Social & Personal Norms: A Literature Review on M-Health Services

This literature review delves into the influence of social and personal norms on consumer behavior, with a specific focus on m-health services. It examines how social norms, defined as perceived expectations from relevant individuals or groups, impact consumer satisfaction and usage behavior, drawing from theories like the Theory of Reasoned Action and the Theory of Planned Behavior. The review further explores the role of personal norms, which are self-expectations based on internalized values, in shaping consumer decisions related to technology adoption and service usage. Hypotheses are presented regarding the positive impact of social norms on m-health service usage and satisfaction, as well as the negative impact on service discontinuation. The analysis considers how these norms influence consumer perceptions, reduce cognitive dissonance, and ultimately affect their engagement with m-health services. The document is available on Desklib, a platform offering study tools and resources for students.

October 2021 Final
Research gaps on social and personal norms:
Consumer behaviour (usage behaviour in the present study) is not only an individual
phenomenon concerned with cognitive processes and independent or individual behaviour,
but also a social phenomenon which involves shared social feelings or cognition, group
influences, social circumstances, social identity, influence from social norms. As a
consequence, in a social setting theories concerning shared social will and action should be
applied to consumer satisfaction and intended or actual behaviour .It is possible that the
sometimes skewed relationship between satisfaction and behavioural measures like loyalty,
consumption, and purchase retention is related to social aspects of consumptions. Oliver
(1997) theoretically proven this relation to be strong. However, some studies have
concluded that the relationship is weak, and that in the worst-case circumstances, there is
no link at all (Seiders, 2005). After conducting a longitudinal and phenomenological study on
customer satisfaction, a more dynamic, comprehensive, and context-dependent approach
to analyse satisfaction and behaviour was presented by Fournier and Mick (1999). Better
knowledge of the social variables that influence satisfaction and its relationship to
behaviour is one of their many future development recommendations.
Understanding the many ways that users influence one another, as well as the involvement
of and behavioural, motivational and cognitive factors in these interactions, has never been
more important than it is today.
Only few studies has focused on the influence of social norms on satisfaction with mobile
technologies especially m-health services.
When assessing the acceptance of technology innovation like m-health service the social
context of the m-health user should not be neglected because if the social context is on
favour of using the m-health service , this can plays an important role in the continue usage
of the service.
The study's goal was to see if age had an influence on how entertainment and subjective
norms impact m-shopper satisfaction and WOM. The findings revealed that satisfaction can
be obtained in the case of adult m-shoppers as an effect of subjective norms (group
influence).As a result, the researchers empathised that influence of reference groups
(friends, relatives) should not be forgotten to achieve users’ satisfaction. Infect, they
recommended that normative social pressure can be used to induce subjective norms
related to m-health service use and to make m-health users not to be isolated from the
service.

Literature review:
………..The majority of studies have examined the impact of social norms on attitude-
behaviour linkages using perspectives from the theory of planned behaviour (Ajzen, 1991)
and reasoned action (Fishbein and Ajzen, 1975). In these studies, social norms are defined
as expectations or perceived social pressure from relevant persons in general (subjective
norms) or specific groups or individuals (normative beliefs), and they're utilised to evaluate
the influence of the social environment.
Subjective norms are the beliefs that a significant person or group of people will approve
and support a particular behaviour. These norms are determined by the perceived social
pressure from others for an individual to behave in a certain way also their motivation to
comply with their perceptions. Individuals' decision-making and whether or not they take
action are influenced by these factors. The idea of social norms came from subjective norms
which also have significant impact of intentions and behaviours. Social norms are ethical
standards and rules of conduct that are widely accepted in society and can be seen as a type
of societal pressure. These norms referred as the shared standards of acceptable
behaviours.
Theory:
The most common approach to incorporate social variables in the explanation of intentions
and behaviour is to employ the concept of social norm within the framework of the theory
of reasoned action (TRA) or the theory of planned behaviour (TPB) and theory of reasoned
action (Ajzen, 1991; Armitage and Conner, 2001). However, the social norm concept relates
to people' perceptions of relevant other's expectations (family, friends, groups) and
motivation to meet those expectations, omitting social interactions that may occur during
joint decision-making or individual decision-making that impacts others.

