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Factors that motivate young people’s intention to undergo cosmetic surgery in

Vietnam

Article in International Journal of Pharmaceutical and Healthcare Marketing · April 2020

DOI: 10.1108/IJPHM-07-2018-0035

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 Page 7 of 22 International Journal of Pharmaceutical and Healthcare Marketing
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Factors that motivate young people's intention to undergo cosmetic surgery in
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5 Vietnam.
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Abstract:
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10 Purpose-The main objective of this study is to assess the factors that motivate young people’s
11 intention to undergo cosmetic surgery in Viet Nam.
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Design/methodology/approach- This study applies Ajzen's Theory of Planned Behavior as a
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14 research model. The study is based on the quantitative method, which applied exploratory factor
15 analysis.
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Findings- In total, 412 valid responses are used for the statistical analysis. The results confirm that
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18 subjective norm, attitude toward cosmetic surgery, and perceived behavioral control are the main
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19 factors that motivate young people's intention to undergo cosmetic surgery.
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Originality/value- The results show the positive relationship between attitude toward cosmetic
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surgery, subjective norm, perceived behavioral control, and intention to undergo cosmetic surgery
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23 in Viet Nam.
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24 Paper type-Research paper

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26 Keywords – Customer Intention, cosmetic surgery, Theory of Planned Behavior, young people.
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28 Introduction
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People typically choose forms of cosmetic surgeries because they want to improve their physical
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31 attractiveness and feel satisfied with their appearances. Individuals, moreover, have the desire to
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33 be more beautiful and closer to ideal social images with the belief that they would be treated better
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35 with an attractive appearance (Langlois et al., 2000). Haas et al. (2008) defined that motivation for
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plastic surgery is based on a combination of psychological and emotional factors. Specifically, the
38 intention of medical cosmetic surgery requires a lot of complicated emotions and feelings.
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40 Furthermore, making a face and body more beautiful is just one of so many advantages of cosmetic
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42 surgery because this kind of technique can help patients accept themselves better and improve their
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psychological states (Hasan, 2000). In Asia, the cosmetic surgery market is also crowded.
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45 According to the research of ISAPS (2017), there are 4 Asian countries appeared in the chart with
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the first rank being Japan (1,137,976), the second being India with 878,180 procedures, the next
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49 coming up with Chinese - Taipei with 387,815 and the last one being Thailand with 112,821
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procedures. Thanks to the development of technology, the level and quality of plastic surgeons in
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52 Vietnam has been significantly improved. Besides, a young population with about 94 million
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54 people, along with the rapidly growing demands for beauty, the plastic surgery industry has played
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 International Journal of Pharmaceutical and Healthcare Marketing Page 8 of 22
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3 an essential position and become one of the most potential services in Vietnam. According to the
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5 theory of planned behavior (Ajzen, 1991), there are a large number of factors that motivate people
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7 to have cosmetic surgery such as subjective norm, perceived behavioral control, and so on. In order
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to solve all these problems, it is essential to research the factors related to survey problems by using
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10 both qualitative and quantitative research. This research methodology is significant and useful for
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12 businesspeople in the plastic surgery industry who want to understand better the intentions that
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14 affect people’s choice of undergoing cosmetic surgery. Besides, the main target of research is to
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investigate the intention of undergoing cosmetic surgery of young people in Viet Nam.
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19 Literature Review
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Ajzen’s Intention Model in Cosmetic Surgery
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22 (Please insert Figure 1)
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24 Figure 1: The constructs of the theory of planned behavior.

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26 Following the analysis belonging to chapter 2, Ajzen's model had shown that it could give the
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27 advantages to analyze the intention of young people to cosmetic surgery for a more exact purpose.
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29 Also, it had been proved by Sivell et al., (2013) that Ajzen Model is a predictor of this field. This
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31 model, furthermore, had been practically used in academics. Therefore, the Ajzen model is the
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most suitable model for this research. Besides, quantitative methods are integral parts of our study.
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34 According to Babbie (1973), quantitative methods emphasize objective measurements and

