Consumer Buying Behavior Towards Chocolates Marketing Essay

Consumer Buying Behavior Towards Chocolates Marketing Essay As consumers, we play a very vital role in the health of the economy local, national or international. The decision we make concerning our consumption behavior affect the demand for the basic raw materials, for the transportation, for the banking, for the production; they effect the employment of workers and deployment of resources and success of some industries and failures of others. Thus marketer must understand this. In order to become a successful marketer, he must know the liking or disliking of the customers. He must also know the time and the quantity of goods and services, a consumer may purchase, so that he may store the goods or provide the services according to the likings of the consumers. Based on the attribute that different buyer seeks while making purchase decision, marketers has to device appropriate marketing mix to position their product in the targeted market(s). Through this descriptive study we have tried to analyze the various attribute that different buyer seeks while making purchase of chocolates of different size and quantity for different purposes altogether with significant differences in favorite brand; flavor; price and place of buying etc. Also, we have tried to examine the various degree of relationship that exist between the different attributes of the product that consumer favors and the brand loyalty that consumer have toward his liked brand. Also main emphasis is laid to find out what results in brand loyalty and is this relationship is significant with changing marketplace. Keywords: Chocolate, Consumer behavior, Consumption INTRODUCTION: If people thought that chocolates were just restricted to kids think again. According to a recent study conducted by a major chocolate brand in India the major consumers of chocolates apart from kids are teenagers and people between the ages of 15 35. Chocolates which were considered expensive once have now become affordable by one and all. Most of the chocolate brands in India produce chocolates in different sizes that are priced according to their sizes. Chocolates like Diary Milk and Five Star can be got for just  `  10. Chocolates in India are slowly and steadily substituting the mithai or traditional Indian sweets. Due to the increasing levels of social consciousness people prefer gifting well wrapped chocolate packets rather than sweets on occasions and festivals. Taking advantage of this situation the top chocolate brands in India are now concentrating on the packaging and are introducing well packaged chocolates for specific occasions.   OBJECTIVE: The objective of this study is to make generalization of consumers buying behavior towards the purchase of chocolates and than to measure the extent of brand loyalty, altogether with knowing what other marketing mix variable affect buyers decision regarding the purchase of chocolates. This study is a step toward generalizing the consumer purchase pertaining to following major set objectives: To know the customer behavior and to identify the level of customer satisfaction towards different brands of chocolates. To know the significant promotion mix that plays role in particular market. To test the brand loyalty among different gender of different age. CONSUMPTION OF CHOCOLATES IN INDIA Chocolate consumption is gaining popularity in India due to increasing prosperity coupled with a shift in food habits, pushing up the countrys cocoa imports. Chocolate market in India is pegged at Rs 2,000 crore and is growing at the rate of 18 20 per cent per annum. The global chocolate market is estimated around $80 billion. The Indian chocolate market is seen growing at a compounded annual growth rate of 15-20%. The Indian chocolate market is thought to be worth some R1,500 crore and has been hailed as offering great potential for Western chocolate manufacturers as the market is still in its early stages. Over 70% of chocolate consumption takes place in the urban areas. Chocolate consumption in the rural areas is negligible in India. Chocolate market is a highly concentrated market, with Cadbury having 70 per cent and Nestle around 20 per cent. The two giants have been instrumental in building up the chocolate market in India with huge investments in product development, advertis ing and brand building. Modern trade constitutes about 10% of the overall chocolate category, or roughly Rs 320 crore, according to Nielsen. Of this, brand Cadbury Dairy Milk has a share of 35%, while Bournville and Silk together account for 18%. Facts Figures: Indian Chocolate Industry as today is dominated by two companies, both multinationals. The market leader is Cadbury with a lions share of 70%. The companys brands like Five Star, Gems, Éclairs, Perk, Dairy Milk are leaders in their segments. Until early 90s, Cadbury had a market share of over 80 %, but its party was spoiled when Nestle appeared on the scene. The other one has introduced its international brands in the country (Kit Kat, Lions), and now commands approximately 15% market share.  Bars or molded chocolates like Dairy Milk, Amul, Nestle Premium, and Truffle account for 35 40 per cent of the total market (in terms of volume). The Count chocolates such as Five Star, Kitkat, Perk etc. is the next largest segment, accounting for 30 per cent of the total market. Panned chocolates enjoy 10 per cent of the total market share. In India, chocolates are consumed as excitement / enjoyment and not as snack. Therefore, more than 75 per cent of chocolate purchases are impulse. Ch ocolate consumption in India has nearly trebled since 2005, which is the reason why leading chocolate companies are investing in bringing premium brands such as Toblerone. Seasonal and boxed assorted chocolates have been experiencing the fastest growth, and sales are expected to expand 13% between 2010 and 2015. Cadbury India, which has been on an overdrive to promote its premium brands such as Cadbury Dairy Milk Silk and Bournville, is now rolling out Toblerone from parent Kraft Foods stable. The per capita consumption of chocolates in India, according to Chandramouli Venkatesan, director (snacking strategy), Cadbury