Objective This study examines how online appointment systems technology-based service encounters (OAS-TSE) relate to patient value co-creation behaviors through the mediating role of hospital image (HI) in Chinese healthcare settings. Methods This study surveyed 387 patients in China who had experienced OAS-TSE during their first hospital visit within the past 3 months. Using structural equation modeling in SmartPLS 4.0, this study tested relationships between OAS-TSE, HI, and four dimensions of value co-creation behaviors: Dialogue, Access, Risk Assessment, and Transparency (DART). Results Favorable OAS-TSE were associated with higher HI, which in turn was associated with all four DART dimensions. Direct associations between OAS-TSE and co-creation behaviors were significant for Dialogue, Access, and Transparency, but not for Risk Assessment. HI mediated all relationships, with full mediation observed only for Risk Assessment. The model explained substantially less variance in Risk Assessment compared to other dimensions. Conclusion This study reveals associations between OAS-TSE and patient participation through HI. Theoretically, HI emerges as a key psychological mechanism connecting digital touchpoints to patient co-creation, with boundaries identified for direct technology associations. Practically, findings suggest hospitals may benefit from recognizing digital touchpoints as image-building tools and adopting differentiated strategies for promoting patient participation based on behavior complexity.
Zhang et al. (Sun,) studied this question.