Physician-user interaction and users' perceived service quality: evidence from Chinese mobile healthcare consultation

Pathways Linking Online Physician-Patient Communication to Health Outcomes

Online platforms have proliferated in response to the increasing demand for online medical services. However, the underlying mechanisms through which online physician‒patient communication are associated with better health outcomes are under-researched. We employed mixed focus groups and in-depth interviews to investigate the impact of online physician‒patient communication on health outcomes, including psychological and physical quality of life, as well as perceived diagnosticity. A modified pathway framework was subsequently generated to illustrate the relationship between online communication and health outcomes based on the clinician‒patient communication pathway model. Overall, we redefined the concept of perceived diagnosticity in online healthcare and identified an indirect pathway through which psychological quality of life affects physical quality of life mediated by perceived diagnosticity.

A Systematic Review of Online Medical Consultation Research

Online medical consultation is a form of medical service that facilitates interactions between patients and doctors online, offering significant utility and value. This review aims to retrieve, screen, and analyze articles related to online medical consultations, formulating a theoretical framework and proposing future research directions. According to PRISMA guidelines, a systematic search was conducted in Web of Science, EBSCO, ScienceDirect, PubMed, and Scopus, retrieving a total of 4072 English records on 16 December 2023. After rigorous screening, 75 articles were included in this review. Among these, 8 articles focused on patients utilizing online medical consultation platforms, 5 on doctors participating in online medical platforms, 18 on patients' choice of doctors, 12 on doctors providing services, 7 on online reviews of patients, 14 on service quality for patients, 8 on rewards to doctors, and 11 on the spillover effect between online and offline services. These themes comprise the theoretical framework of the starting point, process, and outcomes of the online medical consultation system, providing a comprehensive understanding of the field and a foundation for future research.

Exploring the Effects of Online Physician Voice Pitch Range and Filled Pauses on Patient Satisfaction in Mobile Health Communication

The convenience of mobile devices has driven the widespread use of voice technology in mobile health communication, significantly improving the timeliness of online service. However, the issue of listening to therapeutic content, which requires great cognitive effort and may exceed the patient's information processing capacity (i.e., information overload), is of concern. Based on information processing theory, this study reports how online physicians' voice characteristics (pitch range and filled pauses) affect patient satisfaction. We obtained 10,585 mobile voice consultation records of 1,416 doctors from China's largest mHealth platform and analyzed them using audio mining and empirical methods. Results showed that pitch range (β = 0.0539, p < .01) and filled pauses (β = 0.0365, p < .01) in doctors' voice positively influenced online patient satisfaction. However, the effect of filled pauses becomes weaker for patients with higher health literacy and higher disease risk. This suggests that there is heterogeneity in the way different patients process audio information. This study provides important insights for guiding online physician behaviors, enhancing patient satisfaction, and improving mobile health platform management.

The Association Between Linguistic Characteristics of Physicians' Communication and Their Economic Returns: Mixed Method Study

BACKGROUND

Web-based health care has the potential to improve health care access and convenience for patients with limited mobility, but its success depends on active physician participation. The economic returns of internet-based health care initiatives are an important factor that can motivate physicians to continue their participation. Although several studies have examined the communication patterns and influences of web-based health consultations, the correlation between physicians' communication characteristics and their economic returns remains unexplored.

OBJECTIVE

This study aims to investigate how the linguistic features of 2 modes of physician-patient communication, instrumental and affective, determine the physician's economic returns, measured by the honorarium their patients agree to pay per consultation. We also examined the moderating effects of communication media (web-based text messages and voice messages) and the compounding effects of different communication features on economic returns.

METHODS

We collected 40,563 web-based consultations from 528 physicians across 4 disease specialties on a large, web-based health care platform in China. Communication features were extracted using linguistic inquiry and word count, and we used multivariable linear regression and K-means clustering to analyze the data.

RESULTS

We found that the use of cognitive processing language (ie, words related to insight, causation, tentativeness, and certainty) in instrumental communication and positive emotion-related words in affective communication were positively associated with the economic returns of physicians. However, the extensive use of discrepancy-related words could generate adverse effects. We also found that the use of voice messages for service delivery magnified the effects of cognitive processing language but did not moderate the effects of affective processing language. The highest economic returns were associated with consultations in which the physicians used few expressions related to negative emotion; used more terms associated with positive emotions; and later, used instrumental communication language.

CONCLUSIONS

Our study provides empirical evidence about the relationship between physicians' communication characteristics and their economic returns. It contributes to a better understanding of patient-physician interactions from a professional-client perspective and has practical implications for physicians and web-based health care platform executives.

Public preferences for online medical consultations in China: a discrete choice experiment

Background

Online medical consultation (OMC) is significant to promote the utilization and accessibility of healthcare resources and save time on consultation. However, the usage and public acceptance rates of it are still low in China. Meanwhile, few studies have focused on consumers' demand of OMC services. This study aims to identify attributes that influence users' preference for OMC services, quantify the value of these characteristics, and compare their relative importance.

