Purpose Physicians’ knowledge sharing behavior (KSB) is crucial to the sustainable development of the online health communities (OHCs). While online reputation is known to incentivize physicians, prior studies often treat it as a single-dimensional signal, this study aims to explore synergistic mechanisms from multiple sources such as patients, peers and systems. Design/methodology/approach A three-dimensional online reputation signal research model was constructed covering patients, peers and systems based on signaling theory and online reputation-related literature. By acquiring the objective data of 37,382 physicians on a Chinese OHC, the effect of different reputation signals on physicians’ KSB was empirically tested. Findings Both patient- generated and system-generated reputations promote KSB, but they act as substitutes. Peer-generated reputation negatively affects KSB, though system-generated reputation mitigates this effect. No significant interaction exists between patient and peer signals. Offline seniority strengthens the impact of online reputation on KSB. Originality/value This study reveals the direct and interactive effects of multi-source reputation signals in OHCs, offering a nuanced view of signaling complexity and practical insights for patients, physicians and OHCs.
Yuan et al. (2026) studied this question.