In order to determine its position in the chiropractic marketplace, Phoenix-based Activator Methods, Inc. commissioned a nationwide mail study of chiropractors.

Specifically, says Dr. Arlan W. Fuhr, president of Activator Methods, the company sought to measure the level of awareness and usage of the Activator instrument, one of many techniques used in chiropractic. In addition, they wanted to find out which attributes chiropractors felt were most important in a technique.

"We did the market survey to find out where we were and how we ranked," Fuhr says, "because if you don't know where you're at, you can't find out where you're going."

The Activator instrument is a patented device which uses a metered force to make adjustments to the patient, in contrast to what Fuhr calls the "more forceful" manipulation of chiropractic methods like Gonstead, Thompson and Diversified.

"It moves the bone a minute amount and activates mechano receptors which in turn cause muscles to contract and help the deranged nerve function return to normal," he says.

Methodology

The survey, conducted by Olsen Marketing, Inc., Willmar , Minn., was sent to 1036 chiropractors nationwide in the summer of 1986, using a random sample from the mailing list of a chiropractic magazine. Each packet contained a personalized cover letter (which began with the appeal "Chiropractors across the nation need your help!"), with a quarter affixed as an incentive, the four page survey, and a stamped return envelope, all of which came in under the 1 ounce first-class limit.

The questionnaire and its contents gave no indication of who was conducting the survey. "It was mailed under the name and letterhead of Professional Mail Surveys," says Chris Olsen, president of Olsen Marketing. "The doctors had no idea who was conducting the survey, whether it was an association, a government agency or one of the chiropractic technique developers."

Olsen says a mail survey was chosen for three reasons.

"First, it allowed us to do a more thorough evaluation and study of the corporate recognition and image of Activator Methods. Second, it was less expensive than a phone survey, and third, it allowed us to reach busy doctors not always available for or receptive to phone surveys."

To make sure the doctors wouldn't balk at the idea of completing the survey, it was designed to look open, easy to read, and not time consuming.

High response rate

The survey enjoyed a response rate of over 30%, with 283 of the 330 returns qualifying for use in the study. Though Olsen is unable to explain the high response rate, he speculates that perhaps the chiropractors responded to the cover letter's entreaty.

Also, he says, "I think maybe the chiropractic doctors had never been approached before in this manner, so I think they were more open to it, their curiosity was piqued."

The chiropractors were asked about the following topics:

Technique

Which technique (or combination of techniques) did they use most, and how satisfied were they with it? (Some chiropractors, Fuhr notes, mix treatment methods in the belief that different techniques are more effective in certain situations.)

In addition, their familiarity with seven techniques, including Activator, was gauged—using a scale from "know it well" to "never heard of it,"—as was their awareness of advertising of seminars for the various methods. Also, each of the techniques was assessed on a number of criteria, including effectiveness, ease of use, safety, widespread acceptance, and the level of research validation.

Education and seminars

How often did they attend seminars and for which techniques? How satisfied were they with the seminars? They were also asked which areas they saw as the most important to gather knowledge in in the next 12 months: technique, practice-building (office management), or both.

Chiropractic newsletters and periodicals

Which chiropractic publications did they receive and read regularly, and what was their favorite?

Personal statistics

This section gathered information on age, number of years in practice, average number of patients and income per week, overall income, and college attended.

(Determining which chiropractic college each respondent attended was important, Olsen says, because their educational background influences their opinions of the various methods, as most colleges primarily teach the Diversified method, offering instruction on other methods only on an elective basis.)

Findings

As expected, the Diversified technique was the most used, followed by Gonstead and Activator. A total of 41% said they knew the Activator technique "well" or "moderately well," as compared to 44% for Cox, and 67% for Gonstead. Activator was the most recognized technique in the section on awareness of advertising on technique seminars.

Fuhr says he was pleased with Activator's third place showing, as some of the techniques had been around since the turn of the century and Activator is comparatively new. In fact, he says, finding out that Activator was number three made him feel a bit like Lee Iacocca.

"It said to me: We're number three (overall), but we're going to be number one, period. So it provided us with a goal."

Chiropractors also rated the technique highly in two important attribute areas: it achieved the highest "ease of use" score, and 148 respondents said it was safest to use, 50 more than the next closest technique.

Not only is the Activator instrument safer for the patients, Fuhr says, it is also less taxing for chiropractors to use. Other methods require them to make adjustments manually by exerting tremendous pressure with their thumbs and hands, which can result in a chronic muscle fatigue that leaves many doctors worn out by the time they reach their 40s. (Indeed, 73% of the respondents to the mail survey were between the ages of 25 and 44.)

Increased validation

Activator's rankings in the "scientific research" and "published paper" attributes showed a need for increased validation of the Activator method's effectiveness through publication of articles in recognized scientific and chiropractic journals.

This need for validation was applied to the profession as a whole, as the doctors expressed their desire for continued scientific research of all chiropractic treatments and their effects on patients.

"We found that the doctors were very interested in information about chiropractic and in scientifically documented research about chiropractic," Olsen says.

As a result, in 1987, Fuhr formed the National Institute of Chiropractic Research, a non-profit organization created specifically to increase the level of chiropractic research. Since then, he says, great strides have been made.

"It really spurred us on. We've had five published papers in blind, peer-reviewed indexed journals.' We've got a major association with Arizona StateUniversity and the Harrington Arthritis Research Center."

Communication with students and faculty

The survey results also pointed out the need for increased publicity efforts, focusing on communication with the chiropractic college faculties, students, and practicing doctors about the Activator method and the scientific research studies.

To this end, Activator Methods replaced their 4-page quarterly newsletter with a 12-page, bimonthly publication called Activator Update. Fuhr began to publish the results of the survey in the newsletter to show chiropractors where the technique stood in the eyes of the profession.

"I think that did a great deal for us. It let people know where we were, and it gave (the chiropractors) the confidence to stay with (us) or join (us)."

Another goal, Fuhr says, is to increase Activator Method's presence in the curricula of chiropractic colleges. Progress has already been made in this area, he says, noting that five years ago, only one college was teaching Activator as an elective, and now eight are doing so.

Further research

Now that the findings of the first study have been acted upon, another mail study similar to the first one is in the planning stages.

"We may change a few questions, but overall it will be very much the same," Olsen says. "We're going to see how much and in what areas the company's corporate image has changed, how effective the advertising, public relations, and direct mail have been."

"We're going to see if the perception has changed," Fuhr says. "What's our market share? Are we changing it? Is it static? How are we doing now?"