Granularity Effect of Patient’s Medication Compliance Moderated by

Communicator

Bugi Satrio Adiwibowo

, Suryari Purnama

and Andi Rahmat Saleh

Communication Science Faculty, Esa Unggul University, Jl. Arjuna Utara No.9,

Duri Kepa, Kb. Jeruk, 11510, Jakarta Barat, Indonesia

Economy and Business Faculty, Esa Unggul University, Jl. Arjuna Utara No.9,

Duri Kepa, Kb. Jeruk, 11510, Jakarta Barat, Indonesia

Keywords: Granularity, Communicator, Compliance, Specialist Doctor, Co-assistant Doctor.

Abstract: Information about the time to take medication to patients is very important to be considered by each

hospital. Many hospital communicators in this study (specialist doctors or co-assistants) who provide

information about the time to take medication using the word 3 times a day, so that there are often

differences in perceptions received by patients that affect adherence to taking medication. The use of fine

granularity (every 8 hours) is once thought to be more precise than coarse granularity (3 times a day).

Objective: Analyze fundamentally (exploratory research) the effect of granularity on patient compliance

with medication moderated by communicators. Method: The study was conducted by collecting quantitative

data with a questionnaire distributed to 120 respondents. This data is analyzed using two ways ANOVA.

Results: Information about the time to take medicine delivered by expert communicators using fine

granularity every 8 hours once more increases the patient's need to take medication. The contribution of this

study is so that specialists at the Hospital can use the word every 8 hours for the time to take medication to

further improve the health of the Indonesian people.

1 INTRODUCTION

Lately, there are a lot of doctors in hospitals that

provide information about the time to take

medication to patients by using the word 3 times a

day rather than the word every 8 hours. The use of

the word 3 times a day often leads to differences in

perceptions received by the patient and will lead to

patient disobedience for taking medication. So that

the effect of the medicine is not optimal or even

cause excessive side effects. Therefore, the role of

the communicator, namely the doctor in relation to

the recipient of information, namely the patient, is

an important thing that must be given attention to all

of us, in order to provide information about the

timing of taking the medicine more clearly. So that

the welfare of the Indonesian community will be

increased.

This issue was first placed from the context made

by Grice's (1975), the logic of conversation, which

provides a conceptual framework for understanding

how recipients of information get substantially

different conclusions that are equivalent to speech

speakers.

It was first predicted and observed that the

granularity effect of the communicator's quantitative

speech influenced the recipient's confidence in the

accuracy of the information. In study 1 conducted by

Zhang and Schwarz (2012) states that consumers put

a window of time around the time that will be

fulfilled from a project by showing the fastest time

and the longest time they think of the project to be

completed. This time window resembles a shrinkage

of the confidence interval with the granules of

quantitative expression, where completion time is

expressed as "1 year" coming with a window of 140

days, but this time window shrinks to 84 days and at

the same time is presented as “52 weeks”.

This effect seems to reflect that the recipient of

the information draws pragmatic conclusions from

the form of communicator speech, which is

consistent with the Gricean logic of conversation.

Thus, both granularity should only influence

consumer conclusions under conditions where they

can assume that the communicator is cooperative,

that is, follow the Gricean norms in conducting

conversation (Schwarz, 1996). Empirically this case

occurs when the communicator is cooperative.

Adiwibowo, B., Purnama, S. and Saleh, A.

Granularity Effect of Patient’s Medication Compliance Moderated by Communicator.

DOI: 10.5220/0009561900130019

In Proceedings of the 1st Inter national Conference on Health (ICOH 2019), pages 13-19

ISBN: 978-989-758-454-1

This research is a replication of the Journal of

Consumer Research Inc. entitled "How and Why 1

Year Differs from 365 Days: A Conversational

Logic Analysis of Inferences from the Granularity of

Quantitative Expressions" by Y. Charles Zhang and

Norbert Schwarz "in 2012. Results from study 1

conducted by Zhang and Schwarz, recipients of

information go beyond the literal meaning of

communicator sayings and they are present to

choose granularity in interpreting the approximate

meaning of time. In accordance with predictions

from Grice's (1975) Logic of Conversation, it can be

concluded that when communicators express using

fine granularity it turns out to have a higher level of

precision than when communicators express using

coarse granularity. It was first predicted and

observed that the granularity effect of the

communicator's quantitative speech influenced the

recipient's confidence in the accuracy of the

information. In study 1 conducted by Zhang and

Schwarz (2012) states that consumers put a window

of time around the time that will be fulfilled from a

project by showing the fastest time and the longest

time they think of the project to be completed. This

time window resembles a shrinkage of the

confidence interval with the granules of quantitative

expression, where completion time is expressed as

"1 year" coming with a window of 140 days, but this

time window shrinks to 84 days and at the same time

is presented as "52 weeks".

