| [Objective]This research provides a foundation for understanding the value co-creation process by conceptualizing and operating the community's value co-creation behavior of patients with chronic diseases.On this basis,it explores the impact of Internet medical services on patients' value co-creation behavior,and promotes Internet medical service resources and processes.Provide reference for integration and service model innovation.By constructing and verifying the antecedent(available resources)-behavior-result model of patients with chronic diseases participating in value creation,identifying the influencing factors of all parties in the cooperation network participating in value co-creation,and revealing the resources of the community chronic disease service cooperation network,the integrated mechanism is expected to provide a theoretical basis for establishing a long-term physician-patient interaction mechanism for chronic disease services.[Methods]1.In the stage of model construction and measurement questionnaires,this study first uses literature analysis,semi-structured interviews,content analysis,and expert consultation to develop conceptual models of value co-creation,and develop patient value co-creation behavior measurement scales and value co-creation mechanism model measurement questionnaires.(1)The measurement of value co-creation behavior of patients with chronic diseases in the community is based on the scale of Sweeny et al.,combined with the theme extracted by semi-structured interviews and content analysis,to initially construct a value co-creation behavior measurement scale.(2)Using the standardized procedures of questionnaire development to develop the questionnaire of the value co-creation mechanism model,firstly combine literature analysis,informal discussion,and qualitative analysis to generate the initial questionnaire,and then 8experts and 10 members of the research group evaluate the surface validity of the questionnaire,Importance and accuracy.2.In the data collection stage,collect questionnaires using on-site surveys.The research team collected 166 valid patient questionnaires in Wuhan,Hubei Province in August 2019,and 34 matched doctor questionnaires for small sample testing.From September 2019 to June 2020,a formal questionnaire survey was conducted on 7 community health service centers in Wuhan City,Hubei Province,and 6 community health service centers in Taiyuan City,Shanxi Province.A total of 747 valid patient questionnaires and 121 doctor questionnaires were collected..3.In the data analysis stage:(1)Using the Rasch analysis method,first test the reliability and validity,separation coefficient,and option classification of the value co-creation behavior measurement scale,and then test the unidimensionality and local independence of the scale,and obtain The value co-creation behavior measurement scale composed of 12 activities measured by the 4-level option classification is finally used to measure the value co-creation behavior and behavior level of patients with chronic diseases in the community in my country.(2)On this basis,the use of Internet medical care by patients and demographic sociological characteristics are used as independent variables,and measurable value cocreation behaviors are used as dependent variables to construct a multiple linear regression model to analyze the value of the Internet medical environment to patients The impact of cocreation behavior.(3)Finally,the structural equation model analysis method(PLS)based on variance is used to verify the value co-creation mechanism model.We adopted a two-step method—measurement model analysis and structural model analysis to empirically test the value cocreation model.For the analysis of the measurement model,since the model includes the third-order construct of opportunity,motivation,and ability of physicians and patients,and the endogenous second-order construct of service-leading ability,in addition to using factor analysis to test the reliability and validity of the questionnaire,we used weighted indicators and latent variable scoring methods to test the correlation between higher-order constructs.For the analysis of the structural model,we use the repeated index method and use the latent variable score to test the causal model.[Results]1.Research on Value Co-creation Behavior of Patients with Chronic DiseaseCombining semi-structured interviews and Rasch analysis results,it is found that the value co-creation behavior of patients with chronic diseases in the community can be represented by 12 value co-creation behaviors measured by a 4-point rating,and the 12 behaviors are distributed in 7 levels of difficulty.The value co-creation behavior of patients with chronic diseases in the community can be divided into 7 levels according to the difficulty.The first level behavior that gets the most recognition,more people implement it,and is easier to eat is to maintain a healthy diet;the second level is to tell the physician about disease information;the third level is(1)to follow the physician's advice for treatment,(2)to maintain the relationship with family and friends;Level 4 is for better physical condition and change many things in life;Level 5 is(1)consciously thinking"I will not let the disease beat me",(2)confirm information with the physician and take the initiative to consult,(3)will not always pay attention to me Illness,will do other things to distract attention;the sixth level is(1)will try treatment or rehabilitation methods not notified by the physician,(2)communicate with patients with the same disease to obtain information and encourage each other;the most difficult level 7 is(1)do a lot of information search in order to understand your condition and(2)If dissatisfied with my own treatment plan,ask to change it.2.Research on the impact of patients' use of Internet medical treatment on value co-creation behaviorThe use of patients' Internet medical treatment and demographic sociological characteristics are used as independent variables,and measurable value co-creation behaviors are used as dependent variables to construct a multiple linear regression model.Multiple linear regression results show that the use of smart phones has a positive effect on value cocreation behavior(?=0.232,p<0.05),and community Internet medical use has a positive effect on value co-creation behavior(?=0.200,p<0.05).Compared with no follow-up,telephone follow-up has a positive effect on value co-creation behavior(?=0.214,p<0.05),and continuous medical behaviors such as follow-up and physical examination have a positive effect on value co-creation behavior(?=0.659,p<0.001;?