Author ORCID Identifier

https://orcid.org/0000-0002-6947-9895

Semester

Summer

Date of Graduation

2025

Document Type

Dissertation

Degree Type

PhD

College

Chambers College of Business and Economics

Department

Marketing

Committee Chair

Paula Fitzgerald

Committee Co-Chair

Emily Tanner

Committee Member

Jody Crosno

Committee Member

Courtney Nations Azzari

Abstract

This dissertation investigates the mechanisms of effective co-creation in patient-provider interactions within the U.S. healthcare system, a critical area given pervasive systemic frustrations and the dyadic nature of care. Grounded in Social Cognitive Theory and Service-Dominant Logic, the research proposes a conceptual model where patient self-efficacy fosters cooperation, mediated by the dimensions of symmetry, alignment, and agreement, ultimately influencing patient outcomes. Perceived response efficacy is hypothesized to moderate this relationship. A mixed-methods approach was employed, consisting of two complementary studies. Study 1 utilized qualitative, semi-structured interviews with 20 patients and 5 healthcare providers to deeply explore how self-efficacy, perceived response efficacy, and the cooperative triad manifest in real-world clinical encounters. Key findings revealed that patient self-efficacy is a relationally shaped construct, often reinforced by social support, and reconceptualized perceived response efficacy as trust in the effectiveness of the interaction process with the provider. Symmetry, alignment, and agreement emerged as a cumulative progression, with symmetry serving as a foundational entry point for deeper collaboration. Emergent themes also highlighted the significant influences of spirituality, historical/institutional trauma, gendered communication preferences, relational memory, and provider emotional labor on co-creation dynamics. Study 2 quantitatively tested the revised model using a cross-sectional survey of 372 patients with long-term conditions. The results largely supported the hypotheses: higher patient self-efficacy significantly predicted increased symmetry, alignment, and agreement, and was associated with lower psychological distress and greater adherence. Both symmetry and alignment emerged as significant predictors of patient satisfaction, while alignment also promoted adherence. Contrary to the initial hypothesis, perceived response efficacy did not significantly moderate the link between self-efficacy and cooperation; instead, it emerged as a strong direct predictor of cooperation components and patient satisfaction. Cluster analysis identified three distinct patient personas—Skeptical Observers, Empowered Collaborators, and Cautious Partners—differentiated by their levels of self-efficacy and perceived response efficacy, offering practical insights for tailored communication strategies.
Collectively, this research validates and expands the patient-provider co-creation framework, underscoring the interplay between patient agency, relational trust, and cooperative communication in achieving improved satisfaction, emotional well-being, and adherence. The findings offer actionable insights for healthcare providers to optimize engagement strategies and contribute theoretically by refining co-creation and perceived response efficacy concepts within the healthcare context.

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