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The broad objective of this study was to identify factors that parents consider when choosing
pedodontist services for their children in Harare, Zimbabwe. This study was done against the backdrop
of lack of consistency between expectations of consumers and quality of the service provided by
dentists. Structured questionnaires based on a 19-item importance scale were administered to a
convenience sample of 51 respondents from 5 selected dentists in Harare. The results of the study
showed that quality of service rendered, accessibility of dental clinic, friendliness of the dental
environment and the manner in which the dental process was conducted were the main determinants
influencing choice. A major implication of the study is that dentists should consider marketing as a
critical component of practice management.
Key words: Dentistry, service quality, Zimbabwe, pedodontics, consumer behaviour, dental services,
marketing.
INTRODUCTION
The marketing of dentistry is an important subject for
dentists practising in developed economies (Mindak,
1998). However, marketing of dentistry services has
rarely been studied in developing countries. Although
there is debate about the significance of services in
national economies, Yavas (1998) argues that today one
of the fastest growing sectors not only in the developed
but also in emerging countries is the services sector. The
eminent position of the services sector within the national
economy becomes apparent in the macro-economic
analysis of its size and structural features of this sector
especially with respect to real value added, employment,
and capital formation (Reinhardt et al., 1989). Zimbabwes services sector contributed 57.9% to GDP in 2001
(Muzondo, 2003). Mindak (1998) also states that dentistry is a service- a deed, a performance, an effort.
Dentistry for children is perhaps the most needed and
yet the most neglected area of all services performed by
the dentist (Finn, 1998). Pediatric dentistry is synonymo*Corresponding author. E-mail: leontauya@yahoo.co.uk.
Muzondo et al.
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Muzondo et al.
explaining the purpose of the study and asking permission for their
receptionists or telephonists to administer the questionnaire. Where
necessary the researchers visited the clinic to explain to the recaptionist how the questionnaire was to be administered.
It was highlighted to dentists and their receptionists that respondents were to be selected using the self-selection sampling technique. Self-selection sampling occurs when you allow a case, usually
an individual, to identify their desire to take part in the research
(Saunders et al., 2000). Therefore, a copy of the questionnaire had
to be given to respondents who, after being informed of the objecttives and benefits of the study, agreed voluntarily to participate in
the study.
Analytical framework
Factor analysis was used to reduce the data set to a limited number
of factors. This technique is concerned with finding a small number
of common factors that linearly reconstruct a large number of
variables such that:
METHOD
Target population and sampling
The target population for this study were parents who took their preadolescent children (0 - 12 years) for treatment or routine check up
to privately owned dental clinics during the research period in
Harare, the capital of Zimbabwe. Given the relatively large number
of private dental clinics in Harare it was not feasible to gather data
through all of them but a sample. The study was confined to an
accidental sample of 100 parents and/or guardians who took their
children to five selected clinics within the city centre and an outlying
northern low density residential area (during the one-month period
when data was gathered). The clinics were chosen using
convenience sampling i.e. clinics within the city centre.
The sample had 100 elements consisting of parents who took
their children to the selected dental clinics during the 30 day period
the researchers gathered primary data. In convenience sampling
the researcher selects the most accessible population members
(Kotler, 2002).
Each participating clinic was allocated 20 questionnaires. The
researchers talked to the owner-dentists of the selected clinics to
get their permission to gather data from parents who visited their
surgeries. All the dentists were given a personally addressed letter
159
Z ij =
h
p =i
Fip a pj + eij
Where Zij is the value of the ith observation, Fpi is the set of linear
coefficients or factor loadings; eij is the variables unique factor or
residual. The extracted factors are linear combinations of variables
such that:
Fpi =
k
j =1
q pj z ji
Where Fpi is the value of factor p, for individual i for each of the n
individuals with observations on k variables and q is the weighting
of the pth factor in variable j (Cunningham and Maloney, 1999). A
rotated Varimax factor solution was used to interpret results.
Following Norusis (1990), small factor loadings of less than 0.5 in
absolute value were omitted from the factor analysis solution. The
data were inputted into the Statistical Package for Social Scientists.
