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The purpose of this paper is to identify how need for service, enabling factors and pre-disposing characteristics influences access to service. In addition, the authors seek to examine the moderating influence of pre-disposing variables on the relationship between insurance and health services utilization.

The authors utilize data from a major metropolitan hospital in the USA to test and extend the behavioral model of health care.

Results indicate that insurance and pre-disposing variables have a direct impact on type of health service utilization. However, the insurance effect is found to vary by demographic factors.

This paper is limited to secondary data. Future work can incorporate both attitudinal and behavioral measures to obtain a more comprehensive evaluation of services access.

The research offers a tactical framework for management to segment consumer markets more effectively.

Through the framework, management will have the requisite knowledge to target segmented populations based on need, insurance, and pre-disposing variables which will help improve access to services and clinical outcome.

The findings of this paper will serve as a basis for future research exploring the influence of insurance on access to services.

This study examined use of preventive health care services, for working-age adults with mobility limitations (uses mobility aids, has difficulty walking, difficulty standing for extended periods of time, or difficulty climbing steps) and for working-age adults reporting no mobility limitation, in order to identify similarities and disparities between the two populations. We analyzed data from the 1994 National Health Interview Survey Disability Supplement and NHIS Year 2000 file with cross-tabulation and logistic regression procedures to examine the relationship between mobility limitation and use of health screenings, immunizations, and health behavior counseling. Results were mixed, but disparities in preventive service use were identified.

This ‘case study’ demonstrates how one local authority approached the development of preventative services in response to the Department of Health's Promoting Independence initiative. It considers the key building blocks of a preventative strategy ‐ consultation and partnership, needs and risk assessment, monitoring and evaluation ‐ and describes how an action plan was formulated.

The purpose of this paper is to investigate the role of multiple actors in the value creation process for a preventative health service, and observe the subsequent impact on key service outcomes of satisfaction and customer behaviour intentions to use a preventative health service again in the future.

An online self-completion survey of Australian women (n=797) was conducted to test the proposed framework in the context of a free, government-provided breastscreening service. Data were analysed using Structural Equation Modelling (SEM).

The findings indicate that functional and emotional value are created from organisational and customer resources. These findings indicate that health service providers and customers are jointly responsible for the successful creation of value, leading to desirable outcomes for all stakeholders.

The results highlight to health professionals the aspects of service that can be managed in order to create value with target audiences. The findings also indicate the importance of the resources provided by users in the creation of value, signifying the importance of customer education and management.

This study provides a significant contribution to social marketing through the provision of an empirically validated model of value creation in a preventative health service. The model demonstrates how the creation and provision of value can lead to the achievement of desirable social behaviours – a key aim of social marketing.

Preventative health services are keen to identify how to engage men and increase their participation, thus improving health, well-being and life expectancy over time. Prior research has shown general gender norms are a key reason for men’s avoidance of these services, yet there is little investigation of specific gender norms. Furthermore, masculinity has not been examined as a factor associated with customer vulnerability. This paper aims to identify the relationship between gender norm segments for men, likely customer vulnerability over time and subjective health and well-being.

Adult males (n = 13,891) from an Australian longitudinal men’s health study were classified using latent class analysis. Conditional growth mixture modelling was conducted at three timepoints.

Three masculinity segments were identified based on masculine norm conformity: traditional self-reliant, traditional bravado and modern status. All segments had likely customer experience of vulnerability. Over time, the likely experience was temporary for the modern status segment but prolonged for the traditional self-reliant and traditional bravado segments. The traditional self-reliant segment had low subjective health and low overall well-being over time.

Practitioners can tailor services to gender norm segments, enabling self-reliant men to provide expertise and use the “Status” norm to reach all masculinity segments.

The study of customer vulnerability in a group usually considered privileged identifies differential temporal experiences based on gender norms. The study confirms customer vulnerability is temporal in nature; customer vulnerability changes over time from likely to actual for self-reliant men.

The purpose of this paper is to investigate the role of masculine identity in generating value destruction and diminished well-being in a preventative health service.

This research used five focus groups with 39 Australian men aged between 50 and 74 years. Men’s participation in the National Bowel Cancer Screening Program informed the sample frame. In total, 12 Jungian male archetypes were used to identify different masculine identities.

