Open Journal of Medical Psychology, 2013, 2, 7-10
doi:10.4236/ojmp.2013.24B002 Published Online October 2013 (http://www.scirp.org/journal/ojmp)
Copyright © 2013 SciRes. OJMP
The Role of Medical Wor d-of-Mouth on Sport Therapists:
A Patient Psychological Perspectives
Fangyi Liu1, Ming-Yu Chou1*,Yung-Lun Liu1, Hong-Zhou Chen2
1Department of Leisure Recreation & Travel Management, Toko University, Chiayi County, Chinese Taipei.
2Department of Animation & Game Design, Toko University, Chiayi County, Chinese Taipei.
Received June, 2013
In 21st century, more and more people see medical services of sport therapists as a promising industry due to global
aging population and high biotechnology development. Hence, understanding medical word-of-mouth (WOM) process
among patients in medical services of sport therapists could be interesting and useful. This study would find out the role
of WOM on patients psychology when choosing the sport therapists, understand how patients look for sport therapists’
information and which information source is important to them. As a pioneer, this study would like to improve medical
WOM marketing of sport therapists. The authors designed a questionnaire based on how patients choosing sport therap-
ists, including questions search importance of different information sources of sport therapists with medical service de-
cision, and respondents’ psychological demographics. We released 253 questionnaires of judo therapy clinics in Taiwan.
More than half of the respondents see sport therapists due to others’ recommendations (referral of family, friends and
professionals）. Women are more likely to seek medical word-of-mouth information than men; and respondents who
think choosing sport therapists are important tend to seek medical word-of-mouth information. Further, patients focus
on “therapist’s behavior”, “therapist’s skills”, and “therapist’s ethic”.
Keywords: Medical Word-of-Mo uth; Sport Therapist; Patient Psychology
Medical worth-of-mouth (WOM) of doctors or therap ists
reviews commonly circulate in conversations, such as
chats, experience sharing, or when people ask their
friends to recommend a sport therapists For example,
people often make statements like “Dr. Liu is the best
judo therapist in the country!” “Nobody can diagnose my
problem. Do you know which therapist is an expert on
this?” When people are asked about famous cardiologists,
several names may enter their minds, and their i mpress-
sions usually come from hearing the discussions of oth-
ers. When people cannot determine which therapis t to
visit, they are commonly influenced by WOM reviews,
deciding to try the recommended therapist s. WOM re-
views are especially convincing when the receiver has
heard the same WOM review regarding the same sport
therapist many times, or when the spreader has substan-
tial knowledge of sport health care, for example, people
working at sport therapy clinics.
Although the phenomena of sport therapy medical
WOM reviews exist, very few sport health care-related
studies have explored this issue. In the field of sport
health care management, most of the studies on patients’
psychology have enabled medical institutions to improve
sport health care information communication by focusing
on patients’ psychological behaviors of seeking informa-
tion regarding their symptoms and self-care after visiting
doctors and therapists . A significant number of stu-
dies on health care management focused on issues such
as the quality of medical services, doctor-patient or the-
rapi st-patient relationships, and patients’ psychological
satisfaction of medical services . Most of these studies
focused on patients’ behaviors during or after medical
treatments, whereas in this study, we investigated pa-
tients’ psychological behavior prior to medical treatment.
After reviewing literature on WOM, we explored the
influence medical WOM reviews had on patients’ sport
therapist selection decisions. The literature we reviewed
included that on the definition of WOM, the influence of
WOM on receivers’ psychological decisions, and the
influence of WOM on professional services.
F. LIU ET AL.
Copyright © 2013 SciRes. OJMP
In addition, we limited the discussion to “the influence
of medical WOM on patients’ sport therapist selection”
for a more focused study. We conducted surveys and
interviewed patients to increase the credibility of the re-
sults. The research questions were as follows:
1) What is the significance of medical WOM on pa-
tients’ sport therapist selectio n ?
2) What are the traits of the people actively seeking
medical WOM of sport therapists?
3) What are the traits of the people spreading medical
WOM of sport therapist?
4) What types of WOM do patients value when they
select sport therapists?
