Consumers Of Health Care Services Research Articles

Clients’ Satisfaction with the Services of the National Health Insurance Scheme at the Moddibo Adama University Teaching Hospital, Yola, Adamawa State

Background: Worldwide, patient satisfaction is one of the cardinal indices for evaluating the quality of healthcare service delivery and the effectiveness of a healthcare system. As consumers of healthcare services, patients have expectations that need to be met. Objective: To assess clients’ satisfaction with the quality of care rendered through the National Health Insurance Scheme in a Nigerian Specialist Medical facility. Methods: This was a descriptive, cross-sectional study of 403 respondents selected randomly from NHIS enrolees attending the Federal Medical Centre, Yola. The study assessed the enrolee's level of satisfaction at the various service points using a self-administered, semi-structured questionnaire. Results: The overall average satisfaction score was 61.0.%. The satisfaction score on the various aspects of service was as follows: hospital environment/cleanliness (87.9%), doctors’ consultation (74.2%), reception/registration (69.5%), laboratory services (64.3%), waiting time (64.2%), staff attitude (60.5%), and availability of prescribed drugs (48.2%) been the lowest. Conclusion: Overall, patients' satisfaction with the services provided was good, with the hospital environment/cleanliness rated highest and the availability of prescribed drugs the lowest. The current level of patient satisfaction needs to be improved by making drugs more available in the NHIS pharmacy and improving the attitude of staff to work and clients.

Attitude and ethical behaviors of healthcare providers as antidotes of health service consumer satisfaction in Mgbuoshimini Primary Health Centre, Port Harcourt, Nigeria

Health service consumers' satisfaction with the services they receive has been a challenge over the past decade, and this has been attributed to many factors that diverse scholars have investigated using different variables. In this study, the attitude and ethical behaviours of healthcare providers as antidotes to health service consumers' satisfaction in the Primary Health Centre at Mgbuoshimini, Port Harcourt, Nigeria, were investigated. A cross-sectional descriptive research design was used to select participants from pregnant women, nursing others, couples for family planning, and sick patients. The data were analysed using descriptive statistical tools. The results of the grand total response values were 400 (100%) and strongly agree had 190 (47.5%), agree had 160 (40%), 390 (100%) and strongly agree had 260 (66.7%), agree had 100 (25.6%), and strongly disagree had 13 (3.3%). The overall results were strongly agreed (66.7%) and agreed (25.6%); these connote that the attitudes and ethical behaviours of the healthcare providers towards healthcare service consumers in the primary healthcare facility were poor and that healthcare providers do not execute good ethical behaviour towards health service consumers in the facility, leading to low levels of health resource consumption, low patronage image promotion, and consumers' loss of confidence in the service provider. Therefore, the government should put mechanisms in place to ensure a positive attitude and favourable ethical behaviour among healthcare providers, and individual healthcare providers should also acquire soft skills to improve their attitude and ethical behaviour.

Teaching and Learning Interventions Designed to Improve Cultural Competence in Health Profession Students: A Systematic Review

Purpose: Developing healthcare profession students’ cultural competency knowledge, skills and attributes is critical to meet the needs of culturally and linguistically diverse healthcare service consumers. The purpose of this systematic review was to identify effective cultural competence interventions for healthcare profession students. Methods: A systematic review of peer reviewed articles published from 2010-2021 using PRISMA guidelines was conducted by searching CINAHL, EMBASE, ERIC, PubMed, and Psych INFO databases. Article quality was assessed using the Evaluation Tool for Quantitative Research and Mixed Method Appraisal Tool. Results: The initial search identified 2,261 potentially relevant studies, 41 studies met the inclusion criteria in which intervention effectiveness was evaluated using a validated outcome measure pre- and post- intervention. Only one study used a non-self-report outcome measure. Out of the 41 studies, only eight studies employed randomisation in the method. Conclusion/Recommendations: This review evaluated effectiveness of cultural competence interventions and evaluation of the intervention using either self-report or non-self-report validated outcome measures at pre- and post-intervention exposure. Combining cultural competence teaching methods such as lectures with simulations, role-playing and community engagement with diverse populations enhanced cultural competence. Further studies are required to compare effective cultural competence teaching models and identify reliable non-self-report outcome measures to assess the effectiveness of interventions post-exposure. Comparing effective cultural competence teaching models that utilise reliable non-self-report outcome measures will be valuable for guiding the design of teaching and learning interventions directed towards cultural competence. Further research is also required to examine the duration of intervention efficacy and how to maintain efficacy post-intervention exposure. Findings from this review are important for designing and structuring of cultural competence curriculum for healthcare profession students and informing future research on cultural competence teaching. This review has identified that most evaluation tools and studies have been designed for the nursing discipline. There is need to design more cultural competence evaluation tools and studies for other healthcare disciplines such as pharmacy and physical therapy.