Thematic analysis of the data revealed three themes of masculinity that explain why men destroy value by avoiding the use of a preventative health services including: rejection of the service reduces consumer disempowerment and emasculation, active rejection of resources creates positive agency and suppressing negative self-conscious emotions protects the self.

Limitations include the single context of bowel cancer screening. Future research could investigate value destruction in other preventative health contexts such as testicular cancer screening, sexual health screening and drug abuse.

Practical implications include fostering consumer empowerment when accessing services, developing consumer resources to create positive agency and boosting positive self-conscious emotions by promoting positive social norms.

This research is the first known study to explore how value is destroyed in men’s preventative health using the perspective of gender identity. This research also is the first to explore value destruction as an emotion regulation strategy.

The purpose of this paper is to understand the role of perceived threat, brand congruence, and social support on consumer coping strategies for a preventative health service.

An online survey of 570 women aged over 50 in one Australian state was conducted (users and non-users of the service). The data were analyzed using structural equation modeling.

A competing models approach reveals that threat on its own is associated with avoidance coping; however, when brand congruence is high, there is an association with active coping. Social support appears to have a buffering effect on threat and is associated positively with active coping and negatively with avoidance coping.

The study findings suggest that threat appeals should be used with caution in increasing participation in transformative preventative health services due to its double-edged sword effect (increasing both avoidance and active coping). When consumers have social support, this results in active coping and buffers avoidance coping. This research offers useful insights for social marketing and transformative service research.

China launched a comprehensive health reform in 2009 to improve healthcare quality. Because preventive care utilization in China has not been frequently discussed, the purpose of this paper is to focus on the association between education level and preventive care before and after the initiation of the reform. Education has been referred to as the best health outcome indicator and China’s educational reform has been progressive, such as the health reform.

The authors analyzed data from four China Health and Nutrition Surveys (CHNS): 2004 (n=9,617); 2006 (n=9,527); 2009 (n=9,873); and 2011 (n=9,430). Variables were selected based on Andersen’s healthcare utilization model (predisposing, enabling and need factors). Multivariable logistic regression models, odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) were conducted and reported.

In the adjusted multivariable logistic regression models, the authors found that general education was associated (p<0.05) with access to preventive care in 2004, 2009 and 2011, but not in 2006. Individuals with higher education had higher ORs for utilizing preventive care, compared with lower education (primary school education or none).

Policy implications include providing educational protocols regarding preventive care’s significance to residents educated at lower level schools, especially younger individuals.

To the authors’ knowledge, this is the first comparative assessment on education level and preventive care utilization before and after the implementation of the Chinese health reform.

Despite the availability and accessibility of standardized screening services, such as preventative health services, many individuals avoid participation. The extant health literature has indicated that health locus of control (HLOC) influences engagement and uptake of health services. The purpose of this paper is to explore how the microfoundation, HLOC, contributes to value co-creation via service-generated and self-generated activities in standardized screening services.

A qualitative study of 25 consumers who have experienced one of the three standardized screening services in Australia was undertaken, followed by thematic analysis of the data.

Service-generated activities elicit reactive responses from consumers – compliance and relinquishing control – but when customers lead co-creation activities, their active responses emphasize protecting self and others, understanding relationship needs and gaining control. Consumers with high internal HLOC are more likely to take initiative for their health, take active control of the process and feel empowered through participating. Consumers with low internal HLOC, in contrast, require more motivation for participation, including encouragement from powerful others through promotion or interpersonal dialogue.

These findings can be used by policymakers and providers of preventative health services for the betterment of citizen health.

The integration of the DART framework, customer value co-creation activities, and the delineation of self-generated and service-generated activities provides a holistic framework to understand the influence of HLOC on the co-creation of value in standardized screening services.

A workshop on the evaluation of a controversial plan to integrate preventive and curative mother‐and‐child services in Jerusalem was conducted by the Hebrew University — Hadassah School of Public Health and Community Medicine. An extensive field study, conducted by second‐year MPH students led to a better understanding of community problems and needs, and to the formulation of recommendations for closer co‐ordination, rather than integration, between the municipal preventive health services and the curative clinics operated by the sick funds. This paper shows how these recommendations affected the decision‐making process in Jerusalem, and discusses the implications of these and other policy interventions on attaining the various goals of public health academicians.