International Journal of Pharmaceutical and Healthcare Marketing

Value creation in virtual communities: the case of a healthcare web site

Ram Misra, Avinandan Mukherjee, Richard Peterson,
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Value creation
Value creation in virtual in virtual
communities: the case communities
of a healthcare web site
321
Ram Misra, Avinandan Mukherjee and Richard Peterson
School of Business, Montclair State University, Montclair, New Jersey, USA

Abstract
Purpose – With the advent of the internet café, chat sessions, instant messengers, special interest
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e-groups and now blogs, people do not need to be physically close together to exchange their ideas.
The participants can have shared experiences that are instantaneous and pretty much of the same
nature that is usually realized by the traditional collection of special interest people in close proximity.
The members of these virtual communities share their knowledge, cooperate with each other to solve
problems, and feel responsibility for each other. Internet based technologies have been the great
enablers of virtual communities. In the high-involvement healthcare sector, patients are increasingly
seeking online advice and information by participating in virtual communities. The purpose of this
paper is to understand the process of consumer value creation in virtual communities.
Design/methodology/approach – This paper first adopts Cothrel’s framework for the creation of
value in virtual communities followed by an application of Kozinets’ segmentation model of online
consumers to explore the process of consumer value creation by a healthcare virtual community.
“Netnography” was used as the research technique for this study. Netnography is an ethnographic
research method adapted to the online environment. Discourse analysis is applied to interpret the huge
volume of online postings.
Findings – The paper identifies four segments of virtual community users – tourists, minglers,
devotees, and insiders, and studies their online activities and discussion topics to demonstrate their
differential roles as members of healthcare virtual communities.
Originality/value – Most of the earlier works that are focused on virtual communities have been
conducted at the conceptual level. In this paper a priori user segments in healthcare virtual
communities are empirically profiled. Based on the findings, managerial implications for healthcare
virtual communities are formulated.
Keywords Internet, Communities, Health services, Networking, Group discussion
Paper type Research paper

Introduction
Consumers are increasingly using computer mediated communication, such as websites,
newsgroups, chat rooms, email list servers, and personal worldwide web pages to share
ideas, build communities and contact fellow consumers to obtain information with the
objective of making better decisions on product and brand choices. This is particularly
important in high involvement services such as healthcare, where the internet has the
potential to change the way in which service users perform their roles and interact with
International Journal of
each other as well as with service professionals, by providing them with information Pharmaceutical and Healthcare
resources. Patients and consumers are increasingly turning to peer-to-peer Marketing
Vol. 2 No. 4, 2008
communication by building communities and contacting fellow consumers on the pp. 321-337
internet. Such computer-mediated communities, called “virtual communities,” are q Emerald Group Publishing Limited
1750-6123
increasingly becoming popular with consumers across demographics and behaviors. DOI 10.1108/17506120810922358
 IJPHM The purpose of this research is to understand the process of consumer value creation in
2,4 virtual communities.
Healthcare is widely viewed as the archetypal professional service (Wilson, 1994).
Core to such service is the perception that the consumer or patient lacks knowledge and
expertise in both diagnostic skills and treatment options, while the healthcare provider
is the specialist, possessing relevant technical skills and knowledge. The established
322 format of the professional service encounter, i.e. the process of interaction between the
patient and the healthcare provider (John, 1996), could potentially be altered by patient
access to virtual communities for healthcare information and support.
Virtual communities are the coffee houses of internet space. It is here that people
gather, electronically, to talk and listen; to satisfy curiosities; to form and reinforce
opinions; to learn; or to form and maintain relationships (Hagel and Armstrong, 1997).
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Every user is at once a producer and a consumer of information, providing