India, has increased from 40gm per person per year in 2005 to 110-120gm. However, the launch of Toblerone is in line with Cadbury Indias business objective of growing the premium-gifting chocolate market. Gifting is a Rs 15,000-crore category in India, of which branded chocolate gifting is about 6%. Cadbury Indias share in branded chocolate gifting is 80%. Despite the fact that Indians have strong affinity for sweets, the size of domestic confectionery market is small on account of traditional consumer tastes and habits. The Chocolate market in India is a niche market penetrated largely in urban areas and per capita consumption is low as compared to those in developed countries of the West. Cadbury Indias main source of revenue is its 70% bite of the 23,000 tonnes Indian chocolate market. Advertisement Trends (AdEx division of TAM Media Research) Regional GEC took the second place with a 21 per cent share ad volumes of chocolates, followed by Hindi movie with 13 per cent share during January-November 2007. Cadbury India Ltd was way ahead of its peers with 66 per cent share followed by Nestle India Ltd and Parle Products Private Ltd during January-November 2007. As expected chocolate advertising skewed towards kids channels and regional GEC took the second position. Cadbury India Ltd rules chocolate advertising on television. Chocolate advertising rose by 30 per cent during January-November 2007 compared to January-November 2006. Maximum chocolate advertising was during Raksha Bandhan across 2005 and 2006 and January-November 2007. 17 per cent more advertising during third quarter 2007 (Raksha Bandhan festival) compared to first quarter 2007. LITERATURE REVIEW After having detailed study of Principles of marketing management book by Kotler and Keller, we came to know about consumer purchasing behavior and other various attributes of marketing mix like place and product strategy in alignment with promotion and pricing strategies and concept of brand loyalty with all the major attributes of a good brand. Beside this detailed study of various research papers and articles has also been made to know the practical applicability of the concept. Consumer leant about chocolate from many sources, mainly from friends and families, through advertisement and from their own experience. Whether a promotion and advertising hurt or help a brand is under-researched (Mela, Gupta Lehman, 1997). In the long-run, advertisement help brands by making consumer less price sensitive and more loyal. The purchase decision pertaining to particular brand and loyalty is a result of various attributes of the product. Advertisers must remember that advertising messages are interpreted differently between different genders (Maldonando, Tansuhaj Muehling, 2003; Hogg Garrow, 2003; Putrevu, 2001). Previous studies have proven that females were more likely to engage in elaboration than men (Maldonado Muehling, 2003). Hogg and Garrow (2003) found that women paid more intention about the details of the characters of an ad when asked to analyze advertising messages. They said that this may be explained by the fact that females have a greater tendency than men to consider external information and information related to others. Women are comprehensive processors who try to gather all available information about the product Advertisement can change consumers perception of a product in terms of attributes content and proportion and also influence consumers taste for attributes (Gwin Gwin, 2003). Brand preference and product attribute: Attributes are the characteristic or features that an object may or may not have and includes both intrinsic and extrinsic (Mowen Minor, 1998). Understanding why a consumer choose a product based upon its attributes helps marketers to understand why some consumers have preferences for certain brands (Gwin Gwin, 2003). Both tangible and intangible attributes of a product are equally important in choosing a product or brand (Myers, 2003). There is no evidence that certain attributes are more related to customer loyalty than others (Romariuk Sharp, 2003). Romariuk and Sharp (2003) suggested that marketers should focus more on how many attributes the brand should be associated with and not what attributes. For low-involvement products, consumers have more objective view of the nature of the attributes (e.g. food, cosmetics) because they are constantly being advertised and promoted. Price is another form of attribute used by consumers to evaluate a product. Price can sometimes be an indicator of quality; with a higher price indicating higher quality (Mowen Minor, 1998; Siu Wong, 2002). Consumers perceive that a higher price can be attributed to the higher cost of quality control (Siu Wong, 2002). Some consumers are highly price sensitive (elastic demand), whereby a high prices may shift consumers to competitive brands (Mowen Minor, 1998). Therefore price can have a positive or negative influence on customers. RESEARCH METHODOLOGY In this study the problem pertains to both State of nature and relationship among the variable i.e.; what is general behavior of consumer and than inferenceing the relationship that exist among the different variables to test the extent of brand loyalty and influence of one variable over the other from the data. As the study is related to the study of consumer behavior toward chocolates thats why the appropriate research design used is Fundamental descriptive with the use of both qualitative and quantitative design with static research approach. Formalized research design is also taken into consideration in order to test the Hypothesis framed. In this cross sectional co-relational field study data related to various independent variables dependent variables was collected from the stratified sample of 100 individuals, including males and females of different age groups constituting the sample. All the respondents were approached on the basis of simple random sampling in convenient ma rket place to ensure the accuracy precision of results. Personally administrated questionnaires were used for conducting the survey. INTERPRETATION AND ANALYSIS OF FINDINGS: In our study 48% (41) of respondent are males while 52% (45) of respondent were females. In this 57% (49) respondent are student, 16% (14) were professional, 13% (11) were businessman while 14% (12) respondent were females. 