Patient value co-creation in online health communities: Social identity effects on customer knowledge contributions and membership continuance intentions in online health communities

A Meta-Analysis of the Effects of Interaction on Value Co-Creation in Online Collaborative Innovation Communities Based on the Service Ecosystem Framework

Interaction is typically at the core of the value co-creation process through operant resource exchange in online collaborative innovation communities (OCICs). While some studies emphasize the facilitating effect of interaction on value co-creation, others have drawn opposite conclusions, such as more peer interaction leads to less idea generation. Thus, the purpose of this paper is to utilize the service ecosystem framework to clarify the overall relationship between interaction and value co-creation and to explore the moderating factors that may have contributed to the divergence and inconsistency of previous studies. We conducted a meta-analysis of 65 effect sizes obtained from 63 articles with a cumulative sample size of 25,185 between 2004 and 2023, using a random effects model. The results indicate that interaction has a significantly positive impact on user value co-creation within OCICs (r = 0.453, 95%CI [0.405, 0.499]), and the heterogeneity among studies was significant (Q = 1409.29, p < 0.001). The strength of this correlation was moderated by the types of interaction (human-computer or human-human interactions), the types of OCICs (business-sponsored or socially constructed online communities), and the number of involved OCICs (one or multiple online communities), but not by the cultural background. These findings support the service ecosystem perspective rather than resource scarcity theory by resolving the mixed findings regarding the relationship between interaction and user value co-creation. Furthermore, this study systematically examined the contingent factors separately across three levels, micro (types of actor interactions), meso (types and number of OCICs), and macro (cultural background), combining the whole and the part insights, and empirically integrating service ecosystems as the foundational paradigm and unit of analysis for value co-creation research for the first time. This research contributes to theoretical frameworks in service ecosystems and offers actionable insights for management practices in business and marketing.

More knowledge, more choices? How peer recognition of physicians' knowledge sharing affect patients' consultation in online health communities

Background

The advent of telemedicine has revolutionized healthcare consultations, primarily due to the digital era and global health concerns. Online healthcare communities (OHCs) have emerged as platforms for physicians to share health-related articles, promoting digital public health awareness and knowledge dissemination. The continuous dissemination of health knowledge by physicians online is considered a crucial driving force in attracting patients to seek online consultations.

Methods

Based on the elaboration likelihood model and the information overload theory, this study explores how persuasive messages from other patients' peer recognition, including knowledge popularity and attractiveness, affect patients' consultation decisions. Additionally, the study examines the three-way interaction between knowledge popularity, attractiveness, and quantity in shaping patient consultations. Using data collected from 2,676 physicians on haodf.com, this study established an ordinary least squares (OLS) regression model with time and city fixed effects to test the hypothesis.

Results

The results show that: (1) peer recognition (knowledge popularity and attractiveness) from other patients positively impacts patients' consultation; (2) knowledge attractiveness positively moderate the relationship between knowledge popularity and patients' consultation; (3) there is a three-way effect of knowledge popularity, knowledge attractiveness, and knowledge quantity on patients' consultation.

Conclusion

Our findings offer valuable guidance for platform design and healthcare practitioners, boosting patient-physician engagement in online healthcare communities.

The Googling Effect on patient co-creation in physiotherapy service exchange

We study the process of value co-creation in physiotherapist-patient relationships and the underlying mechanisms of this process. We present the Googling Effect Model outlining the relationship between patients' pre-encounter online information search and their commitment to compliance in physiotherapy service exchange. We tested the model on a sample of physiotherapy service patients (n = 446) in the United States. We analyzed the collected responses using the partial least squares method, using SmartPLS 4.0. Our study contributes to the existing body of knowledge in several ways. We developed and tested the Googling Effect Model. Doing so adds to the healthcare literature on value co-creation in physiotherapy. The Googling Effect Model increases the predictive value of the Service-Dominant Logic as it outlines the mechanism underlying value co-creation in healthcare, including the role and importance of pre-encounter online information search in collaborative healthcare. Moreover, the findings illustrate how the underlying mechanism through which pre-encounter online information search affects commitment to compliance differs between men and women and different ethnic groups. These findings can be used to create an environment that increases service engagement and commitment to compliance by accounting for patients' gender and ethnicity.

Continuous adoption of online healthcare platforms: an extension to the expectation confirmation model and network externalities

BACKGROUND

Online healthcare platforms (OHPs) promote the accessibility of health services while integrating online and offline service delivery. Continuous adoption of these platforms can reduce the information asymmetry between patients and healthcare providers. However, existing study has rarely focused on how the network externalities of these platforms influence patients' continuous adoption. Expectation Confirmation Model (ECM) explains the continuous behavior after initial adoption and reveal the factors influencing satisfaction and continuous adoption intention. Few studies have integrated network externalities with the ECM to understand patients' continuous adoption of OHPs.

OBJECTIVE

This study aims to explore what factors affect the continuous adoption of OHPs based on an extension to the ECM and network externalities. We propose a comprehensive model for the continuous adoption of OHPs by patients with chronic diseases. We extend the conceptual framework by incorporating constructs related to perceived value, habits, and switching costs.

METHODS

This study utilized a web-based survey to collect data from participants in China. We selected a sample of individuals who had experience with OHPs using a random sampling method. This method ensured that participants was randomly chosen from a pool of patients without any regional bias. A total of 568 questionnaires were collected and 518 valid questionnaires were obtained. Structural equation modeling was applied to assess the relationships among the constructs. Hierarchical regression analysis was utilized to examine the moderating effects, while the mediating effects were investigated using the bootstrapping approach.

