School of Economics and Management, Zhejiang Sci-Tech University, Hangzhou, China.
College of Business and Economics, Human Capital Research Center, United Arab Emirates University, Al Ain, United Arab Emirates.
J Med Internet Res. 2024 Nov 29;26:e59904. doi: 10.2196/59904.
Digital platforms offer a venue for patients and physicians to exchange health information and provide health care services outside traditional organizational contexts. Previous studies have seldom focused on the factors that drive the proactivity of physicians' online behavior. Additionally, there is limited research exploring the influence of patients on physicians' online behavior, particularly from the perspective of patients possessing power.
This study aims to investigate the effect of patient-empowering behaviors on physicians' online knowledge sharing and uncover the potential mechanisms of proactivity. Based on the proactive motivational model and empowerment theory, we propose the existence of a reverse empowerment process, where empowerment flows from patients to physicians. We suggest that patient-empowering behaviors may drive physicians' online knowledge sharing as a form of proactivity. Specifically, 3 proactive motivational states-knowledge-sharing self-efficacy, sharing meaning, and positive professional affect-mediate this relationship. Additionally, platform extrinsic rewards, as a contextual factor, have a moderating effect.
To validate our proposed research model, we conducted a survey in China using the WJX platform, targeting physicians engaged in online knowledge sharing. The measurement instrument utilizes validated items adapted from prior research, using a 5-point Likert scale. We collected 257 valid responses, ensuring that participation was both anonymous and voluntary. Data analysis was performed in 2 stages. The first stage assessed the measurement model for reliability and validity, using the Harman 1-factor test and confirmatory factor analysis. The second stage used partial least squares-structural equation modeling to examine the direct, moderation, and mediation effects among the constructs, with bootstrapping used for significance testing. This comprehensive approach ensures a robust analysis of the proposed hypotheses and contributes to the overall validity of our research model.
Perceived patient-empowering behaviors significantly and positively influence physicians' online knowledge sharing (β=0.27, P<.001). Knowledge-sharing self-efficacy (effect=0.06, P=.04), sharing meaning (effect=0.12, P<.001), and positive professional affect (effect=0.10, P=.003) each partially mediate the effect of patient-empowering behaviors on physicians' online knowledge sharing. The overall proactive motivational states play a complete mediation role, meaning the entire indirect effect of the model is significant (effect=0.29, P<.001), while the direct effect in the model is nonsignificant (effect=0.07, P=.26). Additionally, platform extrinsic rewards significantly and negatively moderate the effect of sharing meaning on physicians' online knowledge sharing (β=-0.13, P=.001).
This study is the first to recognize and examine proactivity as an alternative mediating mechanism for physicians' online knowledge sharing, highlighting the active role of patients in empowering physicians. It makes a significant contribution to the existing literature on empowerment, eHealth, and proactive behavior. Additionally, the findings offer valuable guidance for designing and managing digital platforms to ensure service sustainability.
数字平台为患者和医生提供了一个在传统组织背景之外交流健康信息和提供医疗服务的场所。先前的研究很少关注驱动医生在线行为主动性的因素。此外，从拥有权力的患者的角度来看，关于患者对医生在线行为的影响的研究也很有限。
本研究旨在探讨患者赋权行为对医生在线知识共享的影响，并揭示主动性的潜在机制。基于主动激励模型和赋权理论，我们提出了一种反向赋权过程的存在，即赋权从患者流向医生。我们认为，患者赋权行为可能会促使医生将在线知识共享视为一种主动性。具体来说，3 种主动激励状态——知识共享自我效能感、共享意义和积极的专业情感——中介了这种关系。此外，平台外在奖励作为一种情境因素，具有调节作用。
为了验证我们提出的研究模型，我们在中国的 WJX 平台上进行了一项调查，针对从事在线知识共享的医生。该测量工具采用了先前研究中经过验证的项目，使用 5 点李克特量表。我们共收集了 257 份有效回复，确保参与是匿名和自愿的。数据分析分两个阶段进行。第一阶段使用 Harman 1 因子测试和验证性因子分析评估测量模型的可靠性和有效性。第二阶段使用偏最小二乘-结构方程建模来检验结构之间的直接、调节和中介效应，使用自举法进行显著性检验。这种综合方法确保了对假设的稳健分析，并提高了我们研究模型的整体有效性。
感知到的患者赋权行为对医生的在线知识共享有显著的正向影响（β=0.27，P<.001）。知识共享自我效能感（效应=0.06，P=.04）、共享意义（效应=0.12，P<.001）和积极的专业情感（效应=0.10，P=.003）均部分中介了患者赋权行为对医生在线知识共享的影响。整体主动激励状态起到完全中介作用，即模型的总间接效应显著（效应=0.29，P<.001），而模型中的直接效应不显著（效应=0.07，P=.26）。此外，平台外在奖励显著负向调节共享意义对医生在线知识共享的影响（β=-0.13，P=.001）。
本研究首次认识到并检验了主动性作为医生在线知识共享的替代中介机制，强调了患者在赋予医生权力方面的积极作用。它为赋权、电子健康和主动行为的现有文献做出了重要贡献。此外，研究结果为设计和管理数字平台以确保服务可持续性提供了有价值的指导。