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36 the statistical, mathematical, or numerical analysis of data collected through polls, questionnaires,
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38 and surveys, or by manipulating pre-existing statistical data using computational techniques.
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Quantitative research focuses on gathering numerical data and generalizing it across groups of
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41 people or explaining a particular phenomenon. Zhang and Creswell (2013) claimed that the
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43 quantitative approach allowed researchers to make use of post-positivist cases for creating learning.
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45 This approach is referred to as a valid procedure. This study analyses, therefore, mainly focus on
46 primary data collected from our designed survey; and secondary data collected through public
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48 studies, which are used as a reference. The relationship between independent variables and
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50 dependent variables of cosmetic surgery’s intention will be able to be analyzed by using
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quantitative research. The data collected will be analyzed by computational techniques. Hence, this
53 study concentrates on data analysis, logic, and mathematical testing methods.
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 Page 9 of 22 International Journal of Pharmaceutical and Healthcare Marketing
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5 Cosmetic Surgery
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7 Cosmetic surgery is defined, for a healthcare payer, like any invasive procedure where the primary
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intention is to achieve what the patient perceives to be a more desirable appearance and where the
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10 procedure involves changes to bodily features that have a normal appearance on presentation to
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12 the doctor (Dean et al., 2018). Cosmetic surgery is not essential for everyone. Most cosmetic
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14 surgeries are implemented on the people who feel unsatisfactory with their appearance. Dean et al.
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(2018) explain that cosmetic medical and surgical procedures are surgical operations and other
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17 procedures that revise or change the appearance, colour, texture, structure or position of natural
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19 bodily features with the sole intention of achieving what the patient perceives to be a more desirable
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appearance or boosting the patient's self-esteem. A surgeon should consult the patient before
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22 surgery if he believes there is an underlying problem that cannot be solved by the surgery or if the
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24 patient shows signs of Body Dysmorphic Disorder (Hannan, 2017). There are several types of
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26 procedure which are available at present. For example, people who undergo cosmetic surgery are
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27 more likely to experience psychological issues (Hannan, 2017). Voelker and Pentina (2011)
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29 examined attitudes towards, and utilization of, cosmetic augmentation procedures among
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31 Generation Y individuals. Cosmetic augmentation is defined as the utilization of advanced
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technologies to augment the appearance of otherwise healthy individuals. Examples of cosmetic
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34 augmentation include plastic surgery and laser surgical procedures. A social exchange framework
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36 is advanced, suggesting that an individual's access to others who have utilized cosmetic
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38 augmentation increases the positive attitude towards cosmetic procedures. Voelker and Pentina
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(2011) confirm that a social exchange model for intention to utilize laser cosmetic procedures as
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41 well as a positive relationship between the diversity of a subject's ego network and access to others
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43 who have utilized some form of cosmetic augmentation. In terms of personal experience, the
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45 common experience of cosmetic surgery (via family and friends) increased the likelihood of
46 undergoing cosmetic surgery for women, but not for men (Brown et al., 2007). On the other hand,
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48 The Theory of Planned Behavior (TPB) details the determinants of an individual’s decision to enact
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50 a specific behavior. In detail, TPB has been applied in cosmetic surgery and has shown that it can
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become a predictor in this field (Sivell et al., 2013). The current study assesses the robustness of
53 the Theory of Planned Behavior in predicting and explaining factors motivating people to take
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55 surgery cosmetic and providing a test of the model.
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3 Attitude toward Cosmetic Surgery
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5 The first concept in this list is behavioral beliefs. According to Aizen (1991), “behavioral beliefs
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7 link the behavior of interest to expected outcomes. A behavioral belief is a subjective probability