RESULTS

Direct network externality had significant positive impacts on the confirmation (β = 0.232, p < 0.001) and perceived value (β = 0.167, p < 0.010). Cross network externality had significant positive impacts on confirmation (β = 0.307, p < 0.001) and perceived value (β = 0.120, p < 0.05). Indirect network externality had significant positive impacts on confirmation (β = 0.169, p < 0.010) and perceived value (β = 0.270, p < 0.001). Confirmation had a significant positive impact on perceived value (β = 0.205, p < 0.001) and satisfaction (β = 0.508, p < 0.001). In addition, satisfaction had a significant positive impact on continuous adoption intention (β = 0.579, p < 0.001). Continuous adoption intention had a significant positive impact on continuous adoption behavior (β = 0.547, p < 0.001). Confirmation and perceived value significantly mediate the relationship between network externalities and satisfaction. Moreover, both confirmation and perceived value enhance continuous adoption intention by positively influencing satisfaction, which serves as a mediator. Additionally, confirmation directly influences satisfaction through the mediating role of perceived value. Habits and switching costs positively moderate the relationship between continuous adoption intention and behavior.

CONCLUSIONS

This study contributes by expanding the incorporation of network externalities into the ECM. Results enrich the existing literature on the continuous adoption of professional online platforms.

Using machine learning to explore the determinants of service satisfaction with online healthcare platforms during the COVID-19 pandemic

This study investigates the determinants of service satisfaction with online healthcare platforms using machine learning (ML) algorithms. By training and testing eleven ML models based on data mined from a leading online healthcare platform in China, we obtained the best-performing ML algorithm for service satisfaction prediction, namely, Light Gradient Boosting Machine. Furthermore, our empirical results indicate that gifts, patient votes, popularity, fee-based consultation volume, gender, and thank-you letters positively impact service satisfaction, while the impacts of consultation volume, free consultation volume, views, waiting time, articles, physician title, and hospital level are negative. We discuss the theoretical and managerial implications.

Do ethics drive value co-creation behavior in online health communities?

Purpose

Online health communities (OHCs) have been recognized as emerging platforms on the Internet used for health purposes. Despite its emergence, developing a successful OHC is still a challenge. Prior studies identified that value co-creation behavior (VCB) of members is an essential factor for sustaining OHCs; however, little is known about how members’ behavior drives to co-create value? Therefore, this study aims to discover the inclusive mechanism for members’ VCB in OHCs.

Design/methodology/approach

The authors develop the study model and hypothesis based on the service-dominant logic of value co-creation theory and social support (SS) literature. The survey data of 608 active OHCs users in China were analyzed using partial least squares structural equation modeling (PLS-SEM).

Findings

The results revealed that SS positively affects members’ VCBs. Ethical aspects; Trust and ethical interaction (EI) partially mediate their relationships. In addition, community members’ current health status (CHS) negatively moderates the relationships between SS and VCB. From the findings, it becomes evident that only SS is not enough; developing an ethical environment in OHCs, i.e. trust and ethically rich interactions among members, significantly helps OHCs to promote co-creation. Also, the negative moderation of CHS findings provides novel insights when cramming health conditions.

Originality/value

Exploring the complex mechanism of co-creation in OHC, the authors illustrate the potential of service-dominant logic to create new theoretical insight for healthcare and provide the framework of co-creation with ethics for the first time. This will extend the application of ethics in healthcare services and offer a robust platform from which the understanding of drivers of members’ VCB can be advanced in the OHC context.

Value creation and cost reduction in health care – outcomes of online participation by health-care professionals

Purpose

The authors explore the outcomes of health-care professionals' participation in a vendor-hosted online community by combining qualitative and quantitative data collected in two separate studies. The authors aim to shed light on the potential value outcomes of community participation covering the reduction of service costs by professionals' community participation.

Design/methodology/approach

The authors explore the outcomes of health-care professionals' participation in a vendor-hosted online community by combining qualitative and quantitative data collected in two separate studies. The authors also introduce GABEK® as a unique method of qualitative empirical content analysis. In the quantitative study, the authors refer to customer survey data and transactional data.

Findings

The results show that participation in online communities by professionals emerges as a dual concept, consisting of both help-seeking and help-providing behaviors. These behaviors in turn facilitate the creation of economic and relational value, as well as influencing the perceived usefulness of the online community, resulting in higher satisfaction with the community among the participating professionals. Customer survey data and transactional data were gathered from a major medical equipment vendor hosting an online community, and those data confirm that participation also decreases service support costs to professionals by reducing the number of necessary service visits by the vendor's service technicians.

Practical implications

The resulting model of participation and corresponding benefits in an online community for health-care professionals reflects and informs current developments in the health care industry.

Originality/value

The combination of qualitative as well as quantitative studies relying on the data of a world leading medical equipment vendor hosting an online community provides unique and innovative insights into participation and value creation within B2B communities.

Foresight study on online health community: The perspective of knowledge empowerment for patients with chronic diseases

Patient empowerment is an indispensable precondition for patients to self-manage their disease. The article takes the position that patients are empowered for disease self-management through patient knowledge empowerment when sharing knowledge. One of the most important instruments to successfully empower a patient to manage a chronic disease and maintain social relations, which are also a precondition for the prevention of chronic illnesses, is the possibility to access online health communities (OHCs) and participate in them. The aim of the article is to model possible development scenarios of OHCs as enablers of patient knowledge in relation to other digital health technologies (DHTs). A foresight methodology was used to achieve the goal, employing a technology scanning approach after selecting 10 foresight studies, which resulted in four future scenario models for the empowerment of patients wcith chronic diseases through digital health communities. They reveal options for the future interoperability of OHCs with other DHTs and highlight their importance and significance for the healthcare system as a technology for balancing patient self-efficacy and social relations as well as the need to maintain and develop them.

Psychological Distance Impacts Subgroup Reciprocity in Technological Innovation Networks: The Mediating Role of Divisive Faultlines

As information flows at ever-increasing speeds across technological innovation networks, it is crucial to optimize reciprocity among partnering enterprises. However, the impact of psychological distance on subgroup reciprocity in such networks has not yet been investigated. To address this gap, the current study drew on theories of faultlines and cohesive subgroups to model the relationship between psychological distance and subgroup reciprocity within technological innovation networks. Our hypotheses were tested using data from 174 respondents working in Yunnan Province, China. The results were as follows: first, psychological distance had negative effects on subgroup reciprocity in technological innovation networks; second, relationship-divisive and innovation-divisive faultlines negatively impacted reciprocity within and between subgroups; third, the faultlines partially mediated the negative relationship between psychological distance and intra-subgroup reciprocity; and fourth, the negative relationship between psychological distance and subgroup reciprocity was not mediated by the faultlines. The findings uncover the psychological mechanism of subgroup reciprocity within technological innovation networks. They will inform the decision-making process of enterprises when selecting partners within their technological innovation networks and support the development of effective reciprocal relationships with other innovators.

