Development And Application Of Patient Value Co-Creation Behavior Scale Based On DART Model

BackgroundValue is the key concept of marketing and providing value to customers is the fundamental goal of corporate marketing activities.Value creation,which goes through Goods-Dominant Logic,Service-Dominant Logic and Customer-Dominant Logic these three development stages,is closely related to stakeholders' behavior.Currently,customers play an increasingly important role in value creation.For example,they become more active,with higher consumer expectation and no longer accept products and services provided by enterprises passively,which means the traditional concept about enterprises are the only creators of value while customers are users of the resources is no longer in conformity'with the development of the society.In order to enhance their competitiveness,producers should create value by working with customers and should not ignore consumers'needs and expectations while producing products and providing services.At present,research on value co-creation focuses on its use in the commercial field.Related studies about medical and health filed are few.Medical service,with the characteristics of public welfare,emphasizes patient-center and providing humanistic care for patients other than pursuing profit.Meanwhile,hospital is an important place to treat and save people and its service behavior is closely related to the life and health of patients.Therefore,its character of value co-creation is obvious.Currently,patients can learn more medical knowledge on the internet.The information asymmetry between doctors and patients is less clear.Patients are able to discuss treatment plans with doctors,instead of accepting what the latter prescribes for them passively.In addition to medical technology,patients'support and cooperation are necessary during treatment.The effectiveness of treatment and the quality of medical care can be improved though joint-efforts by doctors and patients.Objectives1.To develop value co-creation behavior scales based on DART model,which can provide an effective tool for measuring value co-creation behavior.2.To explore the influencing factors of patient value co-creation behavior and its impact on medical quality and propose corresponding suggestions.Method1.Literature analysisDefined the preliminary connotation of doctors and patients value co-creation behavior based on DART model and established items pool of value co-creation behavior based on literature review,relevant research tools and coordination group discussion.2.Delphi method17 domestic and foreign experts from relevant research fields participated in expert consultation.After 3 rounds expert consultation on alternative items,the connotation of doctors and patients value co-creation behavior as well as 3 scales based on DART model were formed,namely self-evaluation scale of patient value co-creation behavior,scale of doctor's perception of patient value co-creation behavior,scale of patient's perception of doctor value co-creation behavior.3.Statiscal analysis method(1)Preliminary investigation was conducted and the scale items were screened by using critical ration method,coefficient of variation method,correlation analysis,factor analysis,principal component analysis,Cronbach's Alpha.Furthermore,evaluating the reliability and validity of the scales.The final versions of the scales were formed at last.(2)An integrated model that included antecedents and outcomes of patient value co-creation behavior was built.Outpatients and inpatients who were randomly selected from a first-grade class-A hospital in Guangzhou,Guangdong participated in questionnaire investigation.SEM analysis,mono-factor and multivariable analysis were conducted to analyze the database.After that corresponding suggestions were proposed.Results1.Preliminary connotation of doctors and patients value co-creation behavior and items pool of value co-creation behavior scale(1)Preliminary connotation and items poolPreliminary connotation of doctors and patients value co-creation behavior based on DART model was proposed through literature review and coordination group discussion.Meanwhile,the three scales consisting of 81 items were developed through referring related scales and questionnaires at home and abroad,considering medical specific traits,revising and modifying expression of some items and discussing in coordination group.(2)Final connotation of doctors and patients value co-creation behavior and first draft of three scales.In the first round consultation,the positive coefficient of 17 experts was 85%,the average authoritative coefficient was 0.85,and the coordination coefficient of items judgment was 0.268.In the second round consultation,the positive coefficient of 16 experts was 94.12%,the average authoritative coefficient was 0.86,and the coordination coefficient of items judgment was 0.379.The positive coefficient of 15 experts in the third round consultation was 93.75%,the average authoritative coefficient was 0.86,and the coordination coefficient of items judgment was 0.419.The coordination coefficient increased gradually along with the increase of consultation rounds and it was greater than 0.40 in the third round,which meant the consistency of experts'opinions could be accepted.Finally,first draft of three scales based on DART model which consisted of 23 items,21 items and 25 items respectively,were established.In terms of the connotation of doctors and patients value co-creation behavior based on DART model,after two rounds consultation,experts',advice reached unanimity,and we got the final connotation.(3)Items Screening of ScalesUsing the scales that established in expert consultation to conduct preliminary investigation.Items were evaluated and screened again through critical ration method,coefficient of variation method,correlation analysis,factor analysis,principal component analysis,Cronbach's Alpha.After discussing in coordination group,all items were remained finally.