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that the behavior will produce a given outcome" (Ajzen, 1991). This factor may bring a favorable
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10 or unfavorable attitude toward the behavior. The reliable affiliation between the attention of
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12 cosmetic surgery and lower self-rating of physical attractiveness and negative body image are
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14 confirmed (Brown et al. 2007; Crerand et al. 2006; Swami et al. 2009a). In another research that
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belongs to Swami et al. (2012), the result also points out the relation between body appreciation
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17 and self-esteem with the acceptance of cosmetic surgery. The lower self-rating and negative body
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19 image, as a result, reflect a favorable attitude toward cosmetic surgery. Personality traits such as
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self-esteem, conformity, and extraversion are found to influence the attitude toward cosmetic
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22 surgery (Swami et al., 2009). Furthermore, Furnham and Levitas (2012) studied 204 British
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24 participants to assess their attitude toward cosmetic surgery as well as measures of self-esteem, life
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26 satisfaction, self-rated physical attractiveness, religiosity, and media consumption. Two factors
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27 emerged from a factor analysis of their attitudes toward surgery: likelihood to undergo and benefits
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29 of undergoing cosmetic surgery. Females with low self-esteem, low life satisfaction, low self-rated
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31 attractiveness, and little religious beliefs, which were heavy television watchers reported a higher
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likelihood of undergoing cosmetic surgery. Stepwise regression analysis with the two attitude
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34 factors as criterion variables showed two significant predictors for likelihood: religiousness and
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36 low self-esteem, and four significant predictors for benefit: religiousness, media consumption, life
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38 satisfaction, and sex (Furnham and Levitas, 2012). Moreover, the effect of the culture on the
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attitude toward cosmetic surgery is also confirmed through a study implemented by Jung and
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41 Hwang (2016) among South Korea and US female college students.
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43 In conclusion, attitude plays an essential role in the decision of a person to make cosmetic surgery.
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45 Thus, the first hypothesis can be drawn as follows:
46 H1: Attitude toward cosmetic surgery is positively related to cosmetic surgery intention.
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48 Subjective Norm
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50 The second concept mentioned is normative belief. Ajzen claims that "normative beliefs refer to
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the perceived behavioral expectations of such important referent individuals or groups as the
53 person's spouse, family, friends, and depending on the population and behavior studied as teachers,
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55 doctor, supervisor, and coworker” (Ajzen, 1991). Normative beliefs cause perceived social
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 Page 11 of 22 International Journal of Pharmaceutical and Healthcare Marketing
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3 pressure or subjective norm, which leads to the consequence of performing or not performing. The
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5 reason for having cosmetic surgery is to please or to secure a partner or a job. On gender difference,
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7 women are reported to have a higher likelihood of undergoing cosmetic surgery than men, older
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men expressed less desire to undergo cosmetic surgery than younger men, and lower self-ratings
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10 of physical attractiveness predicted a higher likelihood of undergoing cosmetic surgery (Brow et
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12 al.,2007). Moreover, people that look younger and more pleasant may get better and faster
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14 promotions, at work, and earn more money than their colleagues who are less attractive and look
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older (Rinzler, 2009). In a study in South Korea, Park and Cho (2011) revealed exposure to the
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17 media coverage of cosmetic surgery, interpersonal experiences with cosmetic surgery, and self-
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19 esteem predicted socio-cultural attitudes toward appearance and the perceived physical and
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psychological risks of cosmetic surgery. Furthermore, Ashikali et al. (2017) show that the
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22 advertising of cosmetic surgery has had a negative impact on women’s body image. Subsequently,
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24 the pressure of owning a good appearance has been increased. Hence, the subjective norm is a
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26 crucial element of cosmetic surgery.
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27 H2: Subjective norm is positively related to cosmetic surgery intention