A Qualitative Investigation to Develop an Adapted Version of the EQ-5D-Y-3L for Use in Children Aged 2-4 Years

ObjectivesFew preference-weighted health-related quality-of-life measures exist for children under 5 years of age. Young children are substantial consumers of healthcare services. This project aims to assess EQ-5D-Y-3L’s appropriateness in children aged 2 to 4 years and to coproduce with parents a suitable adaptation. MethodsPurposive sampling at the Murdoch Children’s Research Institute and Royal Children’s Hospital was used to recruit parents or carers of children aged 2 to 4 years in Australia. Online focus groups were conducted consisting of 13 parents of healthy children, and 6 parents of children with moderate to severe health conditions. Parents provided feedback on each dimension of the proxy EQ-5D-Y-3L. Recordings were transcribed and thematic analysis was conducted. Qualitative findings guided the design of adaptations to the instrument. The adaptations were piloted to obtain feedback and refined to improve language translatability and comparability with other EuroQol instruments. ResultsThe adapted EQ-5D-Y-3L was considered generally acceptable by the parents. Parents provided a wide range of examples of how each domain related to their children, with varied examples provided across ages 2 to 4 years and health status. Additional or alternative wording was suggested by parents to improve the applicability of the instrument to this age group. One example of this was the change of the domain wording “walking about” to “movement”—ID5:“In this age group, movement is more important than walking.” ConclusionsThe adapted EQ-5D-Y-3L has improved relevance for 2-4-year olds and appears easy to complete. Further testing of the adapted instrument is required to evaluate acceptability, reliability, and validity.

International Spinal Cord Injury Community Survey: Socioeconomic and Healthcare Satisfaction in Spain.

Survey study. People living with spinal cord injury (SCI) are major healthcare and rehabilitation services consumers and have unmet healthcare needs. This study aimed to describe the socioeconomic characteristics of people living with SCI in Spain and to determine the level of use and satisfaction with the public healthcare system. We conducted a survey (the Spanish version of the International Spinal Cord Injury Community Survey) consisting of 134 questions. We analyzed the age, sex, neurological classification of the injury on the American Spinal Injury Association Impairment Scale, time of injury, socio-occupational and socioeconomic status, and level of use and satisfaction with the public health system. 472 people responded to the survey [68.9% male; mean age 51.2years (standard deviation: 13.9years); 61.7% with paraplegia and 38.3% with tetraplegia]. 89.2% of those surveyed were unemployed and 77.1% received a disability pension. The number of medical visits was 2.3/year, and 19.8% of the patients required at least 1 hospital admission during the previous year. 94.7% of the people with SCI considered the health care received as good or very good. Respondents with SCI in Spain considered they had good access to primary and specialized care and were satisfied with the healthcare system. Notably, we observed a high average of annual visits to medical professionals but a low rate of hospitalizations. Technical aids and state services related to disability should be the most important elements to be improved.

Value co-creation with family caregivers to people with dementia through a tailor-made mHealth application: a qualitative study

BackgroundDigitalization has been recognized as an efficient and cost-effective solution to address the increasing need for care due to the ageing population and the rise in people with dementia. This has subsequently increased the need to also care for family caregivers in community settings. Another benefit of digitalization is the introduction of new service concepts within service-dominant logic namely, value co-creation, which is changing the dynamics in healthcare, transitioning from a provider-centric to a customer-centric approach. The literature indicates that this transition is a slow process in healthcare due to the complex service context consisting of multi-stakeholders, with a fragmented decision-making process. This has resulted in limited research on how individuals co-create value through technology. The study aimed to explore how family caregivers to people with dementia living at home, as consumers of healthcare services co-create value in a multi-stakeholder context through a tailormade mHealth application.MethodsA qualitative explorative design was used. Data were collected through semi-structured interviews with 12 family caregivers of people with dementia living at home. The data were analyzed deductively using qualitative content analysis.ResultsThe findings show how family caregivers to people with dementia as healthcare consumers, engaged with a mHealth application and other actors in their service network through different levels of value co-creation activities.ConclusionThis paper showed a willingness among family caregivers to people with dementia living at home, who mostly consisted of older people, to implement new technology to assist them with their caregiving tasks. The different value co-creation activities adopted by the family caregivers generated different levels of experiential value such as support, knowledge, and increased access to healthcare.