Social norms, service quality, satisfaction and usage behaviour:
Before engaging in any behaviour, people generally consider the social norms and the
difference between their behaviours and that of others. As we live within a society,
technology usage behaviour has characteristics of externality and interactivity. Thus, the
behaviour of others could affect the technology usage behaviours of individuals. Individuals
are also more likely to participate in behaviours that are congruent with the groups to which
they belong in order to obtain social support and meet social needs [26]. Social norms, for
example, can encourage people to exercise more. Huber et al. observed that social
descriptive norms play an essential role in explaining citizens, what their neighbours are
doing, and can stimulate community recycling behaviour. As a result, the public and
surrounding people's views and behaviours about the usage of mobile health services will
have a significant impact on everyone who lives inside that social sphere. Individuals will
adjust their behaviour in response to the positive or negative reactions of others, including
general public. In other words, the stronger the social norms felt by m-health service users,
they are more likely to continue to use the m-health services.
The relevance of subjective norms in attitude regarding intention to use was highlighted by
Nysveen (2005) and Schierz (2010). The concept was applied by Nysveen in a mobile
environment. According to Schierz (2010), when consumers lack reliable knowledge or
information on usage details, such as when shopping for products or services in the early
stages of development or diffusion, the relevance of group opinions for individual attitude
formation increases (Schierz et al., 2010). Since subjective norms integrate perceived
expectations from relevant persons or groups with the intention to comply with those
expectations, Chang and Chin (2011) studied the influence of subjective norms on
complaints intentions on the event of dissatisfaction. According to Okazaki and Navarro
Bailon (2010), the opportunity to receive supportive messages from others affects
participants' satisfaction with a mobile phone-assisted smoking cessation programme.
If the users have subjective knowledge (for example, group support) or personal experience
(satisfaction), the advantages people obtain from technology use rise, resulting in
satisfaction. One of the most significant factors in obtaining satisfied technology users is
that they feel like they're part of a group (subjective norms), making subjective norms a key
determinant of satisfaction. Besides Ansari (2012) stated that users actually adapt the
technology in accordance to their individual needs and lifestyles, and not just adopt it for
simple use. In the context of the present study users’ satisfaction level of the m-health
service can get increased, when they consider the fact that, continue usage of m-health
service will make them a part of the well-established group, if the group also believes the
same.
San-Martín, Prodanova and Jiménez (2015) studied perceived entertainment and group
influence (subjective norms) in purchasing, as determinants of satisfaction with m-shopping
and WOM. Subjective norms emerged as an effective approach to obtaining satisfied m-
shoppers in the study.

Following the logic of the previous reasoning, this study claims that social norms can help
reduce m-health service-related cognitive dissonance and, as a consequence, increase m-
health service satisfaction.
Hypothesis. Social norms have a positive impact on m-health service continue usage
behaviour.
Hypothesis: Social norms have a negative impact on m-health service discontinue usage
behaviour.
Hypothesis: Social norms has a positive impact on satisfaction with m-health service.
Personal norms:
A frequent strategy to evaluate personal relevance in a consumer behaviour environment
has been to examine the extent to which the target behaviour is seen to be linked to the
accomplishment of personal life values. Life values are beliefs and conceptions about
desirable end states or behaviours that transcend specific contexts, guide the assessment of
behaviour and events, and are ordered by relative importance (Schwartz and Bilsky, 1987).
Because they are cognitions of a very high level of abstraction and guide behaviour across a
broad variety of behaviours and events, they are unlikely to account for much of the
variability in individual attitudes and behaviours (Rokeach, 1973). As opposed to directly
influencing attitudes and behaviour values influence attitudes and behaviour indirectly
through other cognitive components in the hierarchy. From this basis, the value-attitude-
hierarchy paradigm (e.g., Homer and Kahle, 1988) suggests that influence should flow from
abstract values through mid-range cognitions to specific behaviours.
Unlike individual values, these mid-range cognitions are more specific and numerous than
personal values, but more abstract than attitudes. According to research carried out in the
context of the theories of reasoned action or planned behaviour, such mid-range cognitions
have been understood by the construct of personal or moral norms (e.g. Kaiser, 2006). In
these studies, personal norms are defined as self-expectations based on internalized values
and feelings of obligations to engage in certain behaviours. A personal norm is a belief that
some behaviours are inherently right or wrong, regardless of their personal or social
consequences (Manstead, 2000).
In research in the tradition of the theories of reasoned action and planned behaviour, it has
been common to add personal or moral norms as an additional predictor along with
attitude, social norm and perceived control as it improves the predictive power of the
theories in a wide range of behavioural domains such as blood donation, dishonest action,
employee behaviour, business ethics, sexual behaviour and smoking behaviour (Manstead,
2000). In the 11 studies reviewed by Conner and Armitage (1998), moral norm was a
significant predictor of intentions in nine cases. For example, Shepherd and Raats (1996)
proposed that the inclusion of moral norm increases the predictive power of the theory of
planned behaviour when a person is involved in buying and preparing foods for other
people and, perhaps, particularly for children. Their propositions are based on studies