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31 Perceived Behavioral Control
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In terms of control belief, which is the last concept in this theory, Ajzen reports that control beliefs
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34 have to go with the perceived presence of factors that may facilitate or impede behavior (Ajzen,
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36 1991). According to Ajzen (Ajzen, 1991), the perceived behavioral control is linked with people's
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38 perceptions of the ability to perform a given behavior, said. According to the TPB model, before
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generating an intention, the perceived behavioral control must be developed. The relationship
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41 between perceived behavioral control and behavioral intention has been proved by a large number
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43 of researchers (Mathieson, 1991). Besides, surgical costs have a significant impact on the patient’s
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45 choice (Chen, 2011). The more consumer income is, the more they are willing to pay for the
46 cosmetic surgery (Chen, 2011). Brown et al. (2007) reported that lower self-ratings of physical
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48 attractiveness lead to consideration of cosmetic surgery. In a study conducted in the US and
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50 Colombia, Carrion et al. (2011) suggested that participants from Colombia with greater disordered
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eating were more likely to endorse cosmetic surgery for social reasons, while those from the U.S.
53 were more likely to consider undergoing cosmetic surgery for personal reasons. Differing findings
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55 between the two samples may be due to cultural and social factors, which people delineate. In
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3 general, based on the influences of the perceived behavioral control, the third hypothesis was
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5 written as:
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7 H3: Perceived behavioral control is positively related to cosmetic surgery intention
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10 Research Methodology
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12 In general, the survey was conducted through both online and offline channels with the
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14 questionnaires for at least 400 participants; however, the total responses collected were 463. The
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questionnaires were initially written in Vietnamese to ensure respondents fully understand the
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17 contents. The online survey was distributed via a link on Google Form with all information
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19 collected are confidential and only used for the research purpose. The offline survey was
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distributed for potential customers at beauty saloon and cosmetic surgery clinics with the approval
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22 from the premise's managers. After filtering the data, 412 samples were selected. This research
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24 aims at exploring possibilities and reasons that people, especially the young generation, may have
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26 a concern in reconstructive surgery or plastic surgery. All items are measured on the Likert-7 scale,
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27 which ranges from 1: strongly disagree with the statements to 7: strongly agree with the statements
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29 (see the Appendix: the measurement of the constructs). The study also clarifies the benefits that
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31 customers claim or hope to achieve after their decision to reconstructive surgery. Behavioral
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intention is considered as the immediate antecedent to behavior. According to Ajzen (1991), there
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34 is no universal format for the TPB questionnaire. Formative research is required to establish a
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36 questionnaire that is appropriate for the behavior and population of interest, so the questionnaire
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38 was based on Ajzen’s study (2013). The first step of establishing the questionnaire is to define the
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behavior of the research. In other words, the behavior of interest must be clearly and carefully
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41 defined in terms of its context, target, context, and time factors. In this research, the primary
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43 purpose is to figure out the elements which influence the intention of undergoing cosmetic surgery.
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45 Therefore, the defined behavior is the choice of undergoing cosmetic surgery. The population is a
46 factor that will profoundly affect the performances and methods of research. The population of this
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48 research would be young people from 18 years old to 30 years old, both male and female. This
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50 population is diversified with several people with various jobs such as students, officers, business
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owners. In general, five to seven items are formulated to analyze each of the theory's primary
53 constructs, which are Attitude, Subjective Norm, Perceived Behavioral Control, and Intention.
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55 Moreover, this research applies the seven-point bipolar adjective scales for the evaluation of each
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 Page 13 of 22 International Journal of Pharmaceutical and Healthcare Marketing
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3 statement related to the behavior of undergoing cosmetic surgery. The items and questionnaire
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5 assessing intention, attitude, subjective norm, and perceived behavioral control will be shown
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7 below. Besides, items and instructions to the participants will be indicated in the next part of the
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questionnaire. Participants are invited to give answers to different items in the questionnaire by
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10 circling the number that best describes their points of view. The items are formulated to be exactly
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12 compatible with the behavioral criteria and to be self-directed.
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Data Analysis
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18 According to Tavakol and Dennick (2011), Cronbach’s Alpha reliability index is to indicate
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20 whether the measurements are linked or not; however, it cannot show which variable needs to be
21 eliminated and which needs to be kept. Therefore, the calculation of the correlation coefficient of
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23 variables and the total will help to eliminate variables that do not give much contribution to the
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25 description of the concept.
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27 (Please insert table 1.1)