Augmented reality magic mirror in the service sector: experiential consumption and the self

Purpose

This paper examines what the use of an augmented reality (AR) makeup mirror means to consumers, focusing on experiential consumption and the extended self.

Design/methodology/approach

The authors employed a multimethod approach involving netnography and semi-structured interviews with participants in India and the UK (n = 30).

Findings

Two main themes emerged from the data: (1) the importance of imagination and fantasy and (2) the (in)authenticity of the self and the surrounding “reality.”

Research limitations/implications

This research focuses on AR magic makeup mirror. The authors call for further research on different AR contexts.

Practical implications

The authors provide service managers with insights on addressing gaps between the perceived service (i.e. AR contexts and the makeup consumption journey) and the conceived service (i.e. fantasies and the extended self).

Originality/value

The authors examine the lived fantasy experiences of AR experiential consumption. In addition, the authors reveal a novel understanding of the extended self as temporarily re-envisioned through the AR mirror.

Effects of social capital of social networking site on social identity and continuous participant behavior

Purpose

The paper focuses on social capital as the characteristic of social groups that promote coordination; moreover, social identity plays a key role in the construction of group relationships. However, few research studies have looked at how the social capital of social networking sites (SNSs) is related to the social identity of its members. Drawing on social capital and social identity theory, this study investigated the effects of SNS social capital (shared language, social trust and network density) on social identity and continuous participation. The mediating role of social identity was also investigated.

Design/methodology/approach

In total, 444 SNS members volunteered to participate in this study. Structural equation modeling was applied to analyze a conceptual model.

Findings

The results revealed that SNS social trust and network density directly and significantly affected the social identity and continuous participation behavior of members. SNSs using a shared language positively affected social identity, but this was not directly associated with continuous participation behavior.

Originality/value

Because the network externalities of SNSs exert critical effects on user benefits, attracting continuous user participation remains one of the critical challenges for SNS administrators. Both the theoretical and practical implications of this study can aid SNS administrators in developing effective continuous participation strategies.

Peer review

The peer-review history for this article is available at: https://publons.com/publon/10.1108/OIR-07-2021-0369

Value Cocreation in Health Care: Systematic Review

Background

Value cocreation in health care (VCCH), mainly based on service-dominant logic, emphasizes that participants, including both patients and physicians, can effectively enroll in the health care value creation process. Effective VCCH is of great significance for realizing value-based health care and improving doctor-patient relationships. Therefore, a comprehensive understanding of VCCH is critical. However, the current literature on VCCH is fragmented and not well studied.

Objective

The goal of the research is to investigate the antecedents, consequences, and dimensions of VCCH by systematically searching, selecting, summarizing, and evaluating relevant literature.

Methods

English-language articles on VCCH in the Web of Science, PubMed, and Scopus databases published from January 2008 to December 2019 were identified. The articles were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, and the quality of studies included were appraised using the Mixed Methods Appraisal Tool.

Results

Out of the 181 publications initially identified through the bibliographic searches, 28 publications met the inclusion criteria. This review summarizes antecedents, consequences, and dimensions of VCCH, as well as possible associations among them. An integrative framework is also proposed for mapping the literature of VCCH grounded on social cognitive theory to reveal the whole process of VCCH.

Conclusions

The findings of this systematic review provide implications for continued development of VCCH and contribute to inspire more research in the future.

Continuance Intention of Online Healthcare Communities- The Mediation Mechanism of Social Interaction Ties

The purpose of this research is to evaluate the continuance usage intention on online healthcare community (OHC) platform for patients and examine the "doctor-OHC-patient" relationship. The proposed model attempted to integrate social interaction ties, shared value, trust with the indirect effects on the relationship between the determinants and continuous usage intention of the OHC platform. The empirical results showed that perceived critical mass, social identity, and para-social interaction would strengthen continuance intention via the social interaction ties. In addition, this study found that the shared values and trust increase users' willingness to continue usage of OHC. This study provides OHC platform managers with an in-depth understanding of the "doctor-OHC-patient" online social interaction. The results of this study may also help hospitals, health policy makers, and related healthcare practitioners to improve the way they use the web for advocacy and guidance, and provide insight into the intent of promoting the ongoing use of OHC platforms.

Using an Individual-Centered Approach to Gain Insights From Wearable Data in the Quantified Flu Platform: Netnography Study

BACKGROUND

Wearables have been used widely for monitoring health in general, and recent research results show that they can be used to predict infections based on physiological symptoms. To date, evidence has been generated in large, population-based settings. In contrast, the Quantified Self and Personal Science communities are composed of people who are interested in learning about themselves individually by using their own data, which are often gathered via wearable devices.

OBJECTIVE

This study aims to explore how a cocreation process involving a heterogeneous community of personal science practitioners can develop a collective self-tracking system for monitoring symptoms of infection alongside wearable sensor data.

METHODS

We engaged in a cocreation and design process with an existing community of personal science practitioners to jointly develop a working prototype of a web-based tool for symptom tracking. In addition to the iterative creation of the prototype (started on March 16, 2020), we performed a netnographic analysis to investigate the process of how this prototype was created in a decentralized and iterative fashion.

RESULTS

The Quantified Flu prototype allowed users to perform daily symptom reporting and was capable of presenting symptom reports on a timeline together with resting heart rates, body temperature data, and respiratory rates measured by wearable devices. We observed a high level of engagement; over half of the users (52/92, 56%) who engaged in symptom tracking became regular users and reported over 3 months of data each. Furthermore, our netnographic analysis highlighted how the current Quantified Flu prototype was a result of an iterative and continuous cocreation process in which new prototype releases sparked further discussions of features and vice versa.

CONCLUSIONS

As shown by the high level of user engagement and iterative development process, an open cocreation process can be successfully used to develop a tool that is tailored to individual needs, thereby decreasing dropout rates.