2. Literature Review
2.1. Medical WOM in Health Care
Many studies have been conducted on the WOM of service
products and manufactured products, whereas few
studies have been conducted on the WOM of health care
services. Numerous scholars have indicated that the
WOM for service products had more influence on the
consumers than the WOM for manufactured products .
 also indicated that because services were intangible,
consumers typically asked people with experience for
information to determine whether the services met their
demands and to evaluate the quality of the service. 
emphasized the risks of service products to consumers;
they argued that the purchase of service products was more
risky because services were intangible, no standards
could be applied, and service providers rarely offer
guarantees to customers .
A number of scholars examine WOM in professional
service sectors. For example,  indicated that in high-
risk and highly invasive professional services, WOM was
extremely significant to consumers.  Found that the
value of WOM increased when consumers were planning
to purchase service products that were complex, highly
invasive, expensive, risky, and significant, such as health
care services. Health care services were credence goods,
which differed from search goods and experience goods.
Search goods are products whose quality consumers can
discern prior to the purchase; for example, consumers
can try on clothing to determine whether it fits prior to
purchasing. Experience goods are products whose quality
consumers can judge after purchasing ; for example,
they can determine whether the canned goods they pur-
chase are tasty. By contrast, credence goods are products
whose quality consumers have no way of judging before
or after purchasing. Therefore, WOM played a signi fi-
cant role in the purchase of credence goods .
2.2. Seeking Medical Treatment and Information
Seeking medical treatment is a purchase psychological
behavior. When patients evaluate their decisions regarding
medical treatments, they use a psychological decision
model similar to that of purchase behaviors, which is a
series of psychological processes from demand evaluation
to result evaluation after the purchase, including demand
confirmation, information seeking, evaluation of alternatives,
purchase psychological decision making, and after-
purchase psychological behaviors . The purpose of
information seeking is to obtain and compare options.
Thi s psychological process comprised internal seeking,
where the consumers make judgments based on their
experience and knowledge, and external search, where
consumers seek external information, such as actively
seeking WOM . According to , because most
patients did not understand their own psychological
illnesses, they tended to seek information regarding
doctors, sport therapists, clinics or hospitals from friends
or relatives with a similar experience (actively seeking
WOM) to save them the trouble of blind searching and to
overcome their lack of sport health care information.
Several studies regarding sport health care manage-
ment have been conducted on health information seeking
psychological behaviors. However, these studies primar-
ily focused on patients’ psychological behaviors of seek-
ing information on disease diagnosis and care . The
study by Lambert differed from this study on the point in
time that was discussed: Those scholars examined how
patients sought external health care information to better
understand their illnesses and prepare for self-care after
they had visited the sport therapists, whereas we explored
how patients sought sport therapist information to deter-
mine which sport therapist to visit, that is, a pre-purchase
3. Methodology and Design
This study was conducted in cooperation with the Toko
University and judo therapy clinics in Taiwan. A quantita-
tive study was conducted at the Taiwan judo therapy clinics,
where questionnaires were administered and analyzed. We
selected judo therapy clinics to distribute the question-
naire and explore residents’ behaviors of seeking sport
We distributed the questionnaires in the waiting area
of the judo therapy clinics in Taiwan. Over a week, six
researchers distributed questionnaires during the morning,
afternoon, and evening clinic hours. The participants
were randomly selected patients or the friends and
families of patients. After the researchers obtained the
participants’ consent, the participants completed the
questionnaires anonymously. The researchers assisted the
elderly and visually impaired participants in completing
The questionnaires were designed to study the
significance of doctor WOM, who was more likely to
F. LIU ET AL.
Copyright © 2013 SciRes. OJMP
actively seek medical WOM of sport therapist, whose
recommendation and medical WOM were effective, and
what information patients valued most when selecting
sport therapists. We conducted numerous discussions,
revisions, and pre-tests to obtain the final version of the
questionnaire. To design the question for identifying
what information patients valued the most when selecting
sport therapists, we posted an open-ended question
(“What do you value most when selecting sport therapists?”)
on social networking sites and asked internet users to
nominate the top three factors they considered. We
collected 125 samples and summarized the top 12 factors
as follows: sport therapist’s medical skills, sport therapist’s
attitudes, sport therapist’s medical ethics, whether the
sport therapists were well-known, whether the sport
therapists had been involved in medical disputes, medical
expenses, sport therapists’ appearances, experience,
education, the clinics of the sport therapist had worked at,
sport therapist s’ gender, and reputation.
