Meta-Analyses of Attitudes toward Advertising by Professionals Author(s): Robert E. Hite and Cynthia Fraser Source: Journal of Marketing, Vol.

52, No. 3 (Jul., 1988), pp. 95-103 Published by: American Marketing Association Stable URL: http://www.jstor.org/stable/1251453 . Accessed: 14/01/2014 15:12
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Robert E. Hite & Cynthia Fraser

of Attitudes Meta-Analyses Toward by Advertising Professionals

Two meta-analyses of attitudes toward advertising by professionals are presented, which allow formulation of generalizations from 10 years' research spanning the time since the relaxation of professional advertising restrictions first was discussed and subsequently implemented. Results suggest that differences in attitudes across professions may be attributable to the importance, heterogeneity, and assessability of quality levels; that exposure to professional advertising produces attitude changes in favor of increased advertising by professionals; and that consumers are more favorably disposed toward such advertising than are professionals.

dental, accounting)or in other media ought to be protected by First Amendment guarantees. After these stricted by professional associations in medicine, importantlegal events, professional associations bedentistry, accounting, law, and other professions. In the late 1970s, key rulingsby the SupremeCourtforced gan officially to authorizeadvertising. Relaxation of relaxationof historic advertisingbans by professional advertising restrictions occurred for the legal and medical professions in 1976, for dentists in 1977, and associations. In Goldfarb v. Virginia State Bar (1975), for accountantsin 1978. the Court held that the learned professions were subWith the newly available option to advertise, ject to the ShermanAct antitrustguidelines, suggestprofessionals faced new decisions about whether or ing that the restrictionof price advertising might be not they should advertise, which informationought to anticompetitive and, hence, illegal. Federal Trade be included in advertising, and which media should Commission actions reinforced the Court's direction be used. Clearly consumers were going to notice adin 1975, when advertisingrestrictionsby the American Medical Association were deemed anticompetivertising by professionals, given the absence of such tive. In Bates v. State Bar of Arizona (1977), the Court advertising for decades. Unclear were the likely reheld that attorneyshave First Amendmentfreedom of sponses of current and prospective clients: Would consider advertising by professionals in consumers services for routine fees to advertise speech rights Or and unethical have consumers that also the Court consequentlyavoid such advertisers? argued newspapers; would consumers appreciatethe availabilityof adverthe right to receive such information. Broad genertised information,select professionalswith advertised alizations of this ruling implied that advertising indifferential advantages (special talents, reasonable information of sorts other (e.g., specialties, cluding other or medical, prices, etc.), and be more satisfied given opportuniprofessions (e.g., qualifications) by ties to make more informed and presumably better choices? How many consumers are price elastic and areAssociate Fraser E.Hite andCynthia Professors, Robert Department potentially responsive to advertisementsemphasizing authors fees? The State Kansas of of Marketing, Business, University. College andsugcomments forvaluable JMreviewers three thank anonymous Given the unique characterof professional service of the manuscript. version on a previous gestions markets, their growing importance in the national

FOR decades, advertisingby professionals was re-

Journal of Marketing Vol. 52 (July 1988), 95-105.

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economy, and the radicalrelaxationof advertisingrestrictions, the attitudes and actions of both professionals and consumerstowardprofessionaladvertising attractedthe attention and curiosity of numerous researchers. The purpose of this study is to generalize and extend research findings on attitudes toward adin the vertisingby professionalsthat have accumulated past 10 years. From the large numberof independent but related studies, quantitativegeneralizationsabout attitudes towardadvertising are drawn. by professionals Additionally, comparisons are made between consumers' and professionals' attitudes and across professions by means of meta-analyses (Farley and Lehmann 1986; Glass, McGaw, and Smith 1981; Hedges and Olkin 1985; Hunter, Schmidt, and Jackson 1982). Two sets of analyses used here are patternedafter meta-analysesreportedrecently in the marketingliterature(Assmus, Farley, and Lehmann1984; Churchill and Peter 1984; Churchillet al. 1985; Farley, Howard, and Lehmann 1976; Farley, Lehmann, and Oliva 1985; Farley, Lehmann, and Ryan 1981, 1982; Monroe and Krishnan 1983; Peterson, Albaum, and Beltramini 1985; Ryan and Barclay 1983), but with two notable departuresfrom earlier work. The first series of analyses is based on raw data from multiple studies, unlike prior studies in marketingthat have been based, of necessity, on summary statistics. In addition, in both sets of analyses, principal components analyses are used to pool observationson multiple indicators of underlying attitudinal dimensions. Consequently, though meta-analyticalmethodology is not focus of this article,the methodologyused the primary may suggest some alternativeand useful ways to analyze marketingdata in future studies.