self-selecting forums for those who care to listen – or talk – to each other. Users
consider themselves members of a virtual community and attempt to guard the quality
of that community, a unique bastion of cooperation, sharing, and information
exchange. While self-fulfilling exchanges have flourished, rhetorical exigency – the
type of shared communication exchange that underlies commerce – has not.
Much like coffee shops in real space, virtual communities are capable of increasing
stickiness on the part of “customers,” drawing them into frequent repeat visits. Over
time, the community members build trust, relationships, and commitments. These
three customer behaviors may have powerful impacts on e-healthcare organizations in
terms of relationship marketing, customer loyalty, and service image (branding).
However, there are differences between virtual communities for healthcare and
traditional physical patient support groups. Laing et al. (2004) observe that virtual
communities have lower barriers to participation than traditional information sources
such as patient support groups. In virtual communities, time and commitment
requirements are lower, and the patient can remain anonymous – something very
important when it comes to healthcare. These virtual communities also offer the
opportunity to compare healthcare systems, diagnosis and treatment, as well as
offering mutual support and counselling.
Virtual communities are abundant within the healthcare sector. WebMD.com,
eHealth.com, eHealthforum.com, MayoHealth, ThriveOnline, drkoop.com, WellMed,
and FamilyMed.com, among others, are some of the more known ones. Healthcare
organizations are also teaming up to create their own websites. MedUnite.com is a
consortium of at least six major health plans: Aetna US Healthcare, CIGNA, WellPoint
Health Systems, Oxford Health Plans, Foundation Health Systems, and PacifiCare
Health Systems (Lin and Umoh, 2002). Britain’s National Health Service (NHS) also has
its own web site for e-healthcare information, called NHSnet. Virtual healthcare
communities may provide ideal tools for online information search, self-diagnosis, and
word of mouth communication, leading to efficient knowledge building and sharing
activities in the realms of e-health, e-medicine, and e-detailing.
However, only one half of adults in the United States place a high priority on
seeking health information. Navarro and Wilkins (2001) conducted an examination of
today’s health information seeker based upon health behavioral intentions, values, and
priorities (valuegraphics). Their results reveal that an individual’s level of health
information seeking corresponds to the value he or she places or the quality of health
 desired, and current level of personal health involvement. The objective of this paper is Value creation
to explore the consumer segmentation for healthcare virtual communities, their in virtual
motivations, and the types of interactions taking place in these communities. We here
adopt an interpretive framework – an in-depth analysis of the specific significance that communities
a virtual community has for its members. The theoretical framework adopted for this
research is that of value creation within a virtual community.
323
Value creation in virtual communities: a framework
Virtual communities: theories
Mukherjee and McGinnis (2007) identified virtual networking as one of the five major
themes of e-healthcare research. Virtual communities are contexts in which consumers
often partake in discussions whose goals include attempts to exchange information
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and influence fellow consumers about products and brands (Kozinets, 1999; Muniz and
O’Guinn, 2001). Although they are popularly called “virtual communities” (Rheingold,
1993), the term “virtual” might misleadingly imply that these communities are less
“real” than physical communities (Jones, 1995). Yet as Kozinets (1998, p. 366) points
out, “these social groups have a ‘real’ existence for their participants, and thus have
consequential effects on many aspects of behavior, including consumer behavior.”
Virtual communities can be theorized or conceptualized from several perspectives.
Wang et al. (2002) suggest that these perspectives are multi-disciplinary that
include sociology, technology, business, economics, and e-commerce. Lee et al. (2002)
analyzed a number of studies and developed a working definition of virtual
communities: “ . . . A technology-supported cyberspace, centered upon communication
and interaction of participants, resulting in a relationship being built up.”
Relational capital theory (Hunt, 2000) has been applied to analyze what factors
determine consumer commitment to a virtual community. Casalo et al. (2008) found a
positive and significant effect of trust placed in a virtual community on consumers’
commitment to that community. Research also shows that a general disposition to
trust, a greater familiarity with the community and a stronger norm of reciprocity in
communication in the community increase trust placed in a virtual community (Casalo
et al., 2008).

Typologies of virtual communities

Literature on virtual communities shows little convergence with regard to their
typological schema. Not all virtual communities develop and flourish with the same
common objectives. Hagel and Armstrong (1997) focused on classifying virtual
communities according to the underlying purpose or needs served:
.
Communities of relationship, where people with similar experiences come
together and form meaningful personal relationships.
.
Communities of interest, which aggregate a dispersed group who share an
interest or expertise in a specific topic.
.
Communities of transaction, where information is traded among participants.
.
Communities of fantasy, for exploring new worlds of entertainment.

