Research On The Mechanism Of Value Co-Creation Behavior In Online Health Community

[Objective]Enhancing the value of healthcare is a common goal for all parties involved in the healthcare system.Online health community presents an opportunity for multiple parties to participate in the whole process of healthcare services,however,the lack of effective interaction between community members has resulted in poor online experience and insufficient enhancement of health outcomes.Value co-creation emphasises that participants co-create value through effective interaction and that the value co-creation behavior is the prerequisite for gaining value.This study combines the service environment of online health community,oriented to the value co-creation process involving multiple subjects,based on service dominant logic,professional-client interaction theory,S-O-R model,socio-technical systems theory,social interdependence theory and consumer value theory,and focuses on the value co-creation behavior of online health community,with the Type of behavior-Influencing factors of behavior-Results of behavior as the main line of research,to develop three aspects of research: identify the types of value co-creation behaviors of physicians and patients in online health communities;clarify the influencing factors of value co-creation behaviors of physicians and patients in online health communities and their mechanisms of action;explore the mechanisms of influence of value co-creation behaviors of physicians and patients on the value of healthcare.The results of the study provide a theoretical basis for enhancing the value of healthcare,guiding patients to participate in the whole process of healthcare,and providing strategies and suggestions for the service management of online health communities.[Methods]This study focuses on value co-creation behaviors,using online health communities as the research context and using mixed research methods that combine qualitative research methods(literature analysis method,grounded analysis method)and quantitative research methods(data crawling,questionnaire survey method,statistical analysis method).(1)In the model construction and measurement questionnaire stage.The literature analysis method was used to sort out the theories and researches in related fields,to construct the research model of value co-creation behavior influence factor and value creation mechanism of online health community respectively,and to develop the scale of value co-creation behavior influence factor and the measurement questionnaire of value creation mechanism model.(2)At the data collection stage.Using data crawling to obtain the online interaction contents of online health community physicians and patients,a total of 7268 valid texts were obtained.Using the questionnaire survey method,empirical data were collected through the Credamo platform,and finally 519 valid patient responses and 468 valid physician responses were obtained for the value co-creation behavior influence study,and 516 valid patient responses and 450 valid physician responses were obtained for the value creation mechanism study.(3)In the data analysis stage.Based on the principles and methods of grounded theory,open,principal axis and selective coding were deployed using NVivo 11.0 to construct a framework of online health community value co-creation behavior types.Combining the coding table,the frequency and proportion of the main category and the concept were quantitatively described,to explore the quantitative characteristics of the sub-dimensions of two types online health community value co-creation behaviors.After a sufficient valid sample size was obtained using the questionnaire survey,descriptive statistics were used to perform a preliminary demographic descriptive analysis of the sample.Using confirmatory factorial analysis(CFA)method for measurement model testing,including common method bias,reliability and validity tests of the scales.Using the structural equation modeling based on partial least squares(PLS-SEM),hypothesis testing was conducted to analyze the influence of environmental stimuli(stimulus “S”)and the degree of perceived social interdependence(organism “O”)on the value co-creative behavior(response “R”)of physicians and patients in online health communities.A multigroup analysis of the model of factors influencing value co-creation behavior was conducted in combination with Smart PLS 3.0 software.To examine the differences in the influence of community environment stimuli(stimulus “S”)on the degree of users’ perceived social interdependence(organism “O”)under the influence of participating subject and community type grouping moderators.Finally,a structural equation model based on partial least squares(PLS-SEM)is used to test the hypotheses of the online health community value creation mechanism research model,and to analyze the impact of physician and patient value co-creation behaviors on the “online experience” of value creation,and the impact of the “online experience” created by patients on the "health outcomes”.