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It is indicated in the table that, Cronbach’s Alpha of Attitudes Toward the Behavior is 0.928, which
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32 is higher than 0.7 and considered as appropriate. The results of Corrected Item-Total Correlation
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are all greater than 0.3; therefore, it is suitable to be used. Besides, according to the study’s results
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35 of Cronbach's Alpha, if Item Deleted, AB1 is 0.929, which is higher than Cronbach’s Alpha; as a
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37 result, it will be deleted while five items left to satisfy the requirements.
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39 (Please insert table 1.2)
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42 The Cronbach's Alpha of Subjective Norm is 0.92, which is higher than 0.7 and can be considered
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44 as appropriate. Among five items, SN1 cannot satisfy the requirements, which are its' Cronbach's
45 Alpha if Item Deleted is greater than Cronbach’s Alpha; consequently, it will be deleted while
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47 others will still be kept.

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50 (Please insert table 1.3)
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52 The Cronbach’s Alpha of Perceived Behavioral Control equals 0.877, which is greater than the
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54 requirement 0.7 and good for measure scale. The Corrected Item-Total Correction of those items
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3 is higher than 0.3, and there are no items with the Cronbach’s Alpha if Item Deleted is higher than
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5 Cronbach’s Alpha. According to Rahn (2018), Exploratory Factor Analysis aims to discover the
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7 relationships among the variables. Besides, Exploratory Factor Analysis (EFA) helps to find out
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the underlying structure of a large number of variables; therefore, data can be reduced to a much
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10 smaller set of variables. EFA is technically a data-driven approach, which means all items can load
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12 on all factors.
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(Please insert table 1.4)
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17 As can be seen from the table, KMO equals 0.886, which between 0.8 and 0.89; therefore, it is
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19 considered to be appropriate for further research. As a result, it indicates that exploratory factor
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analysis for independent variables is suitable and meaningful. Sig of Barlett’s test of sphericity is
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22 less than 0.05; as a result, the Sig of Barlett's test of sphericity certainly meets the condition.
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24 Besides, this also proves that the variables have overall correlations. Eigenvalues are 6.077, 2.417,
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26 1.186, respectively, and they are all greater than 1, which also satisfies the condition. Cumulative
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27 percentage equals 80.671%, which is much greater than 50%, which means these three factors
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29 explain 80.671% data variations in observed variables. As clearly indicated in the table that all
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31 factor loadings are greater than 0.5, which means they all meet the condition and have possible
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meanings. Finally, all the indications of EFA analysis satisfy the conditions. Variables, moreover,
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34 are formed and grouped, and all the independent variables are appropriate.
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37 (Please insert table 1.5)

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39 As can be seen in the above table, KMO is 0.8. Since this figure is between 0.8 and 0.89, it is
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41 considered to be appropriate for further research. As a result, it indicates that exploratory factor
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43 analysis for independent variables is appropriate and meaningful. Sig of Barlett's test of sphericity
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is less than 0.05; therefore, the Sig of Barlett’s test of sphericity certainly meets the condition.
46 Also, these figures prove that the variables have overall correlations. The eigenvalue is 3.287,
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48 which is greater than 1 and certainly satisfies the condition. Cumulative percentage equals 82.179,
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50 which is much greater than 50%, which means BI factor can explain 82.179% data variations in
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observed variables. It is clear from the table that all factor loadings are greater than 0.5, which
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53 means they all satisfy the condition and have possible meanings. Lastly, all indications of EFA
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55 analysis for dependent variables are shown to meet the conditions. It means the given data is
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3 appropriate enough for further analysis, such as correlation analysis and regression analysis. Hair
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5 et al. (1998) state that the Pearson correlation coefficient is a degree measuring the strength of the
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7 linear relationship between two metric variables. This coefficient can be either negative or positive,
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but the greater value of the correlation coefficient expresses the stronger association of this
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10 relationship. Hair et al. (1998) explained the measure of this coefficient rules as below.
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According to the result of Pearson correlation analysis, the correlation between Undergoing
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17 Cosmetic Surgery Intention (BI) variable and Subjective Norm (SN) variable is 0.825. The
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19 relationship between BI and SN, therefore, is solid, which is based on the table of Strength of
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Correlation Coefficients. Besides, the correlation between BI and Attitudes Toward Behavior (AB)
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22 and the correlation between BI and Perceived Behavioral Control (PBC) are 0.495 and 0.599,
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24 respectively. According to the table of Strength of Correlation Coefficients, these correlations are
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26 moderate when they are from ±0.41 to ±0.60. It is illustrated from the table of Pearson Correlation
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27 Analysis that the significance between BI with the other three variables, which are SN, AB, PBC,
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29 respectively, are all smaller than 0.05. Therefore, the significances (2-tailed) are satisfactory.
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31 Multiple linear regression is a method used to explain and predict the relationships between a
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dependent variable and two or more independent variables. In this research, there are three
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34 independents variables, which are SN, AB, PBC, and the dependent variable, which is BI.
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37 (Please insert table 1.7)

