An Holistic Approach to Household Management of Well Being: a Thick Description

ABSTRACT - This pilot study of ten families examined the underlying motivations, factors, and processes involved in family management of well-being. In-depth interviews aimed at theory generation were administered. In examining the responses, an holistic approach to family well-being emerged. Families conceptualize the construct of overall well-being as being comprised of the interrelated dimensions of physical health, mental health, and material health. Hypotheses and further research questions are offered based on the analysis of this study.

Citation:

Keith Neergaard and Alladi Venkatesh (1989) ,"An Holistic Approach to Household Management of Well Being: a Thick Description", in NA - Advances in Consumer Research Volume 16, eds. Thomas K. Srull, Provo, UT : Association for Consumer Research, Pages: 189-194.

Advances in Consumer Research Volume 16, 1989      Pages 189-194

AN HOLISTIC APPROACH TO HOUSEHOLD MANAGEMENT OF WELL BEING: A THICK DESCRIPTION

Keith Neergaard, University of California - Irvine

Alladi Venkatesh, University of California - Irvine

ABSTRACT -

This pilot study of ten families examined the underlying motivations, factors, and processes involved in family management of well-being. In-depth interviews aimed at theory generation were administered. In examining the responses, an holistic approach to family well-being emerged. Families conceptualize the construct of overall well-being as being comprised of the interrelated dimensions of physical health, mental health, and material health. Hypotheses and further research questions are offered based on the analysis of this study.

BACKGROUND AND PURPOSE OF STUDY

On the whole, consumer behavior research studying family health behaviors has been limited. With the increasing American concern for health enhancement, the time is ripe for a critical examination of how consumers view preventive and curative health decisions. The household level of aggregation is chosen because most health behaviors necessitate the adoption of various family member roles in the process of choosing and engaging in preventive or acute care actions. Individual decisions, choices, and purchases pertaining to health are at least partially determined by the connectedness of the family network (Heisley and Holmes, 1987).

In order to understand the manner in which families manage their members' health, an in depth, "thick description" (Geertz, 1973) interview was conducted with the husband and wife dyad of ten households. Health issues are considered to be subsumed by the broader construct of well-being, a distinction drawn in earlier conceptualizations (c.f. Wright 1982; House 1986; Abbey and Andrews 1986; Pratt 1976). Therefore, the open-ended questions referred to "well-being" issues that each family manages to varying degrees. We were interested in all aspects of daily life which the participants felt influenced their levels of well-being. Of special interest was the role of materialism on family well-being, a relationship which some consumer researchers are beginning to systematically study (Belk 1985, 1984; Belk and Zhou 1987; Richins 1987).

PRIOR RESEARCH ON WELL-BEING

Most family role research has investigated tasks and decisions of non-health behaviors such as home financial management, food shopping (not focusing on nutrition), durable purchases, and child care. However, one study did explicitly examine the impact of gender role changes on one aspect of household health behavior. Green and Cunningham (1975) studied the impact that sex role changes have on family purchasing roles. One decision variable considered was the selection of a family doctor. They found that the wife was far more likely to handle this family health decision than the husband or a joint decision. Furthermore, wives possessing modern gender role perceptions were more likely to select the family doctor than wives holding a traditional gender role orientation. The significance of this study is the dominant role wives perform in this aspect of health behavior. Similar decisions related to physical well-being, such as selecting a health plan or choosing a hospital can be hypothesized to be largely within the wife's domain, or role expectation.

While dominant theories in consumer socialization have centered on the goal-oriented skills necessary to be good consumers (O'Guinn and Faber, 1987), the consumer socialization framework also encompasses dysfunctional relationships among family socialization agents. In his seminal review of household decision making, Davis (1976) produced a conceptualization of various strategies family members use to attain their shared or unshared objectives. Four of the strategies are especially relevant to decision making in the health products context. The strategies, or processes, are: being coerced, coalition formation, accepting the family's specialist/expert recommendation, and group problem solving. All four strategies are unique to household decision making.