Methods

A nationwide discrete choice experiment was conducted to survey Chinese residents' preference choices for six attributes of OMC services. Conditional logit model and mixed logit model were used to analyze respondents' preference. Willingness to pay and heterogeneity were estimated by the mixed logit model.

Results

A total of 856 respondents completed the study, and 668 questionnaires passed the consistency test. All of 6 attributes in the study were statistically significant except for "Doctor's professional title - Associate Senior." When choosing OMC services, respondents preferred to spend as little time and money as possible on a large online medical platform to consult a high-rated physician with a senior title from a well-known Grade-A tertiary hospital. Besides, respondents valued doctor's evaluation score most and were willing to pay ¥107 to obtain the services of higher-scored doctors.

Conclusion

The study measured Chinese residents' preferences for six attributes of OMC and showed the heterogeneity of attributes among subgroups. Our findings suggested that OMC services providers should reduce the customers' waiting time, improve the quality of services and enhance professional skills to meet the customers' requirements. More research on preferences for OMC needs to be conducted in China, especially for key populations such as patients with chronic diseases.

D. Kassim AA. Determinants of instant messenger (IM) adoption and its effect on team performance: Mediating role of knowledge creation and quality communication

Computer-mediated communication has dramatically transformed the human communication landscape by enhancing speed, content and social presence. The world has been experiencing a sharp decline in using email and phone calls due to organizations' rapid adoption of instant messenger (IM) for their day-to-day communication with their stakeholders. Moreover, the world has been experiencing a sharp decline in using email and phone calls since the beginning of the IM era. Hence, the aim of this study is to comprehend the IM adoption process through the lens of three theories. A structured questionnaire was developed to collect data from the organizations and test hypotheses using consistent PLS-SEM (PLSc) in SMART PLS combined with bootstrapping. The results indicated that parallelism is the most dominating factor explaining IM adoption in organizations followed by transmission velocity, rehearsability and symbol set. The findings of this study also confirmed that team performance is not influenced by communication but by the quality of the communication and the level of knowledge within the group that can create using instant messenger. Indeed, this empirical study is one of the limited investigations that combine three theories to explain the IM adoption process and its effect on team performance. Moreover, this study contributes both theoretically and practically to comprehending the adoption process of IM. Lastly, this study reconfirmed the importance of Media Synchronicity Theory (MST) and Social Presence Theory (SPT) in predicting IM adoption; and the findings of this research extended the applications of the Adaptive Structuration Theory (AST) from the IM perspective, which is, indeed, rare. Finally, this study provides a great foundation for managers to understand the importance of IM in their day-to-day communication systems.

Physicians' Online Writing Language Style and Patient Satisfaction: The Mediator of Depth of Physician-Patient Interactions

Online health counseling (OHC) is increasingly important in modern healthcare. This development has attracted considerable attention from researchers. However, the reality of the lack of physician-patient communication and dissatisfaction with online health services remains prevalent, and more research is needed to raise awareness about important issues related to OHC services, especially in terms of patient satisfaction and depth of interaction (i.e., the product of the number of interactions and the relevance of the content). This study constructs an empirical model to explore the relationship between physicians' online writing language style (inclusive language and emojis), depth of physician-patient interactions, and patient satisfaction. The study obtained 5064 online health counseling records from 337 pediatricians and analyzed them using text mining and empirical methods. The results showed that physicians' inclusive language (β = 0.3198, p < 0.05) and emojis (β = 0.6059, p < 0.01) had a positive impact on patient satisfaction. In addition, the depth of the physician-patient interaction partially mediated this effect. This study promotes a better understanding of the mechanisms of physician-patient interactions in online settings and has important implications for how online physicians and platforms can better provide online healthcare services.

Exploring the factors that affect user experience in mobile-health applications: A text-mining and machine-learning approach

Recent years have witnessed an increased demand for mobile health (mHealth) platforms owing to the COVID-19 pandemic and preference for doorstep delivery. However, factors impacting user experiences and satisfaction levels across these platforms, using customer reviews, are still largely unexplored in academic research. The empirical framework we proposed in this paper addressed this research gap by analysing unmonitored user comments for some popular mHealth platforms. Using topic-modelling techniques, we identified the impacting factors (predictors) and categorised them into two major dimensions based on strategic adoption and motivational association. Findings from our study suggest that time and money, convenience, responsiveness, and availability emerge as significant predictors for delivering a positive user experience on m-health platforms. Next, we identified substantial moderating effects of review polarity on the predictors related to brand association and hedonic motivation, such as online booking and video consultation. Further, we also identified the top predictors for successful user experience across these platforms. Recommendations from our study will benefit business managers by offering an improved service design leading to higher user satisfaction across these m-health platforms.

Counseling for Health: How Psychological Distance Influences Continuance Intention towards Mobile Medical Consultation

As mobile healthcare services entered the public sight with high frequency during the COVID-19 pandemic, patients are increasingly recognizing the effectiveness of mobile medical consultation (MMC). Earlier studies have investigated what influences continuance intention (CI) towards MMC, but few studies have scrutinized it from the perspective of patients' psychological distance. We formulated a framework to examine the psychological factors influencing CI towards MMC by integrating the information systems continuance model and psychological distance theory. The framework was validated using the partial least squares structural equation modeling (PLS-SEM) approach and data from 475 MMC users in China. The empirical results revealed that immediacy, telepresence, intimacy, and substitutability were significant predictors of CI, while satisfaction mediated these pathways. Pandemic-induced anxiety positively moderated the effect of immediacy on satisfaction and the effect of satisfaction on CI. Practical implementations for MMC healthcare practitioners, designers, and marketers are drawn.