signment, or the drycleaningof a suit and low quality performancein those cases is fairly inconsequential. It is much more difficult to assess the quality of a surgical procedure, legal representation,or accounting assistance, though quality performance is relatively important. Professional services are complex, their effects are often delayed, and the times between repeateduses are generally long. In many cases (e.g., surgery, personal liability representation),usage is so infrequentthat a consumer might not collect enough observationsin a lifetime to form an adequateassessment of the quality of a professional service. Finally, professional service marketstend to be characterized by the absenceof pricesignals. In manymarkets,prices convey quality levels; however, in most professional service markets,prices are not known before purchase (Kwoka 1984). Consumerscan neither search to determine available price/quality combinations nor accumulate experience to assess quality levels (Nelson 1970, 1974, 1978).

Meta-Analyses of Attitudes Toward Advertising by Professionals

To assess level and stability of attitudes toward professionaladvertisingby consumersand professionals in diverse service sectors, several independentbut related empirical studies are examined. Two sets of analyses are used to pool the extant data and generalize. Raw data containing measures of 24 comparable items are available from three studies that surveyed consumers' attitudestoward advertisingby attorneys, accountants, physicians, and dentists, as well as professionals' attitudes in the dental and medical professions, permittinga pooled multivariateanalysis of variance. Farley and Lehmann(1986) suggest that pooled analysis across studies based on raw data is the ideal situation for meta-analysisand one that has not been encounteredpreviously in marketing. Summary data containingcomparablemeasures are available from an additional set of 13 studies, allowing multivariateanalysis of variance of mean attitudinal responses across professions.

Advertising of Professional Services

Marketsfor professional services present particularly interestingchallenges to marketers.As is true of other services, quality levels vary both across and within individual providers because quality levels typically depend to some degree on customer characteristics. Also, as with otherservicesand many consumergoods, the quality levels of professional services are difficult testimonialsand other sorts of hearsay to demonstrate; to assertthat particular be used must quality levels are available. It is the general haziness of quality levels of services that creates challenges to advertisers. Professional services pose greaterthan average challenges, becausequalitylevels are both difficultto assess, even aftermultiplepurchases,and relativelyimportant.One can easily assess the quality of a haircut, a typing as-

Meta-Analysis of Raw Data

Raw data from three studies (Hite and Bellizzi 1986; Hite, Bellizzi, and Andrus 1988a,b) contain the 24 attitudinalitems listed in Table 1, all measuredon a 5-point Likert-typescale of agreement/disagreement. Covariatemeasuresof price elasticity and exposure to professional advertising are also available. The former consist of degree of agreement that "it is good [for consumers] to deal with a professional firm that

of Marketing, 96 / Journal July1988

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TABLE 1 Indicators of Attitudes Toward Advertising by Ptofessionals and Covariates Potential Negative Impacts of Professional Advertising 1. CREDIf a advertises, his credibility is lowered. 2. IMAGIn general, my image of professionals would be lower as a result of advertising. 3. QUAKAdvertising by professionals would benefit only quacks and incompetents. 4. SUSP I would be suspicious of professionals who advertise. 5. PBIMThe advertising of services would lower the public's image of 6. PBCFPublic confidence in professionals would be lowered by professional advertising. 7. DECVProfessional advertising would be more deceptive than other forms of advertising. would tend to lower the dignity of their profession. 8. DIGNAdvertising by 9. CONF Professional advertising would be more confusing than enlightening. to advertise in professional magazines. 10. PRMGIt is appropriate for to advertise in newspapers. 11. NEWS It is appropriate for Appropriateness of Professional Advertising 12. INFOThe public would be provided useful information through advertising professional services. to advertise. 13. PROP It is proper for 14. TAST Advertising can be used tastefully by professionals. Potential Consumer Benefits From Professional Advertising 15. PRICWhen professionals advertise, prices are lowered due to more competition. 16. AWARAdvertising makes the public more aware of the qualifications of professionals. 17. QUALAdvertising will increase the quality of professional services. 18. INTLAdvertising would help consumers make more intelligent choices betwen Appropriateness of Popular Media Vehicles to advertise on billboards. 19. BILBIt is appropriate for to advertise on television. 20. TV It is appropriate for to advertise on radio. 21. RADOIt is appropriate for to advertise in popular magazines. 22. POPM It is appropriate for to advertise by telephone. 23. PHON It is appropriate for to advertise by mail. 24. MAILIt is appropriate for Covariates PRCE It's good to deal with a professional firm that offers the lowest price for routine services. EXPO Have seen professional advertising.

