advertisement and remember its message and other relevant characteristics.Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion The studies of Hewett (1972), Fitts and Hewett (1977), King andTinkham (1990), and Osborne and Coleman (2008) indicate that billboards are capable of generating recall. The primary objective of this research is to gain insights into the performance characteristics of billboard advertising in the healthcare industry and thereby help institutions make more efficient media allocations. The sparse previous research in nonhealthcare settings indicates the following: Several authors have focused on how creative and spatial characteristics affect recall. Studies by Young ( 1984); Donthu, Cherian, and Bhargava (1993); and Bhargava, Donthu, and Caron (1994), for example, indicate that roadway positioning, size of text, use of color, and related characteristics affect consumers’ ability to remember billboard message content. A further element of the billboard performance literature focuses on the ability of billboards to drive sales, although the field experiments of Bhargava and Donthu (1999) are the sole independent contributions in this important area. The Outdoor Advertising Association of America (OAAA 2009) compiled case studies of billboard campaigns, and Taylor, Franke, and Bang (2006) surveyed management views regarding billboards. However, the efficacy of billboards remains seriously underresearched. • Billboards generate recall (Hewett 1972; Fitts and Hewett 1977; King and Tinkham 1990; Osborne and Coleman 2008). • Creative and spatial applications affect billboard advertising recall (Young 1984; Donthu, Cherian, and Bhargava 1993; Bhargava, Donthu, and Caron 1994). • Billboards can drive sales (Bhargava and Donthu 1999). We aim to assess the impact of billboards across what is known in the advertising literature as the hierarchy of effects, which is referred to herein as the patient patronage sequence—that is, the theoretical series of steps through which consumers travel as they move from initial awareness toward making a decision to act or buy. Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussionhe concept that people pass through a hierarchy or sequence of stages in their progression from awareness to action is well established in advertising (Tellis 2004), consumer behavior (Solomon 2007), psychotherapy (Prochaska and Norcross 1999), and social marketing (Velicer, Rossi, and Procbaska 1996). Knowledge relating to the efficacy of billboards at different stages in this sequence is of value to 84 Is BILLBOARD ADVERTISING BENEFICIAL FOR HEALTHCARE ORGANIZATIONS? healthcare providers. More specifically, we also test the efficacy of comer-tab promotions. Secondary objectives pertain to billboard policy matters relevant to the general debate (Taylor 1997) between proponents (Laible 1997) and opponents (Vespe 1997) of this advertising medium. Specifically, we measure whether patients view the medium favorably and consider billboards appropriate for marketing healthcare services to help resolve the issue of whether the public likes or dislikes billboards. A medium regarded as inappropriate or controversial could clearly be detrimental to new business and loyalty. Given the paucity of academic research on billboards in general and its absence in the healthcare context, the study further aims to close significant gaps in the literature on advertising and healthcare marketing. The study draws on two conceptual domains in examining the effects of billboards: first their efficacy in promoting healthcare establishments, and second, the perceived appropriateness of the medium for healthcare promotion. For the first domain, we draw from the literature on billboard performance and the wider literature on hierarchies and models of the effects of advertising and construct scales to measure effects on customer awareness, perceptions of informativeness, and influence on initial and return visits. For the second domain, we draw from a selection of the literature related to billboard policies, and then we measure attitudes of patients toward the medium and its appropriateness for healthcare advertising. Figure 1 shows the conceptual and analytical framework of the study, illustrating these two sets of influences on new or returning patient visits.Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion FIGURE 1 Conceptual Framework of the Study Efficacy: Promoting Healthcare Facility Patient Patronage Sequence Raising/ Creating Awareness Appropriateness: Attitudes Toward Billboards Billboard Policy Debates Conveying Relevant Information Appropriate for Health Advertising? Influencing Visits to the Facility: First Visit >>>> Return Visits 85 Overall Opinion of Medium OF HEALTHCARE MANAGEMENT 55:2 MARCH/APRIL ANALYTICAL PLAN AND METHODOLOGY 2010 The campaign represented a 133 gross rating point showing, which indicates daily exposure levels for the campaign at 133 percent of the population aged 18 years or older. This meant that people in this age group were typically exposed to the campaign more than once per day, given the number of billboards purchased. Willis-Knighton Health System purchased nine bulletins (14 X 48-foot billboards) and seven posters (12 x 24-foot billboards), and these were scheduled mainly in the month of October at a total cost of $25,411. Figure 2 shows the creative treatment, including a corner-tab invitation to telephone a “Flu Shotline.” This approach provided further opportunity to assess performance through direct monitoring of call volumes. To pursue these objectives, we designed and implemented a comprehensive analytical plan following the conceptual framework depicted in Figure 1. Field Experiment Following guidance regarding the preferred method for studying billboards, we developed an associated field experiment with the cooperation of a local healthcare provider. Specifically, our study tracked a 32-day billboard campaign by the Louisiana-based Willis-Knighton Health System promoting its Quick Care urgent care centers in Shreveport and Bossier City, an area with a population of around 260,000 (U.S. Census Bureau 2008). Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion Tbese centers were well suited to the investigation, as urgent care needs occur at any time and require a relatively short decision process, usually within the span of a typical billboard campaign. Furthermore, these centers had not been the focus of extensive advertising in the past. Questionnaire To assess the billboard advertising campaign, we developed a self-administered, three-section questionnaire that was distributed to patients on arrival at Quick Care. FIGURE 2 The Quick Care Billboard Advertisement Source: Reprinted with permission from Willis-Knighion Health System, Shreveport Louisiana. 86 Is BILLBOARD ADVERTISING BENEFICIAL I-OR HEALTHCARE ORGANIZATIONS? The first section focused on performance aaoss the patient patronage sequence. The study context limited questionnaire length and precluded the use of multi-item scales. However, Rossiter (2002) and Bergkvist and Rossiter (2007) show that single-item scales can perform equally well for objects “easily and uniformly imagined,” such as billboards. After first establishing whether the respondent bad noticed the billboards, a seven-point scale adapted from Havlena and Craham (2004) measured change in awareness levels. A scale of advertising informativeness was built on a concept developed by Ducoffe ( 1995) and Smit and Neijens (2000). For a later stage in the patient patronage sequence, an extent of influence scale was adapted from Cilly and colleagues (1998). The second section focused on the billboard policy debate, and patients were asked about the degree to which they view billboards to be appropriate for marketing healthcare services and about their overall view of billboards. Walden HLTH4115 Chapter 9 Community vs Organizational Benefit Discussion The seven-point scale, which ranged from 1 = very negative to 7 = very positive, was adopted from Krosnick, Judd, and Wittenbrink (2005). This section addressed the debate about whether consumers like or dislike billboard advertisements, and it appears to be the first academic study, either within or outside the healthcare sector, that seeks consumer perspectives. The third section included a series of demographic inquiries, which permitted us to investigate potential trends and patterns associated with specific patient groups and subgroups. Questionnaire development included two focus groups, and furtJier qualitative methods helped to interpret the results. Sample Over the course of the campaign, 2,380 patients came to one of the two Quick Care locations for treatment. Of these, 1,640 participated in the survey, yielding a response rate of 68.9 percent. Table 2 summarizes the demographic characteristics of respondents, which TABLE 2 Summary of Respondent Characteristics (N = 1,640) Characteristic Respondent Income ($) Under $10,000 18.2 $10,000-524,999 20.9 $25,000-$39,999 23.9 $40,000-$54,999 15.4 $55,000-$84,999 13.2 $85,000 and over 8.5 Mean income $37,644 Gender Male 37.0 Female 63.0 Age Under 18 years 18-29 years 25.8 3 … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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