[Results](1)Research on the types of value co-creation behaviors in online health communities based on professional-client interaction theory.Based on the behavioral characteristics embodied in the main categories,the value cocreation behaviors of physicians and patients in online health communities are categorized as instrumental value co-creation behaviors and affective value co-creation behaviors.According to the results of quantitative analysis,the total percentage of instrumental value co-creation behaviors of physicians and patients in online health communities are both greater than that of affective value co-creation behaviors.3 sub-dimensions of physicians’ instrumental value co-creation behaviors: health problem solving,health information support,and professional knowledge exchange,with the highest percentage of health problem solving(38.49%).2 sub-dimensions of physicians’ affective value co-creation behaviors: interpersonal adaptive behaviors,and emotional support behaviors,with the highest percentage of emotional support behavior(16.17%).5 sub-dimensions of patients’ instrumental value co-creation behaviors: active information sharing,disease-related counseling,risk assessment,seeking health-related information,offline referral counseling,with a higher percentage of active information sharing(31.16%)and disease-related counseling(26.45%).3 sub-dimensions of patients’ affective value co-creation behaviors:emotional expression,personalized needs expression,and emotional support behaviors,with the highest percentage of emotional expression(16.63%).(2)Empirical study of factors influencing value co-creation behavior in online health communities based on the S-O-R model.For patients,(1)community environmental stimuli and perceived goal interdependence:Information support(β=0.141,P<0.01),emotional support(β=0.133,P<0.01),relational commitment(β=0.120,P<0.05),shared vision(β=0.133,P<0.01),and sociability(β=0.116,P<0.01)of online health communities have significant positive effects on patient perceived goal interdependence.Non-significant effects of reputation,reciprocity,structural assurance,and personalization on patient perceived goal interdependence.(2)Community environmental stimuli and perceived task interdependence: Information support(β=0.129,P<0.01),emotional support(β=0.090,P<0.05),perceived reputation(β=0.135,P<0.01),relational commitment(β=0.126,P<0.01),shared vision(β=0.112,P<0.05),and structural assurance(β=0.155,P< 0.001)of online health communities have significant positive effect on patient perceived task interdependence.Non-significant effects of reciprocity,sociability,and personalization on patient perceived task interdependence.(3)Community environmental stimuli and perceived reward interdependence: Information support(β=0.146,P<0.001),emotional support(β=0.146,P<0.001),perceived reputation(β=0.115,P<0.01),reciprocity(β=0.162,P<0.01),sociability(β=0.077,P<0.05),and personalization(β=0.201,P<0.001)of online health communities have significant positive effect on patient perceived reward interdependence.Non-significant effects of relational commitment,shared vision,and structural assurance on patient perceived reward interdependence.(4)Patient perceived interdependence and instrumental value co-creation behaviors: Patient perceived goal interdependence(β=0.186,P<0.01),perceived task interdependence(β=0.256,P<0.001),and perceived reward interdependence(β=0.323,P<0.001)have significant positive effect on patients’ instrumental value co-creation behavior.(5)Patient perceived interdependence and affective value co-creation behaviors:Patient perceived goal interdependence(β=0.176,P<0.001)and perceived reward interdependence(β=0.193,P<0.001)have significant positive effect on patients’ affective value co-creation behaviors,while non-significant effect of patient perceived task interdependence on patients’ affective value co-creation behaviors.For physicians,(1)community environmental stimuli and perceived goal interdependence: In online health communities,physician-provided information support(β=0.177,P<0.001),perceived reputation(β=0.155,P<0.01),relational commitment(β=0.175,P<0.01),shared vision(β=0.139,P<0.01),structural assurance(β=0.148,P<0.01),and sociability(β=0.123,P<0.05)have significant positive effects on physician perceived goal interdependence.physician-provided emotional support,reciprocity,and personalization have no significant effects on physician perceived goal interdependence.(2)Community environmental stimuli and perceived task interdependence: In online health communities,physician-provided information support(β=0.134,P<0.01)and emotional support(β=0.099,P<0.05),perceived reputation(β=0.143,P<0.01),structural assurance(β=0.292,P<0.001),and personalization(β=0.117,P<0.01)have significant positive effect on physician perceived task interdependence.Reciprocity,relational commitment,shared vision,and sociality have no significant effects on physician perceived task interdependence.(3)Community environmental stimuli and perceived reward interdependence: In online health communities,physician-provided information support(β=0.197,P<0.001)and emotional support(β=0.117,P<0.05),perceived reputation(β=0.147,P<0.01),reciprocity(β=0.177,P<0.05),shared vision(β=0.085,P<0.05),and structural assurance(β=0.208,P<0.001)have significant positive effect on physician perceived reward interdependence.Relational commitment,sociability,and personalization have no significant effects on physician perceived reward interdependence.