offers the lowest price," measured along a 5-point Likert-type scale. Exposure is a zero-one indicator variable operationalized by asking respondents to indicate whether or not they recall exposure to professional advertising. Study differences thought likely to affect attitudes include (1) type of profession (legal, accounting, medical, or dental) and (2) type of respondents (consumers or professionals). These two dimensions constitute the two meta-analytic factors examined. Because the 24 items seem likely to represent a smaller number of attitudinal dimensions, principal components analysis was used to identify those dimensions. Three primary dimensions emerged, reflecting (1) agreement that advertising by professionals would damage professionals' images, (2) agreement that potential benefits to consumers would accrue from advertising by professionals, and (3) agreement that popular media vehicles are appropriate for advertising by professionals. Varimax-rotated principal component loadings are reported in Table 2. To assess the impact of type of respondent (consumer or professional) and type of profession (medical, dental, legal, or accounting) on attitudes toward

advertising by professionals, regression analyses of the three principal component scores were performed. Table 3 lists coefficient estimates and significance levels from those analyses and Table 4 shows average principal component scores by factor levels. All three models are significant, as are multivariate tests of respondent type, profession, and exposure to professional advertising. Impact of differences between respondent samples. Scores along all three components are significantly different between consumers and professionals. In all cases, significant differences are in direction of agreement and not merely in magnitude of agreement or disagreement. Generally, consumers' ratings reflect optimism about potential benefits that may be associated with advertising by professionals and a lack of pessimism about potential detrimental impacts, whereas the professionals' ratings reflect reservations. Consumers disagree that advertising by professionals will damage the credibility, image, or dignity of professionals, confuse or deceive consumers or arouse their suspicions, or benefit quacks and incompetents. In con-

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TABLE 2 Rotated Principal Component Loadings Rotated Principal Components 1 2 3 Adverse Effects on Professional Consumer Media Vehicle Item Benefits Appropriateness Image 1. CRED -.21 .77 -.33 2. IMAGE -.42 -.22 .76 -.22 -.14 3. QUAK .76 4. SUSP -.19 -.35 .75 -.38 -.25 5. PBIM .75 -.17 .72 -.34 6. PBCF -.10 7. DECV .71 -.02 .71 -.38 -.23 8. DIGN -.15 -.45 9. CONF .69 .31 .31 10. PFMG -.37 .42 .44 11. NEWS -.51 .15 .54 12. INFO -.59 .27 .39 -.65 13. PROP .16 .26 14. TAST -.67 .74 .06 -.29 15. PRIC .71 .15 -.37 16. AWAR .18 .68 -.33 17. QUAL .20 .67 -.45 18. INTL 19. BILB
20. TV

professional groups that advertising would damage images in their profession. Consumers tend to agree that popular media vehicles are appropriate for professionals' use in advertising. An exception to that sentiment arises when advertising by physicians is considered. Consumers express disagreement that popular media vehicles are appropriate for physician advertising. Impact of exposure to professional advertising. Respondents who report exposure are less pessimistic about possible detrimental impacts, though they are also less optimistic about potential consumer benefits of advertising by professionals. These findings suggest that initial professional advertising has served to reduce apprehension and that it has not damaged professional images overall, though it may not have conveyed useful information effectively in some cases. Professionals appear to have had a greater level of attitude change as a result of exposure to professional advertising than consumers. After exposure, professionals' attitudes toward advertising become more significantly less pessimistic about the potentially damaging impacts on images. After exposure, professionals are also significantly less optimistic about the potential benefits consumers might derive from advertising. Though consumers are accustomed to reliance on advertising, practitioners have had little familiarity with professional advertising until very recently. Ethical reasons and associated reservations that were long responsible for advertising bans were undoubtedly strongly internalized and high in centrality among professionals, producing greater initial skepticism (in comparison with consumers), as well as interest and curiosity. Exposure to professional advertising seems to have shown professionals that advertising is not likely to be as damaging as they initially suspected. Respondents who agree that consumers ought to choose professionals who charge the lowest prices for routine services alter attitudes the most after exposure. After exposure, those price-elastic respondents agree less strongly that advertising would produce benefits to consumers. Impact of price elasticity on attitudes. Respondents who agree that consumers ought to select providers offering the lowest prices for routine services agree more strongly that consumers will gain benefits from advertising by professionals. Those price-elastic respondents are more optimistic about the informational value of advertising by professionals, undoubtedly because price information is easily conveyed through such advertising. This is true whether respondents are consumers or professionals and regardless of the profession; all interactions between price