We employed SPSS 17.0 to analyze the data, and used
descriptive statistics to describe the information collected
in the survey to gain an initial understanding of the in-
fluence medical WOM had on sport therapists’ selection.
4. Results and Analysis
We administered the questionnaires outside the waiting
area of judo therapy clinics in Taiwan and recovered 253
effective questionnaires. We analyzed the data using
SPSS 17.0 and the results were as follows:
The age of the participants was evenly distributed,
with an average of 48 years; 48.2% of the participants
were male, and 51.8% were female.
Of the participants, 92.5% were local judo therapy
clinics’ counties, and only 7.5% were from other coun-
ties. Additionally, most of the participants (34.2%) were
4.1. The Significance of WOM on Patients’ Sport
WOM was significant to patients’ sport therapists’ selec-
tion. The patients that selected the sport therapists they
would visit based on medical WOM accounted for
48.02% of the participants. Among them, 32.40% used
walk -in registration, and 19.58% used online registration.
These results confirmed that reported in numerous pre-
vious studies and provided data for this study. According
to , because service products are invisible and intangi-
ble, consumers typically ask people with experience for
information regarding the products prior to the purchase,
to determine whether the service suits their needs and
evaluate the quality of the service.  Also indicated
that the value of WOM increased when consumers were
planning to purchase service products that were complex,
highly invasive, expensive, risky, and significant, such as
health care services.  Found that medical WOM ac-
counted for highest percentage of American patients’
pre-treatment information searching. In addition, older
patients were more likely to be influenced by medical
WOM when making health care decisions, because they
cannot search the information on the Internet.
4.2. The Traits the Spreaders of Sport Therapist
Recommendations from families, friends, and profess-
sionals were the most useful. More than 70% of the par-
ticipants considered recommendations from families and
friends crucial, and 80% of the participants considered
recommendations from medical professionals crucial,
which indicated that the tie strength between the receiv-
ers and the spreaders and the professionalism of the
spreaders had a significant influence on the patients .
4.3. The Most Valued Factor in Patients’ Sport
Therapis t s Selection
The most valued factor in patients’ sport therapist selec -
tion was sport therapist’s attitudes (82.99%), followed by
sport therapist’s skills (71.16%), medical ethics (67.19%),
reputation (35.58%), experience (33.20%), whether the
sport therapists had been involved in medical disputes
(26.01%), the therapy clinics the sport therapists were
working at (23.71%), sport therapists’ education (11.86%),
whether the doctors were well-known (9.88%), medical
expenses (9.49%), sport therapists’ gender (2.37%), and
sport therapists’ appearance (0.79%). A comparison be-
tween the answers from the participants who selected the
doctors based on WOM and those who randomly se-
lected doctors during walk-in registration showed that no
significant differences in the factors they valued during
sport therapists selection.
5. Discussion and Implications
In general purchase behaviors, when consumers considered
the purchase decisions significant, they usually sought
relevant information and WOM prior to the purchase
. However, in this study, we found that although
most of the patients considered sport therapists selection
crucial (74%), only 41.5% of them actively sought WOM,
whereas 59.5% of them did not. We concluded that the
patients in this study tended not to actively seek medical
WOM because most of them had relatively easy-to-treat
illnesses (they were outpatients recruited from a clinic)
and the risks were relatively low ; for example,
patients with a cold do not need to visit a specific sport
therapist. Additionally, a number of patients were
unaware of the severity of their illnesses. Equally
possible was that the patients had passively received
F. LIU ET AL.
Copyright © 2013 SciRes. OJMP
WOM regarding the sport therapists or the patients had
heard about the sport therapists from another sport
therapist when the patients were transferred from one
clinic to another. In both cases, the patients did not
actively seek medical WOM. Patients might have also
failed to actively seek medical WOM because of the lack
of health care information or channels.
In this study, we enabled medical staff to understand
why the patients selected them and where the patients
acquired sport therapists information from. We also
found that patients’ behaviors of seeking medical treat-
ment enabled the health care system and doctors to un-
derstand the sources of patients’ health care information.
We concluded that patients with higher levels of med-
ical professionalism were more likely to actively seek
medical WOM. We suggest that the health care system
provide additional health care education to the public to
enhance their knowledge of health care. This health care
system should also create more platforms for the public
to exchange sport therapists’ information (e.g., health
care websites and forums) to improve the information
flow of health care.