testing people’s attitudes towards food with artificial sweeteners and synthetic colourings,
high-fat food and high-sugar food.
Personal norms, service quality, satisfaction and usage behaviours:
As mentioned earlier personal norms refer to the individual’s sense of self-ethical obligation
to perform an action. As a result, personal norms are a type of self-expectation that reflects
an individual's sense of responsibility for performing specific behaviours. Personal norms are
more strong predictors of behaviour than social-demographic variables or personal values.
Thus, this study has posited personal norms as a measure of internal responsibility in terms
of using the DGHS m-health service.
Individual behaviour is influenced by personal norms in a positive way. Several scholars have
backed this up. Personal norms, for example, are the most important determinants of
individual clothing consumption intention and behaviour, according to Tina's research.
According to Doran, personal norms have the strongest relation to environmentally
conscious travel choices.
In healthcare settings, individuals' technology usage behaviours have also been shown to be
affected by personal norms in previous research. Holden (2010) studied the influence of
personal and social norms to use electronic health records (EHR). Findings of the study
revealed significant impact of personal norms on physicians’ use of EHR, as the physician
believed that it is their moral obligation to use EHR for maintaining patients’ safety and
quality of care. Thus, in the present study context, users of m-health are more likely to
continue using the service if they have strong personal norms regarding the continue usage
of the service
Personal norm can also acts as a value and second-order predictor of behaviour (Homer and
Kahle, 1988), meaning that personal norms in engaging in the target behaviour will activate
satisfaction, than the behaviour. In the light of the value-attitudes-behaviour hierarchy, one
may ask whether some of the effect of personal or moral norms is mediated by the other
constructs. Sparks (1995), in a study on predicting expectations about eating food produced
by gene technology in the future, found that measures of perceived ethical obligations
produced only a marginally significant independent contribution to the prediction of
expectations; however, they did provide a significant contribution to the prediction of
attitudes. This is also confirmed in a study about intention to purchase organic food (Arvola,
2008).
Kaiser and Scheuthle (2003) followed Sparks (1995) suggestions and found that moral norms
had no independent and direct effect on intention to behave ecologically, but had an
indirect positive effect through attitude. In a recent study, Kaiser (2006) tested a structural
model where attitude is a fully mediator between moral norm and behavioural intention to
act conservational.

Furthermore, till date only studies investigated the influence of personal norms on
perceived service quality. Users with strong moral obligations to use the m-health service
will require lower perception of service quality as their moral obligations will strongly
encourage them to continue using the service despite of weak service quality perception. In
contrast, users who are not morally obliged to continue use the m-health service will require
higher perception about the quality of the service, to encourage them continue use the
service.
Based on the discussion above, this study proposes that-
Hypothesis. Personal norms have a positive impact on the m-health continue usage
behaviour.
Hypothesis. Personal norms have a negative impact on the m-health discontinue usage
behaviour.
Hypothesis. There is a positive relationship between personal norms and satisfaction with
m-health service.
Hypothesis. The higher the personal norms, the lower the perceived service quality of the
m-health users.
Theoretical framework