Bressler (2000) modified the classification of virtual communities to a business

perspective by considering the motivation(s) of participants:
 IJPHM .
Purpose – where people are trying to achieve the same objective.
2,4 .
Practice – where people share the same profession or situation.
.
Circumstance – similar to purpose, but driven by personal experiences rather
than professional motivations.
.
Interest – where people share a common passion.
324 Virtual communities have also been classified by their focus (Jones and Rafaeli, 2000):
.
Basic human needs – interest, relationship, fantasy, transaction.
.
User social structure, or technology-base – e.g., FAQ, expert knowledge (stewards
accumulate and organize knowledge), news groups, web site, or social multiplier
(e.g., friendster.com).
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.
Motivation – communities of purpose, practice, circumstance, interest.

These various categorization schemes of virtual communities point to four key attributes:
.
Sense of belonging to a community, a feeling based on human relationships, not
physical presence.
.
Virtual location people can go to in order to meet.
. Bonding, a sense of membership or connectedness to others in the community.
.
Shared interest(s) among the participants.

Of most interest to healthcare management are those virtual communities which are
purposively structured around pharmaceutical and healthcare consumption (Kozinets,
1997; Kozinets and Handelman, 1998). The healthcare virtual community that we used in
our research to collect data on value creation is one of those. In these virtual communities,
there is a shared enthusiasm for healthcare services that invites commitment to the
community. This enthusiasm and its outcome of repeated visits create the stickiness that
allows for repeated marketing messages. The attributes of stickiness seem to develop at
different rates, depending on characteristics of the participants.

Virtual community members

Kozinets (1999) suggests two independent factors to segment participants in virtual
communities of consumption. First is the centrality (in terms of importance) of the
consumption activity to the person; the more central the consumption is to the
individual and his/her self-concept, the more likely it is that the person will pursue and
value membership in a virtual community based on the type of consumption. The
second factor is the intensity of relationships with other members of the virtual
community versus the intensity in real space. Other things being equal, the value of a
membership in a real or virtual community depends on which fulfills the relationship
needs better.
Kozinets (1999) suggests that these two factors define four segments of virtual
community members. These segments are:
(1) Tourists have only a passing interest in the consumption activity and lack
strong ties to the group.
(2) Minglers also have only a superficial interest in consumption, but have strong
social ties to the group.
 (3) Devotees, the opposite of minglers, have strong interest in the consumption Value creation
activity and only passing interest in the social ties of the virtual community. in virtual
(4) Insiders exhibit both strong consumption activity and strong social communities
relationships.

Figure 1 depicts the four segments on a graph with intensity of relationship and
centrality of consumption as the two axes. 325
Navarro and Wilkins (2001) developed another segmentation scheme for consumers
based on their valuegraphics, health status and health care use. They observed
significant variance in Web use and satisfaction based upon the valuegraphic profiles
of visitors to a hospital system-sponsored consumer web site. This led to identification
of nine “valuegraphic” PATH segment profiles:
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(1) Clinic Cynic: Does not trust the medical profession.

(2) Avoider: Abstains from using healthcare services until absolutely necessary.
(3) Generic: Balances cost and quality.
(4) Family Centered: Prioritizes family health above all else.
(5) Traditionalist: Pays more for quality and has a tendency to use the same
provider.
(6) Loyalist: Modernized in healthcare opinions and behaviors.
(7) Ready User: Active in seeking and using healthcare services of all kinds.
(8) Independently Healthy: Actively involved in self health.
(9) Naturalist: Tends to use non-traditional or alternative healthcare methods.

Hernandez et al. (2004) segmented virtual community users by the expression of emotions.
In our analysis of the online healthcare community, we chose to apply Kozinets’
framework. In doing so, we profile these four types of members, analyze their online
behavior and relate them to the notion of value creation within the community.

Intensive
Minglers Insiders

Intensity
of
Relationship

Devotees
Tourists

Non-Intensive

Non-Central Central Figure 1.