=0.688,p<0.05).The patient's gender,age,occupation,education,type of chronic disease,time of diagnosis of chronic disease,time spent on smartphones,and mhealth usage scores for tertiary medical institutions have no statistically significant influence on value co-creation behavior.3.Research on the value co-creation mechanism of patients with chronic diseases in the communityAfter a small sample test and formal questionnaire survey data,the mechanism model was analyzed by factor analysis and reliability and validity test.It was found that the questionnaire with 82 items after purification can test the value co-creation mechanism model for patients with chronic diseases in the community.The physician questionnaire consists of17 measurement items including operant resources,motivation and professional commitment,operand resources,physical resources,and policy resources constructs;the patient questionnaire consists of value co-creation behavior,independent decision-making ability,information acquisition ability,communication ability,and emotional management ability,value in health management participation,access to health services,personalized interaction capabilities,moral interaction capabilities,authorized interaction capabilities,development interaction capabilities,coordination interaction capabilities,quality of life,behavioral intentions,and service satisfaction constructs consist of 65 measurement items.High-level variables patient available resources(including autonomous decision-making ability,information acquisition ability,communication ability,emotional management ability,health needs,access to services),physician available resources(including operant resources,motivation and professional commitment,operand resources,physical resources,policy resources)and service dominant orientation capabilities(personalized interaction capabilities,moral interaction capabilities,authorized interaction capabilities,development interaction capabilities,and coordination interaction capabilities)have been tested to have high reliability and validity.Among them,physician available resources and patient available resources are high-order variables developed for the first time in this research achieve a balance between measurement accuracy and rich information.In the hypothesis test of the value co-creation model,10 of the 11 hypotheses were confirmed to be statistically significant.Specifically,physician available resources(?=0.102,p<0.01)and patient available resources(?=0.588,p<0.001)have a direct and significant positive impact on the ability of service dominant orientation capabilities.Hypotheses 1 and 2 are valid;Because it significantly positively affects patients' value cocreation behavior(?=0.463,p<0.001),Hypothesis 3 is established;service dominant orientation capabilities significantly positively affects value co-creation behavior(?=0.334,p<0.001),service satisfaction(?=0.334,p<0.001;?=0.361,p<0.001)and behavior intention(?=0.241,p<0.001),hypotheses 4,5,and 6 are established;value co-creation behavior significantly positively affects service satisfaction(?=0.301,p<0.001)and patient's quality of life(?=0.217,p<0.001),hypotheses 7 and 9 are established;service satisfaction significantly positively affects the patient's behavior intention(?=0.505,p<0.001)and quality of life(?=0.595,p<0.001),Hypotheses 10 and 11 are valid;only Hypothesis 8:patient value patient value co-creation behavior positively affects patient behavior intention is not established(?=0.075,p>0.05).The mediating effect analysis in the value co-creation mechanism model found that patient factors have greater influence on patient value co-creation behavior than physician factors,and the path coefficients are 0.66(direct effect and indirect effect,namely0.463+0.588*0.334)and 0.034(only indirect effect,namely 0.102*0.334).Physician available resources and patient available resources have a significant positive impact on behavioral intention,service satisfaction,and quality of life,and the mode of action is indirect(mediation effect).After calculation,the influence of physician's antecedents and patient's antecedents on the quality of life are 0.037 and 0.388,respectively;the influence of physician available resources and patient's antecedents on behavioral intentions are 0.049 and 0.384,respectively,and the influence of physician's antecedents and patient's antecedents on service satisfaction is 0.047 and 0.410,respectively.[Conclusions]In this study,the author verified the value co-creation behavior and mechanism of patients with chronic diseases in the community under the Internet medical environment through three sub-studies,and also answered the core research question of this article-how to drive patients to co-create value and enhance value co-creation results ? The results of the study show that patients' value co-creation behavior not only occurs inside and outside the community health service center,but also includes self-motivation behavior.The patient's value co-creation behavior has different levels of difficulty;the use of community Internet medical services can promote patient value co-creation.Innovative behavior;the motivation,opportunity,and ability of patients and physicians will affect the value of the patient's cocreation behavior,which in turn affects the patient's quality of life;mobilize the patient's own motivation and ability to create more opportunities for patients to participate,and will achieve twice the result with half the effort.This research not only enriches the existing value co-creation research,but also has practical significance in improving the management effect of chronic disease services in our community.[Innovation and Limitation]1.Research innovation:First of all,this study expands the content of research related to patient value co-creation.From the perspective of physician-patient collaboration,the study analyzes the internal mechanism of the value co-creation of patients with chronic diseases in the community.Based on the definition and measurement of patient value co-creation behavior,we analyzes the antecedents(available resources),intermediaries,and intermediaries of patients' value co-creation behaviors.The internal logic and relationship between behavior and results can provide a reference for the service system to improve the co-creation of behavior results and promote the realization of the social value of the service system.Secondly,this study quantitatively analyzes the impact of the Internet medical environment on patients with chronic diseases,quantitatively analyze and demonstrate the influence of different Internet medical platforms on the value co-creation behavior of patients with chronic diseases in the community,which avoids the previous research focusing on a single physical scene or the interaction of online platforms,and enriches the theoretical research on value co-creation.2.LimitationsFirst of all,limited to material resources and energy input,this study selected 13 institutions using a convenient sampling method,which may cause insufficient variability in the characteristics of institutions,doctors,patients,and Internet medical use.Secondly,the value co-creation from the micro perspective includes the internal organization,the organization and its stakeholders,between patients,clinicians and patients.This study only selects the clinician and patient-level co-creation,and future research can be deeper on the research level.step.Finally,on the basis of the conclusions of this research,further qualitative research will provide information for a more comprehensive understanding of the reasons for value co-creation. |
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