(4)Reliability and validity evaluation of scalesEvaluating the reliability and validity of 3 scales based on data collected frompreliminary investigation.? Result of reliability evaluationSpearman-Brown Coefficient of the 3 scales were 0.943,0.951,0.959 respectively,all greater than 0.90.The overall Cronbach's Alpha coefficients of the three scales were 0.920,0.937,0.952 respectively,all greater than 0.90.The analysis result showed that split-half reliability and internal consistency reliability of 3 scales were acceptable.?Result of validity evaluationIn terms of structural validity,Kaiser-Meyer-Olkin index of 3 scales were 0.809,0.845,0.836 respectively,all greater than 0.70 and Bartlett's test x2 value of 3 scales were 922.819,958.852,1321.008 respectively,all P values less than 0.01,which suggested that factor analysis could be performed appropriately.The factor analysis showed that 3 scales all worked out 4 common factors respectively,and the cumulative contribution rates were 64.887%,69.083%.69.882%.Most of the items had fallen into the corresponding factors after varimax rotation,which was consistent with the theoretical structure design.2.Integrated model that included antecedents and outcomes of patient value co-creation behavior was built Through literature review,research hypotheses and integrated model that includedantecedents and outcomes of patient value co-creation behavior were proposed.Outpatients and inpatients from a first-grade class-A hospital in Guangzhou were investigated via questionnaire.637 valid questionnaires were collected.Scale evaluation during preliminary investigation indicated that reliability and validity of the scales were not very ideal.For example,in the factor analysis,the last factors worked out of the 3 scales contained few items and had small factor loadings than other factors.What's more,formal investigation mainly consisted of outpatients and inpatients.Therefore,it was necessary to evaluate the reliability and validity of the scales again.Structural equation model was used to test reliability and validity of the scales.The result showed that most of the indicators met the requirements,indicating that the scales had good reliability and validity.According to descriptive analysis,the result showed that the evaluation of patient value co-creation behavior and patient's perception of doctor value co-creation behavior gained high score.The structural equation model analysis showed that self-efficacy,cognition of duty and cognition of doctor value co-creation behavior had positive effect on patient value co-creation behavior.The total standardized effects were 0.170,0.137,0.671 respectively,and cognition of doctor value co-creation behavior had the greatest impact on patient's behavior.Meanwhile,patient value co-creation behavior had positive effect on medical quality especially non-technical quality,the total standardized effect was 0.729.In terms of relationship between general information of patients and their value co-creation behavior.Multivariable regression analysis result indicated that education background was the main influence factor on patient value co-creation behavior.In conclusion,except research hypothesis about different general information of patients have different effect on patient value co-creation behavior was verified partially,other research hypotheses were verified,and the fitting effect of theoretical model was acceptable.3.Strategies and suggestionsAccording to the results of empirical analysis,corresponding strategies and suggestions were proposed from patient level,doctor level,and hospital level.Conclusions1.This study defined the connotation of doctors and patients value co-creation behavior based on DART.Dialogue means communication,knowledge sharing between doctors and patients.Access means doctors and patients obtain medical service and information about disease treatment through relevant channels or tools.Risk Assessment means doctors and patients evaluate and manage the potential danger to during treatment.Transparency means treatment information transparency and emphasizes information authenticity,information disclosure.2.The reliability and validity of 3 scales were acceptable.Three scales were established,namely self-evaluation scale of patient value co-creation behavior based on DART model,scale of doctor's perception of patient value co-creation behavior based on DART model,scale of patient's perception of doctor value co-creation behavior based on DART model,which consisted of 23 items,21 items and 25 items respectively.Testing result showed that the reliability and validity of 3 scales were acceptable and could be used as measuring tools for evaluating patient value co_creation behavior.3.Research hypotheses and model were verified.The result showed that self-efficacy,cognition of duty,cognition of doctor value co-creation behavior and some condition of patients had impact on patient value co-creation behavior.Meanwhile,patient value co-creation behavior had positive effect on medical quality,especially on patient's satisfaction in non-technical quality dimension and higher than technical quality dimension.The result shows that it is significant to introduce value co-creation in medical field.Meanwhile,doctor's value co-creation behavior that perceived by patient is of great importance on stimulating patient's value co-creation behavior and patients are intending to pursue humanistic care and high quality medical service.Therefore,in order to improve health quality,instead of investing large quantity of resources in medical technology blindly,the hospital should return to the medical humanistic essence of "patient-centered" and "people-oriented",pay more attention to non-technical medical services,and provide patients more humanistic care.