Types of virtual
community members by
Low High value propositions
Centrality of Consumption
 IJPHM Value creation in virtual communities
2,4 Cothrel (2000) provides a framework for value creation in online communities. Value
creation in virtual communities has three objectives: incremental benefits the
community generates for its members; growth in community membership; and
converting visiting members to using members (Cothrel, 2000). There are also three
dimensions of community value creation: insight (topic), health (activity), and return on
326 investment or ROI (economics). One of the major goals of any virtual community is to
increase customer loyalty and to create greater stickiness for the site – this is the notion
of “health” of the virtual community. Activity measures describe the general health of
the community and aid in creating value for users on a day-to-day basis. “Insight” is
defined as the multi-way communication loops between customers, suppliers,
employees, and the host of the online forum. This helps in generating information,
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feedback, debates, and discussions within the community. Topic measures assess the
ongoing insights that a community offers for consumer value creation. According to
Cothrel (2000), topic measures include the most heavily trafficked community areas or
discussion threads and the most commonly discussed subjects, based on content
analysis across the virtual community. Using this information, researchers can identify
concentration of interest and describe how member activity is distributed across the
most commonly discussed subjects. In this research, we apply Cothrel’s framework to
understand consumer value creation in the healthcare virtual community.
Figure 2 depicts the three dimensions of value creation in virtual communities,
i.e. insight, health, and RoI.

ROI

Economic

Topic

INSIGHT

Activity

Figure 2.
Three dimensions of value
creation in virtual
communities HEALTH
 Research methodology Value creation
The method of collecting primary information over the internet is still new (McDaniel in virtual
and Gates, 2002). We employed “netnography” (Kozinets, 2002) as the research
methodology for this study. Netnography, an online marketing research technique for communities
providing consumer insights, is particularly suited for studying online communities.
Kozinets (2002, p. 61) observes that “netnography is faster, simpler, and less expensive
than traditional ethnography and more naturalistic and unobtrusive than focus groups 327
or interviews.” Netnography is an ethnographic research method adapted to the study
of online communities. It provides information on the symbolism, meanings, and
consumption patterns of online consumer groups.
Our choice of the healthcare virtual community was based on the following criteria
as suggested by Kozinets (2002): the community should have:
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.
a more focused and research question-relevant segment, topic, or group;
.
higher “traffic” of postings;
.
larger numbers of discrete message posters;
.
more detailed or descriptively rich data; and
.
more between-member interactions of the type required by the research question.
Based on these criteria, we selected only one virtual community dedicated to a common
health condition (depression) on a prominent healthcare web site. The selection was
based on accessibility and population size of the community so that we would have
good consumer heterogeneity in our netnography study. The number of postings in the
“depression” section of the community was 8,768 and the number of replies was 1,332.
In our research, we defined community members as regular users who have visited the
community and returned, and we excluded people who have come once as a visiting
guest and never returned. The rationale for this definition is that the guests who visited
the community only once are less likely to have further or ongoing associations with the
community.
We anonymously joined the community and built repertoire with community
members for the purpose of observing communication and interaction among members
and identifying user values. Postings were categorized into relevant segments by the
researchers and two graduate student assistants, with high inter-rater reliability
(greater than 90 percent).

