Health First

Healthcare services dynamics

Selected Publications
Gessl, A. S., Brodtka, N., Zhao, J., & Gessl, N. (2023). Analyzing pharmacist representation in public-facing health media: Insights and implications. Research in Social and Administrative Pharmacy.

Background Despite the importance of marketing for community pharmacies, evidence on its effectiveness in influencing consumer behavior and the added value for pharmacies remains limited. This study explores the representation of pharmacists in consumer-facing print media used for consumer marketing.

Objective The aim of this study is to analyze professional representation, especially of community pharmacists alongside other health professionals, in health-related public-facing print media, and to explore and further develop the use of novel, consumer facing data sources in a healthcare research context.

Methods An exploratory qualitative content analysis of a sample of issues from a leading consumer-facing healthcare print magazine was conducted. Of 565 extracted text passages, 328 were retained for analysis and coded using a coding scheme focused on described professional role, type of content, depth of voice, and demographics.

Results Physicians (42 %) and researchers (19 %) were the largest professional groups to be directly cited in print media texts while pharmacists provided 14 % of all direct quotations. Nurses were identified as sources in 1 % of texts. Male professionals were quoted almost twice as frequently as their female counterparts. Images accompanying texts were more gender balanced but did not reflect workforce demographics.

Conclusion The comparative lack of pharmacist representation in marketing print magazines suggests a missed opportunity both as a marketing tool and for educating the public about community pharmacist expertise. There is a need to harness the potential of print media, especially those financed by and distributed in community pharmacies, to improve public perception and visibility of pharmacists, and to inform the public about the evolving roles of pharmacists in the healthcare ecosystem. Further research should explore pharmacist representations in different types of news media to better understand the impacts on public perception of pharmacists internationally.
Nakata, C., Sharp, L. K., Spanjol, J., Cui, A. S., Izberk-Bilgin, E., Crawford, S. Y., & Xiao, Y. (2021). Narrative arcs and shaping influences in long-term medication adherence. Social Science & Medicine, 285, 114264.

Long-term adherence to medications is not well understood and poses a significant challenge for many chronically ill persons. Past research provides insights on adherence in short durations such as a day or several weeks, even though chronically ill patients are required to take medications for periods as long as a lifetime. To fill this important knowledge gap, we study the temporal unfolding of prolonged medication-taking experiences among thirty adults, mostly African American, with chronic hypertension in the U.S. Specifically, we take an extended, experience-centered, narrative approach to examine retrospective patient accounts of adherence efforts over spans of one year to more than four decades. Applying Gergen and Gergen's concept of narrative forms (1983), we find four distinct narrative arcs, or patterned sequences of medication consumption, that we term Out of the Gate, Existential Turn, Fits and Starts, and Slow Climb, along with individual and social elements that shape and shift practices in the context of time.
Azzari, C. N., Anderson, L., Mende, M., Jefferies, J. G., Downey, H., Ostrom, A. L., & Spanjol, J. (2021). Consumers on the job: contextualization crafting in expert services. Journal of Service Research, 24(4), 520-541.

Tasked with a greater role in the coproduction of expert services, consumers often face an immense burden in coproducing service and well-being outcomes. While some prior research has explored customer work, we delineate unique aspects of expert services and articulate consumer efforts that transpire outside the dyadic service interaction. Through netnographic inquiry in a health care context, we find that coproduction efforts are job-like and require job crafting efforts. Upon this foundation, three major themes emerged: (1) consumers leverage their context expertise by adapting content expertise to their unique circumstances, (2) consumers develop and deploy strategies (hacks) through affordances in order to manage their coproduction jobs, and (3) consumers move through the expert service journey in a variety of ways that shift them toward or away from well-being outcomes. After assessing the transferability of our results by analyzing a second expert service context (financial services/debt management), we suggest implications for theory, practice, and future research.
Gallan, A. S., McColl-Kennedy, J. R., Barakshina, T., Figueiredo, B., Jefferies, J. G., Gollnhofer, J., ... & Winklhofer, H. (2019). Transforming community well-being through patients' lived experiences. Journal of Business Research, 100, 376-391.