This effect seems to reflect that the recipient of

the information draws pragmatic conclusions from

the form of communicator speech, which is

consistent with the Gricean logic of conversation.

Thus, both granularity should only influence

consumer conclusions under conditions where they

can assume that the communicator is cooperative,

that is, follow the Gricean norms in conducting

conversation (Schwarz, 1996). Empirically this case

occurs when the communicator is cooperative.

This research is a replication of the Journal of

Consumer Research Inc. entitled "How and Why 1

Year Differs from 365 Days: A Conversational

Logic Analysis of Inferences from the Granularity of

Quantitative Expressions" by Y. Charles Zhang and

Norbert Schwarz "in 2012. Results from study 1

conducted by Zhang and Schwarz, recipients of

information go beyond the literal meaning of

communicator sayings and they are present to

choose granularity in interpreting the approximate

meaning of time. In accordance with predictions

from Grice's (1975) Logic of Conversation, it can be

concluded that when communicators express using

fine granularity it turns out to have a higher level of

precision than when communicators express using

coarse granularity.

Based on the results of these studies, we will

conduct a follow-up study of Study 1 conducted by

Zhang and Schwarz (2012) regarding "Estimate of

Precision" which explains that communicators who

express with fine granularity are estimated to have a

higher level of precision. When the doctor speaks to

his patient in giving an explanation of the time to

take the medication, the explanation for the

medication is often heard three times a day. But

there are also some doctors who provide an

explanation of the time to take medicine every 8

hours. From the doctor's information about the time

to take the medicine has different perceptions

received by the patient. The information received by

these patients is two different things where the

effects of information provided when

communication occurs between the doctor and the

patient can affect the patient's adherence to taking

medication. Besides that, communicators in this case

specialist doctors or co-assistants have an important

role in influencing patient compliance to take

medication. The importance of explaining the time

to take the medicine is very influential on the

effectiveness of the medicine that will be felt by the

patient, therefore researchers feel it is important to

discuss this so that it can be used as a reference that

each doctor should be able to provide more accurate

information on taking medication so that the patient

can obey him.

In this study, it was found that patient

compliance with medication was strongly influenced

by the information conveyed by the communicator,

in this case, a specialist or co-assistant. Information

conveyed in conversations between patients and

specialist doctors or co-assistants regarding the time

taken to take the medicine is in the form of fine

granularity, which is 3 times a day and coarse

granularity which is every 8 hours. This study will

prove whether there is a difference between fine

granularity and coarse granularity to patient

compliance with medication? Is there an influence

from patient compliance with medication that is

moderated by a specialist or co-assistant?

2 THEORY

2.1 Customer Behavior

According to Schiffman and Kanuk (2004), the

notion of consumer behavior is the behavior shown

by consumers in the search for purchases, use,

ICOH 2019 - 1st International Conference on Health

evaluation, and replacement of products and services

that are expected to satisfy their needs. Many

understandings of consumer behavior by experts,

one of which is defined by Umar (2003), namely

"consumer behavior is direct action in obtaining,

consuming and spending products and services,

including the decision process that precedes the

action".

2.2 Health Communication

Health communication is the process of delivering

health messages by communicators through certain

channels or media to the communicant with the aim

of encouraging human behavior to achieve

prosperity as strength which leads to a healthy

(mental) and social (status) condition. Health

communication is narrower than human

communication in general. Health communication is

closely related to how individuals in society try to

maintain their health, dealing with various issues

related to health. In health communication, the focus

includes specific health relationship transactions,

including various factors that influence the

transaction in question.

In the level of communication, health

communication refers to areas such as national and

world health programs, health promotion, and public

health plans. In the context of small groups, health

communication refers to areas such as meetings

discussing treatment planning, staff reports, and

medical team interactions. In the context of

interpersonal, health communication is included in

human communication which directly affects

professionals and professionals with clients. Health

Communicalevation is seen as part of the relevant

fields of science, the focus is more specific in terms

of health services.

