Online health services are a rapidly growing coping resource for consumers to draw on in managing health ‐ related stressors. We apply a (dis)engagement coping lens to understand consumer coping, identify the distinct purposes of consumer coping captured in six coping scales, and develop an inventory (via multiple studies), to measure consumer positioning on these scales. In a final survey ( N = 623), we assess the extent to which consumers use online health services, the ways in which they draw on these services as coping resources using the 6 ‐ scale inventory and the influence of health status on coping efforts. We demonstrate that consumer engagement coping efforts with respect to health ‐ related stressors are largely directed toward direct management of health stressors (e.g., active planning). We also identify how consumers combine multiple ways of coping through distinguishing three coping profiles based on the enactment and perceived helpfulness of the six coping scales and current health status. Our profiles emphasize the need to understand the progress of health conditions as a determiner of coping efforts. Practitioners and policymakers can use this structured understanding of coping efforts to strategically plan future service provision, although some caution is noted with respect to health inequalities.

Complex services, such as healthcare, struggle to realize the benefits of value co-creation due to the substantial challenges of managing such services over the long-term. Key to overcoming these challenges to value co-creation is a profound understanding of dialogue (i.e., ‘quality of discourse’ facilitating shared meaning) during service interactions. Contributing to an emerging literature, we undertake a longitudinal, ethnographic study to assess dialogue between professionals and patients through the lens of dialogic engagement (i.e., iterative mutual learning processes that bring about action through dialogue). We develop and empirically support six dialogic co-creation and co-destruction mechanisms that impact on the resolution of tensions and integration of knowledge resources between service providers and consumers. We reveal the multidimensional and dynamic nature of value created or destroyed through these mechanisms in dialogue over time. Taking healthcare as an exemplar, we offer a research agenda for developing our understanding of DE in complex services.

PurposePolicymakers push online health services delivery, relying on consumers to independently engage with online services. Yet, a growing cluster of vulnerable patients do not engage with or disengage from these innovative services. There is a need to understand how to resolve the tension between the push of online health service provision and unengagement by a contingent of health-care consumers. Thus, this study aims to explore the issue of digital unengagement (DU) (i.e. the active or passive choice to engage or disengage) with online health services to better inform service design aligned to actual consumer need.Design/methodology/approachAdopting a survey methodology, a group of 486 health services consumers with a self-declared (acute or chronic) condition were identified. Of this group, 110 consumers were classified as digitally unengaged and invited to write open-ended narratives about their unengagement with online health services. As a robustness check, these drivers were contrasted with the drivers identified by a group of digitally engaged consumers with a self-declared condition (n= 376).FindingsDU is conceptualized, and four levels of DU drivers are identified. These levels represent families of interrelated drivers that in combination shape DU: subjective incompatibility (misalignment of online services with need, lifestyle and alternative services); enactment vulnerability (personal vulnerabilities around control, comprehension and emotional management of online services); sharing essentiality (centrality of face-to-face co-creation opportunities plus conflicting social dependencies); and strategic scepticism (scepticism of the strategic value of online services). Identified challenges at each level are the mechanisms through which drivers impact on DU. These DU drivers are distinct from those of the digitally engaged group.Research limitations/implicationsAdding to a nascent but growing literature on consumer unengagement, and complementing the engagement literature, the authors conceptualize DU, positioning it as distinct from, not simply a lack of, consumer engagement. The authors explore the drivers of DU to provide insight into how DU occurs. Encapsulating the dynamic nature of DU, these drivers map the building blocks that could help to address the issue of aligning the push of online service provision with the pull from consumers.Practical implicationsThis paper offers insights on how to encourage consumers to engage with online health services by uncovering the drivers of DU that, typically, are hidden from service designers and providers impacting provision and uptake.Social implicationsThere is a concern that there will be an unintentional disenfranchisement of vulnerable segments of society with a generic policy emphasis on pushing online services. The paper sheds light on the unforeseen personal and social issues that lead to disenfranchisement by giving voice to digitally unengaged consumers with online health services.Originality/valueOffering a novel view from a hard-to-reach digitally unengaged group, the conceptualization of DU, identified drivers and challenges inform policymakers and practitioners on how to facilitate online health service (re)engagement and prevent marginalization of segments of society.

