How doctors take initiatives in online healthcare communities

In China, healthcare services have historically been expensive and difficult to access, with resources being unfairly distributed, often being centralized in large hospitals in major cities. In rural regions, hospitals often suffer from limited supplies, including human capital and equipment. E-health technologies have received significant attention from governments and citizens, with online healthcare communities (OHCs) providing easier communication between patients and doctors. Although doctors play a pivotal role in the success of OHCs, they are often unsure how to attract patients, with limited research focusing on this. The purpose of this paper is to explore how doctors can take initiatives in OHCs, from the joint perspectives of individual effort (i.e. intrapersonal factor) and identity in medical teams (MTs) (i.e. interpersonal factor), based on attribution theory.

Hierarchical linear regression was conducted on data from 3,170 doctors participating in 865 online MTs, to examine the effects of individual effort and identity in MTs on individual performance. Individual effort included central effort (log-in frequency to OHC) and peripheral effort (articles published on doctors' homepages). Identity in MTs was represented as the identity of team leader and multiple team membership (MTM).

This study found that the main variables – central and peripheral effort, and leader and MTM identity – all had significant and positive impacts on the service quantity (SQ) of both written and telephone consultations. Although positive effects could be experienced in most conditions that were congruent with the logic of identity theory, the interaction terms demonstrated complex influences. Specifically, leader identity did not moderate the effect of article effort in written consultation, while MTM identity could not moderate the relationship between frequency effort and SQ in telephone-consultation services. Further, the leader identity negatively moderated the relationship between article effort and SQ in telephone consultations. Thus, for doctors with the leader identity, the impact of article effort on SQ was weaker. In summary, both aspects were proved to play important roles in individual SQ.

This study provides empirical findings through focusing on the SQ of both written and telephone consultations in OHCs, thereby enabling healthcare providers to take initiatives and ultimately improve the efficiency and provision of delivered healthcare services. It is worth mentioning that doctors possessing the identity of team leader should be cautious that the more articles published by them may not lead to envisaged telephone-consultation performance, according to the negative moderating effect of leader identity on the relationship between article effort and SQ during telephone consultations.

This study contributes to the OHC literature by investigating how doctors' efforts and identity in OHCs affect individual performance, based on attribution theory and identity theory. Further, we provide healthcare practitioners with an improved understanding of these dimensions to improve autonomy regarding service provision in OHCs.