-.04
-.23

.18
.34

.78
.75

21. RADO
22. POPM

-.28
-.25

.35
.33

.73
.66

23. PHON 24. MAIL % var

-.02 -.31 31

.19 .00 18

.64 .61 16

trast, professionals tend to agree strongly that those outcomes are likely. Consumers agree (and professionals strongly disagree) that advertising by professionals will increase awareness of the differences between professionals, reduce prices, increase quality levels, and help consumers make more intelligent choices. Consumers further agree (and professionals disagree) that popular media vehicles are appropriate for use by professionals and that advertising is an important source of consumer benefits. Differences by type of profession. Scores along the first dimension reflecting agreement that advertising would adversely affect professionals' images are significantly different across professions, though the differences are in degree of agreement or disagreement and not in direction. Respondents agree most stongly that advertising by accountants or attorneys will adversely affect the images of those professions. Among professional respondents, physicians are less concerned about potential negative consequences from advertising; physicians agree least strongly of the four

98 / Journalof Marketing, July 1988

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TABLE 3 Coefficient Estimates and Significance Levels from Regression Analyses of Attitudes Toward Advertising by Professionals Rotated Principal Component Scores 3 1 2 Media Vehicle Adverse Effects on Image Consumer Benefits Appropriateness b b b Prob. Prob. Prob. Predictor Respondent (R)a Consumers
Profession
(p)b

-1.57

.0001

.78

.0001

.38

.01

.12 ns -.42 .004 ns -.01 Physicians .11 ns -.02 ns .0003 .39 Accountants ns .04 ns -.09 .46 .0001 Attorneys -.01 ns -.32 .01 .0005 -.50 Exposure (E) ns .01 .32 .0001 ns .00 Price elasticity (PE) RxP .005 -.38 -.20 ns .73 .0001 Consumers x physicians RxE ns -.07 .22 .007 .05 .34 Consumers x E R x PE ns -.06 .05 ns ns -.02 Consumers x PE Px E ns -.01 .16 ns .11 ns Physicians x E ns -.02 ns .06 ns -.02 Accountants x E ns -.03 ns .00 ns -.08 Attorneys x E P x PE ns .09 ns -.03 ns -.02 Physicians x PE ns .09 ns -.04 ns -.03 Accountants x PE ns .11 ns -.01 ns -.05 Attorneys x PE ns .03 .02 -.09 ns .01 E x PE ns -.12 -.41 .002 .0001 1.12 Intercept were consumers. variableequal to zero when respondentswere professionalsand equal to one when respondents "Indicator variablesequal to zero when professionwas dentistry. blndicator elasticity and type of respondent or profession are insignificant.

Meta-Analyses of Summary Statistics

TABLE 4 Average Scores of Attitudes Toward Advertising by Professionals Average Rotated Principal Component Scores 3 2 1 Media Adverse Vehicle Effects on Professional Consumer Appropriateness Benefits Image Respondent Consumers Professionals Profession Physicians Accountants Attorneys Dentists Exposure Not exposed Exposed -.21 .61 .04 -.16 -.16 .18 .00 .00 .31 -.90 .04 .34 .35 -.56 .18 -.15 .07 -.21 -.19 .32 .10 -.04 .02 -.02 Sixteen studies, spanning the same four professions, are available for broader analyses of attitudes toward advertising by professionals. Each involves some subset of the 24 items examined before, though most studies involve only a subset. To make the most efficient use of the data from all 16 studies, three primary attitudinal dimensions (adverse effects on professional image, consumer benefits, and media vehicle appropriateness) are examined. Measures of each of the 24 items are treated as measures of one of the three dimensions to allow efficient pooling of comparable, but not identical, data. Table 5 is a summary of the number of observations provided by each of the 16 studies. If a study included one (24) item(s) that loads high along component 1 (agreement that advertising by professionals will have an adverse impact on professionals' images), that study contributed one (24) observation(s) to the pooled dataset. All studies used Likert-type scales of agreementdisagreement. The major differences distinguishing