Deans and academic colleagues are collectively involved in the delivery of business education. Yet their perspectives on teaching and learning can vary significantly reflecting the distinctive position from which they view the process. The dean’s perspective is shaped by external drivers and reference groups that are very different from those shaping the perspective of academics on the educational front line. Despite commonality of background there can be mutual incomprehension of each other’s worlds and associated world view. Sharing the obsessions of deans around teaching and learning is critical to addressing such incomprehension and enhancing the delivery of business education.

Purpose The purpose of this paper is to focus on the changing nature of healthcare service encounters by studying the phenomenon of triadic engagement incorporating interactions between patients, local and virtual networks and healthcare professionals. Design/methodology/approach An 18-month longitudinal ethnographic study documents interactions in naturally occurring healthcare consultations. Professionals (n=13) and patients (n=24) within primary and secondary care units were recruited. Analysis of observations, field notes and interviews provides an integrated picture of triadic engagement. Findings Triadic engagement is conceptualised against a two-level framework. First, the structure of triadic consultations is identified in terms of the human voice, virtual voice and networked voice. These are related to: companions' contributions to discussions and the virtual network impact. Second, evolving roles are mapped to three phases of transformation: enhancement; empowerment; emancipation. Triadic engagement varied across conditions. Research limitations/implications These changing roles and structures evidence an increasing emphasis on the responsible consumer and patients/companions to utilise information/support in making health-related decisions. The nature and role of third voices requires clear delineation. Practical implications Structures of consultations should be rethought around the diversity of patient/companion behaviours and expectations as patients undertake self-service activities. Implications for policy and practice are: the parallel set of local/virtual informational and service activities; a network orientation to healthcare; tailoring of support resources/guides for professionals and third parties to inform support practices. Originality/value Contributions are made to understanding triadic engagement and forwarding the agenda on patient-centred care. Longitudinal illumination of consultations is offered through an exceptional level of access to observe consultations.

The internet is portrayed as the harbinger of fundamental change in the nature of consumer healthcare behaviours. It offers the scope to ‘equalize’ the power and knowledge asymmetries that characterize healthcare service delivery, addressing a central contemporary challenge in health to ensure that the patient voice is heard (von Roenn 2013). The internet’s impact on the behaviour of the ‘patient-consumer’ cannot be isolated from the social and political context within which consumers and professionals interact. Yet there is a lack of methodogically robust cross-national evidence regarding consumer use of the internet for healthcare purposes and how this shapes utilisation of healthcare services. This research addresses this gap by examining the ‘patient-consumer’ use of the internet for healthcare purposes and associated health-related behaviour across China, Colombia, France, the UK and the USA. The overall research project involved four strands of activity conducted across all five countries. (1) analysis of key features of respective healthcare systems and prevailing policy agenda; (2) interviews with healthcare managers, policy makers and academics to enhance understanding of respective healthcare systems and policy agendas; (3) survey of 623 (UK) and 200 participants each in France, China, Colombia and the USA to gather comparative data on patterns of information usage; (4) two focus groups in each country with 8–10 patients to understand the rationale for information acquisition and utilisation behaviours. In this paper a descriptive analysis of the survey strand is offered, with insights from the qualitative elements, to establish the comparative patterns in use of the internet for healthcare purposes. It is evident from the data gathered across the five national contexts in which the research was conducted that consumers are active in using the internet for a wide variety of healthcare purposes. The key differences and commonalities can be summarised according to the following themes (1) access and attitudes to the internet for healthcare issues (2) patterns of use, e.g., divergence in accessing tangible support (3) attitudes to healthcare professionals, in terms of accepting, or not, professional authority. However, it is equally apparent that prevailing assumptions of wholesale change in patient-consumer behaviour and direct challenging of health professionals are unduly simplistic, in terms of both variability across consumers within specific locations and variability across locations. The particular configuration of the prevailing healthcare system is fundamental in shaping the particular patterns of change. However, the structure of the consultation requires to be rethought to reflect the diversity of patient-consumer behaviours and expectations. Irrespective of the nature of the internet space, the effect is to create a driver for change, with the potential to challenge established practices of both consumers and professionals to reshape the healthcare service encounter. Further analysis of the intra-group patterns will be made available.