Understanding relationship commitment and continuous knowledge sharing in online health communities: a social exchange perspective

Purpose

Online health communities (OHCs) have become increasingly popular sources of health information in recent years. However, little is known about the factors that affect the relationship commitment and continuous knowledge sharing intention among OHC members. Thus, this study aims to integrate social exchange and commitment-trust theories to establish a theoretical model to fill the gap.

Design/methodology/approach

A research model that integrates social exchange theory and commitment-trust theory is developed. Quantitative data from 519 valid questionnaires are collected via an offline survey. Statistical product and service solutions 20.0 and analysis of a moment structures 20.0 software are used to test the hypotheses.

Findings

Relationship commitment directly influences continuous knowledge sharing intention, partially mediates the relationship between social support and continuous knowledge sharing intention, and fully mediates the relationship between perceived health risks and continuous knowledge sharing intention. Informational and emotional supports are identified as benefit factors that positively affect relationship commitment and perceived health risks are regarded as cost factors that negatively influence relationship commitment. Informational and emotional supports of OHC members produce different effects on relationship commitment when members obtain social support from different sources. Moreover, trust moderates the influences of informational support and perceived health risks on relationship commitment.

Originality/value

The findings provide additional insights that can augment the knowledge management literature by indicating how people are driven to share knowledge continuously in the context of OHCs. This study empirically clarifies the relationships of benefits (i.e. social support) and costs (i.e. perceived health risks) to continuous knowledge sharing intention by demonstrating the significant mediating effect of relationship commitment. In addition, the findings of this study highlight the importance of the social support source in OHCs and provide additional insights into commitment–trust theory by integrating the moderating effect of trust on the relationships between relationship commitment and its antecedents.

Influencing Factors of Continuous Use of Web-Based Diagnosis and Treatment by Patients With Diabetes: Model Development and Data Analysis

Background

The internet has become a major source of health care information for patients and has enabled them to obtain continuous diagnosis and treatment services. However, the quality of web-based health care information is mixed, which raises concerns about the credibility of physician advice obtained on the internet and markedly affects patients’ choices and decision-making behavior with regard to web-based diagnosis and treatment. Therefore, it is important to identify the influencing factors of continuous use of web-based diagnosis and treatment from the perspective of trust.

Objective

The objective of our study was to investigate the influencing factors of patients’ continuous use of web-based diagnosis and treatment based on the elaboration likelihood model and on trust theory in the face of a decline in physiological conditions and the lack of convenient long-term professional guidance.

Methods

Data on patients with diabetes in China who used an online health community twice or more from January 2018 to June 2019 were collected by developing a web crawler. A total of 2437 valid data records were obtained and then analyzed using correlation factor analysis and regression analysis to validate our research model and hypotheses.

Results

The timely response rate (under the central route), the reference group (under the peripheral route), and the number of thank-you letters and patients’ ratings that measure physicians’ electronic word of mouth are all positively related with the continuous use of web-based diagnosis and treatment by patients with diabetes. Moreover, the physician’s professional title and hospital’s ranking level had weak effects on the continuous use of web-based diagnosis and treatment by patients with diabetes, and the effect size of the physician’s professional title was greater than that of the hospital’s ranking level.

Conclusions

From the patient's perspective, among all indicators that measure physicians’ service quality, the effect size of a timely response rate is much greater than those of effect satisfaction and attitude satisfaction; thus, the former plays an essential role in influencing the patients’ behavior of continuous use of web-based diagnosis and treatment services. In addition, the effect size of electronic word of mouth was greater than that of the physician’s offline reputation. Physicians who provide web-based services should seek clues to patients’ needs and preferences for receiving health information during web-based physician-patient interactions and make full use of their professionalism and service reliability to communicate effectively with patients. Furthermore, the platform should improve its electronic word of mouth mechanism to realize its full potential in trust transmission and motivation, ultimately promoting the patient’s information-sharing behavior and continuous use of web-based diagnosis and treatment.

Mitigating loneliness with companion robots in the COVID-19 pandemic and beyond: an integrative framework and research agenda

Purpose

Loneliness and isolation are on the rise, globally threatening the well-being across age groups; global social distancing measures during the COVID-19 crisis have intensified this so-called “loneliness virus”. The purpose of this paper is to develop an integrative framework and research agenda on the role of companion robots in mitigating feelings of loneliness.

Design/methodology/approach

A netnographic analysis of 595 online visual and textual descriptions offer empirical insights about the role of the companion robot Vector during the COVID-19 pandemic.

Findings

The contributions of this study are twofold. First, it postulates that companion robots have the potential of mitigating feelings of loneliness (i.e. indicator of well-being). Second, this study contributes to transformative service by developing an integrative framework introducing the roles (personal assistant, relational peer and intimate buddy) that companion robots can fulfill to mitigate feelings of loneliness through building different types of supportive relationships.

Research limitations/implications

The proposed research agenda encourages future service scholars to investigate 1) the role of robots in addressing loneliness, 2) design features that drive adoption of robots, 3) social support for different groups, 4) the operationalization and the measurement of loneliness and 5) an impact analysis of companion robots.

Practical implications

Service providers and policy makers can leverage the insights about how companion robots can help reduce a sense of loneliness.

Originality/value

The integrative framework on loneliness reduction, based on 595 unprompted online contributions issued during the COVID-19 pandemic, offers initial evidence for the impact of companion robots in reducing people's feelings of loneliness.

Improving the Theoretical Understanding Toward Patient-Driven Health Care Innovation Through Online Value Cocreation: Systematic Review

Background

Patient participation in the health care domain has surged dramatically through the availability of digital health platforms and online health communities (OHCs). Such patient-driven service innovation has both potential and challenges for health care organizations. Over the last 5 years, articles have surfaced that focus on value cocreation in health care services and the importance of engaging patients and other actors in service delivery. However, a theoretical understanding of how to use OHCs for this purpose is still underdeveloped within the health care service ecosystem.

Objective

This paper aimed to introduce a theoretical discussion for better understanding of the potential of OHCs for health care organizations, in particular, for patient empowerment.