(4)Physician perceived social interdependence and value co-creation behaviors: Physician perceived goal interdependence,perceived task interdependence,and perceived reward interdependence have significant positive effects on physicians’ instrumental value co-creative behaviors(β=0.136,P<0.01;β=0.352,P<0.001;β=0.251,P<0.001)and affective value co-creative behaviors(β=0.208,P<0.001;β=0.231,P<0.001;β=0.352,P<0.001).According to the results of the multigroup analysis,differences in the effects of online health community environmental stimuli on the perceived social interdependence of different participating subjects: Structure assurance differs for the effects of physician and patient perceived task interdependence and perceived reward interdependence(SA→PTI(β=0.168,P<0.05),SA→PRI(β=0.223,P<0.01)),and personalization differs for the effects of physician and patient perceived task interdependence(PER→PTI(β=0.149,P<0.05)).Differences in the effects of environmental stimuli on the perceived social interdependence of physicians and patients in different community types: In doctor-patient and patient-patient community,there are significant differences in the effects of relational commitment and shared vision on patients perceived goal interdependence(RECO→PGI(β=-0.184,P<0.05),SV→PRI(β=-0.184,P<0.05)),and significant differences in the effects of personalization on patients perceived reward interdependence(PER→PRI(β=0.255,P<0.01)).In doctor-patient and doctor-doctor community,there is a significant difference in the effect of relational commitment on physicians perceived goal interdependence(RECO→PGI(β=-024,P<0.05)),and personalization has significant differences on physician perceived goal interdependence and perceived task interdependence(PER→PGI(β=0.150,P<0.01),PER→PTI(β= 0.116,P<0.05)).(3)Research on the value creation mechanism of online health communities based on service dominant logic and consumer value theory.For patients,value co-creation behaviors and the “online experience” of value creation:(1)Both instrumental value co-creation behaviors(β=0.453,P<0.001)and affective value co-creation behaviors(β=0.348,P<0.001)significantly and positively affect patients’ satisfaction.(2)Both instrumental value co-creative behaviors(β=0.462,P<0.001)and affective value co-creative behaviors(β=0.305,P<0.001)significantly and positively affect patient perceived social support.(3)Instrumental value co-creation behaviors have a significant positive effect on patient perceived reputation in online health communities(β=0.503,P<0.001),while affective value co-creation behaviors have no significant effect on patient perceived reputation.“Online experience” and “health outcomes” in value creation:(1)Patients’ satisfaction significantly and positively affects physical wellbeing(β=0.339,P<0.001),psychological wellbeing(β=0.336,P<0.001)and social wellbeing(β=0.360,P<0.001).(2)Patient perceived social support significantly and positively affects their physical wellbeing(β=0.389,P<0.001),psychological wellbeing(β=0.419,P<0.001)and social wellbeing(β=0.288,P<0.001).(3)Patient perceived reputation in the community significantly and positively affects psychological wellbeing(β=0.096,P<0.05)and social wellbeing(β=0.294,P<0.294),and has no significant effect on physical wellbeing.For physicians,value co-creation behavior and the “online experience” of value creation:(1)Physicians’ instrumental value co-creation behavior significantly and positively affects physicians’ satisfaction(β=0.416,P<0.001),financial reward(β=0.300,P<0.001),and perceived reputation(β=0.238,P<0.001).(2)Physicians’ affective value cocreation behavior significantly and positively affects physicians’ satisfaction(β=0.344,P<0.001),financial reward(β=0.316,P<0.001),and perceived reputation(β=0.290,P<0.001).[Conclusions]In online health communities,the value co-creation behaviors of physicians and patients include 2 categories: instrumental value co-creation behaviors and affective value co-creation behaviors.For instrumental value co-creation behaviors,physicians have 3 subdimensions and patients have 5 sub-dimensions;for affective value co-creation behaviors,physicians have 2 sub-dimensions and patients have 3 sub-dimensions.Physicians and patients in online health communities are dominated by instrumental value co-creation behaviors.This study provides a new perspective for scholars to understand and study value co-creation behaviors among participants in online health communities.Social factors(information support,emotional support,perceived reputation,reciprocity,relational commitment,shared vision)and technical factors(structural assurance,sociality,personalization)of the community promote instrumental and affective value co-creative behaviors by influencing perceived social interdependence(perceived goal interdependence,perceived task interdependence,perceived reward interdependence)of physicians and patients in the community.There are differences in the influence of social and technical factors of communities on the perceived social interdependence of different participating subjects(physicians and patients),and there are also differences in the perceived social interdependence of physicians and patients in different types of