Impact of a physician's prosocial behavior on the patient's choice: an empirical investigation in online health community

Purpose

The purpose of this paper is to explore the influence of a physician’s prosocial behavior on a patient's choices in the online health community (OHC) context. Moreover, the authors explore how such effects differ across different online word-of-mouth (WOM) and professional titles.

Design/methodology/approach

Guided by the motivation, opportunity and ability (MOA) framework, this paper develops hypotheses and an econometric model. Then this paper used spline regression to test hypotheses on 6,204 physicians at The Good Doctor (www.Haodf.com), which is one of the largest Chinese OHCs. The authors conducted the propensity score matching and difference-in-difference method (PSM-DID) to address the concern about the bias caused by possible endogeneity concerns.

Findings

The authors’ results show that a physician’s prosocial behavior improves a patient's choice only when the strength of a physician’s prosocial behavior is below the tipping point. In addition, the influence of a physician’s prosocial behavior is heterogeneous for physicians with different online WOM and professional titles. For physicians with higher online WOM, the effect of a physician's prosocial behaviors on a patient's choice is positive, while for physicians with lower online WOM, a physician’s prosocial behavior has no impact on a patient’s choice. For physicians with higher professional titles, the quantity of a physician’s prosocial behavior has a positive impact on a patient’s choice, while for physicians with lower professional titles the quality of a physician’s prosocial behavior has a positive impact on a patient’s choice.

Originality/value

This study contributes new knowledge and provides new perspectives to study a patient's choice by addressing the importance of physician's prosocial behavior. With the effort of explicitly explaining the complex mechanisms, this study encourages physicians' engagement in a physician’s prosocial behavior and gives some implications on how to perform the behaviors strategically.

Understanding online review behaviors of patients in online health communities: an expectation-disconfirmation perspective

Purpose

Although online health communities (OHCs) and online patient reviews can help to eliminate health information asymmetry and improve patients' health management, how patients write online reviews within OHCs is poorly understood. Thus, it is very necessary to determine the factors influencing patients' online review behavior in OHCs, including the emotional response and reviewing effort.

Design/methodology/approach

Based on expectation-disconfirmation theory, this study proposes a theoretical model to analyze the effects of service quality perception (i.e. outcome quality and process quality perceptions) and disconfirmation (i.e. outcome quality and process quality disconfirmations) on patients' emotional response and reviewing effort. The authors test the research model by using empirical data collected from a popular Chinese OHC and applying ordinary least squares (OLS) regression and zero-truncated negative binomial (ZTNB) regression models.

Findings

Both service quality perception and disconfirmation have a positive effect on patients' positive emotional intensity in textual reviews, and disease severity enhances these relationships of process quality. Moreover, there is an asymmetric U-shaped relationship among service quality perception, disconfirmation and reviewing effort. Patients who perceive low service quality have higher reviewing effort, while service quality disconfirmation has the opposite relationship. Specifically, patients' effort in writing textual reviews is lowest when perceived outcome quality is 3.5 (on a five-point scale), perceived process quality is 4 or outcome quality and process quality disconfirmations are −1.

Originality/value

This study is the first to examine patients' online review behavior and its motivations and contributes to the literature on online reviews and service quality. In addition, the findings of this study have important management implications for service providers and OHC managers.

Media features and communication control in the digitalized workplace: a study about regulating negative emotional communication

Purpose

One challenge facing the digitalized workplace is communication control, especially emotion regulation in which individuals try to manage their emotional experiences and/or expressions during organizational communication. Extant research largely focused on the facilitating role of a few media features (e.g. fewer symbol sets). This study seeks to provide a deeper understanding of media features that individuals, as receivers of negative emotions expressed by communication partners, could leverage to support regulating negative emotional communication in the workplace.

Design/methodology/approach

This study used qualitative research methods to identify media features that support regulating negative emotional communication at work. Data were collected using interviews and was analyzed using directed content analysis in which media features discussed in media synchronicity theory (MST) were used as the initial coding schema but the researcher was open to media features that do not fit with MST.

Findings

In addition to media features (and capabilities) discussed in MST, this study identified five additional media features (i.e. message broadcasting, message blocking, receiving specification, recipient specification and compartmentalization) and two underlying media capabilities (i.e. transmission control capability and participant control capability) that may support regulating negative emotional communication. Two major mechanisms (i.e. reducing or eliminating emotion regulation workload, and providing prerequisites or removing obstacles for emotion regulation) via which media features support emotion regulation were also identified.

Originality/value

This paper provides a more comprehensive understanding regarding communication media features that may support emotion regulation in particular and communication control in general. Findings of this study contribute to several literatures and may also transfer to other similar contexts.