2.3 Granularity Effect

The above reasons imply that Gricean's

consideration will influence the choice of

communicators of granularity where they reveal

quantitative information as well as conclusions of

recipients of this choice. In general, quantitative

communications provide more information when

quantities are represented in the form of fine

granularity rather than coarse forms. This is the

clearest example, estimates show "$ 5,000-$ 6,000"

or "$ 1,000 - $ 10,000," here, the choice of the width

of the interval strengthens the communicator's

confidence in the accuracy of his estimates. Not

surprisingly, information recipients prefer narrow

intervals, which provide further information. In

addition, they are willing to sacrifice formal

accuracy to assess information. For example, when

the actual value is $ 22.5 billion, 80% of participants

expect "$ 18- $ 20 billion" to exceed the estimates of

"$ 20- $ 40," Although the last interval includes the

correct value and the non-forming (Yaniv and

Foster, 1995).

We assume that recipients are sensitive to the

communicator's granularity choices and take them

into account when they interpret communicators'

sayings. Therefore, we predict (i) that recipients that

the recipient of the information will see the time

estimate more precisely if the information conveyed

use fine granules rather than coarse granularity,

produced (ii) in the estimation of narrow intervals.

These effects should not be observed when

recipients doubt that the speaker is a cooperative

communicator. When many variables can damage

the perception of recipients from cooperativeness

communicators (Levinson, 1983 and Schwarz,

1996).

Finally, the pragmatic conclusions of consumers

tend to have behavioral consequences. If the same

estimates are expected to be more precise when

delivered in fine-granularity units, (iv) consumers

must be more confident that the products provided

are promised when quantitative promises are

expressed well rather than coarse units that influence

their product choices (study 4). When we assume

that this prediction of granularity applies to all

quantity of expressions, this study tests them in the

area of the estimated time. Consumer perception

about time is an important element in many aspects

of consumer habits, from planning. (Leclerc,

Schmitt, and Dube, 1995. Ulkiimen, Thomas, and

Morwitz, 2008) and menu (Kumar, Kalwani, and

Dada, 1997) toward product service and evaluation

(Mogilner, Aaker, and Pennington, 2008).

2.4 Compliance

Obedient means to like and obey orders or rules, and

be disciplined. Compliance means obedience,

submission to teachings or rules. Compliance is the

level of behavior of patients who are directed

towards the instructions given in any form of

therapy that is determined either diet, exercise,

treatment or keeping an appointment with a doctor

(Stanley, 2007). Compliance is a change in behavior

from behavior that does not adhere to behaviors that

comply with regulations (Green in Notoatmodjo,

2003).

Granularity Effect of Patient’s Medication Compliance Moderated by Communicator

According to Tyler (2004), there are two basic

perspectives in the sociology literature regarding

compliance with the law, which are called

instrumental and normative. The instinctual mental

perspective assumes that the individual as a whole is

driven by personal interests and responses to

changes intangible, incentive, and penalties related

to behavior. The normative perspective relates to

what people perceive as moral and contrary to their

personal interests (Saleh, 2004; Prabowo, 2008;

Sulistyo, 2010). In terms of delivering financial

reports to the public, the instrumental perspective

illustrates that the incentives obtained by the

company when delivering its financial statements on

time are the response of the public to the company

itself, and vice versa. Whereas for the second

perspective, an individual tends to comply with the

provisions, in this case, the timeliness of financial

reporting because it is considered as a normative

commitment through morality and because the

authoring authority of the provision dictates

behavior to report its financial condition at the

specified time (normative commitment through

legitimacy) in this case is Bapepam.

3 RESEARCH METHOD

The thinking framework in this study described

above can be seen in the picture below:

Figure 1: Thinking Framework.

Therefore to prove whether the patient is more

obedient for the time to take the medication with

coarse granularity (3 times a day) or fine granularity

(every 8 hours) and has a higher level of precision

when explained by a specialist than a co-assistant,

the authors propose several hypotheses:

H1: It is assumed that the level of patient

compliance for taking medication using fine

granularity (every 8 hours) is better than coarse

granularity (3 times a day).

H2: Alleged communicator expertise (specialist)

modera- tes granularity and compliance.