33% respondent includes people of age group 10-18, while other includes those of age 19-59. Q.1 who do purchase how frequently and how much they purchase Out of 86 respondents 13 (15%) respondents buy chocolates daily while 35 (41%) of them buy it weekly compared to 16 (19%) who buy them monthly against 22 (25%) respondents who buys it occasionally. In this 12% of males buy daily while 14% of female buy it daily. While 42% of males buy chocolates in a week against 33% of females, whereas 31% of females like to buy chocolate in a month compared to 22% of males. The result of collected sample reveals that 62% (53) respondent buys less than 5 chocolates a week, while 28% (24) people buys 5-10 chocolates a week. Only 3% of respondent said that they buy more than 15 chocolates an week against 7% who buys 10-15 chocolates a week. The analysis of sample data results that females buy more chocolates than males in a week as 38% of them buy 6-10 chocolates while only 17% of males do so. 73% of males generally buy chocolate in between 1-5 packs a week compared to 51% of female respondent. It is analyzed that 21% (18) of respondent purchases chocolate costing between 5-10 Rs while 47% (40) buys chocolate that cost 10-20 Rs. Chocolates costing 20-50 Rs is preferred only by 24% (21) of respondent and only 7 (8%) out of 86 respondent buys chocolates costing more than Rs 50. Price of chocolate significantly affect different gender differently as 22% female purchase chocolates costing 5-10 Rs against 19% males, while 49% of females prefers to buy those costing in between 10-20 Rs as against 44% of males. 32% Males buy chocolates those costing in between 20-50 Rs compared to 18% of female buying the same. Q.2 For whom it is purchased In collected sample 41% (35) respondent buys chocolates for self consumption against 29% (25) who never buys for them-self. Among them 44% (38) respondent purchases for children against 15% (13) who never buys for childrens. 28% (24) of respondent buys chocolates only for the gifting. The percentage of those who buys always and never for special occasion is approximately 27% and 24% respectively. Analysis shows that 42% of females always buy choclates for self consumption where only 39% of males do same for self consumption. When it comes for buying choclates for children than insignificant of gender both have same buying behaviour. Males seems to gift chocolate more than female as 20% of them buy it for gifting compared to 12% of females. Q.3 what motivate to buy chocolate In a study of 86 respondent it was found that 17% (15)of the respondent were very tempted by the display ads while 34% (29) respondent are moderately affected by the display ads while it has no affect on purchase decision of 13% (11) of respondent. In the undertaken study visual ads highly affect 41% (35) respondent while only 9% (8) of respondent are not affected by it. 24% (21) of respondent perceives affect of family and friends on their purchase decision while it has no affect on 5% (4) of respondent. This shows that family and friends has very high affect on purchase decision of chocolates buyers. Very insignificant numbers of respondent only 2% are affected by sales-man persuasion while it has no affect on 49% (42) of respondent. Also celebrity endorsement has only a moderate influence on purchase decision of respondents. Only 9% respondent are affected by celebrity endorsement compared to no affect on 16% respondents. 42% females are affected by visual advertisment against 39% of males while the display ads affect male more compared to females with 24% and 11% of significant impact on purchase decision respectively. Also family and friend affect females(27%) more against males (22%). Q.4 Important Attribute of the chocolate It can be inferred from study that taste is very important for buying chocolate 95%males 93% females buy chocolates because of taste. 54% males 49% females are showing neutral response to availability, while 27% males 36% females say that availability is most important for buying chocolate. 19% males 15% females have least impact of availability. Price is most important consideration for 29% males 33% females. It affects 42% males 29% females moderately. For 29% males 38% female price is least important. Packaging seems to impact purchase decision of 49% males 58% females moderately during purchase of chocolates. For 22% males 27% females packaging is most important consideration for buying chocolate. 29% males 15 % females have least impact of packaging. Q.5 Advertisement seems to have moderate impact on purchase decision irrespective of gender; however 29% males 22% females are mostly affected by advertisement. 17% males 24% females are not affected by advertisement. Q.6 Forms of chocolate impact 54% males 44% females moderately while 24% males 27% females are mostly affected by form of chocolate. 22% males 29% females are least impacted by form. 80% chocolate buyer seems to buy particular brand against 7% who do not care for the brand name Q.7 how advertisements persuade consumers to purchase Sample in hands results that 20% of people like to buy due to emotion in their advertisement while 43% of respondent love fun in advertisement while only 27% of people like knowledge in the promotion mix against 10% of people who likes music/jingle. So it can be concluded that people watch and are persuaded due to fun content in the advertising of the chocolate more than any other factor. While analysing data on the basis of gender it can inferred that males (81%) like fun and emotional content in advertisement than females(47%), while female (33%) prefer knowledge content more than males (19%). While 20% of female loves music and jingles in comparison no male like it. Q.8 which brand mostly prefered by consumers In the undertaken study it was found that Cadbury is the most favoured brand with 70% of share as against 21% of Nestle, 4% 5% respectively for Amul and miscellaneous ones. It can be inferred from the collected data that females (71%) like Cadbury more than males (68%), while males prefer nestle (24%) more than that of females (18%). While demand for Amul chocolates is found to be very insignificant and equal in both the gender. Q.9 effect of increament in rates The sample analysis say that 82% respondent are highly brand loyal as 18% of them will buy the costly pack of same and 64% of them will not show any change in demand pattern. Only 5% of respondent are in favour of shifting brand against 13% who will reduce the purchase quantity if the rate increases by 2-5 Rs. The deep gender-wise analyses of result show that both genders are equally brand loyal towards price sensitivity. Results show that around 64% (in both gender) will have no change in their purchase decision while 19% of them show positive relation toward buying as they will buy more thinking quality has improved. Also its seems that Law of demand (increase case) operate on males more than females as 15% 11% of them will reduce buying chocolate with increase in prices. Q.10 from where consumers mostly buy The sample study results show that 35% (30) respondent buys from local shop against 49% (42), 7% (6) and 9% (8) respondent who buys from store, cafeteria and malls respectively. In this study, males (42%) prefer to buy more from local shop than compared to females (29%) while female (55%) prefer to buy more from stores against males (41%). While the ratio of buying from malls and cafeteria reveals there is no significant impact of it on gender as both have almost equal choices in this regard. Q.11 what consumers do if preferred bran not available The analysis of sample data says that 9% of total respondent will buy costly pack of same brand while 56% of them will move to next shop. This shows that 65% of respondent are highly brand loyal against those 30% who will buy another brand or other (6%) will postpone their purchase decision. The analysis of sample data gives result that females are highly brand loyal than males as 71% of them will buy the costly pack of same brand or move to another shop compared to 59% of males if that particular is not available. While36 % males 24% female say that they will shift to another brand while 6% of both genders will postpone their purchase decision. Q.12 how much customer are loyal to specific brand To check brand loyalty and competitive affect we has analyzed that 15% of respondent will not buy any other brand while 53% of them may consider the same against 35% who are not sure of taking decision. Our study 41 male 45 female respondents were there if another brand of the same product appears in the market then 7% males 22% females will not buy the new brand. 64% males 44% females may be considering the new brand. 5% males 18% females shall not consider new brand. 24% males 16% females cant say they will buy new brand or not. CONCLUSION: In study of 86 respondents it was found that 95% (82) respondents like Cadbury Brand, 68% (59) respondents like Nestle Brand, 24% (21) of respondents like Amul Brand 1% respondents like Other Brand. So it can be concluded that Cadbury is most famous brand among others. 50% Cadbury buyers like to buy Dairy milk out of 82 respondents 15% Cadbury buyers like to buy 5 Star out of 82 respondents. 10% Cadbury buyers like to buy Perk out of 82 respondents. So, the findings from study that most preferred chocolate are Dairy Milk out of Cadbury buyers. 36% of Nestle buyers like to buy Kit -Kat out of 59 respondents. 24% of Nestle buyers like to buy Éclairs out of 59 respondents. 20% of Nestle buyers like to buy Munch out of 59 respondents. 52% of Amul buyers like to buy Chocà ³ Mines out of 27 respondents. 48% of Amul buyers like to buy Chocà ³ Zoo out of 27 respondents. To be concluded that Kit -Kat and Chocà ³ Mines is most preferred chocolate in Nestle and Amul respectively. Also, it was found that 59% (51) of respondents like chocolate flavor, 23% (20) likes coffee flavor 20% (17) respondents like nuts flavor. So it can be concluded that chocolate is the most profitable flavor coffee second most profitable. APPENDIX 1. Ho = their exist no relationship between the gender who buy chocolate for self consumption, children, gift. Ha= Gender have significant impact on the purpose of buying chocolates. Gender Child Chi-Square(a,b) .186 13.000 Df 1 2 Asymp. Sig. .666 .002 Gender Gift Chi-Square(a,b) .186 34.907 Df 1 2 Asymp. Sig. .666 .000 Gender Self Chi-Square(a,b) .186 2.116 df 1 2 Asymp. Sig. .666 .347 After applying Chi square test on the data it is found calculated value of test is less than the tabulated one. It means that Ho is accepted thats prove that their is very insignificant difference in perception of both the gender and thus both gender buy chocolates for self consumption, gifting and children in a equitable amount. APPENDIX 2. Ho = their is no relationship in gender and frequency of buying chocolates Ha= Gender affect frequency of buying chocolates. Gender How Often Chi-Square(a,b) .186 13.256 Df 1 3 Asymp. Sig. .666 .004 our Ho is selected and Ha is discarded. Thus use of chi square test proves here that both the gender have similar frequency in buying chocolates. APPENDIX 3. Ho= Cost do not affect the purchase decision of diferent age group Ha = different age group have different perception towards cost Age Cost Chi-Square(a,b) 45.209 26.279 Df 30 3 Asymp. Sig. .037 .000 Here in this study it is found that the age and cost have significant relationship among them. It means different age group have different reaction towards different price levels. Thus our Ha is accepted and Ho is rejected. APPENDIX 4. Ho=Visual ads do not have different on different gender Ha=Visual ads affect different gender Gender Visual Ad Chi-Square(a,b) .186 32.256 Df 1 4 Asymp. Sig. .666 .000 Here Chi Square test show that tabulated value of Chi square is greater than calculated thats why our Ho is accepted, which means that there is no relationship betwen gender and visual ads. APPENDIX 5. Ho= The cost of chocolate do not affect the brand purchase Ha=The price of chocolate affect the brand purchased Cost Brand Chi-Square(a,b) 26.279 85.558 Df 3 2 Asymp. Sig. .000 .000 Here Chi Square test show that tabulated value of Chi square is greater than calculated thats why our Ho is accepted, which means that there is no relationship between cost and brand purchased.