Methods

This literature review study involved a comprehensive search using 12 electronic databases (EMBASE, PsycINFO, Web of Science, Scopus, ScienceDirect, Medical Literature Analysis and Retrieval System Online, PubMed, Elton B Stephens Co [academic], Cumulative Index of Nursing and Allied Health Literature, Accelerated Information Sharing for Law Enforcement, Association for Computing Machinery, and Google Scholar) from 2013 to 2019. A total of 1388 studies were identified from the database search. After removing duplicates and applying inclusion criteria, we thematically analyzed 56 articles using the Braun and Clarke thematic analysis approach.

Results

We identified a list of 5 salient themes: communication extension, improved health literacy for patients and health care organizations, communication transparency with patients, informational and social support for patients, and patient empowerment in self-management. The most frequent theme was communication extension, which covers 39% (22/56) of the literature. This theme reported that an extension of communication between patients, caregivers, and physicians and organizations led to new opportunities to create value with minimal time and cost restrictions. Improved health literacy and communication transparency with patients were the second and third most frequent themes, respectively, covering 26% (15/56) and 25% (14/56) of the literature, respectively. The frequency of these themes indicated that the use of OHCs to generate new knowledge from patients’ interactions helped health care organizations to customize treatment plans and establish transparent and effective communication between health care organizations and patients. Furthermore, of the 56 studies, 13 (23%) and 10 (17%) studies contended the opportunity of using OHCs in terms of informational and emotional support and empowering patients in their self-management of diseases.

Conclusions

This review enables better understanding of the current state of the art of the online value cocreation and its potential for health care organizations. This study found that the opportunities for health care organizations through enhancement of patient participation and their cocreation of value in digital health platforms have been rapidly increasing. The identified gaps and opportunities in this study would identify avenues for future directions in modernized and more effective value-oriented health care informatics research.

Exploring the Factors Influencing Consumers to Voluntarily Reward Free Health Service Contributors in Online Health Communities: Empirical Study

BACKGROUND

Rewarding health knowledge and health service contributors with money is one possible approach for the sustainable provision of health knowledge and health services in online health communities (OHCs); however, the reasons why consumers voluntarily reward free health knowledge and health service contributors are still underinvestigated.

OBJECTIVE

This study aimed to address the abovementioned gap by exploring the factors influencing consumers' voluntary rewarding behaviors (VRBs) toward contributors of free health services in OHCs.

METHODS

On the basis of prior studies and the cognitive-experiential self-theory (CEST), we incorporated two health service content-related variables (ie, informational support and emotional support) and two interpersonal factors (ie, social norm compliance and social interaction) and built a proposed model. We crawled a dataset from a Chinese OHC for mental health, coded it, extracted nine variables, and tested the model with a negative binomial model.

RESULTS

The data sample included 2148 health-related questions and 12,133 answers. The empirical results indicated that the effects of informational support (β=.168; P<.001), emotional support (β=.463; P<.001), social norm compliance (β=.510; P<.001), and social interaction (β=.281; P<.001) were significant. The moderating effects of social interaction on informational support (β=.032; P=.02) and emotional support (β=-.086; P<.001) were significant. The moderating effect of social interaction on social norm compliance (β=.014; P=.38) was insignificant.

CONCLUSIONS

Informational support, emotional support, social norm compliance, and social interaction positively influence consumers to voluntarily reward free online health service contributors. Social interaction enhances the effect of informational support but weakens the effect of emotional support. This study contributes to the literature on knowledge sharing in OHCs by exploring the factors influencing consumers' VRBs toward free online health service contributors and contributes to the CEST literature by verifying that the effects of experiential and rational systems on individual behaviors can vary while external factors change.

Customer participation risk management: conceptual model and managerial assessment tool

Purpose

Customer participation (CP) has received considerable interest in the service literature as a way to improve the customer experience and reduce service providers' costs. While its benefits are not in question, there is a paucity of research on potential pitfalls. This paper provides a conceptual foundation to address this gap and develops a comprehensive model of the risks of customer participation in service delivery, integrating research from the marketing, operations and supply chain management, strategy, and information technology fields.

Design/methodology/approach

The model is derived deductively by integrating insights from research in marketing, operations and supply chain management, strategy, and information technology.

Findings

This paper identifies three categories of potential risks of CP (i.e. market, operational, and service network) and discusses ways that firms can mitigate these risks. Building on the model, it develops a CP risk assessment tool that managers can use when evaluating increases in CP.

Research limitations/implications

The conceptual model proposed in this paper can serve as a robust basis for future research in customer participation, particularly in such areas as sharing economy services, service delivery networks, and experiential services. The risk assessment tool offers clear guidelines for managers who are considering an increase in customer participation in their service.

Originality/value

This is the first attempt to conceptually define customer participation risk and develop a comprehensive model of its drivers and strategies to mitigate it. This paper develops a straightforward method for managers to evaluate CP risk.

Fostering older adult care experiences to maximize well-being outcomes

Purpose

Caring for older adults is an increasingly complex and multi-dimensional global concern. This article provides a comprehensive definition of the older adult care experience and discusses its key components to help practitioners deliver older adult-centered care to maximize well-being outcomes for older adults.

Design/methodology/approach

Based on prior research on service operations, service experience, person-centered care and the unique, evolving needs of older adults regarding their care, this paper develops a conceptual framework in which the older adult care experience is the central construct, and key dimensions of well-being are the outcomes.

Findings

The older adult care experience is shaped by older adults' perceptions and evaluations of the care that they receive. Older adult-centered care has autonomy, dignity, unique needs and social environment as its core dimensions and results in those older adults feel empowered, respected, engaged and connected as part of their experience. The article also discusses how such experience can be evaluated by using quality dimensions from service operations, hospitality and healthcare contexts, and challenges that service firms may face in creating older adult care experience.

Research limitations/implications

Given the changing demographics and unique needs of older adults, it is an imperative for academics and practitioners to have an understanding of what determines older adult care experience to better serve them. Such understanding is important as by creating and fostering older adult care experience, service organizations can contribute to individual and societal well-being.

Originality/value

To the authors' best knowledge, this is the first paper to provide a comprehensive conceptualization of the older adult care experience.