Research findings
Discourse analysis is used to interpret the data collected online from the virtual
community in our netnography-based research. Our analysis shows that healthcare
virtual communities have the potential to become serious value-creation agents by
combining content and communication. As Hagel and Armstrong (1997) predicted at
the beginning of the internet revolution, virtual communities have evolved into critical,
branded first-port-of-call online interfaces with which healthcare consumers frequently
develop lasting affinities.
The most visible form of interaction in the “depression” section of the virtual
community we studied took place in the form of a chat room (Pew Research Centre,
2000). This community can be characterized as a community of relationship,
centered on the emotional and informational ties associated with the medical condition.
 IJPHM As with the membership of many virtual communities, the members of this
2,4 “depression” group can be characterized as devoted, enthusiastic, knowledgeable, and
innovative. We found that in this community, some members took active role,
contributing in discussion or assisting other members. The community contains a core
of insiders who frequently post messages and are referenced by other community
members, referred to by existing members, and mentioned by members as opinion
328 leaders or depression symptoms and medication. Within this forum, a host monitored
the information exchange and helped to stimulate discussion.
Often members simply read what other have posted without taking an active role
themselves Armstrong and Hagel (1996). However, we know that the value of a community
increases as the square of the number of participants interacting in the community
(Marathe, 1999); hence, the value of inactive participants should not be underestimated. In
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this community, readers outnumbered posters by about 20-1, higher the normal 10-1 or
more, as suggested by Cothrel (2000). In other words, people who visit this community
regularly but do not post typically represent 80 percent of the total community population.
We employ the three dimensions of community measurement (Cothrel, 2000) as an
appropriate model for understanding the value creation in the context of our research.
The “insight” and “health” dimensions emerged as critical ones in the healthcare
context. The third dimension given by the ROI (Return on Investment) was not found
to be salient as there was no e-commerce or e-business transaction related activities in
the virtual community. As a result, there is no economic metric (Messerchmitt, 2001).
Also, according to Figallo (1998), ROI is not particularly useful to capture intangible
assets with regard to online communities, particularly for services like healthcare.
The driver for “Health” is the activities in the community. In other words, “activity”
describes the general health of the community and aids in managing the community on
a day-to-day basis. On the other hand, the driver for “Insight” is the topic of discussion
in the community. It includes coding of the most heavily discussed subjects and
interests that represents a success, an opportunity, or a problem related to healthcare.
In our research, we found the following components for the “activity” driver:
.
Number of visitors in a day/month and at different times of the day and month.
.
Peak period of the day.
.
Of the number of visitors, how many of them are guests who have visited the
community once and never returned versus the number of members who have
returned, stayed on and contributed further to the community.
.
Number of visitors at different times of the day and time where the visitor
number is highest.
.
Session time that the visitors stay in the communities in each visit.
.
Number of passive (i.e. read only) and active (i.e. read and contribute) visitors.
.
Number of postings per day/week/month.
.
Effectiveness of community recommendations.
.
Number of people that an existing community member recommended.

We used observations made by monitoring and interacting with the community as our
“topic of discussion” driver (for the insight variable). From observations, we discovered
that the most heavily discussed topics were on the following are as:
 .
professional consultations (, 20 percent of the generated conversations); Value creation
.
information searches on the internet (, 20 percent of the generated in virtual
conversations); communities
.
medical professionals and their profession (, 10 percent of the generated
conversations);
.
healthcare activities and involvement (, 20 percent of the generated 329
conversations);
. source credibility, reliability, trust (, 10 percent of the generated conversations);
.
use of the community and social bonding (, 10 of the generated conversations);
and
.
future use (, 10 percent of the generated conversations).
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We then applied Cothrel’s model on Kozinets’ a priori segments. The purpose was to
profile the segments and describe their online behavior and motivations.
Tourists
Tourists lack strong social ties and deep interest in the consumption activity (they
often post casual questions). They are irregular in community presence and are
frequently inactive, with smaller session times and fewer postings. They also
recommend fewer people to the community. Generally, tourists lead healthy lifestyles,
but have some general health issues. Tourists enquired about ways of healthy living
and how to locate a healthcare service provider. They also discussed on challenging a
professional opinion or seeking a second medical opinion, identifying healthcare
options, knowing more about diseases and symptoms, and understanding a
professional recommendation. In general, tourists also exhibited the following
PATH segment characteristics: they do not trust the medical profession too much
(clinic cynic); abstain from using medication until absolutely necessary (avoider);
balance cost and quality (generic); are actively involved in self-health (independently
healthy); and tend to use non-traditional or alternative healthcare methods (naturalist).
An example of a “tourist” posting is given below:
I’m depressed. I’m 21, I don’t drink alcohol so I don’t join my friends in the pubs, clubs, etc.
I don’t mind being with my friends but if I look outside and see someone I don’t know with
them or just a lot of people I won’t go out. Or if someone wants to meet up I can’t do it. Even
picking up my bro from the pub I have to be perfectly sure that no one else will come in the
car with him either. It’s one of the main reasons why I’m unemployed and currently doing
nothing. Which leads to more depression of feeling useless, worthless, hopeless as I’m just
stuck being unhappy.