160
Factors
Positive assurance on dentist from other parents
Satisfaction with quality of dental service
Effectiveness of dentist communication with children
Dentist experience
Dentist care and empathy
Dentist ability to manage children with uncooperative behaviour
Dentists sex
Effectiveness of dental support staff communication with children
Dentist permission on presence of parent/guardian during treatment of child
Provision of information on available treatment options and the preferred option
Amount of dental fees
Dental clinic nearness to patients residential area
Dental clinic nearness to a public transport road
Dental clinic nearness to a childs school/crche
Availability of parking space at or near dental clinic
Decoration at the dental office
Friendliness of dental office environment to children e.g. availability of toys, music,
reading material, video, etc
Friendliness of dental office environment to parents or other accompanying adults
e.g. availability of adult reading material, video, music, etc in waiting room
Cleanliness of dental office environment
Mean
Score
Percentage responses
NVI
SI
VI
15.7
23.5
3.9
13.7
2.0
3.9
21.6
5.9
19.6
3.9
9.8
23.5
2.0
7.8
23.5
9.8
2.0
3.9
2.0
15.7
25.5
9.8
11.8
31.4
11.8
23.5
9.8
27.5
11.8
17.6
25.5
5.9
15.7
15.7
13.7
23.5
13.7
11.8
13.7
23.5
29.4
21.6
15.7
23.5
5.9
17.6
35.3
4.3
4.8
4.6
4.2
4.5
4.4
1.4
3.9
4.1
4.5
3.2
2.8
2.7
2.5
3.7
3.0
4.0
NAAI
3.9
11.8
3.9
80.4
11.8
2.0
21.6
27.5
35.3
35.3
3.9
19.6
2.0
EI
56.9
82.4
72.5
62.7
62.7
62.7
3.9
45.1
43.1
64.7
29.4
23.5
19.6
15.7
29.4
19.6
39.2
3.9
3.9
25.5
45.1
25.5
4.7
2.0
3.9
19.6
74.5
Variables
Positive assurance on pedodontist from other parents
Satisfaction with quality of service
Pedodontist experience
Pedodontist care and empathy
Pedodontist ability to manage children with uncooperative behaviour
Pedodontists way of treating children
Effectiveness of dentist communication with children
Effectiveness of dental support staff communication with children
Dental clinic nearness to a childs school or crche
Dental clinic nearness to a public transport road
Dental clinic nearness to residential area
Availability of parking space
Friendliness of dental environment to children i.e. music and reading materials
Friendliness of dental environment to accompanying parents e.g. availability of reading materials
and music in waiting room
Decoration of dental office
Age and appearance of dental equipment
Cleanliness of the dental office environment
Permission of parent during treatment of child
Eigen values
Percentage of variation
Factors (means)
1
2
0.751
0.752
0.822
0.747
0.776
0.789
0.587
0.780
0.908
0.913
0.684
0.710
0.669
0.698
0.706
0.885
0.5
6.2
32.6
2.45
11.1
2.1
9.7
0.816
1.8
8
Factor 1: Service Quality; Factor 2: Access/ Distribution of dental services; Factor 3: Physical evidence in the dental environment; Factor 4:
Processes in the dental office.
Muzondo et al.
RESULTS
The study sought to answer the questions what factors
do parents consider is choosing a pedodontist? We present the results under the two sections in our questionnaire (which forms our conceptual framework).
Response rate and demographic characteristics of
respondents
Of the 100 questionnaires distributed to the five private
dental clinics 51 usable ones were returned. Seventy five
(75) percent of the respondents were women and the
remainder, 25%, were males. The majority of respondents (45%) lived in low density areas, 29% dwelt in high
density suburbs, 22% resided in a medium density suburb and very few (4%) in peri-urban areas. The majority
of respondents (39%) had a degree, 24% diplomas, and
14% had Ordinary level education. Respondents who
held the Zimbabwe Junior Certificate, Matriculation (South Africa) and Advanced Level were a minority.
Given the number of participating dental clinics and the
accidental nature of the sample, there were too many
categories of occupations in the sample. As such, we
reduced the categories to 8 with the largest category
being that of managers (21%), followed by that of health
professionals (16%), etc. The other category while appearing large (17%) was composed of respondents from
many occupations with few people in the sample e.g. 1 or
2 as in the case lawyers, customer service officer, self
employed people, businessman, toolmaker, etc. Only 8%
of the respondents were homemakers i.e. housewives.
According to Finn (1998), the areas social and economic
factors is one many factors that should be considered in
locating the type of dental practice you wish to establish.
In Berry and Parasuramans (1991) SERVIQUAL model
location of a service provider falls under the access criterion and in the marketing mix this is dealt with under
place or distribution (Kotler, 2002; Doyle, 2002).