In order to understand how consumers move between online and offline channels in the context of multi-channel retail environments, an exploratory study has been conducted. To prepare for this study, the literature on consumer channel choice and contemporary consumption behaviour together with relevant HCI literature was reviewed. The initial findings from the research show that consumers move between online and offline channels in a straightforward, almost matter-of-fact way, though the factors influencing their multi-channel use are complex and dynamic. In their empowered parallel interactions with various businesses consumers are actively shaping the outcome of the service encounter. Introduction Several studies from the fields of marketing and Human-Computer Interaction (HCI) (e.g. Ahuja et al., 2003, Forsythe and Shi, 2003, Goldsmith, 2000, Lee, 2002) report that although consumers regularly use e-commerce websites for browsing and searching, they often do not conclude this process with online purchasing. The percentages of consumers actually engaging in online purchases vary from 24% (Ahuja et al., 2003) to 32% (Lee, 2002). Based on these statistics it is suggested that consumers move between online and offline channels during the course of the consumption process, and that they actively decide which stages of this process they want to conduct through which channel. Contextualising Channel Proliferation and Consumer Behaviour Since new channels, such as internet, interactive telephone systems, and interactive TV have become available for shopping as an alternative to the traditional retail stores and catalogues, many studies (e.g. Black et al., 2002, Chiang et al., 2004, Gupta et al., 2003, Schoenbachler and Gordon, 2002, Reardon and McCorkle, 2002) have tried to ascertain what drives consumers in their choice of a particular channel. Black et al (2002) investigated why consumers, although purchasing essentially similar financial products, used particular channels in preference to others. The results of their study showed four categories of factors influencing consumers’ choice of channel: consumer characteristics, product characteristics, channel characteristics, and organizational factors. Other researchers have elaborated on each of these categories. In their study on consumer characteristics, Gupta et al (2003) have found that after making purchases through one channel, whether online or offline, risk-averse consumers tend to be more loyal customers than risk-neutral consumers. In a study on the influence of product characteristics on consumers’ patronage frequency, Chiang et

ABSTRACTOnline communities provide promising opportunities to support patient–professional negotiations that address the asymmetries characterizing health services. This study addresses the lack of in‐depth understanding of these negotiations, what constitutes successful negotiation outcomes, and the potential impact of negotiation on offline health behaviors. Adopting a netnographic approach, two threads were observed from each of the four online health communities focusing on breast cancer, prostate cancer, depression, and diabetes, respectively. This analysis was supplemented with 45 in‐depth interviews. The evidence suggests that online health communities can be constructed as permissible spaces. Such virtual spaces facilitate the type of patient–professional negotiations that can redress asymmetries. The critical elements of the negotiation process are identified as occupation, validation, advocacy, and recording. These support patients and professionals as they debate and resolve conflicts in how they experience health. Direct tangible offline negotiation outcomes are reported (e.g., changes in treatment plans). Implications for professional–patient partnerships are also explored.