Minglers
Minglers have strong social ties but have minimal interest in the consumption activity.
Like tourists, minglers are also irregular in community presence and are frequently
inactive, with smaller session times. However, they differ from tourists in their
involvement on the site. They indulge in heavy postings and recommend more people
to the community. Generally, minglers lead healthy lifestyles, but have some general
health issues. Minglers posted messages and gave and received advice with regard to
healthy living and locating a healthcare service provider, Also of interest to them were
 IJPHM issues such as challenging a professional opinion or seeking a second medical opinion,
2,4 identifying healthcare options, knowing more about diseases and symptoms, and
understanding a professional recommendation. Minglers also were very interested to
share information with others and meet people in similar circumstances on the virtual
community. Minglers tended to correlate with the following PATH segment
characteristics: they prioritize family health above all else (family centered); balance
330 cost and quality (generic); are actively involved in self-health (independently healthy);
and tend to use non-traditional or alternative healthcare methods (naturalist).
An illustration of a “mingler” posting is given below:
I truly believe I am a failure with finding a girlfriend because I am ugly. About me: i’m 6’,36,
never had a serious gf, receding hairline but not bald, quiet but sociable, intelligent and
slender. However, my face is ugly. I have no cheeks and ugly features in general. I have
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emailed hundreds of women online with the ability to engage their interest. However, as soon
as I email them a pic of myself, they never respond back. This proves my appearance is a
turnoff! The picture is also the best and most accurate I can send. I’ve tried various pics and
the one I send is in the best lighting, best appearance I could get of myself. I can email it to
you for honest feedback if you’d like. I have been posting on this forum for long. Did any of
you face anything like this ever? Any advice would be greatly appreciated. Thanks!

Devotees
Devotees have strong consumption interests but few attachments to the online group.
Devotees are regular and active members on the virtual community. They spend long
times per session on the community, but do not post too much. They also recommend
fewer people to the community. Devotees have specific health issues pertaining to the
discussion group and are frequently in the at-risk or affected group with regard to the
disease. Devotees look for information on suitable medical service providers and try to
evaluate different medical services. They also check advice given by a medical
professional and try to inform themselves before consulting a medical professional.
Their profile corresponds to the following PATH valuegraphic segments: they pay
more for quality and have a tendency to use the same provider (traditionalist); and they
are modernized in healthcare opinions and behaviors (loyalist).
A “devotee” posting looked like this verbatim quote:
I have been diagnosed with depression, and I’m sure it’s what I’m afflicted with. I no longer
want to do anything with friends, or even leave my house in general. I feel the need to isolate
myself and find myself sitting in my room all day and night. I eat maybe once a day and
ignore my hunger. I recently basically stopped going to school. I gave up and my grades all
plummetted straight to Fs. I smoke a pack a day and it’s going up rapidly. I feel as though I’ve
lost interest in everything, and that I don’t care about my life anymore. I know this isn’t who I
am, and I feel I need more help whether it be medication or something else. I am seeing a
doctor, but want to change him. Which doctor should I see and which medication is right for
me? Any advice would be appreciated.

Insiders
Finally, insiders have strong social ties to the online group and are strong in the
consumption activity. They tend to be long-standing and frequently referenced
members. Insiders are most involved as consumers in the virtual community. They are
most regular and active as community members. They have significant influence on
 other members and on the discussion in the community in general. They spend lots of Value creation
time on the site, with very high number of postings. They also recommend higher in virtual
number of people to the site through positive word of mouth. As such, insiders are very
critical to the long-term performance of a virtual community. communities
Insiders are in the at-risk or affected group with regard to the disease condition and
can discuss specific health issues pertaining to the discussion forum. Within the virtual
community, insiders tend to help others to identify suitable medical service providers 331
and to evaluate medical services. They also exchange information concerning advice
given by medical professionals, and like to inform themselves and others before
consulting a medical professional. Insiders like to share information with others and
meet people on the virtual community.
Insiders can be described by the following PATH segment characteristics: they
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prioritize family health above all else (family centered); they are modernized in
healthcare opinions and behaviors (loyalist); and they are active in seeking and using
healthcare services of all kinds (ready user).
An example of an “insider” posting follows:
I have been on wellbutrin for about a month. I noticed many warnings about alcohol
consumption, some from this group as well. Ron and Christin, thanks for sharing your
experiences with this med. Has anyone drank on this med? What is the biggest problem with
drinking and wellbutrin? I start out 150 mg for a week, then 150 mg twice a day. I really want
this medication to work for me. But I do enjoy social drinking. I’m willing to stop social
drinking, if the meds will make the panic, mild-depression, and racing thoughts go away.
I have never been on medication before. I feel like a nut job. I feel you guys might have the
right info on this, I just love positing on here. We help each other out, right? Just any good
advice would be great.
Table I summarizes the profile of each segment, with information on their consumption
activity, social ties, regularity, activity, number of postings, number of people
recommended, health condition, healthcare activities, online behavior, and healthcare
orientation.
Tourists and devotees are relatively passive in their online behavior. However,
passive members may be actively using the information they gain by discussing these
with their physician or pharmacists. Tourists are satisfied with current treatment
and/or information provided. They receive their information from the primary service
encounter. They are not prone to seeking out alternative sources information and
usually have good relations with their current healthcare professionals. Devotees are
not completely satisfied with either their treatment and/or the information provided.
They will actively seek out information within their healthcare system and are willing
to take control of their healthcare by voicing their opinion. They are not likely to go
outside their current healthcare system for information. Minglers and insiders are not
at all satisfied with their treatment and/or the information provided. They will actively
seek out information and actively take control of their own healthcare by voicing their
opinion. They are willing to go outside their healthcare system and actively seek
external opinions from other members of the virtual community. Insiders will also
discuss experiences with other service users within the virtual community. Insiders are
the most aggressive patient segment and have embraced the internet as a primary
medium of communication and as a means to compare healthcare systems.
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2,4