Summary findings in terms of the original 19 items
Table 1 summarises the findings in terms of the 19-item
in the researchers conceptual framework. The Cronbach
Alpha coefficient was used to test the reliability of the
conceptual framework. The Alpha score was 0.8343, which confirmed the reliability of the scale. In summary, the
findings indicate that 13 of the 19 items in conceptual
model are important in influencing parents choice of a
pedodontist on the basis of mean scores. Using factor
analysis, four factors were identified namely quality of
services rendered, accessibility, physical evidence and
processes in the dental environment (Table 2). Table 3
synthesizes the results in terms of the initial propositions
in the study. Only two of the propositions were rejected.
Discussion and managerial implications
The authors conceptual framework contained 19 factors
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162
Proposition
P1: A dentists care and empathy influence parents choice of a pedodontist.
Confirmed/
Rejected
Confirmed
Evidence
(in Table 2)
Factor 1
P2: The amount of dental fees charged by a dentist influences parents choice of a pedodontist.
Rejected
P3: The quality of a dentists services as commented by parents who have consumed her services
before influences parents choice of a pedodontist.
P4: A dentists experience and ability to manage children with uncooperative behaviour influences
parents choice of a pedodontist.
P5: Parents satisfaction with quality of dental services influences their choice of a pedodontist.
P6: Nearness of a dental clinic to a childs school or crche influences parents choice of a pedodontist.
P7: Nearness of a dental clinic to a public transport road influences parents choice of a pedodontist.
P8: Nearness of a dental clinic to residential area influences parents choice of a pedodontist.
P9: Availability of parking space at or near a dental clinic influences parents choice of a pedodontist
P10: Sex of pedodontist influences parents choice of a pedodontist
Confirmed
No factor
supporting
Factor 1
Confirmed
Factor 1
Confirmed
Confirmed
Confirmed
Confirmed
Confirmed
Rejected
Factor 1
Factor 2
Factor 2
Factor 2
Factor 2
No factor
supporting
Muzondo et al.
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stringent [infection control] protocols imposed by governmental organisations and various professional organisations and societies. According to the findings parents
and/or guardians are aware that the dental clinic can
spread infection if proper sanitary measures are not
practiced. From the level of cleanliness in the clinic, parents can calculate the risk of their children catching
infection therein.
Mindak (1998) recognises that the customer uses several criteria to assess how a service is provided. She cites
Berry and Parasuraman (1991) who identify five principal
dimensions that customers use to judge a service one of
them being tangibles. Cleanliness of the dental office
and the people working therein are tangible aspects.
The manner in which these aspects are handled assists
in building confidence and sense of security in custommers i.e. that they would not get infection from the dental
clinic. Confidence and security are among the 10 service
quality measures in the SERVIQUAL model (Parasuraman et al., 1985).
The friendliness of the environment or ambience falls
under physical evidence, one of the 7Ps of marketing.
Dentistry literature acknowledges that the ambience in
the dental office should assist in relaxing the child and at
the same time cater for the entertainment of the accompanying parent. However, for Berg and Bebermeyer
(1994) the maintenance of an office ambience that pleases the eye and psyche of the child while complying with
inexorably more stringent infection control regiments is
difficult to achieve. Finn (1998) suggest among other things soothing, muffled music in the reception room for
both parent and patient, adult reading material including
dental health material. Marwah et al. (2005) conducted a
study in India to ascertain if music distraction is an effective means of managing anxiety in paediatric dental
patients aged between 4 and 8 years. They concluded
that audio distraction did decrease the anxiety level in
paediatric dental patients, but not to a very significant
level. The results of the present study seem to corroborate the findings of Marwah et al. (2005) study.
Processes in the dental office
The survey has revealed that the dentists permission for
a parent to remain in the operatory observing her child
being treated is an important determinant of parents
choice of a pedodontist. This corroborates a previous
study, which found that an overwhelming majority of
parents (66% from a sample of 79 elements) wished to
observe their young children being treated in the dental
surgery (e.g. Kamp, 1992 as cited in Primosch and
Mathewson, 1995). Whereas some parents in Kamps
sample felt that their presence would improve their childs
acceptance of the dental procedure, some authorities
(e.g. Mitchell et al., 1999) argue that some children will
play up to an overprotective parent in order to gain
sympathy or rewards and may prove more cooperative by
themselves. Some dentists feel the presence of a parent
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