Coercion, or forcing an individual to unwillingly perform a behavior, is most frequently encountered when children are directed by their parents to act in a certain manner to maintain prescribed health standards. Common examples include exhortations to "eat your vegetables," 'brush your teeth," and "go to bed," all substantiated with implicit or explicit threats. Coalition formation occurs when a majority of family members implore an individual or minority to join the majority in their choice. For example, the lone smoker in the household may face extreme pressure to provide a smoke-free environment for the other family members. The group problem solving approach assumes multiple inputs from various household members will lead to a better decision regarding a health behavior than an individual could independently achieve. An example would be buying fluoridated bottled water for the home, in which family members voice their preferences as to taste and dental benefits.

Some household members often adopt a role as "expert" or "specialist"and the concomitant authority to prescribe health practices for other members. In this research, it is hypothesized that wife-mothers are more likely to be regarded as health "experts" than wives without children. Holding primary responsibility for the physical care of a child enhances the acquisition of health expertise. This proposition is based on the work of Litman (1971) in which the wife-mother was found to play the primary role of family diagnostician and decider of health services utilization. Wives without children may still be considered the family health expert, but the experience of s eking medical care resulting from childbirth rapidly increases the wife-mother's expert standing in the family.

Barber and Venkatraman (1985) suggest that the selection of a physician deserves more attention by marketers because of the serious implications of patient satisfaction or dissatisfaction. Patient satisfaction has been shown to enhance patients' psychological trust, physical well-being, compliance, and utilization of medical care. Utilization is influenced by post-purchase behavior such as repeat purchase and word-of-mouth. Conversely, patient dissatisfaction has been found to encourage doctor shopping and malpractice claims. Appropriate physician-patient communication was found to influence patient satisfaction (and continued enrollment) in a health maintenance organization (Fincham and Wertheimer, 19865. Repeat purchase and word-of-mouth behaviors (Barber and Venkatraman, 1985) directly influence the entire household because many products and services in the health care arena are based upon "family purchases." Just one disgruntled household member may seek to initiate a different purchase choice, which encompasses the entire family.

In stark contrast, the theoretical and empirical work (pertaining lo family health behaviors) in other social science disciplines is richer and more eclectic. Hochbaun (1958), Kasl and Cobb (1966), and Rosenstock (1974) have developed a social-psychological model known as the Health Belief Model (HBM). The model has been somewhat successful at predicting a consumer's utilization of provider services (curative care), but has had limited success predicting preventive actions taken by family members (Langlie, 1977). Investigators in the health services field have incorporated the health locus of control variable as a modifying variable in the HBM (c.f. Lindsay-Reid and Osborn 1980; Seeman and Seeman 1983). In sum, the HBM attributes preventive and curative health behaviors to an individual's concern with health, the perceived effectiveness and cost of the action, and the individual's perceived control over his/her health.

An alternative explanation for family members engaging in health-promoting behaviors is based on a concern with physical appearance. Hayes and Ross (1987) propose that some types of healthful behaviors are practiced because people are concerned with their visible, physical appearance as much as with their health. Their survey results, using eating habits as the dependent variable, showed that most people (across all age segments) seem to be motivated by looking good at least as much as by maintaining good health.

When examining overall well-being, the role of materialism assumes a prominent position with the nonmaterialistic elements. There are some indications that heightened materialism may produce a deleterious effect on an individual's composite well-being. Material well-being may not operate in a complementary capacity with the other components well-being. Belk (1985) cites studies in which higher materialism is associated with lower feelings of happiness and overall well-being. Such results imply that psychological well-being and other components of well-being may be adversely affected by aspirations for material goods and services. Adaptation theory provides a possible explanation for this negative relationship between material and overall well-being (Richins, 1937). Individuals adapt to a certain level of material comfort. Once that level is possessed for a period of time, the expectation level rises again, creating a gap between actual and desired material levels. This gap results in a state of continual dissatisfaction, which negatively impacts overall well-being.

