Segmentation of health-care consumers: psychological determinants of subjective health and other person-related variables

Abstract

Background: There is an observable, growing trend toward tailoring support programsin addition to medical treatmentmore closely to individuals to help improve patients' health status. The segmentation model developed by Bloem & Stalpers [Nyenrode Research Papers Series 12:1-22, 2012] may serve as a solid basis for such an approach. The model is focused on individuals' 'health experience' and is therefore a 'cross-disease' model. The model is based on the main psychological determinants of subjective health: acceptance and perceived control. The model identifies four segments of health-care consumers, based on high or low values on these determinants. The goal of the present study is twofold: the identification of criteria for differentiating between segments, and profiling of the segments in terms of socio-demographic and socioeconomic variables. Methods: The data (acceptance, perceived control, socioeconomic , and socio-demographic variables) for this study were obtained by using an online survey (a questionnaire design), that was given (random sample N = 2500) to a large panel of Dutch citizens. The final sample consisted of 2465 participantsage distribution and education level distribution in the sample were similar to those in the Dutch population; there was an overrepresentation of females. To analyze the data factor analyses, reliability tests, descriptive statistics and t-tests were used. Results: Cutoff scores, criteria to differentiate between the segments, were defined as the medians of the distributions of control and acceptance. Based on the outcomes, unique profiles have been formed for the four segments: 1. 'Importance of self-management'relatively young, high social class, support programs: high-quality information. 2. 'Importance of personal control'relatively old, living in rural areas, high in homeownership; supportive programs: developing personal control skills. 3. 'Importance of acceptance'relatively young male; supportive programs: help by physicians and nurses. 4. 'Importance of perspective and direction'female, low social class, receiving informal care; support programs: counseling and personal care. Conclusions: The profiles describe four segments of individuals/patients that are clearly distinct from each other, each with its own description. The enriched descriptions provide a better basis for the allocation and developing of supportive programs and interventions across individuals.

Differences between expert reported and patient reported burden of disease rankings

“…In order to understand how these rankings differ, it is important to develop patient reported burden of disease rankings and discuss how these compare with the usual expert reported burden of disease rankings. One reliable and valid way to develop patient reported burden of disease rankings is by determining and ranking the subjective health experience of patients 11 .…”

“…Subjective health experience is defined as “an individual’s experience of physical and mental functioning while living his life the way he wants to, within the actual constraints and limitations of individual existence” 12 [p. 8]. Research shows that the two central determinants of subjective health experience are ‘acceptance’ and ‘perceived control’ 11 . ‘Acceptance’ is basically an affective concept: it refers to the extent to which patients are able to experience their health condition as an integral part of their existence 13 .…”

“…Based on these determinants, a model consisting of four segments (see Fig. 1 ) was developed with each segment describing a particular subjective health experience profile 11 . Patients in segment I are able to come to terms with their health condition and attempt to manage it.…”

“…Patients in segment III have considerable control, but experience difficulties living their lives in poor health. Patients in segment IV are unable to accept their health condition and are also unable or unwilling to gain control over their own health 11 . As diseases are more incapacitating, a larger proportion of patients accumulates in segment IV of the Bloem & Stalpers model, indicating a higher burden of disease 11 .…”

Differences in tobacco smoking status in segments of the Australian population

“…Other papers that examine segmentation within selected segments of a population include Hwang and Park (2019), which focuses on gender differences in a large sample, Low et al (2019), which examines the effectiveness of “expert defined segmentation” in the context of healthcare, Primack et al (2012), which focuses on US university students, and Nighbor et al (2018), which looks at smoking patterns among women of reproductive age in rural and urban US papers that specifically focus on demographic segments within a population include Banks et al (2015), which identifies changes in segments of an ongoing cohort study. Bloem et al (2020) segmented consumers of healthcare services on the basis of psychological determinants, and Kaleta et al (2012) explored socio-demographic determinants of tobacco smoking in Poland, drawing on data from a large, global survey. Papers such as Langton et al and Barnet et al , mentioned above, are exceptions, in that they explore the use of segmentation in the design of health-related initiatives.…”