Behavioural indicators of compassionate nursing care of individuals with complex needs: A naturalistic inquiry.

To explore behavioural indicators of compassionate nursing care from the perspectives of individuals with multimorbidities and complex needs. Complex patients are individuals with multimorbidity and/or mental health concerns, andoften with medication and drug-related problems requiring ongoing person-centered care, mental health interventions, and family and community resources. They are frequent consumers of health-care services and it is documented that these patients experience discrimination and substandard care. Compassionate care can improve patient care experiences and health outcomes. However, missing is the guidance on how to provide compassionate care for this population from the perspectives of complex patients. A qualitative descriptive approach was conducted in eastern Canada from December 2020-April 2021. The COREQ guidelines were followed for reporting. Data from in-person and virtual semi-structured interviews with 23 individuals having experiences as complex patients were analysed using reflexive thematic analysis. Among them 19 were homeless and lived in a shelter. Six indicators of compassionate nursing care were generated: sensitivity, awareness, a non-judgmental approach, a positive demeanour, empathic understanding, and altruism. Individuals perceived that nurses who acknowledge personal biases are better at providing compassionate care by manifesting compassion through their genuine and selfless interest in the complicated health problems and underlying socio-cultural determinants of each patient. Kindness, positivity, and a respectful nursing approach elicit openness and the sharing of heartfelt concerns. Comprehensive health assessment, dedicated efforts to know the patient as a human being, and listening to the patient's preferences can improve health outcomes among individuals with complex needs. Healthcare administrators can effect the change by supporting nurses to address complex health and social care needs with compassion. Patients and healthcare professionals helped in data collection at the community care centre.

Compliance With Health-related Behaviors in Mothers of Hospitalized Children in Kashan, Iran: A Cross-Sectional Study

Compliance With Health-related Behaviors in Mothers of Hospitalized Children in Kashan, Iran: A Cross-Sectional Study

Patient Satisfaction Among the OPD Attendees at a Secondary Care Hospital in Northern India.

Patient satisfaction reflects the quality and effectiveness of healthcare. Healthcare services have become more patient-centric in today’s era as patients are viewed as active consumers of healthcare services rather than passive recipients. Measuring patient satisfaction level has become an objective criterion for defining the effectiveness of these services. Feedback from patients makes healthcare services more responsive to the expectations of patients. We conducted a cross-sectional study among 200 OPD attendees of a secondary-care hospital to assess the level of satisfaction. A 5-point Likert scale was used to record the responses. For overall satisfaction with the OPD services, most common responses were “good” or “very-good”, with mean (SD) score of 3.8 (0.77). Majority of the patients were satisfied with facilities such as drinking water and toilets, and with consultation time provided by the doctors. The patients were not satisfied with the time taken at the registration window and behavior of other hospital employees. This highlights the importance of reorientation training on communication and interpersonal skills for all categories of healthcare staff.

Lauderdale Paradox in COVID-19 Pandemic Times- A Study on Kerala

Karl Marx explains the Lauderdale paradox as a contradiction between public wealth and private profit and how the latter increases as the former diminishes. The present paper argues that COVID-19 pandemic has been strengthening the Lauderdale Paradox in the healthcare sector, for example in the state of Kerala in India. Kerala, the most literate state and more advanced than most other states of the country, in terms of social development indicators, experienced progress in the public health system in an impressive way, till the 1980’s and declined thereafter. Higher levels of literacy and public healthcare services are possible because of government expenditure. With improvements in literacy, standards of living and awareness, consumers of healthcare services start demanding more and better quality of the same. However, public healthcare systems do not develop enough. Private players, especially large private hospitals enter and expand their share in the space created in the healthcare sector. This is an instance of unfolding of the Lauderdale paradox in the healthcare sector.
 The present study explains the increasing domination of private hospitals in the healthcare sector development in Kerala, against the backdrop of the Marxian theory. Health is treated like a commodity and offered for sale with mainly profit motive. This trend is strengthened during the pandemic times. A few suggestions for further research in this exciting area of study are given at the end of the paper.
 Keywords: Lauderdale Paradox, Healthcare sector, Private hospitals.