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Motivation can be described as a psychological process that causes the excitement, direction and persistence of intended actions that are goal directed (Mitchell, 1982). In other words motivation is the force within an individual that begins, directs and keeps goal oriented behaviours. Morgan (1961) describes the following words as synonyms of motivation and these include wants, strivings, desires, needs, motives, goals, aspiration, drive and aims. Motivation is the wish that helps an individual to do certain things based on the desires and needs. If an individual wants to meet these goals and needs, in that case it requires the person to motivate him or herself in order to make certain moves. Morgan (1961) illustrates that motivation is a behaviour instigated by needs within the individual and directed toward goals that can satisfy the needs. Motivation is the determined power which will assist the employee to work up to their efficient level. It is commonly expected that good motivated employees will work better than that of other employees. As indicated by Ber- elson and Steiner (1991) motivation is the procedure of motivating the workforce to actions in order to achieve the organisation goals. Work motivation is a combination of external and internal power that begins the behaviour connected to work and create its direction, form, duration and intensity (Pinder, 1998). External forces can be identified as the nature of work to be performed and the reward system of the organisation. The internal forces can be described as the motives and needs of the individual on the behaviours linked to work. According to Moorhead and Griffin (1998) to motivate employees with the intention of performing to the greatest of their ability and t... ...t. Looking at the day to day responsibilities of a manager, motivating their employees is the most important and difficult function (Handy, 1944). Content theories seek to describe and categorise the needs that influence behaviours. Perry (2006) explains that content theories are the most influential theories as they analyse the behaviours of individuals. Motivation is the force that helps a person to do certain things based on the desires and needs. Investigating the definition of motivation, content theories such as Maslow hierarchy of needs and Herzberg dual factor theory are the most powerful theories that describe motivation works as motivation is controlled by the desires and needs of the people. Maslow (1943) hierarchal theory of needs suggests that humans strive to reach the highest levels of their capabilities with the aim of satisfying their desires. â€Æ'

Evidence Based Practice in Mental Health Nursing Essay

One of the most common and disabling psychological disorders encountered within mental health and general medical settings is that of an anxiety disorder (Dattilio & Kendall 2000). Research has indicated that people with learning disabilities are more prevalent to psychological disorders than the general population (Hassiotis et al 2000) consequently it could be hypothesised that prevalence rates of anxiety disorders are similar if not greater within the learning disabled population. Professional literature suggests that cognitive-behaviour therapy (CBT) has been an effective treatment against anxiety disorder (Beck 1995) however; this literature has predominately concentrated its focus to within the confines of mental health and general medical settings (Dattilio & Kendall 2000). The ability of people with learning disabilities to identify, evaluate and respond to their dysfunctional thoughts and beliefs, fundamentals of CBT (Beck 1995) have put into question the very use of this treatment programme for this particular client group (Kroese et al 1997). From a professional and personal perspective and through the utilisation of the Seedhouse (1998) ‘Ethical Grid’ responding to an anxiety disorder by way of CBT could be considered an ethically acceptable clinical intervention. Nationally and locally through government directives, ‘Valuing People’ (Department of Health 2001) and initiatives such as Health Action Plans (Department of Health 2002) services have recognised that they need to be more responsive to the mental health needs of people with learning disabilities. As a learning disability nurse wishing to ascertain the effectiveness of CBT as a practical intervention when presented with the dual-diagnosis of anxiety disorder and l earning disability, is through the use of ‘evidence-based practice’. When deciding on the best possible clinical intervention for an identified practice problem it seams logical to convert the issue into a single answerable question (Colyer & Kamath 1999). Several authors have identified that the use of frameworks to inform the development of the clinical question provide the practitioner with a systematic process of formulating an answerable question (Sackett et al 1997 Ridsdale1998). One such framework as described by Sackett et al (1997) is a four- stage process, known by the acronym PICO: Patient or Population Intervention or Indicator Comparison or Control Outcome The construction of an answerable question is the basis of evidence-based practice and should guide the practitioner to how to find an answer (Ridsdale 1998). It is important that each variable under the PICO framework is clearly defined, being as detailed and explicit as possible in order to extend clarification to the question. Working through PICO methodically the practitioner would instigate the process by defining the ‘Patient or Population’. Characteristics such age, gender and diagnosis would need to be deliberated and whilst the aforementioned were easily recognised in the practice area as adult male, identifying appropriate terminology for diagnosis can prove problematic. The term ‘Learning Disability’ is often used interchangeably in literature with terms such as, Mental Retardation and Intellectual Disabilities. ‘Learning Disability’ is a term with contemporary usage within the United Kingdom to describe a client group with significant development delays (Gates 1996). Whilst the idiom ‘Learning Disability’ is the preferred terminology for the question