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TABLE 5 Key Features of Data Collection for Research on Attitudes Toward Advertising by Professionals Number of Observations of Year of Principal Component Data Profession 2 1 3 Collection' Respondents Study Consumers 1 4 Accountants 0 1979 Carver, King, and Label (1979) Professionals 12 0 1976 9 Attorneys Darling and Hackett (1978) 12 Accountants 9 0 12 9 0 Physicians 12 Dentists 9 0 Consumers 1981 14 4 6 Hite and Bellizzi (1986) Attorneys 14 4 Accountants 6 14 4 6 Physicians Consumers 1985 14 4 6 Hite, Bellizzi, and Andrus Physicians 4 6 Professionals 14 (1988a) 4 6 Consumers 1986 14 Dentists Hite, Bellizzi, and Andrus 4 6 Professionals 14 (1988b) 0 3 Consumers 1978 2 Kviz (1984) Physicians 4 0 2 1987 Professionals LaBarberaand Reddy (1987) Physicians 2 4 0 1978 Consumers Dentists Meskin (1978) 2 4 0 Professionals 1 0 1978 5 Consumers Miller and Waller (1979) Physicians 1 0 5 Professionals 4 1980 0 Professionals 2 Accountants Oliver and Posey (1980) 0 1982 1 3 Consumers Dentists Shapiro and Majewski (1983) 0 1 3 Professionals 0 1976 4 5 Professionals Attorneys Shimp and Dyer (1978) 0 1 1980 3 Professionals Dentists Swerdlow and Staples (1980) 4 4 1981 6 Consumers Vanier and Sciglimpaglia (1981) Physicians 3 1 0 1984 Consumers Wilson (1984) Physicians 3 1 0 Professionals 0 0 1 1982 Consumers Physicians Young (1983) 2 0 2 Professionals the year of pubwas not available, Whensuch information "The year shown is the year of data collectionwhen it was available.
lication is given.

studies are (1) type of respondent (consumer vs. professional), (2) type of profession (medical, dental, accounting, or legal), and (3) date of data collection. Date of data collection is important because the various professions relaxed advertising restrictions at different times; consequently, there has been differential opportunity for exposure to advertising across professions. To capture this difference in opportunity, the difference between time of relaxation of restrictions and date of data collection is used as a third metaanalytic factor in addition to respondent and profession type. Because a differential number of observations is available for each of the three attitudinal dimensions, parallel regression analyses were conducted. Results are reported in Tables 6 and 7. Type of respondent. As in the analyses of pooled raw data, analyses of summary data reveal that the attitudes of consumers are distinct from the attitudes of professionals toward (1) potential adverse impacts and (2) potential benefits to consumers that might re-

suit from advertising by professionals. Consumers are significantly less pessimistic about potential negative impacts of advertising on professional images than are professionals. Consumers disagree (-.63) that professional advertising will damage the credibility, image, or dignity of professionals, confuse or deceive consumers or arouse their suspicions, or benefit quacks and incompetents. Conversely, professionals tend to agree (.49) that such outcomes are likely to be associated with professional advertising. Consumers are also more optimistic about the potential benefits of professional advertising. Along the second component, the mean consumer rating is .27, indicating agreement that professional advertising will increase awareness of the differences between professionals, reduce prices, increase quality levels, and help consumers make more intelligent choices. Professionals' mean rating, in comparison, is -.88, indicating strong disagreement that those positive impacts will result from professional advertising. Also, as revealed in the pooled analyses of raw

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TABLE 6 Coefficient Estimates from Regression Analyses of Attitudes Toward Advertising by Professionals Dependent Variable: Rotated Principal Component Scores 3 1 2 Media Vehicle Adverse Effects on Consumer Benefits Professional Image Appropriateness b b Prob. Prob. Prob. b Predictor Respondent (R)a Consumers
Profession (p)b

