Keeping the Customer Satisfied: Applying a Kano Model to Improve Vaccine Promotion in the Philippines

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FIGURE 1
Relationships Between Types of Quality Attributes and End-User Satisfaction in the Kano Model
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FIGURE 2
Mapped Kano Importance Coefficients

TABLE 1.

The 6 Types of Attribute Classifications in the Kano Model

Quality Attribute	Definition
Must-be (M)	Basic requirements of a product: Absence of must-be attributes leads to increased dissatisfaction, but their presence is not associated with increased satisfaction.
Attractive (A)	Cherries on top: Absence of attractive attributes does not cause dissatisfaction, but their presence increases satisfaction considerably.
One-dimensional (O)	The more the better: Satisfaction increases linearly with the degree to which a one-dimensional attribute is present.
Reverse (R)	Presence of reverse attributes causes dissatisfaction, but their absence is appreciated.
Indifferent (I)	Whether present or absent, indifferent attributes don't lead to an increase in satisfaction or dissatisfaction.
Questionable (Q)	Response patterns to the Kano questionnaire are contradictory (e.g., when a respondent indicates that an attribute must be present and must not be present at the same time).

TABLE 2.

Functional and Dysfunctional Questions and Their Response Options

Question	Response Options
Functional question: How would you feel if attribute X were present in the final product?	(a) I like it that way. (b) It must be that way. (c) I am neutral. (d) I can live with it that way. (e) I dislike it that way.
Dysfunctional question: How would you feel if attribute X were not present in the final product?

TABLE 3.

Attributes Included in the Kano Questionnaire and Their Descriptions

ID	Attribute	Description
	Intervention characteristics
A1	Video	Preference to receive vaccine information as a video
A2	Cartoon	Preference to receive vaccine information in animated form
A3	Short duration	Preference for a short communication product (less than 5 minutes)
A4	Text	Preference for a video-based intervention to include written text, such as subtitles
A5	Resource information	Preference to receive a pamphlet after the intervention which highlights further resources and lists contact addresses
A6	Key message summaries	Preference to receive a pamphlet which summarizes the key messages of the communication product
	Intervention distribution
B1	Shareability	Preference to be able to share the communication product via Facebook or other social media
B2	Trusted messenger	Preference for the communication product to be distributed by a known and trusted person
B3	Health center location	Preference for the communication product to be screened/distributed at the health center
B4	Privacy	Preference to be alone when watching the communication product
B5	National logo	Preference for the communication product to include the logos of national organizations and authorities
B6	International logo	Preference for the communication product to include the logos of international organizations and authorities
	Intervention content
C1	Fact-based	Preference for the product to focus on presenting scientific facts
C2	Story-based	Preference for the product to include narratives and stories of individuals

TABLE 4.

Classification Assignment in the Kano Model^{^a}

	Dysfunctional Question (Attribute Not Present)
	1: Like	2: Must-Be	3: Neutral	4: Live With	5: Dislike
Functional question (Attribute present)
1: Like	Q	A	A	A	O
2: Must-Be	R	I	I	I	M
3: Neutral	R	I	I	I	M
4: Live With	R	I	I	I	M
5: Dislike	R	R	R	R	Q

Abbreviations: A, attractive; I, indifferent; M, must-be; O, one-dimensional; Q, questionable; R, reverse.
↵a For example, if a respondent answers the functional question with “I like it that way” and the corresponding dysfunctional question with “I dislike it that way,” then the respective attribute is classified as one-dimensional.

TABLE 5.

Sociodemographic Characteristics of the Study Sample

Characteristics	No. (%) (N=205)
Gender
Female	200 (98)
Male	5 (2)
Educational background
Never attended school	2 (1)
Elementary	22 (11)
High school undergraduate	26 (13)
High school graduate	90 (44)
Vocational education	9 (4)
College undergraduate	32 (16)
College graduate	23 (11)
Graduate studies	1 (<1)
Occupation
Housewife	106 (52)
None	32 (16)
Business (e.g., service and sales workers)	19 (9)
Self-employed (e.g., online business, retail)	16 (8)
Professional (e.g., doctors, engineers, IT)	13 (6)
Manual laborer (e.g., craft and related trade workers)	12 (6)
Farmer	0 (0)
Fisherman	0 (0)
Others	7 (3)
Vaccination behavior
Previously delayed or refused vaccination	56 (27)
Previously delayed vaccination	41 (20)
Previously refused vaccination	21 (10)
Would vaccinate their child today	196 (96)
Previous sources of vaccination information (multiple answers possible)
Barangay health workers	104 (51)
Family members	69 (34)
Midwives	48 (23)
Social media	39 (19)
Television	33 (16)
Nurses	27 (13)
Friends	22 (11)
Doctors	11 (5)
Newspapers	10 (5)

TABLE 6.

Kano Classifications and CCA Results

	Individuals Classifying Attribute as A/O/M/I/R/Q Type, %						Resulting Classification			Estimated Binary Truth Value	CCA Item Truth	Item Difficulty
Attribute	A	O	M	I	R	Q	Original	Revised	CCA	Estimated Binary Truth Value	CCA Item Truth	Item Difficulty
A1 video	31	6	4	38^{^a}	11	11	I	I	I	0	0.02	0.74
A2 cartoon	13	1	8	42^{^a}	28	8	I	I	I	0	0.00	0.30
A3 short duration	6	2	12	52^{^a}	22	5	I	I	I	0	0.00	0.24
A4 text	24	20	26^{^a}	25	3	0	M	M	M	1	1.00	0.42
A5 resource information	29^{^a}	21	18	29	1	1	A	A	A	1	1.00	0.48
A6 key message summaries	22	23	20	33^{^a}	1	1	I^{^b}	O^{^b}	O^{^b}	1	1.00	0.53
B1 shareability	27	20	17	30^{^a}	5	2	I^{^b}	A^{^b}	A^{^b}	1	1.00	0.59
B2 trusted messenger	11	12	27	36^{^a}	4	10	I^{^b}	M^{^b}	M^{^b}	1	0.69	0.88
B3 location	29	13	9	31^{^a}	2	16	I^{^b}	A^{^b}	I^{^b}	1	0.45	0.88
B4R company	23	9	7	38^{^a}	10	13	I	I	I	0	0.01	0.72
B5 national logo	19	40^{^a}	19	20	1	0	O	O	O	1	1.00	0.25
B6 international logo	18	24	22	34^{^a}	1	1	I^{^b}	O^{^b}	O^{^b}	1	1.00	0.54
C1 fact-based	10	57^{^a}	22	11	0	0	O	O	O	1	1.00	0.09
C2 story-based	13	30^{^a}	29	26	1	1	O	O	O	1	1.00	0.40

Abbreviations: A, attractive; CCA, cultural consensus analysis; I, indifferent; M, must-be; O, one-dimensional; Q, questionable; R, reverse.
↵a Represents the modal classification.
↵b Instances where classification varied between different classification approaches.