Role of empowerment and sense of community on online social health support group

Purpose

Drawing on the taxonomy of patient empowerment and a sense of community (SoC), the purpose of this paper is to analyze the factors that impact the intention of the individual to continue using online social health support community for their chronic disease management.

Design/methodology/approach

A survey design was used to collect the data from multiple online social health support groups related to chronic disease management. The survey yielded a total of 246 usable responses.

Findings

The primary findings from this study indicate that the informational support – not the nurturant support such as emotional, network, and esteem support – are the major types of support people are seeking from an online social health support community. This research also found that patient empowerment and SoC would positively impact their intention to continue using the online health community.

Research limitations/implications

This study utilized a survey design method may limit precision and realism. Also, there is the self-selection bias as the respondents self-selected themselves to take the survey.

Practical implications

The findings can help the community managers or webmasters to design strategies for the promotion and diffusion of online social health group among patient of chronic disease. Those strategies should focus on patient’s empowerment through action facilitating and social support and through creating a SoC.

Originality/value

An innovative research model integrates patient empowerment and a SoC to study patient’s chronic disease management through online social health groups to fill the existing research gap.

The role of off-topic discussions in online health support groups: insights from a content analysis of an online rectal cancer group

PURPOSE

Both off-topic discussions and exchanges of social support are important to the success of online health support groups. Analyzing their relationship could enhance our understanding of the nature of helpful interactions in online cancer support groups and ways promoting their success.

METHODS

A total of 15,284 messages were collected and analyzed from an online support group for rectal cancer. Two coders coded and categorized the messages into 211 threads using directed content analysis and a social support classification system. The relationship between off-topic discussions and social support was explored using the quadratic assignment procedure.

RESULTS

There are 91 threads of off-topic discussions, 83 threads of informational support, 22 threads of emotional support, seven threads of tangible support, five threads of network support, and three threads of esteem support. More of the off-topic discussions are associated with more emotional and tangible support. Both off-topic discussions and informational support are mutually influenced by the mediating role of emotional support. In addition, off-topic discussions and network support are mutually influenced by the mediating role of emotional and tangible support, and off-topic discussions and esteem support are mutually influenced by the mediating role of tangible support.

CONCLUSIONS

Off-topic discussions directly or indirectly promote different types of social support in an online rectal cancer support group.

Understanding the Impact of Opinion Leaders’ Characteristics on Online Group Knowledge-Sharing Engagement from In-Group and Out-Group Perspectives: Evidence from a Chinese Online Knowledge-Sharing Community

Opinion leaders often play key roles in online knowledge-sharing communities, which has intrigued a lot of researchers and practitioners worldwide. However, it is not clear how various characteristics of opinion leaders may affect different online groups’ knowledge-sharing engagement. This paper aims to answer this question by building upon social capital theory to examine the differential influences of opinion leaders’ characteristics (interactivity, authority, and activity) on online groups. In-groups and out-groups were distinguished, and the study used the context of an investment-oriented online knowledge-sharing community. By leveraging a unique aggregated group-level secondhand dataset collected from Snowball.com, we conducted log-linear and Poisson regression models. The results revealed that the intensity of online group knowledge-sharing engagement was heavily contingent upon the types of characteristics of opinion leaders. We found that in-group knowledge-sharing engagement (generating new knowledge) was driven by an opinion leader’s interactivity and authority, whereas out-group knowledge-sharing engagement (developing new members) could not be facilitated by these types of characteristics. Instead, the opinion leader’s activity hindered out-group users from joining in-groups. The study also identified a “mutual promotion” issue, which was generated from the association between in-group and out-group knowledge-sharing engagement.

Engagement in Healthcare Systems: Adopting Digital Tools for a Sustainable Approach

The rapid development of new technologies has created interesting and unexpected possibilities in e-health, and digital platforms have become widespread, connecting users, experts, and practitioners of the health world. This triggered our investigation into the relationship between the engagement platforms used by 293 doctors with various specializations, their satisfaction, and the dimensions of social sustainability in the healthcare sector. The research focused on professional interaction and its sphere of action in engagement platforms, defined as virtual contact points for exchanging information, thus increasing the co-creation of value between physicians and patients. In order to verify our hypothesis, a health digital platform called paginemediche.it was used, and the two dimensions of engagement and sustainability were considered, examining their causal relationship and evaluating their effects on physician loyalty in terms of the re-use of the digital platform by doctors. Our results, using a multiple linear regression analysis, showed that the social sustainability of the digital health platform was directly influenced by online engagement, generating a positive effect on physician loyalty. In particular, the human dimension of social sustainability proved to be decisive for the re-use of the platform.

Online communities as a new source of exploring patient dissatisfaction

PURPOSE

The purpose of this paper is to analyse whether internet forums are an appropriate source for identification of causes of dissatisfaction of patients with non-medical aspects of healthcare services.

DESIGN/METHODOLOGY/APPROACH

Based on the guidelines of netnography qualitative research the authors identify relevant posts or comments on selected online forums in which web users show their dissatisfaction with healthcare services. Five popular Slovenian forums representing different interest communities have been chosen and 42 forums' topics have been reviewed.

FINDINGS

Online communities have an important role in exploring patient dissatisfaction. Through content analysis comments were coded into meaningful categories and subcategories.

RESEARCH LIMITATIONS/IMPLICATIONS

Some comments were more explicit, while others have provided general and looser reasons for dissatisfaction, and in such cases coding and content analysis of comments was more difficult.

PRACTICAL IMPLICATIONS

Contents expressed within online communities are helpful in designing improvement activities since they enable determination of concrete relevant measures aiming at eliminating and preventing the established causes of discontent, such as instituting new policies, introducing training programs, determining desired changes in culture.

ORIGINALITY/VALUE

Usefulness of the netnography as a qualitative method of research is confirmed through confirmation that causes of dissatisfaction of Slovenian patients, which have been identified in the authors research are similar to those identified in previous research in the field of patient satisfaction conducted in Slovenia. Results constitute a new form of researching patient dissatisfaction and expose the specific causes of patient dissatisfaction with healthcare services in Slovenia.