Although the materialistic component of well-being is viewed differently by various researchers the bulk of consumer behavior research has focused on material well-being, as opposed to the nonmaterialistic components of well-being. Alternatively, this disparate emphasis with material well-being could be considered a disproportionate focus on product satisfaction. Product satisfaction is quite different (both more narrow and utilitarian) than the concept of human well-being. Meanwhile the consumption of many products affects nonmaterialistic elements of well-being, where has been relatively less research emphasis in this area. Similarly, when comparing research emphases on the individual consumer versus the household consumption unit, the major focus has been on the individual (Davis, 1976; Heisley and Holmes, 1987). Figure 1 summarizes the comparative research emphasis in the marketing discipline in relation to the dimensions of well-being and unit of analysis. There is a new emphasis on non-material well-being among a group of phenomenologically oriented consumer researchers (e.g. Morris Holbrook, Elizabeth Hirschman, Russell Belk). Their current efforts, as part of the postpositivistic movement, attempt to broaden consumer behavior research by incorporating humanistic constructs from the liberal arts. Holbrook (1987) has coined the phrase "new wave" to describe this research. The significance of the new wave research to this paper is the increasing acceptance of humanistic, multidisciplinary explanations of consumer phenomena. The right side of Figure 1 is increasingly recognized as important grounds for understanding consumer motivations. The goal of this paper is to widen the knowledge domain of consumer behavior by describing the salient well-being issues and patterns as reported by the families irs this pilot study.

RESEARCH OBJECTIVES

Based on the preceding discussion, the following research questions were addressed in this pilot study.

1. What are the most critical issues which impact a family's well-being?

2. How does the family conceptualize the well-being construct? What are dimensions or components of overall well-being?

3. Does household well-being differ from the sum of the individual members' well-being?

4. Which family members are experts in what areas of health, and how do they evaluate other family members' level of well-being?

5. Why do various family members engage in health behaviors (preventive or curative)? Which behaviors are considered preventive actions?

FIGURE 1

METHODOLOGY

Open-ended questions were administered to ten families, eight of which had either children or stepchildren. Interviews were conducted in family homes, work sites, and a restaurant. A judgment sampling procedure was used, producing a sample of families heterogeneous in terms of age, stage in the family life cycle, ethnicity, and religious affiliations and location within the western state. Most families were middle class with total household income over 550,000. The length of the interviews ranged from 90 minutes to five hours, with an average length of two hours.

The purpose of the study was to generate theories, insights, and hypotheses which will be incorporated in a larger study aimed at more specific well-being behaviors. "Thick" description does not lend itself to summary statistics and analyses which typify quantitative studies (Belk et al. 1988). It does provide an excellent vehicle for gaining significant insights before launching a larger, theory testing study (Bonoma, 19853. Because of the open-ended nature of this study, we had no a priori hypotheses to test, but were guided by the general social science perspectives delineated above. Respondents were encouraged to provide any comments relating to family well-being, either as a result of an interviewer's question or otherwise. Specific behavioral questions were also asked in the areas of preventive activities, exercise, diet, medical care, and risk-taking behaviors. While numerous patterns, themes, and relationships merged from our study, we will devote the majority of our results analyses to the issue of how families conceptualize the construct of well-being, and consequently manage well-being activities. With each succeeding interview, it became clear that an holistic approach is needed to understand the complex, multifaceted construct of family well-being.

RESULTS-AN HOLISTIC APPROACH

The family members interviewed consistently regard well-being as a tripartite concept. The triad consists of physical health, mental health, and material health (see Figure 2). Strategies, issues, tradeoffs, and themes pertaining to each of the three dimensions are summarized in the balance of this article. Divisions of the area of the triangle in Figure 2 are based upon the families' rank ordering of importance attached to each subcomponent of well-being. A discussion of the interrelated nature of these components is provided after each component is evaluated.

PHYSICAL HEALTH

As previously stated, most explanations for preventive health behavior focus on health beliefs (Rosenstock 1974), locus of control (Seeman and Seeman 1983), or social concerns for physical appearance (Hayes and Ross 1987). Our research in the family context disclosed another important determinant for protective health actions. Parents instill beliefs in their children concerning the efficacy of preventive actions. They then feel obligated as responsible parents for proper child habit formation during the formative years. Interestingly, children seem to accept such guidelines as "law," and ironically become role models for their parents. Families noted this phenomenon in areas of seat belt usage, snacking, and dental (flossing, fluoridation) behaviors. In fact, the parents feel guilty and are often ridiculed by their children for parental deviations (e.g. clandestine snacking) from their established household guidelines. Therefore, the notion of "practicing what one preaches" seems to be an important motivation for many preventive health behaviors practiced by parents.

