Marketing communication processes and psychological classification for the gender reassignment health service industry in Thailand through the six buddhist temperaments

Abstract

The objectives of this research are 1) to explore the different types of sanatoriums, formats, methods, messages/content and channels of innovative Integrated Marketing Communication (IMC) in accordance with the Medical Code of Ethics of the gender reassignment health service industry in Thailand and 2) to examine how the Six Buddhist Temperaments can replace or enhance demographics of service users in the gender reassignment health service industry to benefit marketing communications. The study is therefore divided into two parts. The first part explored the qualitative data collected from 15 in-depth interviews with gender reassignment health service providers. The second part examined the quantitative data collected from 530 closed-end questionnaires together with the qualitative data collected from 20 existing service users through in-depth interviews. The first objective of the study found that the service providers want clear requirements and approval to disseminate marketing communication in regard to medical service information in line with the standards for all sectors of the industry, not without any control. In fact, the important variable that can affect the integrated marketing communication is type of sanatorium: 1) government sanatoriums and 2) private sanatoriums that provide gender reassignment surgical service as well as 3) stakeholder sanatoriums that provide related services to the industry such as cosmetic surgery clinics and community health centers. The formats of the integrated marketing communication depend on the management policy of a sanatorium, which consists of three forms: 1) to disseminate knowledge to support decision making for surgery according to Thai law and regulations of the Thai Medical Council, 2) to encourage a decision to have surgery and 3) to create an image specifically for transgender communities. The methods of the integrated marketing communication are divided into two forms: 1) public relations departments of government sanatoriums responsible for collecting and disseminating the findings of medical professors as well as information on medical services offered by their sanatorium to inform the public and 2) management and marketing teams of each private sanatorium that set policy and then either hire or assign persons to be responsible for the implementation. The message/content of the integrated marketing communication for all sanatoriums has three types governed by legislation and the Thai Medical Council: 1) medical information and facts to inform and educate service users in their decision making to undergo surgery, 2) information concerning sanatoriums to create trust in the sanatorium and 3) information about physicians and surgeons to create trust in the physicians and surgeons. The channels of the integrated marketing communication employed by the government sanatoriums include: 1) advertising, 2) personal communication, 3) public relations and 4) special events, without hiring an influencer for personal communication, while, the integrated marketing communication channels of the private sanatoriums and stakeholder sanatoriums include: 1) advertising, 2) personal communication, 3) direct marketing communication, 4) public relations, and 5) sales promotion and special events. They also employ influencers to provide specific individuals who provide high impact communication, such as 1) well-known persons, or influencers, who are related to gender reassignment surgery and health services, 2) persons with direct surgery experience and 3) agents or agencies. It should be noted that these persons with direct surgery experience are the most influential medium and are out of the control of any of these sanatoriums and thus Thai laws and Thai Medical Council regulations. The second objective of the study found that the service users of the gender reassignment health service industry first have devout temperament, followed by intellectual temperament and lustful temperament respectively. For the service buying decision process, problem recognition is the first stage when service users realize they have suffered from Gender Dysphoria (GD) since as early as childhood, which leads to 90.4 percent of those persons having a strong intention to undergo gender reassignment surgery. The next stage is their information search, which can be described as linear in the information seeking process and consists of: 1) exposure, 2) satisfaction and 3) interaction with the integrated marketing communication content: 1) medical information and facts, 2) information concerning sanatoriums and 3) information about physicians and surgeons respectively, acquired via the integrated marketing communication channels. In particular, the integrated marketing communication channels include: 1) personal communication, 2) public relations, 3) advertising, 4) sales promotion and special events, and 5) direct marketing communication. It should be noted that the content information seeking process has a direct connection with the content that the service providers provide in accordance with Thai laws and Thai Medical Council regulations. For the channels, the service users’ temperaments do have a different effect on their media exposure to: 1) direct marketing communication and 2) sales promotion and special events, and media interaction with: 1) advertising and 2) sales promotion and special events. In fact, the devout temperament is the most important temperament affecting service users’ media exposure, satisfaction and interaction because they believe and follow transgender persons they feel similar and close to, making these persons the most influential. Furthermore, the relationship between the variables in the information seeking processes are closely associated, direct variation, but if they have too much interaction, the relationship may be reversed, inverse variation, due to information overload and the character of discursive temperament. The third stage is their evaluation of alternatives in which the service users will apply the following factors: 1) the skills of physicians, 2) service fees and 3) supplement services quality to consider respectively. This shows that although the service users can search but only access the least amount of information about physicians and surgeons, this content is the most important in their evaluation and decision. The fourth stage is decision making to undergo gender reassignment surgery. The first reason the service users would decide to have surgery in Thailand is that Thailand has expert physicians and surgeons as well as modern medical equipment and instruments, followed by economical prices and convenient location to visit, while, the reasons some are still uncertain or have decided not to undergo surgery in Thailand are insufficient capital and information as well as health limitations respectively. It should be noted that the devout temperament is the most important in decision making as the service users base their decision on faith in the surgeon who they learn about through content that they can search for via their influential transgender networks, which can be quite limited. In addition, for the final decision making, other opinions considered by the service users come from physicians, family members, partners and close friends, with physicians being the most influential. The viewpoints of the service users show they do undergo surgery because they want to begin a new life; they want to experience the joy of being the gender they feel they are, and the surgeon is the only person who can do this for them. The final stage is their post service behavior. Their satisfaction after surgery will be dependent on the surgical results and supplement services they received when compared to costs. It is important that surgery and post-surgical services will have an increasing impact and can reduce or erase the devout temperament that the service users applied in their decision making. Those who are satisfied with both surgical results and supplement services will retain the physicians and sanatoriums in their evoked set, or alternative group, if they want additional surgery, while those satisfied with just one or not satisfied at all will consider finding a new sanatorium or physician or both for their further surgery. Moreover, their satisfaction will affect the service users’ recommendations to interested service users provided through word-of-mouth communication in their social networks both in real life and online as 1) persons with direct surgery experience, the most influential medium, or 2) well-known persons, or influencers, related to surgery, which can be classified into three forms: 1) supporter or influencer, 2) sharing direct experience and 3) offering alternatives. In conclusion, the Six Buddhist Temperaments can still be used to complete demographic traits and better understand target audiences. For the gender reassignment health service industry, the service users’ main temperaments are 1) devout temperament and 2) intelligent temperament. Therefore, the reliability of 1) the skills of a surgeon, 2) a sanatorium and 3) quality of supplement services are the most important factors the services providers should respectively emphasize to create effective content for dissemination through all integrated marketing communication channels, particularly through personal communication focusing on transgender persons with direct experience and physicians. In fact, the physicians and surgeons are the best personal communicator who can precisely answer questions and rationally build service user trust.