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39 The table reveals that the adjusted R-square equals 0.759. This statistical value means that 75.9%
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41 dependent variable’s variation (BI) can be explained by three independent variables (SN, AB,
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43 PBC), which meet the condition. Durbin-Watson test’s statistic value equals 1.628, which is
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between the range of 1.5 and 2.5, which also meets the condition. ANOVA Sig (F) = 0.000, which
46 is less than 0.05; therefore, the null hypothesis is rejected, and this regression analysis model is
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48 reliable (The condition is satisfied). VIF of SN, AB, and PBC are 1.276, 1.460, and 1.646,
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50 respectively, and all smaller than 10. Moreover, Trong and Chu (2005) suggest that if the VIF is
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greater than 10, the collinearity may occur. In this research, VIF values of all three factors are
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53 smaller than 10, so that phenomenon cannot happen. As the table shows, the significant relationship
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55 values of SN, AB, PBC are lower than 0.05; as a consequence, they can be used to explain the
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3 dependent variable. The higher beta value means the stronger relationship between the independent
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5 and dependent variables. According to the equation, Subjective Norm (SN) has the strongest
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7 correlation with Undergoing Cosmetic Surgery (BI), while Attitude (AB) and Perceived
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Behavioral Control (PBC) have weaker correlations compared with SN. The linear regression
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10 equation is offered in this research:
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13 BI = -1.107 + 0.755*SN + 0.241*AB + 0.225*PBC
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As can be seen clearly from the linear regression equation, the beta value of Subjective Norm is
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16 the greatest value, which accounts for 0.755. In other words, if the Subjective Norm increases 1
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18 unit, Behavioral Intention will increase 0.755 units. Therefore, Subjective Norm has the strongest
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20 effect on the Intention of undergoing cosmetic surgery. Hence, the H2 hypothesis: “Subjective
21 norm is positively related to cosmetic surgery intention” is supported. Besides, the beta value of
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23 Attitude is 0.241, which means if Attitude increases 1 unit, Behavioral Intention will increase by
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25 0.241 unit. Therefore, the H1 hypothesis: “Attitude toward cosmetic surgery is positively related
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to cosmetic surgery intention” is supported. Lastly, Perceived Behavioral Control has the beta
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28 value of 0.225, which means that if Perceived Behavioral Control increases 1 unit, Behavioral
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Intention will increase 0.225 unit so the H3 hypothesis: “Perceived behavioral control is positively
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32 related to cosmetic surgery intention” is also supported.
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35 Conclusion and Implications
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38 Through a robust analysis of data collected, this study provides some findings which may have
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great support for research projects in the future. The main target of the research is to
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41 comprehensively understand the factors that motivate people to undergo cosmetic surgery,
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43 especially among young people, via using Ajzen's model. Remarkably, the results of the study will
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45 be beneficial for Vietnamese scholars researching in cosmetic surgery and extend previous studies
46 in cosmetic surgery worldwide. According to the theory, the model shows three elements, which
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48 are attitude, perceived norm, and perceived behavioral control leading to the information of
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50 intention. The initial expectation is met when the findings indicate that all three factors are
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accepted. On the other hand, this conclusion is appropriate for a specific situation. The following
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53 table shows the conclusion of hypothesis testing:
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55 (Please insert table 1.8)
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3 Besides, the factor "Subjective Norm" is the factor with the strongest effect with Beta = 0.682,
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5 which is much higher than two other factors, while the weakest one is Attitude with Beta = 0.161.
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7 As a result, in order to encourage young people to undergo cosmetic surgery, cosmetic surgery
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service providers should increase the confidence of their customers via comprehensive consulting.
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10 Service providers also must achieve the legal license for cosmetic operation by the local authority
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12 to assure the quality of their service. Moreover, global medical benchmarking in cosmetic surgery
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14 is also a good way to increase the subjective norms of young customers so they will perceive
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cosmetic surgery as a safe and smooth procedure. The factor that comes second is “Perceived
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17 Behavioral Control” with Beta = 0.198. The analysis has also shown that the differences in
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19 respondent's perceptions exist among different groups such as job, gender, age, income, education,
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and marital status. Secondly, the tendency to have cosmetic surgery motivation is much higher in
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22 females (68.2 %) than that in males (31.8%). It is also revealed from the research most of the
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24 respondents come from women who are educated with average income. The interesting finding of
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26 the research is that the nose, teeth, and eyes are the most common areas undergone cosmetic
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27 surgery, with the number of respondents being 163, 139, and 86, respectively. However, due to the
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29 diversity in cultures, demography, and geography, the findings can be varied. Although the attitude
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31 is the driver of the cosmetic surgery intention model, this category is not paid as much attention as
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others. The firm should understand its target customers and enhance their attitudes for cosmetic
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34 surgery. According to Self-Discrepancy theory expanded by Higgins and colleagues (Higgins et