Conceptualizing negatively valenced influencing behavior: forms and triggers

Purpose

The purpose of this paper is to show how customers engage in negatively valenced influencing behavior (NVIB) and what triggers customers to use different forms of NVIB in an online context.

Design/methodology/approach

A qualitative study is conducted using an unobtrusive netnography. Data collected comprise of 954 negatively valenced online reviews posted on TripAdvisor to hotels, restaurants, and “things to do” in 12 different destinations worldwide.

Findings

Drawing on the recent literature relating to customer engagement behavior (CEB), this paper identifies and conceptualizes the relationship between five cognitive (service failure, overpricing, deception) and emotional (disappointment and insecurity) triggers of six forms of direct (dissuading, warning, and endorsing competitors) and indirect (discrediting, expressing regret, and deriding) NVIB.

Research limitations/implications

The unobtrusive netnography has inherent limitations that lend itself to inductive rich insights rather than generalization. The study only focuses on NVIB within a specific online context, namely, TripAdvisor.

Practical implications

This paper provides managers with knowledge of the specific triggers of NVIB. Additionally, the paper conceptualizes the various forms of NVIB, how customers use them, and what triggers them to use each form. Moreover, the paper offers relevant data-inferred recommendations to service managers on how to manage each form of NVIB.

Originality/value

This research is the first to identify the forms and triggers of NVIB, classify direct and indirect forms, and conceptualize the relationships between forms and triggers.

Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study

BACKGROUND

The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis.

OBJECTIVE

The aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value.

METHODS

A multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Encounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care.

CONCLUSIONS

Digital technology can add value to patients' care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity.

Evolving roles and structures of triadic engagement in healthcare

Purpose

The purpose of this paper is to focus on the changing nature of healthcare service encounters by studying the phenomenon of triadic engagement incorporating interactions between patients, local and virtual networks and healthcare professionals.

Design/methodology/approach

An 18-month longitudinal ethnographic study documents interactions in naturally occurring healthcare consultations. Professionals (n=13) and patients (n=24) within primary and secondary care units were recruited. Analysis of observations, field notes and interviews provides an integrated picture of triadic engagement.

Findings

Triadic engagement is conceptualised against a two-level framework. First, the structure of triadic consultations is identified in terms of the human voice, virtual voice and networked voice. These are related to: companions’ contributions to discussions and the virtual network impact. Second, evolving roles are mapped to three phases of transformation: enhancement; empowerment; emancipation. Triadic engagement varied across conditions.

Research limitations/implications

These changing roles and structures evidence an increasing emphasis on the responsible consumer and patients/companions to utilise information/support in making health-related decisions. The nature and role of third voices requires clear delineation.

Practical implications

Structures of consultations should be rethought around the diversity of patient/companion behaviours and expectations as patients undertake self-service activities. Implications for policy and practice are: the parallel set of local/virtual informational and service activities; a network orientation to healthcare; tailoring of support resources/guides for professionals and third parties to inform support practices.

Originality/value

Contributions are made to understanding triadic engagement and forwarding the agenda on patient-centred care. Longitudinal illumination of consultations is offered through an exceptional level of access to observe consultations.

Ill Literates or Illiterates? Investigating the eHealth Literacy of Users of Online Health Communities

Background

Electronic health (eHealth) literacy is an important skill that allows patients to navigate intelligibly through the vast, often misleading Web-based world. Although eHealth literacy has been investigated in general and specific demographic populations, it has not yet been analyzed on users of online health communities (OHCs). Evidence shows that OHCs are important Web 2.0 applications for patients for managing their health, but at the same time, warnings have been expressed regarding the quality and relevance of shared information. No studies exist that investigate levels of eHealth literacy among users of OHCs and differences in eHealth literacy between different types of users.

Objective

The study aimed to investigate eHealth literacy across different types of users of OHCs based on a revised and extended eHealth literacy scale (eHEALS).

Methods

The study was based on a cross-sectional Web survey on a simple random sample of 15,000 registered users of the most popular general OHC in Slovenia. The final sample comprised 644 users of the studied OHC. An extended eHEALS (eHEALS-E) was tested with factor analytical procedures, whereas user types were identified with a hierarchical clustering algorithm. The research question was analyzed with analysis of variance (ANOVA) procedure and pairwise comparison tests.

Results

Factor analysis of the revised and extended eHEALS revealed six dimensions: awareness of sources, recognizing quality and meaning, understanding information, perceived efficiency, validating information, and being smart on the Net. The factor solution demonstrates a good fit to the data (root mean square error of approximation [RMSEA]=.059). The most developed dimension of eHEALS-E is awareness of different Internet sources (mean=3.98, standard deviation [SD]=0.61), whereas the least developed is understanding information (mean=3.11, SD=0.75). Clustering resulted in four user types: active help-seekers (48.3%, 311/644), lurkers (31.8%, 205/644), core relational users (16.9%, 109/644), and low-engaged users (3%, 19/644). Analysis of the research question showed statistically significant differences among user types across all six dimensions of eHEALS-E. Most notably, core relational users performed worse than lurkers on the validating information dimension (P=.01) and worse than active help-seekers on the being smart on the Net dimension (P=.05). Active help-seekers have the highest scores in all dimensions of the eHEALS-E, whereas low-engaged users have statistically significantly lower scores on all dimensions of the eHEALS-E in comparison with the other groups.

Conclusions

Those who are looking for advice and support in OHCs by making queries are well equipped with eHealth literacy skills to filter potential misinformation and detect bad advice. However, core relational users (who produce the most content in OHCs) have less-developed skills for cross-validating the information obtained and navigating successfully through the perils of the online world. Site managers should monitor their activity to avoid the spread of misinformation that might lead to unhealthy practices.