HealthBlock: A secure blockchain-based healthcare data management system

The security and privacy of electronic healthcare records (EHRs) remain a critical issue for both healthcare services consumers and providers. Breaching a healthcare system causes the disclosure of sensitive health data. This data is usually saved into centralized databases, which creates vulnerabilities and gives rise to cyber attacks. This research focuses on enhancing the security and privacy of EHRs by using blockchain technology. This paper proposes a new architecture that takes advantage of decentralized databases to avoid centralized storage issues. The decentralized used database for storing patient electronic health records is the OrbitDB with Interplanetary File System (IPFS). Besides, we have deployed a blockchain network built on Hyperledger fabric by using Hyperledger composer to save hashes of stored data and control access when retrieving it. The proposed Blockchain-based architecture is designed to contribute to the healthcare management systems’ robustness and to avoid recorded security limitations in commonly used systems for smart healthcare. Performance evaluation results issued from Hyperledger Caliper and comparative analysis have proved the robustness and superiority of the proposed system in terms of security and privacy requirements, key features of blockchain-based healthcare systems, and performance metrics including various throughput and latency.

The "business" of dentistry: Consumers' (patients') criteria in the selection and evaluation of dental services.

The dimensions of patient-centred care include not only clinical effectiveness and patient safety, but, importantly, the preferences of patients as consumers of healthcare services. A total of 249 participants were included in the study, with a balanced population proportional representation by age, gender, ethnicity and geographic region of New Zealand. An online questionnaire was used to identify participants’ decision-making process, and what factors and barriers for participants to seek dental treatment. Cross-tabulations, Spearman correlation analysis and Pearson Chi-Square analysis were used for the statistical analyses. Three most common reasons for visit were check-up (77%), clean (57%) and relief of pain 36%). A desire to treat a perceived problem was the most common encouraging factor to seek dental care. Cost was the most common barrier to seeking dental services. The majority of participants attended a private practice (84%), with convenience of location and referral from professionals the most likely to influence their choice. Participants felt the most important trait a dental practitioner could demonstrate was to discuss treatment options with them before any treatment. Dental check-up, teeth cleaning and relief of pain were the most common reasons for patients to choose dental services. Cost and ethnicity of the consumers had a significant impact on how dental services were perceived and sought. Dental practitioners may need to reorientate how they express value of oral health practice, not just in regard to communication with patients, but also with government funding agencies.

The profile of older adults seeking chiropractic care: a secondary analysis

BackgroundMusculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.MethodsA secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using χ2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.ResultsA total of 6781 chiropractor–adult patient encounters were recorded. Of these, 1067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.ConclusionsFrom 6781 chiropractor–adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions.

What do Australian health consumers believe about commercial advertisements and testimonials? a survey on health service advertising

BackgroundThere has been little examination of consumer attitudes towards the commercial advertising of healthcare services in Australia and how marketing is used by consumers in their health decision-making. In this research, we examined how consumers reported commercial advertising helped them to understand the health services available to them and the influence that marketing had upon their choices.MethodsA survey instrument using a Likert scale to indicate agreement or disagreement with 21 questions was developed using qualitative interviews before being distributed online within Australia. Sampling of participants was stratified by age, gender and location. The results were subjected to statistical analysis with Spearman Rank Correlation test being used for bivariate analysis.ResultsOne thousand five hundred sixty-four complete surveys were collected. The results revealed certain consumer beliefs, for example; the title of ‘Dr’ was believed to indicate skill and high levels of training (81.0%), with 80.3% agreeing incorrectly that use of the title was strictly regulated. Participants reported to have a higher confidence in their own abilities (71.2%) than the public (52.8%) in assessing health advertising. The level of self-confidence increased with higher education level and decreased by age (p < 0.05). Testimonials were reported to be lacking in reliability (67.7%) and that they should not be used in healthcare in the same manner as they are used in other industries. Only 44.8% of participants reported that they felt confident to spot a review that was not written by a genuine user of a service.ConclusionsThe data demonstrated that many health consumers felt that while commercial health advertising was helpful, it was also confusing, with many participants also holding mistaken beliefs around other elements of commercial health advertising. While the advertising of healthcare services might have educational effects and be superficially empowering, advertising is primarily intended to sell, not educate. This research demonstrates that there is significant potential for healthcare advertising to mislead. Future developments in regulatory health advertising policy, and the related ethical frameworks developed by professional healthcare associations, need to consider how the consumers of healthcare services might be better protected from misleading and predatory advertising practices.