332

Table I.
IJPHM

virtual communities
Profiles of healthcare
consumer segments in
Tourists Minglers Devotees Insiders

Consumption Low on consumption activity Low on consumption activity High on consumption activity High on consumption activity
activity
Social ties Low on social ties High on social ties Low on social ties High on social ties
Regularity Irregular Irregular Regular Regular
Activity Inactive Inactive Active Active
Session time Low session time Low session time High session time High session time
Number of Low number of postings High number of postings Low number of postings High number of postings
postings
Number of people Low number of people High number of people Low number of people High number of people
recommended recommended recommended recommended recommended
Health condition Healthy lifestyle, general health Healthy lifestyle, general health At risk or affected groups, At risk or affected groups,
issues issues specific health issues specific health issues
Healthcare Find ways of healthy living, Find ways of healthy living, Identify a suitable medical Identify a suitable medical
activities locate a healthcare service locate a healthcare service service provider, evaluate service provider, evaluate
provider, get a second opinion, provider, get a second opinion, medical services, check advice medical services, check advice
identify healthcare options, identify healthcare options, given by a medical given by a medical
know about diseases and know about diseases and professional, inform professional, inform
symptoms, challenge a symptoms, challenge a themselves before consulting a themselves before consulting a
professional opinion, professional opinion, medical professional medical professional, share
understand a professional understand a professional information with others, meet
recommendation recommendation, share people in similar circumstances
information with others, meet
people in similar circumstances
(continued)
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Tourists Minglers Devotees Insiders

Online behavior Information search; healthcare Information search; healthcare Information search; Information search;
activities and involvement activities and involvement; use professional consultations; professional consultations;
of community and social medical discussions; source medical discussions; source
bonding credibility, reliability, trust; use
credibility, reliability, trust;
future use of community and social
bonding; future use
Healthcare Does not trust the medical Prioritizes family health above Pays more for quality and has a Prioritizes family health above
orientation profession too much (clinic all else (family centered); tendency to use the same all else (family centered);
cynic); abstains from using balances cost and quality provider (traditionalist); modernized in healthcare
medication until absolutely (generic); actively involved in modernized in healthcare opinions and behaviors
necessary (avoider); balances self-health (independently opinions and behaviors (loyalist); active in seeking and
cost and quality (generic); healthy); tends to use (loyalist) using healthcare services of all
actively involved in self-health non-traditional or alternative kinds (ready user)
(independently healthy); tends healthcare methods (naturalist)
to use non-traditional or
alternative healthcare methods
(naturalist)
communities
Value creation
in virtual