due to its contemporary usage it must be accepted that it’s a term not internationally recognised nor is it a term used for long in the United Kingdom (Gates 1996). Anxiety disorder comes in many facets and can be described as severe psychological disorders in which abnormal or chronic anxiety interferes with daily living (Adams & Bromley 1998). The client in the practice area had described psychological and physiological symptoms that were diagnosed as a social anxiety disorder through rating scales and self-report measures. It is crucial that the practitioner is aware that the term identified for the question as ‘social anxiety’ is often recognised by the synonyms, social phobia or panic disorder (Dattilio & Kendall 2000). The recognition of this inconsistent terminology will enable an evaluation to  take place between the relationships of the chosen term to symptoms displayed by the client. The identification of existing clinical interventions is a valuable part of the process of developing evidenced-based interventions (Meijel 2003). Literature suggests that CBT is an effective treatment for a number of psychological disorders (Embling 2002 Hatton 2002). Central to the model of CBT is that distorted or dysfunctional thinking is prevalent in all psychological disorders (Beck 1995). Analysis of accumulated experience of existing interventions and the aforementioned evidence of its validity led to the application of CBT as the ‘question intervention’. It is not imperative for the question to have a comparison intervention and this was the situation in the clinical problem described, therefore the conclusive element utilising the PICO framework was ‘outcome’. The outcome should be measurable (Sackett et al 1997) and after initially trivialising with the term ‘used’ it became evident that this would not develop into something that could be measured. Discussing whether or not an intervention is ‘effective’ however would provide the question with a measurable outcome. Revision of the terminology identified through the PICO framework would consequently translate the question as – Is cognitive-behaviour therapy an effective intervention for adult males with learning disabilities diagnosed as suffering from social anxiety? A well-formulated search strategy is an essential component in gathering appropriate evidence (Hewitt-Taylor 2002). Ridsdale (1998) discusses a four-stage search strategy that helps to translate the question into a meaningful search – a) Identify the subject elements of the question b) Define the relationship between the subject elements c) Convert the subject elements into search themes d) Decide on the scope of the search Assistance to define the subject elements can be found within the PICO framework – Patient – Learning Disability, Social Anxiety Intervention – CBT Outcome – Effectiveness Once identified an effective means of linking the subject elements of a question for the search process is through the use of ‘operators’. Operators such as: And – Or – Not, form a logical link between the elements of the question and can be used collectively or individually in any electronic database search (Ridsdale 1998). All of the subject elements of the question were required in order provide a conclusive answer therefore the operator required for the search strategy could be identified as ‘And’. The subject elements then require conversion into terms by which references can be retrieved (Ridsdale 1998). A keyword search would apply the terms identified as the subject elements, however making a list of the known synonyms of the subject elements such as Intellectual Disability and Mental Retardation, for inclusion, would substantially develop the search process. Finally the scope of the search decides what is wanted from the search. In order to identify the most appropriate type of evidence that is required for the practice problem the type of question asked must be identified (Sackett et al 1997). The question developed through the PICO framework can be readily identified as questioning, ‘the effectiveness of a therapy’. Sackett et al (1997) proposes that the best available evidence to answer this type of question is comparative / prospective studies and ideally random controlled trials (RCTs) which in turn determine the choice of database (Ridsdale 1998). Sackett et al (1997) provides a comprehensive catalogue of information resources such as databases, journals and web sites along with descriptions  of the type of evidence that can be found within these resources. It was established previously that the best type of evidence for the question would be RCTs and comparative / prospective studies. From the descriptions supplied by Sackett et al (1997) it could be identified that the Cochrane Library supplies the user with full text systematic reviews of effects of health-care interventions along with bibliographies of controlled trials. Further electronic databases identified through Salford University library information services were PsycINFO that contains citations and summaries of journal articles and books in the field of psychology chosen for its congruity with the clinical intervention. ‘Swetswise’ an electronic journal aggregator that provides access to full text publications from several major health care related academic publishers and ‘IngentaConnect’ which offers full text availability for all core Blackwell science and medical journals were chosen due to familiarity of use and extensive subject matter. Other databases considered were CINAHL, EMBASE and AMED however all were discounted due to their general nursing bias. Despite the recognition of Ridsdale’s (1998) four-stage search strategy and its systematic approach the initial search were completed exploiting familiar strategies through the IngentaConnect database. Preconceptions from previous endeavours searching for relevant evidence furnished the belief that a similar strategy would provide sufficient evidence to answer the question. A number of the subject elements were used through keyword searches whilst the operator ‘And’ was used to link each in turn (See Appendix). This easy to use search strategy produced a number of hits however none matched the criteria identified as being the most