РЕЄСТРАЦІЙНІ ТА ДОЗВІЛЬНІ ПРОЦЕДУРИ У СФЕРІ МЕДИЧНОГО ТУРИЗМУ

The article is focused on studying such means of administrative and legal guaranteeing as registration and authorization procedures. The purpose of the article is to provide characteristics to authorization and registration procedures as type of administrative and legal means to guarantee the development of medical tourism on the basis of the analysis of the current legislation in the field of medical tourism. The objective of the scientific research is to prepare recommendations for further improvement of the current legislation on the researched issue in the tourist and health care sectors. To achieve scientific objectivity the author has used both general and special legal research methods; the methodological basis of which was universal dialectical methods used to reveal the nature and content of authorization and registration procedures as administrative and legal means of guaranteeing the development of medical tourism. The current regulatory legal acts regulating authorization and registration procedures in the field of tourism operations and health care sector related to medical tourism have been analyzed. It has been stated that the current legislation in the field of tourism operations and health care, regulating authorization and registration procedures, requires further improvement in order to ensure the efficient development of medical tourism, the effective attraction of investment in this area. Thus, the legislation on licensing activities in the field of medical tourism should be improved due to the peculiarities and specifics of medical services as an element of the tourist product, because the activities of travel agents under the current Ukrainian legislation are not subject to licensing, as well as the operations of the companies that are providers of medical services, where licensing of travel agencies’ operations is carried out without taking into account the peculiarities of medical tourism in terms of the content of this activity. Taking into account the conflicting provisions of the current legislation regarding the nature of accreditation of health care institutions, the author has offered to establish their mandatory accreditation at the legislative level, taking into account the risk of medical activities for health and life of consumers of health care services and in order to have real quality staffing, logistical and organizational provision of such services. Visa-requiring procedures need to be simplified in order to ensure the effective development of inbound medical tourism. The formation of the Unified Information Register of Medical Institutions (national and foreign), which have agreements (concluded agreements) in the field of medical tourism acquires special significance among registration procedures.

Overview of Nurse Performance Quality of Service in Theinpatient Room Dr. D. Anatototi Larathospital

The performance of the nurse is the success rate of the nurse in providing nursing care in accordance withthe duties and responsibilities that it carry. While the quality of service is an important factor that can shapepatients’ trust in hospitals so as to create their loyalty as consumers of health care services. This research aimsto analyze the performance of nurses (service orientation, integrity and ability) in the quality of service in theinpatient room dr. D. AnatototiLarathospital. The type of research used in this study is qualitative researchwith a descriptive approach. The research informant is the human resources of Dr. D. AnatototiLarat Hospitalwho works in the Inpatient Room consisting of 13 people. Determination of informants using purposivesampling techniques. The results showed that the performance of nurses seen from the orientation of thenursing service found that the services provided by nurses were very friendly, courteous, and responsive, theintegrity of nurses found that nurses had carried out tasks in accordance with the rules and directives of theprevailing leadership and rules, the ability of nurses found that nurses were very enthusiastic in developingabilities. We recommend that hospitals pay more attention and always improve the performance of nurses interms of service orientation, integrity, ability to improve the maximum quality of health services for all localresidents, especially around the regional general hospital dr. D. AnatototiLarat.

In Response.