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36 al.,1985; Higgins et al., 1986; Higgins et al.,1987; Higgins,1987), when people pay their intention
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38 to themselves as an object, they will make active comparisons between their real self and ideal self.
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Therefore, cosmetic surgeons need to clarify the discrepancy between the real self and ideal self to
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41 increase their motivation and put more effort into bringing the patient's real self near the ideal self."
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43 It is represented from the figure that subjective norm is the factor that most affects one’s intention
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45 for cosmetic surgery. Abbasi (2013) defines subjective norm as "the person's perception that most
46 people who are important to him or her think he/she should or should not perform the behavior in
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48 question." Besides, the subjective norm is a component included in the theory of reasoned action
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50 and the theory of planned behavior, which indicates that subjective norm can influence one’s
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behavior by influencing his/her behavioral intentions (Rivis and Sheeran, 2003). Thus, cosmetic
53 surgeons must base on this theory to create a norm through social media. Furthermore, surgeons
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55 should make patients clear about the advantages of cosmetic surgery, which helps attract the
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 International Journal of Pharmaceutical and Healthcare Marketing Page 18 of 22
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3 patients’ intention. Also, Subjective Norm has the greatest effect on the intention of cosmetic
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5 surgery of young people. Besides, marketers can use a micro-influencer to motivate people to have
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7 a cosmetic procedure because the trend of selling products and services through an influencer is
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one of the most effective ways on the internet at the moment. Through the influencer, the surgeons
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10 will have attractive media messages and make the customer believe in their services. The influencer
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12 is the best person to talk about the service. The surgeons can get a large number of supporters and
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14 also reduce the cost of advertising by transforming the influencer’s fans to the supporter. The major
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factor which is demonstrated in a person’s image is self-esteem. According to Baker and McNulty
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17 (2013), the relationship between low self-esteem and appearance-changing behaviors is significant.
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19 In other words, when a person has higher self-esteem, he or she will also have higher body
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satisfaction. Furthermore, the trust also plays an important role in the intention of one person. In
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22 this modern life, the surgeons are found to increase day by day; however, there are also a large
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24 number of scandals about the quality of surgeons. Thus, the professional surgeons need to keep
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26 their reputation in their industry and gain trust in their patients as well. Specifically, the surgeons
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27 need to make commitments to ensure a good relationship with patients and make sure that they
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29 always keep their promises.
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3 APPENDIX: THE MEASUREMENT OF CONSTRUCTS
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6 Attitude toward cosmetic surgery: Instrumental and experiential aspects
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7 AB1 I think cosmetic surgery is easy to undergo.
8 AB2 I think cosmetic surgery is positive to undergo.
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AB3 I think cosmetic surgery is pleasant to undergo.
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11 AB4 I think cosmetic surgery is necessary to undergo.
12 AB5 I think cosmetic surgery is necessary to undergo.
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13 AB6 I think cosmetic surgery is important to undergo.
14 Perceived norm: Injunctive and descriptive aspects
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SN1 My family and my friends would approve my cosmetic surgery
17 SN2 My family and my friends think that I should undergo cosmetic surgery.
18 SN3 My family and my friends would like me to undergo cosmetic surgery.
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19 SN4 Some of my family and my friends have undergone cosmetic surgery before.
20 SN5 My family and my friends are willing to undergo cosmetic surgery.
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Perceived behavioral control: Capacity and autonomy aspects
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23 PBC1 Undergoing cosmetic surgery will depend on me.
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24 PBC2 Undergoing cosmetic surgery is completely under my control.

25 PBC3 I am confident that I could undergo cosmetic surgery as I wish.
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Behavioral Intention (undergo cosmetic surgery)
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28 BI1 I intend to undergo cosmetic surgery in the next year.
29 BI2 I intend to undergo cosmetic surgery in the next five years.
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30 BI3 I intend to undergo cosmetic surgery in the next ten years.

31 BI4 I intend to undergo cosmetic surgery in the future.
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Note: all constructs are measured on a Likert 7-scale, which ranges from 1: strongly
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34 disagree with the statements to 7: strongly agree with the statements.

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