Factors that influence patient value co-creation behaviour: an empirical study based on the DART model

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BackgroundHealth-care services that are responsible for public welfare should be patient-focused rather than pursuing profits. Hospitals treat patients and save lives, and their service behaviour is closely linked to the quality of life and health of patients. Therefore, it is of great importance to introduce value co-creation theory to the medical field. Patients can now gain medical knowledge from the internet, and they are able to discuss treatment plans with doctors, instead of accepting what is prescribed for them passively. Support and cooperation of patients is necessary during treatment to improve treatment effects, and research shows that patient value co-creation behavior (eg, high self-motivation to search for medical information before treatment, or active interaction with doctors on treatment options) is influenced by various factors. In this study, we defined patient value co-creation behaviour based on the dialogue, access, risk assessment, transparency (DART) model, and a research model was established to explore its influencing factors. MethodsThis study established a research model consisting of three independent variables (self-efficacy, cognition of duty, and cognition of doctor value co-creation behaviour), and one dependent variable (patient value co-creation behaviour based on the DART model). A cross-sectional survey was conducted with patients (both inpatients and outpatients, n=675) at a tertiary-level hospital in Guangzhou, China. Participants were asked to complete an anonymous questionnaire, and the survey response rate was of 96·7% (653 of 675). After exclusion of incomplete or repeated questionnaires, 637 valid questionnaires remained. All items of the questionnaire were evaluated with a five-point Likert scale according to patients' perceptions, and patients' and doctors' value co-creation behaviours were evaluated by use of the DART dimensions. The structural equation model was performed using AMOS 21.0 software to examine our hypotheses and explore the factors influencing patient value co-creation behavior. FindingsThe structural equation model analysis showed that self-efficacy, cognition of duty, and cognition of doctor value co-creation behaviour had significant positive effects on patient value co-creation behaviour (standardised regression weights 0·143 [p=0·007], 0·181 [p=0·001], and 0·588 [p=0·001]), and cognition of doctor value co-creation behaviour had the greatest impact on patients' behaviour. In view of the results of empirical analysis, we proposed relevant strategies to stimulate patient value co-creation behaviour. InterpretationThe results show that doctors' value co-creation behaviour, as perceived by patients, had an important role in stimulating the patients' value co-creation behaviour. During treatment, doctors should perhaps pay more attention to patients and less to clinical technology, and provide patients with more humanistic care, making patients feel being respected, promoting their enthusiasm in participating with treatment and complying with medical advice, which may help to improve the outcome of disease treatment. FundingThis study was supported by the Key Laboratory of Public Health Policy Research and Evaluation (2015WSY0010) and the Guangzhou Public Health Services System Construction Research Base (2018–2020). The funders did not participate in study design, data collection, or analysis.