Luận án tiến sĩ a typology of customer value cocreation activities in healthcare

A Typology of Customer Value Cocreation Activities in Healthcare: Its Antecedents and Impact on Quality of Life Anh Ngoc Tram Pham Master of International Economics and Finance Bachelor of Business Administration (Honours) This thesis is presented for the degree of Doctor of Philosophy of The University of Western Australia Business School Marketing 2020 THESIS DECLARATION I, Anh Ngoc Tram Pham, certify that: This thesis has been substantially accomplished during enrolment in this degree. This thesis does not contain material which has been submitted for the award of any other degree or diploma in my name, in any university or other tertiary institution. In the future, no part of this thesis will be used in a submission in my name, for any other degree or diploma in any university or other tertiary institution without the prior approval of The University of Western Australia and where applicable, any partner institution responsible for the joint-award of this degree. This thesis does not contain any material previously published or written by another person, except where due reference has been made in the text and, where relevant, in the Authorship Declaration that follows.

This thesis does not violate or infringe any copyright, trademark, patent, or other rights whatsoever of any person. The research involving human data reported in this thesis was assessed and approved by The University of Western Australia Human Research Ethics Committee. Written patient consent has been received and archived for the research involving patient data reported in this thesis. This thesis contains published work and/or work prepared for publication, some of which has been co-authored.

Signature: Date: 02/08/2020 i ABSTRACT A new perspective in service literature rooted in a service-dominant logic suggests that health care customers, instead of merely adhering to medical instructions, can actively contribute and cocreate value with a broad range of actors in their service network. To date, research on customer value cocreation has primarily focused on discrete activities, such as comply and coproduce, or specific aspects of value cocreation, such as customer participation in service encounters, and the range of activities has not been fully delineated, limiting our understanding of how customers cocreate value for themselves and for others in complex service contexts. Therefore, this project sought to examine an extended range of customer value cocreation activities to identify different types of activities and customer value cocreation practice styles in a chronic healthcare context, and to explore the antecedents and outcomes of such activity types. The thesis builds on a series of three empirical papers that used both qualitative and quantitative methods.

In line with the overall research objectives, the first paper used qualitative approaches (focus groups and in-depth interviews) and content analysis to identify the range of value cocreation activities customers undertake and developed a typology of customer value cocreation activities, including mandatory (customer), mandatory (customer or organisation), voluntary in-role and voluntary extra-role activities. Some key psychological drivers were suggested (health locus of control, optimism, self-efficacy, regulatory focus and expected benefits), and the associations between different activity types and quality of life outcomes (physical, psychological, existential and social well-being) were explored. ii Based on the extended set of value cocreation activities identified, the second paper used survey data obtained from health care customers across five prevalent chronic health conditions (cancer, diabetes, heart diseases, asthma and arthritis) to identify customer value cocreation practice styles. Results of cluster and discriminant analyses revealed five distinct styles based on the combinations of activities customers undertake, namely highly active, other-oriented, provider-oriented, self-oriented, and passive compliant.

This paper indicated that customer value cocreation practice styles FDQEHEHVWGLIIHUHQWLDWHGQRWDFFRUGLQJWRWKHW\SHVRIDFWLYLWLHVRUWKHDFWLYLWLHV¶OHYHOV of difficulty but rather on the basis of the combinations of activities undertaken with different actors, suggesting how each style can be supported resource-wise. Differences in various quality of life and satisfaction aspects across customers adopting different styles were also evident. The third paper used survey data to examine the impacts several types of resources had on customerV¶ efforts in four types of activities and the impacts efforts had on their quality of life. Based on a number of resources driving customer mandatory and voluntary value cocreation suggested in the qualitative stage (e.

psychological, clinical and social resources), a conceptual model was developed and then tested using PLS-SEM. The findings confirmed the links between clinical resources and mandatory activities and between social resources and voluntary activities. Psychological resources had the greatest impacts on customer efforts across the whole range of activities. Value cocreation effort in each activity type contributed to quality of life differently, with voluntary activities having the greatest impacts on quality of life.

This project contributes to the transformative service research agenda and responds to the call for research to promote better marketing for a better world. It offers additional iii insights into the micro-foundations of customer value cocreation by developing a more nuanced categorisation of customer value cocreation activities beyond the customer- provider dyad that captures activities generating benefits for a broader range of actors, OHDGLQJWRQRYHOLQVLJKWVLQWRKRZFXVWRPHUV¶YDOXHFRFUHDWLRQHIIRUWVDFURVVGLIferent types can be facilitated by pulling together an array of resources. It also advances the understandings of the underlying heterogeneity of customer value cocreation and its implications to outcomes, the networks of resources integrated into customer value cocreation processes that help them take a higher level of responsibility in an unsought service, and the transformative potentials of different types of customer value cocreation activities. In addition to its contributions to the services marketing literature, the project also adds to medical research by unfolding a more comprehensive framework for chronic illness management.