Most of the participants obtained information about
the doctors through walk-in registration or the official
Web site of the hospital, indicating that the patients had
substantial trust in medical institutions in Taiwan. During
the interviews, numerous participants expressed their
faith in the sport therapists at clinics. Therefore, medical
institutions should make it their responsibility to provide
more reliable health care information to the public. We
also found that the families of the patients were more
active than the patients themselves in seeking medical
WOM. Therefore, the sport therapists system should tar-
get their health care publicity at the families of patients.
For example, many public service announcements should
be designed to communicate with the families of patients.
6. Acknow l edgements
We would like to thank the anonymous referees for their
valuable comments and suggestions. The first author
Fangyi Liu can be contacted at email@example.com,
and the corresponding author Ming-Yu Chou can be
contacted at firstname.lastname@example.org.
 J. Weaver, D. Mays, S. S. Weaver, G. Hopkins, D. Eroglu
and J. Bernhardt, “Health Information-Seeking Behaviors,
Health Indicators, and Health Risks,” American Journal
of Public Health, Vol. 100, No. 8, 2010, pp.
 S. Shabbir, H. R. Kaufmann and M. Shehzad, “Service
quality, word of mouth and trust: Drivers to achieve pa-
tient satisfaction,” Scientific Research and Essays, Vol. 5,
No. 17, 2010, pp. 2457-2462.
 Y. Chen, F. Liu, C. H. Fang and T. M. Y. Lin, “Under-
standing the Effectiveness of Word-of Mouth: An Elastic-
ity Perspective,” Journal of Research in Interactive Mar-
keting, Vol. 7, No. 1, 2013, pp.
 J. Bristor “Enhanced Explanations of Word of Mouth
Communications: The Power of Relationships,” Research
in Consumer Behavior, Vol. 4, 1990, pp. 51-83.
 C. H. Fang, T. M. Y. Lin, F. Liu and Y. H. Lin, “Product
Type and Word of Mouth: A Dyadic Perspective,” Jour-
nal of Research in Interactive Marketing, Vol. 5, No. 2/3,
2011, pp. 189-202. doi:10.1108/17505931111187802
 F. Liu, C. H. Fang, T. M. Y. Lin and S. Chung,
“Word-of-Mouth Effect of Aboriginal Cultural Products
Purchase Behavior in Taiwan,” International Journal of
Psychology, Vol. 47, 2012, pp. 178-178.
 F. Liu, I. L. Chien, M. Y. Lan and S. M. Chien, “Devel-
opment The Theme Park Brand Equity Model of Tai-
wan,” International Journal of Psychology, Vol. 47, 2012,
 Y. Chen, F. Liu, L. M. Ho and T. M. Y. Lin, “Develop-
ment of Word-of-Mouth Elasticity Measures for Tourism
Product Categories,” Psychology, Vol. 3, No. 9, 2012, pp.
 M. Y. Lan, F. Liu, C. H. Fang and T. M. Y. Lin, “Under-
standing Word-of-Mouth in Counterfeiting,” Psychology,
Vol. 3, No. 3, 2012, pp. 289-295.
 J. Sweeney, G. Soutar and T. Mazzarol, “Factors Influen-
cing Word of Mouth Effectiveness: Receiver Perspec-
tives,” European Journal of Marketing, Vol. 42, No. 3,
2008, pp. 344-364. doi:10.1108/03090560810852977
 J. Engel, R. Blackwell and P. Miniard, Consumer Beha-
vior, 8th Ed., Dryden Press, New York, 1993.
 H. Bansal and P. Voyer, “Word-of-Mouth Processes
within a Service Purchase Decision Context,” Journal of
Service Research, Vol. 3, No. 2, 2000, pp.
 S. Lambert and C. Loiselle, “Health information seeking
behavior,” Qualitative Health Research, Vol. 17, No. 8,
2007, pp. 1006-1019. doi:10.1177/1049732307305199
 S. A. Nasco and D. Hale, “Information Search for Home,
Medical, and Financial Services by Mature Consumers,”
Journal of Services Marketing, Vol. 23, No. 4, 2009, pp.
 F. Liu and M. J. Lee, “Understanding the Island
Tourism Image Formation in Taiwan: via Fuzzy
Preference Relati o ns,” International Journal of
Psychology, Vol. 47, 2012, p. 174.