communities(doctor-patient,patient-patient,and doctor-doctor).Each types of community should better play the role of community mediators and adopt individualized service measures for different participating subjects.This study provides an empirical basis for guiding the development of value co-creation activities in online health communities,promoting patient participation in the whole process of healthcare services,and playing the main value and central role of patients.The mechanism of value co-creation behavior on the value of healthcare(“online experience” and “health outcomes”)was verified from the perspective of different subjects(physicians and patients).Value co-creation behaviors can lead to a positive “online experience” for both physicians and patients,ultimately improving “health outcomes” for patients.This study provides a new perspective for understanding the value creation process and value outcomes of value co-creation behavior.This study enriches research related to online health communities,value co-creation behavior,and value of healthcare,and contributes to the research on service dominant logic,professional-client interaction theory,S-O-R model,socio-technical systems theory,social interdependence theory,and consumer value theory.According to the empirical results,relevant practical applications are proposed for online health community service management,including strengthening community member management,providing diversified online services,enhancing community technical support,and improving community evaluation and feedback mechanisms.[Innovation and limitation]Three research innovations:(1)This study constructes a framework for the types of value co-creation behaviors in online health communities,and redefined the types and sub-dimensions of value co-creation behaviors in online health communities.This study uses online health communities as a context,professional-client interaction theory as a guiding framework,and the principles and methods of grounded theory to identify the types of value co-creation behaviors of physicians and patients in communities and its sub-dimensions from the content of multiparticipant interactions.The main categories and concepts of value co-creation behaviors of physicians and patients are described quantitatively.Filling the gap in the study of the type of value co-creation behavior from the perspective of multiple subjects in an online context,and provided a new perspective for understanding and studying value co-creation behavior in online health communities.(2)This study explores novel factors influencing value co-creation behaviors and their mechanisms of action.The model of factors influencing value co-creation behavior in online health communities,with participating subjects and community type as grouping moderating variables,is constructed to explore the promotion effect of community environmental stimuli(social factors and technical factors)on physicians’ and patients’ value co-creation behavior by influencing individual internal states(perceived social interdependence).Filling the research gap on the antecedents of physician and patient value co-creation behaviors in the online environment,providing an effective operational mechanism for guiding the development of value co-creation activities in online health communities and strengthening the application of online health community service management.(3)This study reveals the positive effect of value co-creation behaviors on enhancing the value of healthcare and explores the value outcomes created by physicians and patients in online health community contexts.This study combines the value co-creation behavior with the two dimensions of “online experience” and “health outcomes” of medical service value,and constructs the model of value creation mechanism of online health community,verifying that the value co-creation behavior can bring good “online experience” to physicians and patients,and ultimately help improve “health outcomes” of patients.Filling the gap in the study of value creation mechanism of physicians and patients in online health community context,enriching the study of the results of value co-creation behavior and providing a new theoretical basis for understanding the value of healthcare.Limitations:(1)Sample selection.At the stage of studying behavioral types,sample selection should also consider behavioral biases due to disease type.(2)Limitation of online health community contexts.Future research could consider the impact of other health service access ways on physician and patient value co-creation behaviors.(3)Insufficient consideration of the value dimension.From the physician’s perspective,only the value of the physician’s “online experience” is focused,and the transfer of the physician’s online value to offline value should be discussed in the future.(4)Limitations of online and offline integration.Patients’ participation in the online value co-creation process may result in offline doctor selection and offline referral behaviors.Future research can enrich the study of offline transfer of value co-creation behaviors,integrate online contexts with offline visits,and explore the patterns and influence mechanisms of value co-creation behaviors based on the whole process of visits.