We thank Dr Anwari1 for his thoughtful reading of our article2 and agree with his observations regarding the potentially powerful role of customer reviews in today’s marketplace. We also agree that due to social aspects of the physician–patient relationship, patient consumers of health care services differ from consumers of other goods and patient customers are likely incentivized to not anger physicians to whom they entrust their health care. Finally, we agree that our “snapshot” of patient satisfaction in a large private group practice may not fully describe overall satisfaction with providers in that practice due to response bias. Nevertheless, we believe that our observations have potential value for the anesthesiologist seeking to measure patient satisfaction with his/her care. We found (as we hypothesized) that some factors not under direct anesthesiologist control such as increased age and nighttime or inpatient surgery meaningfully affected satisfaction.2 We also identified opportunities to improve. The lowest ranked questions in our survey related to whether the anesthesiologist spent enough time with the patient before and after surgery. Whether better care, salesmanship, or advertising, we would argue that spending more time with the patient improves care and satisfaction both. We agree that our response rate was low. To address that issue, we examined clinical characteristics of nonresponders and found that they were more likely to be older and male, have a higher American Society of Anesthesiologists (ASA) physical status, have undergone inpatient or nighttime surgery, and not have received general anesthesia. Based on our findings, we suggested (as Dr Anwari does) that nonresponders were likely to be less satisfied.2 Despite the many limitations of our analysis, we continue to believe that measuring patient satisfaction is an important aspect of anesthesia care and a positive investment. Improving patient satisfaction is a worthy goal in itself and a business differentiator in winning and retaining hospital contracts for anesthesia services. We recognize that unscrupulous entities may “sell” products not clearly in the patient’s best interest to improve satisfaction, but note that this problem has existed since the time of Maimonides.3 Our observations have changed our personal practices, and we believe that measuring patient satisfaction may do so for other anesthesiologists focused on delivering the best patient experience possible. Anastasia Pozdnyakova, BSPritzker School of MedicineChicago, IllinoisAvery Tung, MDDepartment of Anesthesia and Critical CareUniversity of ChicagoChicago, Illinois[email protected]Richard Dutton, MD, MBAUnited States Anesthesia PartnersFt Lauderdale, FloridaAnum Wazir, BSTexas A&M School of MedicineBryan, TexasDavid B. Glick, MD, MBADepartment of Anesthesia and Critical CareUniversity of ChicagoChicago, Illinois

How NPs can help expand telehealth services.

Consumers of healthcare services are demanding more convenient and accessible options to care. Technologic advancements can support this demand, but telehealth knowledge is lacking. This article will describe the current state of telehealth and examine the role that NPs can play in furthering its adoption.

Climbing the down escalator

PurposeThis paper aims to examine the effect of customer-to-customer (C2C) interaction while using a service on the willingness of consumers to engage in altruistic customer participation (CP) or co-production efforts aimed at helping other customers. It further examines the role of consumer skepticism toward the service category in moderating the effects of C2C interaction on altruistic CP and customer satisfaction.Design/methodology/approachA survey methodology was used to collect data from 374 consumers of health-care services in India. The data collection involved interviews of patients visiting diabetes clinics and focused primarily on the interaction between customers and their willingness to participate in educating members of the community on diabetic self-care.FindingsThe analysis shows that C2C interaction positively affects customer satisfaction and willingness to engage in altruistic CP. Consumer category skepticism does not moderate the effect of C2C interaction on customer willingness to engage in altruistic CP. However, category skepticism does have the moderating effect of significantly reducing the positive effect of C2C interaction on customer satisfaction.Research limitations/implicationsData for this study were collected via interviews of consumers in India. Each consumer was interviewed by a trained interviewer. Although the authors do not detect any systematic influence in the results, the possibility of bias is acknowledged. Regarding the research implications, the finding that category skepticism does not moderate the effect of C2C interaction on willingness to engage in altruistic CP suggest that ultimately consumers may have stronger commitment and loyalty to themselves and that their relationships with the firm’s might be peripheral.Practical implicationsThe study finds that consumer skepticism toward a service category can have adverse effects for service co-creation. The authors advise managers in troubled industries not to focus exclusively on improving brand differentiation but to also consider working with major industry players and regulators to address the deepest fears of consumers.Originality/valueThe findings have implications for the service dominant logic of marketing in that it suggests that category skepticism is disruptive to the value integration process on which service co-creation relies for value creation. This has strong implications for how managers should structure their interaction processes with customers and for future research that seeks to them prove customer productivity.

De-legitimising complementary medicine: framings of the Friends of Science in Medicine-CAM debate in Australian media reports.

Complementary and alternative medicine (CAM) has developed into a complex and formidable commercial, sociocultural and political force in Australia, and given its influence, it is a relevant subject for scholars, health practitioners, health communicators, journalists, policy-makers, and consumers of healthcare products and services. This research will consider a relative newcomer to the claims-making space about CAM in the Australian health media-scape; the Friends of Science in Medicine (FSM), an activist group of medical practitioners, researchers, and scientists, founded in late 2011. Using content analysis supported by NVivo, I searched for articles specifically referring to FSM and measured the patterns and frequencies of media frames, intonation and sources that are featured in Australian mainstream news reports between December 2011 and April 2017. The negative headlining and intonation of reports predominated, along with framing CAM as part of a lucrative, undisciplined and unethical industry as well as an illegitimate healthcare approach, more broadly. The findings offer insight into how journalists respond, replicate or reconstruct the framings that are provided by an influential and elite group of medical practitioners and scientists, and readdresses issues surrounding the need for more critical health reporting in Australia.