-1.25 -.29 -.61 -.42

-.05 .51

.0001 .02 .0007 .008

.0001 .006

1.38 .07 .42 .39

.03 -.07

.0001 ns .005 .007

.02 ns

.26 .07 .01 -.16

-.06 -.24

ns ns ns ns
ns ns

Physicians Accountants Attorneys

Years of exposure (Y)

Rx P

ns -.38 .29 Consumers, accountants -.37 ns .20 Consumers, attorneys RxY -.01 ns -.03 Consumers x Y -1.19 .0001 1.04 Intercept variableequal to zero when respondentswere professionals. "Indicator variablesequal to zero when professionwas dentistry. blndicator TABLE 7 Average Scores of Attitudes Toward Advertising by Professionals Average Rotated Principal Component Scores 3 2 1 Media Adverse Vehicle Effects on Professional Consumer Appropriateness Benefits Image Respondent
Consumers Professionals -.61 .61 -.04 -.23 -.03 .30 -.95 -.37 -.39 -.54 -.21 -.83 -.46 -.08 -.25

Consumers, physicians

ns ns ns .0001

.00 .00 .06 -.34 ns ns

raw and summary analyses, little difference is found in agreement about advertising by physicians or dentists. Opportunity for exposure to advertising by professionals. Exposure to advertising by professionals, operationalized through the time elapsed between relaxation of restrictions and date of data collection, has a significant impact on attitudes toward potentially damaging impacts and toward potential consumer benefits (the first and second principal components), as does actual reported exposure in the pooled raw data. With each additional year of opportunity for exposure to professional advertising, agreement that negative impacts will arise from professional advertising decreases by .05 scale points. This finding is consistent with the pooled raw data results, in which reported exposure produced a difference of .50 scale points in agreement. Agreement that consumer benefits will accrue from professional advertising increases by .03 scale points for each additional year of opportunity for exposure. In contrast, in the pooled raw data analyses, reported exposure reduced agreement (by .32 scale points) that advertising by professionals would be beneficial to consumers. Consumers and professionals in this broader sample appear to alter attitudes at similar rates with elapsed opportunity for exposure. The interactions between type of respondent and elapsed time are insignificant in all three equations.

Profession
Physicians Accountants Attorneys

Dentists

.18

-.70

-.51

data, the interaction between type of respondent and type of profession is a significant influence on attitudes toward potential negative impacts (principal component 1). Consumers are more concerned about negative impacts on professionals' images from advertising in the medical profession. Differences across professions. Significant differences appear across professions along the first and second attitudinal dimensions that were not observed in the pooled analyses of raw data. Advertising by accountants and attorneys is rated as less potentially damaging and more potentially beneficial in these broader analyses of summary data. Across the pooled

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Discussion
Meta-analyses of attitudes of both consumers and professionals across four professions allow comparisons not possible in prior research examining either a single type of respondent or a single profession. Several generalizations are supported by both the analyses of raw data and the analyses of summary data from 16 studies. With each additional year of opportunity for exposure to advertising by professionals, the attitudes of both consumers and professionals toward such advertising have become more favorable, reservations about potential negative impacts have become weaker, and expectations about potential consumer benefits have become stronger. Increased familiarity with advertising by professionals appears to be associated with fewer reservations. Unfortunately, actual remembered exposure reduces agreement that advertising by professionals is beneficial to consumers. Together, these results imply that advertising by professionals has been

neither offensive nor distasteful, yet not as informative as it possibly could be. A rather large schism separates consumers and professionals attitudinally. Consumers favor increased use of professional advertising, but professionals continue to report reservations about its use, beliefs that negative impacts on image, credibility, and dignity are likely consequences, and that benefits to consumers are unlikely. Results further suggest that price-elastic consumers are more optimistic about consumer benefits from advertising by professionals. In comparison with inelastic consumers, price-elastic consumers are more likely to agree that prices are reduced, quality levels are enhanced, and advertising by professionals conveys information that helps consumers make better choices. The level of optimism is lower among those price-elastic consumers who have been exposed to advertising by professionals, suggesting that it may have conveyed less information than is potentially possible.

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