Consumer-led health-related online sources and their impact on consumers: An integrative review of the literature

The aim of the review was to describe consumer-led health-related online sources and their impact on consumers. The review was carried out as an integrative literature review. Quantisation and qualitative content analysis were used as the analysis method. The most common method used by the included studies was qualitative content analysis. This review identified the consumer-led health-related online sources used between 2009 and 2016 as health-related online communities, health-related social networking sites and health-related rating websites. These sources had an impact on peer support; empowerment; health literacy; physical, mental and emotional wellbeing; illness management; and relationships between healthcare organisations and consumers. The knowledge of the existence of the health-related online sources provides healthcare organisations with an opportunity to listen to their consumers' 'voice'. The sources make healthcare consumers more competent actors in relation to healthcare, and the knowledge of them is a valuable resource for healthcare organisations. Additionally, these health-related online sources might create an opportunity to reduce the need for drifting among the healthcare services. Healthcare policymakers and organisations could benefit from having a strategy of increasing their health-related online sources.

Value cocreation in service ecosystems

Purpose

The purpose of this paper is to understand value cocreation in service ecosystems from a multilevel perspective, uncovering value cocreation factors and outcomes at the micro, meso, and macro levels.

Design/methodology/approach

A Grounded Theory approach based on semi-structured interviews is adopted. The sample design was defined to enable the ecosystem analysis at its different levels. At the macro level was the Portuguese Health Information ecosystem. Embedded meso level units of analysis comprised eight health care organizations. A total of 48 interviews with citizens and health care practitioners were conducted at the micro level.

Findings

Study results enable a detailed understanding of the nature and dynamics of value cocreation in service ecosystems from a multilevel perspective. First, value cocreation factors are identified (resource access, resource sharing, resource recombination, resource monitoring, and governance/institutions generation). These factors enable actors to integrate resources in multiple dynamic interactions to cocreate value outcomes, which involve both population well-being and ecosystem viability. Study results show that these value cocreation factors and outcomes differ across levels, but they are also embedded and interdependent.

Practical implications

The findings have important implications for organizations that are ecosystem actors (like the Portuguese Ministry of Health) for understanding synergies among value cocreation factors and outcomes at the different levels. This provides orientations to better integrate different actor roles, technology, and information while facilitating ecosystem coordination and co-evolution.

Originality/value

This study responds to the need for a multilevel understanding of value cocreation in service ecosystems. It also illuminates how keystone players in the ecosystem should manage their value propositions to promote resource integration for each actor, fostering resource density and ecosystem viability. It also bridges the high-level conceptual perspective of Service-Dominant logic with specific empirical findings in the very important context of health care.

Practice styles and service systems

Purpose

The purpose of this paper is to examine how practices influence service systems.

Design/methodology/approach

Data across three service contexts (crafts, healthcare and fitness) were collected through depth interviews and netnographic analysis, and analyzed with a two-study multi-method approach focusing first on the micro- (individual) level and then on the macro- (network) level of service systems. Study 1 focused on a micro-level analysis using qualitative techniques (Spiggle, 1994). Study 2 focused on a macro-level analysis using partial least squares regression.

Findings

The results illustrate how practices can change service systems. This occurs when a nuanced practice (i.e. a practice style) orders and roots a service system in a specific form of value creation. The findings reveal four practice styles: individual-extant, social-extant, individual-modified and social-modified practice styles. These practice styles shift in response to event triggers and change service systems. These event triggers are: service beneficiary enhancement, service beneficiary failure, service provider failure and social change. Thus, the findings show that practices – when shifting in response to event triggers – change service systems. This transpires in the understudied meta-layer of a service system.

Practical implications

The study identifies four practice styles that can serve as the basis for segmentation and service design.

Originality/value

Service systems are dynamic and ever changing. This study explores how service systems change by proposing a practice approach to service systems.

A longitudinal comparison of customer satisfaction and customer-company identification in a service context

Purpose

Customer satisfaction (CS) and customer-company identification (CCI) are two important relational constructs and play a complementary role in the service-profit chain. Drawing from the theory of relationship dynamics, the purpose of this paper is to define CS velocity and CCI velocity as the rate and direction of change in CS and CCI, respectively. A comparison of the relative effects of CCI velocity and CS velocity on customer loyalty is done through a latent growth curve modeling approach.

Design/methodology/approach

A conceptual model is developed and empirically tested based on four waves of a longitudinal survey of 213 restaurant customers.

Findings

The results show that both CCI velocity and CS velocity have positive effects on customer loyalty. More importantly, the effects of CCI velocity on customer loyalty over time are stronger than those of CS velocity. The moderation analysis further shows that the higher the frequency of visits to the service firm, the stronger the effects of relationship velocity on customer loyalty.

Practical implications

The results provide new insights for service marketing managers by suggesting that, to benefit the long-term effectiveness of relationship investments, service firms should shift the priority from increasing CS to engendering CCI.

Originality/value

This paper contributes to the theory of relationship dynamics by conceptualizing new constructs of CS velocity and CCI velocity and by empirically comparing their relative effects on customer loyalty over time.

Coordinating online health communities for cognitive and affective value creation

Purpose

– The purpose of this paper is to develop a framework investigating patterns of online health communities. In particular, the study draws on coordination theory to identify four community configurations. Their distinct features determine communities’ capacity to internalize and externalize knowledge, which ultimately determines their value creation in a service context.

Design/methodology/approach

– The authors apply qualitative and quantitative techniques to detect similarities and differences in a sample of 50 online health communities. A categorical principal component analysis combined with cluster analysis reveals four distinct community configurations.

Findings

– The analysis reveals differences in the degrees of cognitive and affective value creation, the types of community activities, the involved patients, professionals, and other stakeholders; and the levels of data disclosure by community members. Four community configurations emerge: basic information provider, advanced patient knowledge aggregator, systematic networked innovator, and uncomplicated idea sharer.

Research limitations/implications

– The findings show that communities can be categorized along two knowledge creation dimensions: knowledge externalization and knowledge internalization. While, previous research remained inconclusive regarding the synergistic or conflicting nature of cognitive and affective value creation, the findings demonstrate that cognitive value creation is an enabler for affective value creation. The emerging configurations offer a classification scheme for online communities and a basis for interpreting findings of future services research in the context of online health communities.

Originality/value

– This research combines coordination theory with healthcare, service, and knowledge creation literature to provide a fine-grained picture of the components of online health communities. Thereby, inherent trade-offs and conflicts that characterize the components of coordination theory are investigated.