This study uses the setting of medical services in

a polyclinic at a General Hospital, with participants

being male and female students. The criteria for

study participants are school students aged 17-18

years. The study was conducted on high school

students. The total number of participants needed is

120 people with details of 30 people for each group.

To see the effect of fine granularity and coarse

granularity on compliance that is moderated by

communicators, ANOVA is used as a data analysis

tool in this research activity by comparing, so that it

can find out the results of relevant research.

The type of data used in this study is qualitative

data. The data needed are primary data, namely data

obtained directly from the object of research in the

form of responses, suggestions, criticisms, questions,

and assessments of the object of research as

respondents, explanations, and information on the

results of direct observation. The data collection

technique needed is to conduct surveys through field

research (Field Research) by visiting directly to the

object under study. The technique of data collection

is done by questionnaire, namely a number of

written questions that are used to obtain information

from respondents.

In collecting data there are two types of data

clustering that are often used in the process of

grouping data namely hierarchical data clustering

and non-hierarchical data clustering. K-means is one

method of non-hierarchical clustering that seeks to

divide existing data into clusters or groups so that

data that has the same characteristics are grouped

into one and the same cluster of data that has

different characteristics grouped into other groups.

This study uses non- hierarchical data clustering

methods. To analyze the variables of the two

concepts studied, they can be described in the

instrument grid table as follows:

Table 1: Instrument Grid.

Analysis of research is done by categorizing each

participant's answer into a number symbol. For

example, in the granularity variable, the group of

"fine granularity" with the number "1", the group

"coarse granularity" with the number "2". Whereas

in the communicator variable, the group of specialist

ICOH 2019 - 1st International Conference on Health

doctors is coded with the number "1", the co-

assistant with the number "2". After giving the code

to each participant's answer, the researcher checks

the answer to the manipulation check.

Participants who did not give the answer as

expected in the manipulation check sheet were not

included in the hypothesis test. In this study,

descriptive analysis was used to describe the

granularity profile in each group. This analysis is

needed to test the uniformity (homogeneity) of the

granularity profile in the group variable between-

subject. Because the independent variables use

categorical data, the dependent variable uses single

continuous data and there are moderating variables,

the analytical methods carried out in this study are

two ways ANOVA.

Because independent variables use categorical

data and dependent variables using single

continuous data, in general, there is an analysis

method carried out in this study, namely ANOVA

which is an analytical technique that aims to test

whether the average of more than one sample is

significantly different or not, and test whether the

sample has the same population variance or not,

using the ANOVA model:

yij = µ + τi + εij, i = 1, 2, ...a

j = 1, 2, ...ni

(1)

Inf.:

yij: the value of the response variable in the

treatment for the j-th observation

τi: the effect of the second treatment

εij: random error

a: number of categories in treatment

ni: the number of observations in the i category

4 RESULT

SMAN 18 Tangerang Regency students have the

character of teenagers in general. On average they

come from disadvantaged families with a

background of less-educated parents. The SMAN 18

school environment is good enough to shape the

character of students to be better even though their

home environment is less supportive. Cleanliness,

good manners and discipline of students is quite

good. The students who became the object of the

study were 45 grade, 1 students of science 1, as

many as 45 people, 40 Natural Sciences Classes as

many as 40 people, IPS 1 grade students as many as

45 people and IPS 2 students as many as 38 people.

4.1 Hypothesis Test 1

Allegedly the level of patient compliance for taking

medication using fine granularity (every 8 hours) is

better than coarse granularity (3 times a day).

H1: test the hypothesis about the difference in mean

Y deviation between each cell formed by the

level of granularity factor. There is an average

difference in the obstruction of compliance [Y]

between each cell formed by granularity.

Table 2: General Linear Model ANOVA Test Result Tests

of Between-Subjects Effects.

Based on the table above hypothesis 1 is not

proven (rejected) because after testing it turns out

the significance of granularity in the table is 0.191.

These results are> 0.05 which means if Sig> 0.05,

then H1 is rejected.

4.2 Hypothesis Test 2

Presumably communicator expertise moderate’s

granularity and compliance. H2: Test the hypothesis

for each β2, β3. The hypothesis can be either a one-

party or two-party hypothesis. Especially for

specialists [communicators = 2], the average

deviation of compliance [Y] between the degree of

fine granularity [fine = 1] is greater than the degree

of coarse granularity [coarse = 2].