iv TABLE OF CONTENT 1.1 A background to the research .1 The research problem .2 Health care as a research context .3 Significance and originality of the research project .4 The scope of the study and some delimitations .5 The structure of the thesis .1 Service-GRPLQDQWORJLFDQGFXVWRPHUV¶FKDQJLQJUROHV.2 Customer value cocreation .1 Customer value cocreation and related concepts .2 Customer value cocreation activities .3 Customer value cocreation activities in health care services .4 Antecedents to customer value cocreation activities .3 Resources and value cocreation .1 The definition, classification and characteristics of resources .2 Resources integration and value cocreation. 31 &XVWRPHUV¶UHVRXUFHVDQGYDOXHFRFUHDWLRQDFWLYLWLHV .4 Quality of life .1 Conceptualisations and dimensions of quality of life .2 Quality of life as an important marketing outcome .3 Value cocreation and quality of life .1 Customer value cocreation activities .2 Quality of life ± the ultimate outcome of health care services .1 A typology of customer value cocreation activities .2 Ps\FKRORJLFDO GULYHUV RI FXVWRPHU¶V LQYROYHPHQW LQ YDOXH FRFUHDWLRQ activities .3 Customer value cocreation activities and quality of life .7 Managerial implications, limitations and future research .2 Limitations and future research. Focus group interview guide. Example coding scheme.

Example data structure .1 Well-being as the ultimate service outcome .2 Practice approach to segmentation.3 Customer value cocreation .4 Categorisation of customer value cocreation activities .4 Study 1: Deriving and categorising customer value cocreation activities .1 Stage 1a: Deriving a list of customer value cocreation activities .2 Stage 1b: Categorising customer value cocreation activities .5 Study 2: Deriving the customer groups .8 Limitations and future research. Customer value cocreation activities and illustrative quotes. Final items for the value cocreation activities. Measures of outcome constructs.

Background composition of the clusters .1 Value cocreation and resource integration .2 A typology of customer value cocreation activities .4 A conceptual model and hypotheses development .1 The sample and data collection .1 The Rasch analysis. 165 7KHFRQVWUXFWV¶PHDVXUHPHQWSURSHUWLHV .3 The structural model .9 Limitations and future research. Resources pertinent to customer value cocreation activities in health care. Final measurement items .1 Summary and discussion of key findings .2 Overall theoretical contributions .3 Overall managerial implications .4 Research limitations and recommendations for future research.

Article front page (Paper 1). Article front page (Paper 3). Focus group participants. Online survey questionnaire.

Descriptive statistics of measurement items. Measurement properties of the first-order constructs (Paper 3). 251 viii LIST OF FIGURES Figure 3.1 The initial framework .2 The proposed conceptual model .1 The mean discriminant scores for each function for each group. 117 ix LIST OF TABLES Table 2.1 Selected conceptualisations of concepts related to value cocreation .1 Value cocreation activities, antecedents and outcomes .2 Value cocreation activity typology .1 Equality of group means and rotated structural coefficients for value cocreation activities .2 Equality of group means for customer satisfaction and well-being.1 Rasch scale values and fit statistics ± mandatory (customer) activities .2 Rasch scale values and fit statistics ± voluntary in-role activities .3 Rasch scale values and fit statistics ± voluntary extra-role activities .4 Measurement properties of the constructs .5 Structural model: path coefficients.

171 x ACKNOWLEDGEMENT This thesis would not have been possible had it not been for the guidance and support of many individuals that were on my PhD journey with me, regardless of where they are. Choosing to spend the last 3.5 years at UWA is one of the best decisions I have ever made. I feel incredibly privileged to have an amazing supervisory team here. I owe my sincere gratitude to Winthrop Professors Jill Sweeney and Geoff Soutar, my kind mentors who tirelessly helped me throughout this journey with intellectual guidance and emotional support.

Thank you for always making yourselves accessible, and for being so generous with your time, patience and wisdom. Each of you has been an inspiration to me and has changed my perspective on what an ideal supervisor-student relationship should be. Thanks to what you have done for me, I can now clearly see WKH YDOXH RI EHLQJ D µPHQWRU¶ WR P\ IXWXUH students in addition to beLQJ D µTXDOLW\ DVVXUHU¶DQG,KDYe learned how to constantly motivate my students, challenge them, and inspire them to reach beyond what they thought they were capable of so that in the end they can become independent researchers. I am also grateful for the support given by Associate Professor Fang Liu during the thesis submission process.

Thanks to the Marketing academics and fellow PhD candidates for the great experience at UWA. I would like to acknowledge the support provided by the many people participating in this research. I am grateful to Diabetes Western Australia for their assistance in recruiting focus group participants as well as for their valuable insights and contributions at the qualitative phase of this research. My thanks are extended to all participants who volunteered their time and contributed to the focus groups.

I would xi also like to thank the fifteen service research scholars for their help at the start of the quantitative phase. This research was also supported by an Australian Government Research Training Program (RTP) scholarship which has provided me with access to high quality postgraduate education that would have otherwise been unreachable for me. I am also thankful for the support and encouragement I have received from my colleagues at the School of Industrial Management, HCMC University of Technology, Vietnam National University. I would like to express my sincerest thanks to Associate Professors Hau Le and Thuy Pham who had welcomed me to their team and trained me on the basics of marketing research before I embarked on my PhD journey, as well as provided me with emotional support along the way.

I also thank Dr. Hien Nguyen for her guidance at the early stage of my career in academia. I would probably not have gone this path if it had not been for her help. Last but not least, I am grateful for the unconditional love and support from my family, my in-laws and friends.

Your encouragement has inspired me to strive for success. I especially thank my parents. Your sacrifices and firm belief in the value of education have taken me this far. This thesis is dedicated to you! To my husband, who happens to be my colleague, my research partner and my biggest supporter, thank you for walking with me on this journey despite us being 10,000 miles apart, and for always putting me as your priority despite being busy with your own PhD project.