appropriate type of evidence to answer the question. The search revealed that almost all of the evidence found belonged in either mental health (Heimberg 2002) or general medical settings (Scholing & Emmelkamp 1999). Whenever the term learning disability or mental retardation was utilised they invariable appeared indiscriminately amidst the title or abstract of the article providing no specific relevance to the question. The frustration born out of this strategy led to further searches of electronic databases firstly through another familiar database, Swetswise. Ridsdale (1998) identifies that too many hits will be recovered if the subject element is to general  and this was evident in the first keyword search. The term learning disabilities produced 548 hits (See Appendix) far too many to feasibly scan. The subsequent four searches failed to produce a single hit a possibility also recognised by Ridsdale (1998) who suggests alternative synonyms are utilised in this circumstance. Due to the inability to find any relevant material of value towards answering the question Ridsdale’s (1998) four-stage strategy was then conscientiously adopted in conjunction with the knowledge acquired through lectures received at Salford University. A further search of Swetswise database was completed (See Appendix) which revealed significantly less hits than previously achieved but produced a literature review (Hatton 2002) specifically aimed at the use of CBT and people with learning disabilities. Whilst this evidence did not fulfil previous identified criteria it established that pursuing Ridsdale’s (1998) strategy could provide some success. A similar approach was undertaken while searching the Cochrane Library database which allows the user to restrict the search to the acquisition of systematic reviews and controlled trials whilst using a simple keyword option. Again the subject elements were utilised along with the recognised operator and despite new found co nfidence and knowledge the search strategy revealed no evidence of systematic reviews or RCTs with regards to the question (See Appendix). All systematic reviews or RCTs retrieved belonged within general and mental health settings. The final electronic database to be utilised was PsycINFO (via Ovid) where again Ridsdale’s (1998) four-stage strategy was conscientiously adopted. PsycINFO requires the user to have some prior knowledge of how to use electronic databases and their search strategies, which initially can prove bewildering to the novice. Once familiar with the database and its ability to combine search strategies either through keyword, journal or author the user should find it a practical resource (See Appendix). No systematic reviews or RCTs were found within the results however a further literature review (Feldman & Rivas-Vazquez 2003) aimed at psychosocial interventions and people with intellectual disabilities was unearthed along with evidence from child and adolescence services (Dadds & Spence 1997) and psychiatric services (Carmin & Albano 2003). Hatton (2002) suggests that research evidence on the effects of psychosocial interventions  for people with learning disabilities is sparse, whilst Kroese (1998) adds that therapists are reluctant to engage into therapy with this client group due to their dislike of having to relate to them. In an attempt to discover any type of evidence relating to people with learning disabilities and CBT the Salford University library catalogue was searched (See Appendix). A simple keyword search revealed one book (Kroese et al 1997) attaining the subject elements however again it did not produce the type of evidence recognised as the most appropriate to answer the question. Sackett et al (1997 p.2) defines evidence based practice as: â€Å"†¦the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients†. With this definition in mind it should be established as to what constitutes ‘current best evidence’ and its implications for the practitioner wishing to implement ‘evidence based practice’. Belsey & Snell (2001 p.2) states that, â€Å"†¦evidence is presented in many forms†¦ and the value of evidence can be ranked according to the following classification in descending order of credibility†: I. Strong evidence from at least one systematic review of multiple well-designed randomised controlled trials II. Strong evidence from at least one properly designed randomised controlled trial of appropriate size III. Evidence from well-designed trials such as non-randomised trials, cohort studies, time series or matched case-controlled studies IV. Evidence from well-designed non-experimental studies from more than one centre or research group V. Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees In accepting this hierarchy of evidence practitioners should concede that the systematic review of multiple well-designed RCTs constitutes ‘best available evidence’ (Colyer & Kamath 1999). Sullivan (1998) adds weight to this argument when he states that RCTs constitute the strongest source of evidence and that the scientific community prefer the quantitative research technique that makes use of empirical data following a systematic process. Whilst a number of RCTs were found (Dadds & Spence 1997 Scholing & Emmelkamp 1999) whilst undertaking the search strategy none belonged within learning disability settings. The only evidence found specific to the original question were literature reviews and a specialist book (Kroese et al 1997) aimed at CBT and learning disabilities. The literature reviews (Hatton 2002 Kroese 1998) revealed that a number of case studies and a case series had demonstrated the potential feasibility of CBT reducing anxiety amongst people with learning disabilities. Whilst the specialist book (Kroese et al 1997) discussed conceptual and contextual issues of CBT and people with learning disabilities suffering anxiety disorders. This type of evidence appears in the lower reaches of the hierarchy of evidence and as such its subjectivity, reliability and validity can be disputed (Sullivan 1998). Whilst acknowledging the hierarchy of evidence and the proposal that comparative / prospective studies and ideally RCTs were the best forms of evidence to answer this type of question (Sackett et al 1997) it appears that in their absence the evidence revealed is the ‘best available’. RCTs are widely acknowledged as the gold standard of evidence-based practice (Rowland & Goss 2000) however it is suggested that they bear little resemblance to day-to-day reality (McInnes et al 2001). RCTs can be pragmatic or explanatory the former is concerned with the overall effectiveness of an intervention whilst the latter examines the impact of specific treatment elements on outcome (Parry 2000) however neither considers the perspectives and uniqueness of the respondents. The evidence recovered for the question (Hatton 2002 Kroese 1998) albeit in the lower reaches of the hierarchy acknowledges the feelings of the respondents due to its qualitative nature (patient centred, holistic and humanistic) therefore making it extremely suitable for the study of nursing phenomena (Parahoo  1997) along with its relevance as regards answering a therapy question (Parry 2000). Kroese (1997) offers a number of reasons why there is this lack of quantitative research evidence surrounding the subject elements in the question. He suggests that people with a learning disability are a devalued population, it is impossible to ensure that changes are due to clinical manipulations if individuals (learning disabled) do not have stable cognitions. Finally there is a conjecture that anxiety in people with learning disabilities is the same as in the general population consequently there is no need for specifically focused research. It emerges that learning disability services continue to adapt research evidence from general and mental health settings (Finlay & Lyons 2001) a similar approach with the RCTs recovered from the search strategy could make them a valued resource however it would take a skilled clinician to make this a feasible option. Reflection is a necessary component of Continuing Professional Development and is a legitimate method for questioning personal effectiveness and responsibility in all aspects of health care (Driscoll & Teh 2001). Through the process of reflection the practitioner recognised his own limitations in identifying appropriate evidence for his clinical problems, along with the often inconclusive, time consuming and frustrating strategies undertaken in the search of evidence in support of his clinical practice. The structured frameworks utilised throughout the process described earlier gave the practitioner a systematic approach to formulating a question, developing a search strategy and identifying appropriate evidence to answer his practice problem. The ability to systematically approach future clinical problems will enable the practitioner to offer his clients a holistic, client centred practice from the best external evidence available. Adams, B. Bromley, B. 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(2000) Panic Disorder In: Dattilio, F.M. Freeman, A. Cognitive Behavioural Strategies in Crisis Interventions 2nd Edition, London, The Guildford Press. Driscoll, J. Teh, B. (2001) The potential of reflective practice to develop individual orthopaedic nurse practitioners and their practice, Journal of Orthopaedic Nursing, Vol. 5, pp 95-103 Embling, S. (2002) The effectiveness of cognitive behaviour therapy in depression, Nursing Standard, Vol. 17, Nos. 14-15, pp 33-41 Feldman, L.B. Rivas-Vazquez, R.A. (2003) Assessment and Treatment of Social Anxiety Disorder, Professional Psychology: Research and Practice Vol. 34, No. 4, pp 396-405. Gates, B. (1996) Learning Disability In: Kenworthy, N. Snowley, G. Gilling, C. (Eds) Common Foundations Studies in Nursing Second Edition, London, Churchill Livingston. Hassiotis, A. Barron, P. O’Hara, J. (2000) Mental Health Services for People with Learning Disabilities, British Medical Journal, Vol. 321, Issue 7261, pp 583-584 Hatton, C. (2002) Psychosocial interventions for adults with intellectual disabilities and mental health problems: A review, Journal of Mental Health, Vol. 11, No. 4, pp 357-373. Hewitt-Taylor, J. (2002) Evidence-based practice, Nursing Standard, Vol. 17, Nos. 14-15, pp 47-52. Department of Health (2001) Valuing People A New Strategy for Learning Disability for the 21st Century, A White Paper, London, HMSO. Department of Health (2002) Health Action Plans and Health Facilitation Good Practice Guidance for Learning Disability Partnership Boards, London, Department of Health. Heimberg, R.G. (2002) Cognitive-Behavioural Therapy for Social Anxiety Disorder: Current Status and Future Directions, Society of Biomedical Psychiatry, Vol. 51, pp 101-108. Kroese, B.S. Dagnan, D. Loumidis, K. (1997) (Eds) Cognitive-Behaviour Therapy for People with Learning Disabilities, London, Brunner-Routledge. Kroese, B.S. (1998) Cognitive-Behavioural Therapy for People with Learning Disabilities, Behavioural and Cognitive Psychotherapy, Vol. 26, pp 315-322. McInnes, E. Harvey, G. Fennessy, G. Clark, E. (2001) Implementing evidence-based practice in clinical situations, Nursing Standard, Vol. 15, No. 41, pp 40-44. Meijel, van B. Game, C. Swieten-Duijfjes, van B. Grypdonck, M.H.F. (2003) The development of evidence-based nursing interventions: methodological considerations, Journal of Advance Nursing, Vol. 48, No. 1, pp 84-92. Parry, G. (2000) Evidence-based psychotherapy In: Rowland N. Goss S. (Eds) Evidence-Based Counselling and Psychological Therapies Research and Applications, London, Routledge. Ridsdale, L (1998) (Ed) Evidence-based Practice in Primary Care, London, Churchill Livingston. Rowland, N. Goss, S. (2000) (Eds) Evidence-Based Counselling and Psychological Therapies Research and Applications, London, Routledge. Sackett, D.L. Richardson, W.S. Rosenberg, W. Hayes, R.B. (1997) Evidence-based medicine: how to practice and teach EBM, London, Churchill Livingston. Scholing, A. Emmelkamp, P.M.G. (1999) Prediction of treatment outcomes in social phobia: a cross-validation, Behaviour Research and Therapy, Vol. 37, pp 659-670 Seedhouse, D. (1998) Ethics The Heart of Health Care 2nd Edition, Chichester, Wiley. Sullivan, P. (1998) Developing evidence-based care in mental health nursing, Nursing Standard, Vol. 12, No. 31, pp 35-38

Online Dating Essay - 3636 Words

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