Consumer engagement with social media technologies accelerates the need for innovative Marketing Research (MR), whilst new media technologies revolutionise MR capabilities in terms of the scope, efficiency, reach and continuity/persistence An emerging and promising area, and the focus of this paper, is the potential impact of 3D Platforms on Marketing Research, in particular, on the core methodology of surveys. 3D Platforms are currently successfully used for a wide range of MR methods (e.g., Catterall and Maclaran 2002). However, whilst surveys remain a popular and important tool in MR as shown by the innovation in 2D online surveys (see Wright 2005); less emphasis has been placed on developing survey methodologies in a 3D context. This is surprising, given that within 3D platforms we are not tied to traditional, often tedious, methods of survey completion. We argue that the development of surveys exploiting the 3D context may address many current criticisms of surveys. Employing novel and engaging methods will stimulate users’ interest and engagement, whilst retaining the advantages of a well-established and useful tool. We ask, how can 3D Platforms help us to innovate in our survey research and what are the rewards and challenges for Marketing Researchers? In addressing this question, we present a prototype 3D survey, describe technical/user challenges and solutions, propose potential pay-offs for research and identify future avenues of development.

The Internet has opened up new virtual communal spaces for consumers to congregate and address issues of mutual interest. Such virtual communities of interest offer consumers the opportunity to exchange experiential and technical information relating to their shared field of interest. Of the sectors in which virtual communities of interest have emerged, health care has witnessed a proliferation of condition-related communities. Providing health care consumers with the opportunity to share experience and expertise, these communities provide a range of new value propositions offering health care consumers opportunities to undertake self-service activities independent of health care professionals. Utilising the concept of the service encounter as a framework, this paper explores patterns of consumer participation in and utilisation of virtual communities in supporting service consumption. It examines the way in which these permissible spaces act as a virtual parallel service influencing consumer practice in the formal service encounter. For health care consumers and professionals, the utilisation of such space has significant implications for the shape of the service encounter in the information society.

Virtual worlds are three-dimensional (3D) persistent multi-user online environments in which users interact through avatars. Virtual worlds support many kinds of activities, including education, socialising, gaming and e-commerce. Our research focuses on how virtual worlds can be used to facilitate business-to-consumer (B2C) e-commerce involving real items. Examples of affordances of virtual worlds for e-commerce include 3D simulations, multi-user environments and avatar-based interactions. We have conducted empirical research to gather data about consumers' experiences in virtual worlds to understand ways to utilise their affordances for B2C e-commerce. Based on our empirical research and a literature review, we have derived design guidelines for the design and evaluation of B2C e-commerce environments involving virtual worlds. This poster presents a summary of the research project and a subset of the guidelines.

PurposeThe complexity of customer relationships has been recognized in the relationship marketing literature. Yet, the understanding of how this complexity impacts on the formation and development of different relationship forms is limited. Focusing on the development of customer‐service provider relationships in a financial services context, this paper aims to critically examine the nature and formation of business‐to‐consumer service relationships.Design/methodology/approachQualitative methods were employed, with in‐depth interviews undertaken with a sample of UK bank customers.FindingsThe complexity of customer relationships was documented by approaching relationships as multidimensional, dynamic and contextual. A relationship typology based on four key relationship components (trust, commitment, buyer‐seller bonds, and relationship benefits) is proposed. This typology suggests that for a relationship to exist it does not necessarily have to encompass an emotional dimension. Moreover, the paper demonstrates the importance of the fit between customers' relational expectations and their experiences with service providers in developing long‐term committed relationships.Research limitations/implicationsThe study was limited to the UK context. The extension of this study to other sectors or financial institutions operating in different regulatory and technological environments needs to be tested.Practical implicationsIt is crucial that relationships are viewed as multidimensional, taking into account various relationship components. Since different relationship components influence relationships differently, organisations need to develop different relationship marketing strategies for each consumer segment according to consumers' relational expectations.Originality/valueBuilding on preceding research, this paper broadens understanding of the complexity of customer‐firm relationships by presenting insight into the affective element of relationships and highlighting the role of the fit between customers' relational expectations and their experiences in relationship development.