Table 3: General Linear Model ANOVA Test Result

Parameter Estimates.

Granularity Effect of Patient’s Medication Compliance Moderated by Communicator

Regression model equation:

Y = β0 - β1 [granularity = 1] x [communicator = 1]

+ β2 [granularity = 1] x [communicator = 2] - β3

[granularity = 2] x [communicator = 1] + ɛ where

value 1 = fine and coarse 2 = co-assistant. To test the

hypothesis, it is necessary to prepare a table

‘intercept‘ parameter β i

Table 4: Intercept parameter β i.

The contents of each cell are an intercept so that

the difference obtained is the difference in the

intercept.

Table 5: Different in the intercept.

Based on the table 'intercept' parameter β I show

that the results of the special difference are β2. Then

it can be seen in the estimated parameter table of the

β2 significance value is 0.005. These results are

worth <0.05, which means that hypothesis 2 is

proven (accepted).

5 DISCUSSION

In this study, after testing hypothesis 1, it was

assumed that the level of patient adherence to taking

medicines using fine granularity (every 8 hours) was

greater than using coarse granularity (3 times a day)

and the results of hypothesis 1 were not proven. The

unproven cause of hypothesis 1 is that in testing

hypothesis 1 the results are not significant. The

possible causes of the results are not significant is

the possibility caused by the respondents used in this

study are high school students of grade 3 with an

average age of 17-18 years, which when viewed

from the age of those who still do not have sufficient

knowledge and understanding that influence the

answers from questionnaire distributed by resear-

chers.

After testing hypotheses 2, the guess that the

communicator's expertise moderated granularity and

compliance showed that the results of hypothesis 2

were proven. The proven cause of the hypothesis is

that in testing hypothesis 2 the results are significant.

The influence of an expert communicator in this

matter is a specialist who provides information about

drinking time using fine granularity which shows

that patients will be more obedient. The reason for

the patient's compliance may be that patients who go

to a specialist have a serious illness and need to be

treated correctly and precisely because of that the

patient will be more obedient. Other causes of

patient compliance for taking medication every 8

hours delivered by specialists are due to the high

confidence and trust of patients to specialist doctors.

6 CONCLUSIONS

Based on the research conducted by Zhang and

Scwarz (2012), the researchers are very interested in

conducting more exploratory and fundamental

research by conducting experimental research. First,

pre-research is done by making 5 scenarios or story

questions that tell about as if the respondent is sick

and, in a hospital, and getting treatment by a

specialist or co-assistant. From the five illustrations,

the researchers asked 10 people to read and choose

which scenario was good and make the reader as if

they were in a situation created in the story scenario.

Then to ask about the time to take medicine for

the dependent variable (compliance), 5 questions

were made. Then the 5 questions are distributed to 5

people and ask which sentence is easily understood

by the respondent. After getting the best results from

the pre-study, the researchers made 4 booklets

consisting of fine granularity groups with specialist

doctors (booklet 1), the fine granularity with co-

assist- ants (booklet 2), the coarse granularity with

specialist doctors (booklet 3) and coarse granularity

with co-assistant (booklet 4). After that, the

researcher made 30 booklets for each booklet. So

that the total of all booklets is for 120 respondents

then distributed at the same time randomly or

randomly to each respondent in this study who were

respondents were students of SMAN 18 Tangerang

Regency.

After each booklet was collected based on the

group, then the data obtained was entered into excel.

After data processing was performed using two ways

ANOVA method, it was found that hypothesis 1 said

that it was assumed that the level of patient

compliance for taking medication using fine

granularity (every 8 hours) greater than coarse

granularity (3 times a day) was found not proven

ICOH 2019 - 1st International Conference on Health

because the results were not significant. So,

hypothesis 1 is rejected.

Hypothesis 2 which states that alleged

communicator expertise moderates granularity and

compliance it turns out that after data analysis is

found significant results so that hypothesis 2 is

accepted. Based on the testing of hypothesis 2, it is

seen specifically for groups that communicate with

specialists with fine granularity patterns showing

patients to be more obedient in taking medication

compared to specialist communication patterns with

coarse granularity. The authors conducted this study

by using experimental studies. The data analysis

with non-hierarchical clustering data using the K-

means method is still very rarely used because there

is no supporting theory.

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