333

Table I.
 IJPHM Implications and conclusions
2,4 The evolving dialogue between consumers in virtual communities provides one key
axis along which professional service consumption will evolve (Hogg et al., 2003). The
challenge for healthcare consumers is to develop frameworks that facilitate robust
dialogue and exchange of information and emotional support to complement their
rising authority. The parallel challenge is for the established medical profession to
334 recognize the consequences of this evolving dialogue and develop approaches to
service delivery that effectively engage with consumers on the basis of this increasing
authority.
For patient research that is useful for healthcare strategy formulation, the devotees
and the insiders represent the most important data sources. Our research reveals that
devoted, enthusiastic, actively involved, and sophisticated patient segments are
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represented in online communities by insiders and devotees. It is also useful to note

that the virtual community that we studied tended to propagate the development of
loyalty and (sometimes) heavy usage by socially reinforcing consumption. Therefore,
healthcare researchers interested in online word of mouth and influence may find it
useful to track how tourists and minglers are socialized and “upgraded” to insiders and
devotees in healthcare virtual communities (Kozinets, 1999).
The number of visitors at different times of the day will provide virtual community
management with an indication on some of the reasons behind the timing, either
convenience or urgency for the members to participate in the forum. The number of
active versus passive visitors provides an indication of the level of participation by the
members. For example, are the topics generated interesting to debate or only for
information? The issue of the effectiveness of the forum will give them an indication on
the source of its membership. In other words, the management can figure out if new
membership is driven directly through recommendation by existing members or
indirectly through other forms of advertisements. It is also important to understand the
process by which new membership is generated through direct recommendations by
existing members.
Future research could explore the differences in value creation between open
communities and company-sponsored communities. Company-sponsored communities
are private communities formed to discuss sensitive or private issues pertaining to the
particular organization’s services. For example, GSK Consumer Healthcare partnered
with Communispace to create private online communities for discussions on their new
products for launch. Such communities are usually open to customers and employees
of a particular organization, which requires application or certain requirement to be
fulfilled before access is granted. Some virtual communities have also emerged for
physician practice groups to engage in peer-to-peer online interactions, which might
allow special access to some of their patients. Examples are Within3.com
(a professional community that helps physicians, researchers and patients connect),
and Sermo.com (a physician-only network). Private communities are protected from
disruptive individuals who can make life difficult for everyone in open-access
communities. However, it may be difficult to get enough community members to create
the critical mass, which is essential in order for the community to take on a life of its
own. As such, private communities generally have little potential for growth and
diversity. While there are values created for successful private communities, their
model and effectiveness remain to be explored.
 Community tools are another area of future research. Technological tools used for the Value creation
creation and management of a virtual community are critical to the success of the in virtual
community. As an enabler, it indirectly affects the activities of community members and
their contribution to the growth of the community. In selecting the right tools to build the communities
community, community developers need to consider the needs and requirements of the
community members. Some issues are visitors from home or workplace, time zone
differences, technological capability, etc. For instance, if most visitors are home users, 335
they may not have the state-of-the-art equipment and technical support available to
them if they are not technically savvy. Selecting IRC or web cast may discourage such
visitors from participating in the community. On the other hand, newsletters via email
may be a good approach but may not be as effective for what the community set out to
achieve. The types of community tools employed by different types of virtual
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communities and their role in customer value creation need to be explored.

Most of the earlier works that are focused on virtual communities have been
conducted at the conceptual level. In this research, we empirically profile a priori user
segments in healthcare virtual communities. The main contribution of this research is
to identify and profile virtual community user segments and explore their value
creation processes for healthcare services. A combination of Kozinets’ (1999) a priori
segments and Cothrel’s (2000) dimensions was applied to conceptualise value creation
in the virtual community of our research. This was done essentially by identifying the
“Activities” and “Topics” variables in our netnography research that give rise to the
“Health” and “Insight” dimensions of the “Three Dimensions of Community
Measurement” (Cothrel, 2000).

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About the authors
Ram Misra is Professor of Management and Information Systems at Montclair State University,
New Jersey, USA. 337
Avinandan Mukherjee is Chair of the Marketing Department at Montclair State University,
New Jersey, USA. Avinandan Mukherjee is the corresponding author and can be contacted at:
mukherjeeav@mail.montclair.edu
Richard Peterson is Chair of the Department of Management and Information Systems at
Montclair State University, New Jersey, USA.
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