Virtual worlds are three-dimensional (3D) persistent multi-user online environments where users interact through avatars. The affordances of virtual worlds can be useful for business-to-consumer e-commerce. Moreover, affordances of virtual worlds can complement affordances of websites to provide consumers with an enhanced e-commerce experience. We investigated which affordances of virtual worlds can enhance consumers' experiences on ecommerce websites. We conducted laddering interviews with 30 virtual world consumers to understand their perceptions of virtual world affordances. A means-end analysis was then applied to the interview data. The results suggest co-presence, product discovery, 3D product experience, greater interactivity with products and sociability are some of the key virtual world affordances for consumers. We discuss theoretical implications of the research using dimensions from the Technology Acceptance Model. We also discuss practical implications, such as how virtual world affordances can be incorporated into the design of e-commerce websites.

Virtual worlds are three-dimensional (3D) online persistent multi-user environments where users interact through avatars. The literature suggests that virtual worlds can facilitate real world business-to-consumer (B2C) e-commerce. However, few real world businesses have adopted virtual worlds for B2C e-commerce. In this paper, we present results from interviews with consumers in a virtual world to investigate how virtual worlds can support B2C e-commerce. A thematic analysis of the data was conducted to uncover affordances and constraints of virtual worlds for B2C e-commerce. Two affordances (habitability and appearance of realness) and one constraint (demand for specialised skill) were uncovered. The implications of this research for designers are (1) to provide options to consumers that enable them to manage their online reputation, (2) to focus on managing consumers' expectations and (3) to facilitate learning between consumers.

Virtual worlds are 3D, online, persistent, multi-user environments where users interact through avatars. Virtual worlds support many types of applications, such as gaming, education and socialising. Increasingly, they are being used for business-to-consumer (B2C) e-commerce. Our aim is to understand how a phenomenological perspective that highlights embodiment, perception of others and perception of being-in-the-world can inform the design of B2C e-commerce environments in virtual worlds. We have conducted phenomenological interviews and descriptive-phenomenological analysis to understand consumers' lived experiences of the consumption process in virtual worlds. Twenty-two consumers were interviewed in Second Life, a virtual world. The analysis highlights (1) the variety of emotions involved during the consumption process, (2) how consumers become aware of their avatars, and (3) how consumers appropriate affordances of virtual worlds. This suggests that B2C e-commerce environments in virtual worlds should be designed to reflect consumers' emotions, support intuitive control of avatars, and provide context-dependent tools during the consumption process. Design guidelines that are sensitive to the moment-to-moment experience of consumers, which the phenomenological perspective highlights, can result in an immersive online experience and increased consumer satisfaction.

Use of the internet by patients has attracted widespread attention in the popular media. Using the image of hard-pressed doctors besieged by patients waving internet-printout, it is suggested that internet information changes the doctor-patient relationship. The purpose of this research is to examine the extent to which patients search for health information on the internet; how this affects the medical consultation; and how the selection of treatment and outcome is affected. Focusing on three medical conditions where extensive information is available on the internet - cancer, diabetes and depression - the research will gather data from patients and doctors in primary and secondary care. A questionnaire survey will be used to measure the extent to which patients use the internet for finding healthcare information. The effect of the information use on the doctor-patient relationship and patients' health will be examined through the audio-recording of consultations, diary-keeping and interviews. Additionally observation of patients' online searching behaviour will be used to understand how patients judge the quality of information. Online interviews and observation of discussions will be used to understand the nature and role of web-based disease related discussion communities. By providing detailed evidence about how patients use internet based health information the research will enable doctors and healthcare managers to (a) design services to respond to changing patient expectations and requirements, (b) develop systems to support patients in acquiring and evaluating health information, and (c) ensure the appropriate training of healthcare professionals. The research will be overseen by an advisory board comprising patient, professional and NHS representatives. The results of the research will be published through a range of popular and professional media to ensure that the results of the research inform policy and practice.