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However, despite the development of these exemplary healthcare capacities, the UAE's system continued to suffer during this timeframe from a perception among the population that it lacked quality (Kronfel, 1999).
It cannot be discounted that the public may perceive the UAE's healthcare system as lacking in quality because the system does in fact have many developmental issues left to resolve. For example, a study by Margolis (2002) found that as healthcare rapidly expanded in the 1990s, statistically significant numbers of incidents of inappropriate medicine prescription also increased. This finding gave some validity to the concern about quality. However, the majority of the studies reviewed indicated that the UAE's healthcare system was comparable to the healthcare systems in most other developed and developing nations. For example, Margolis et al. (2003) conducted a survey analysis of elderly in the U.S. And the UAE and found that the system of elderly care in the UAE compares favorably with that found in the U.S., both in terms of care rendered and patient satisfaction. Similarly, Rizk et al. (2001) found that the delivery of care and consumer satisfaction regarding health programming around child birth was equal in the UAE to that found elsewhere. Therefore, the disconnect between systemic realities and public perceptions in the UAE's healthcare system seems to be related primarily to a perceptual gap held by the consuming public rather than any long-lasting or intractable problem with the delivery of care itself.
The UAE healthcare system, then, seems to suffer from a lack of trust in the system by those who must participate in order to achieve full mass health coverage. Even with significant economic and development advances, not only are the general masses not quickly moving to adopt the healthcare system's offerings, many even have actively negative reactions to the UAE's healthcare system ("70% of UAE residents would opt for medical tourism," 2009). There are a number of possible reasons for this gap. First, part of the concern may be due to the traditional beliefs of the Arab public generally (Heard-Bey, 2001). Because the UAE was, until recently, a tribal society -- and because the nation skipped through many of the stages of economic development, thereby failing to experience the ameliorating factors of long-phase development on traditional ways of life -- the traditional beliefs and practices remained intact among many demographics. For example, Foster et al., (2009) studied usage patterns of a health-related website among the Arab population and found that -- at least on the subjects of birth control and contraception -- the Arab population desired different types of information from such websites than English populations desired. Similarly, Ypinazar and Margolis (2006) found that Arab elderly healthcare patients operate from traditional cultural perceptions regarding the state of their health rather than from mindsets driven entirely by scientific need and reality. This suggested that the cultural attitudes of the Arab population may impact significantly upon the acceptance of programming in the healthcare system, as participants operate from traditional mindsets even in the face of modern institutional and technological structures.
Second, this may also suggest that there is a perception gap between practitioners and consumers, as those who administer the healthcare system may have different attitudes about what the public wants from healthcare than the mass population does. While Moore (2009) argues that such a perception gap between healthcare workers and consumers exists even in the most mature economies, it is possible that such a gap is exacerbated by the possibility of traditional beliefs impacting negatively upon the public's trust in the healthcare system.
In any event, perception remains high among those responsible for marketing the healthcare system in the UAE that the public still does not trust the healthcare system (Kronfel, 1999). Critical attention is therefore required in order to develop integrated strategies that speak to the needs and interests of the consuming public, and do so in ways that appeal to the public and entice them into the healthcare system (Al-Hosani, 2000). One of the more important needs of the moment is to establish a strong bond between the providers in the system and the consuming public regarding perception of the healthcare system, through the effective use of marketing to develop economic and healthcare messages that drive the country's expanding healthcare system. Significantly, the key questions become then what can the system offer, and what do the various publics involved in the system desire and intend? Ultimately these questions seemed to revolve around very basic questions of supply and demand: What can the healthcare system supply, and what does the consuming public demand? The role of marketing in defining these concepts and bringing demand and supply in closer alignment was thereby established.
In order to address these questions, the researcher turned next to the application of two models designed to provide analytical strength for understanding the institutional and cultural capacities of a product/service such as healthcare as well as the public's ultimate acceptance of marketing related to such a product/service.. Through review of the related literature on the concept of diffusion of innovation, the study defined what characterizes a product or service that is set for rapid launch and acceptance into an economic environment. The five stages of product/service adoption and acceptance, as identified by Rogers (2003) were analyzed in order to determine which stage seemed most appropriate for describing the current situation in the UAE. Then, through analysis of the communities of practice model, the research addressed the variety of ways that involved publics and interested parties can be brought into alignment through effective marketing campaigns designed to link consumer demands and supplier intentions.
Diffusion of Innovation
The diffusion of innovations theory addresses the capacity, the motivations, and the rate at which acceptance of new ideas, products, services, or technologies is evident in a culture. "Getting a new idea adopted, even when it has its obvious advantages, is difficult," Rogers writes (p. 1). His argument is designed to address a key need for marketers, which is the "common problem" of how to "speed up" the rate of acceptance for a given product or service. Rogers develops a theoretical argument and a variety of practical tools for understanding and bringing about this critical adoption attitude.
Rogers' argument links the capacity of the product or service to fulfill the needs of a public, with the ready acceptance of such a product or service. He identifies four critical elements of a diffusion of innovation, including (1) the innovation itself, (2) the types of communication channels available for communicating information about the innovation, (3) the rate at which the innovation takes place, and (4) the social system which frames the innovation (p. 10). If the given innovation does not address the public's needs or does so in a way that cannot be communicated in an advantageous fashion through appropriate channels, then its rate of diffusion will likely be slow. However, if the innovation can be communicated to the proper social participants through acceptable channels, and the innovation can be shown to be relevant and acceptable to the public it is aimed at, the rate of diffusion will likely increase. An innovation which shows higher relevance, as determined by a better ability to satisfy the public, will have still higher acceptance, and the rate of diffusion can be rapid and complete. The capacity to satisfy the public must be in place in order for adoption to take place. Obviously, in the absence of a product, no adoption takes place. Similarly, otherwise fully acceptable products will not succeed if the public does not favor them.
Rogers argues that once the four elements of diffusion are in place, the process of diffusion takes place in a five stage development. The five steps include the following:
1. Knowledge, in which the participant is first made aware of the innovation.
2. Persuasion, in which the individual becomes actively involved with the innovation and seeks out additional information.
3. Decision, in which the participants weigh and pros and cons of adoption the innovation.
4. Implementation, in which the individual employs the innovation.
5. Confirmation, in which participant makes the final decision to use the product and begins to use to its potential. (pp. 162-172)
At any step in this process, the individual and collection of individuals can turn back from a full adoption or choose to adopt another innovation. Therefore some innovations get adopted quickly and permanently whereas others are only adopted temporarily or partially, or both.
Rogers argues that in those cases where the elements of diffusion are in place, and a product can be shown to be advantageous, acceptance can be rapid. He identifies a number of characteristics of innovations which determine their ready acceptance by their target publics. These include relative advantage over previous innovations, compatibility with needs and values, complexity for added utility, trialability so that it can be tested, and observability so that the participant can see the difference that the innovations makes. If each of these attributes are present in…[continue]
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