FIGURE 2

Risk-taking behaviors (e.g. skydiving, owning firearms, smoking) among adults are engaged in less often with the addition of children to the home. Parents feel a heightened responsibility to reduce life-threatening activities or behaviors for the benefit of the other family members. A dominant theme emerging is the ambivalence parents' experience in establishing allowable risk taking practices for their children. One father reluctantly allowed his 11 year-old son to bicycle along a busy highway, an action precipitated by his son's claims of "dad's fanaticism about danger." We label this theme as the overprotective versus nurturance dilemma. In attempting to understand the rationale for engaging in certain health-impinging behaviors, attention should be given to the parent-dyad socialization process, as reviewed by Moschis (1987).

In exercising activities, men appear to be motivated to exercise mainly by the intrinsic enjoyment of the activity. A major inhibitor to husband-wife co-participant exercising is the disparate skill levels between partners. As proposed by Hayes and Ross (1987), we found wives are spurred to exercise more so by concerns for physical appearance while both sexes seem equally knowledgeable and desirous of the long term health benefits. Although exercise is considered consequential to physical health, dietary habits were considered the most critical contributor to physical well-being. Most households exhibit severe skepticism in regards to new food products, or new uses for established products. A recurring criticism from the families is the premature marketing of products before satisfactory safety testing is established. This theme of natural versus artificial has led to altered consumer behaviors such as closer examination of ingredient/nutrition breakdowns and decreased reliance on the popular media for dietary information.

MENTAL HEALTH

In explicating the nature of family well-being, the theme of family time versus time alone was evinced. In most families, at least one parent was considered a borderline or full-fledged "workaholic." In such situations, the other spouse has assumed the responsibility to coordinate family members' schedules and activities to maintain the necessary amount of family time. Furthermore, the other spouse typically monitors the perceived need for family time among the children and workaholic spouse. The families disclosed that many well-being problems are caused by lack of shared family time. Again, ar. alternative hypothesis suggesting the basis for some exercise activities lies in the perceived need for maintenance level family time, with physical benefits of secondary importance.

Regardless of traditional or modem household role structures (Scanzoni 1977), the husband/father emerged as the family expert in the area of mental health (while wife/mothers were the physical health experts). Reported activities which fathers engage in to maintain desired mental health levels include counseling, guidance, and mediation. In assessing their childrens' overall well-being, the dominant indicator is the degree of "being quiet," which often signifies an internalization of personal problems. This quietness indicator is also utilized the most by spouses in evaluation of their partner. Rising stress levels have precipitated major adjustments (e.g. moving out of urban area, occupation change) designed to elevate the entire family's well-being, even in the face of diminished well-being for a given individual in the family.

MATERIAL HEALTH

The importance of material well-being on overall well-being differed among families largely by the stage of the family life cycle. Young families with relatively more children placed large importance on material wealth impacting the family's well-being, in the sense that parents feel responsible lo provide a certain level of material comfort for their children. Comments such as "giving our kids the best start possible" were frequently given. The overriding theme was one of debt avoidance, and being content with "enough to get by on." Parents feel great concern that they and their childrens' lives will be controlled by financial or (indirectly) employing institutions. interestingly, several families indicated that the refrigerator content is their primary indicator of material well-being for a given month. We found that there is an existence and awareness of an income-food choice relationship.

CONCLUSION

In constructing an interpretation, based on our thick description study as to how families conceptualize and manage well-being, we observed that it is inappropriate to examine one dimension (e.g. just physical health) outside of the context of the other dimensions. Families simultaneously balance and consider the three reported dimensions, at least on an implicit level. Physical health is considered an enabling (or necessary) condition which makes it possible for the family to attain desired emotional and material lifestyles. Because of this conceptualization, we have partitioned the relative areas of Figure 2 on the basis of their contribution to overall well-being (the entire area of the triangle). This view of family well-being can be considered an holistic approach, involving interdependencies among the dimensions of well-being.

Future family research efforts focused on the increasing consumer attention to health activities and products need to examine such behaviors in the context of overall well-being management. The roles of parents and children in maintaining, balancing, and restoring well-being, both individually and as a unit, needs explication. Traditional views of utility maximization and product satisfaction may not be appropriate when studying nonmaterial consumption behaviors. The study reported here indicates that an understanding of family health behaviors requires a multidimensional framework, as the "whole" is truly different than the sum of the individual dimensions of well-being.

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