The purpose of this article is to (1) explicate micro-to-meso linkages of well-being, (2) provide a theoretical framework to guide research on connecting patient experiences to community well-being, and (3) offer guidelines to policymakers. We develop a conceptual framework establishing connections between micro and meso levels through the expansion of patients' lived ecosystems. We introduce the concept of patient ecosystem management (PEM), an organizational process that focuses on treating patients differently in terms of assessing, managing, and expanding resources to achieve patient health and well-being goals. This process establishes a foundational perspective that is necessary to connect patients' ecosystems and to facilitate community well-being. Theoretically, this research creates ties between micro-level interactions and a collective measure (community well-being). Policymakers and healthcare professionals should take a PEM perspective, which will require new roles and behaviors, and leverage technology to expand and overlap patients' individual service ecosystems (intra-alignment), thus enlarging community well-being (inter-alignment).
Nakata, C., Izberk-Bilgin, E., Sharp, L., Spanjol, J., Cui, A. S., Crawford, S. Y., & Xiao, Y. (2019). Chronic illness medication compliance: a liminal and contextual consumer journey. Journal of the Academy of Marketing Science, 47, 192-215.

The consumer journey has drawn interest from marketers as an avenue to strengthen sales through managing touchpoints. However, a firm-centric view has produced limited models of the journey, particularly on consumers’ usage experiences over extended periods in everyday settings. We attempt to redress this limitation by studying the situated experiences of disadvantaged consumers endeavoring to comply with medication therapies for chronic hypertension. Our broad aim is to understand more fully the influences on and nature of the journey. We find that compliance is a liminal state of provisional actions shaped contextually by life spheres of meso-structural conditions, micro-individual factors, and interpretive sense-making practices. We contribute a novel, integrated, and nuanced journey framework beyond the detached, steadily progressive model predominant in the literature. Our paper ends with practice, theory, and policy implications for marketing and healthcare, including touchpoint strategies.
Anderson, L., Spanjol, J., Jefferies, J. G., Ostrom, A. L., Nations Baker, C., Bone, S. A., ... & Rapp, J. M. (2016). Responsibility and well-being: resource integration under responsibilization in expert services. Journal of Public Policy & Marketing, 35(2), 262-279.

Responsibilization, or the shift of functions and risks from providers and producers to consumers, has become an increasingly common policy in service systems and marketplaces (e.g., financial, health, governmental). Because responsibilization is often considered synonymous with consumer agency and well-being, the authors take a transformative service research perspective and draw on resource integration literature to investigate whether responsibilization is truly associated with well-being. The authors focus on expert services, for which responsibilization concerns are particularly salient, and question whether this expanding policy is in the public interest. In the process, they develop a conceptualization of resource integration under responsibilization that includes three levels of actors (consumer, provider, and service system), the identification of structural tensions surrounding resource integration, and three categories of resource-integration practices (access, appropriation, and management) necessary to negotiate responsibilization. The findings have important implications for providers, public and institutional policy makers, and service systems, all of which must pay more active attention to the challenges consumers face in negotiating responsibilization and the resulting well-being outcomes.
Spanjol, J., Cui, A. S., Nakata, C., Sharp, L. K., Crawford, S. Y., Xiao, Y., & Watson-Manheim, M. B. (2015). Co-production of prolonged, complex, and negative services: An examination of medication adherence in chronically ill individuals. Journal of Service Research, 18(3), 284-302.

This study examines customer coproduction in a prolonged, complex, and negative service context—medication adherence in chronically ill individuals. We integrate services and medical perspectives to develop a novel theoretical framework of adherence as a nested system of coproduction behaviors, characterized by temporal and scope dimensions. Utilizing a qualitative approach, our findings point to two key insights about coproduction in the customer sphere. First, the enactment and form of regular-restricted, intermittent-intermediate, and irregular-expansive coproduction behaviors are determined by the characteristics of the customer sphere—that is, coproduction is contextualized. Second, the coproduction system in the customer sphere is complex and the different levels are interdependent. Our research contributes to the emerging literature on service coproduction by elucidating the behaviors through which customers strive toward adherence. The identified coproduction framework holds important implications for providers of prolonged and complex services and future research directions.
Watson-Manheim, M. B., Crawford, S., Nakata, C., Xiao, S., Holly, E., Spanjol, J., ... & Cui, A. (2013). Developing Targeted Text Messages for Enhancing Medication Adherence.

Developing Targeted Text Messages for Enhancing Medication Adherence.

Adherence to prescription medication regimens is one of the main problems that patients and doctors face when trying to manage chronic disease. This research-in-progress paper reports on the development of text messages to be used in a large-scale mobile technology intervention to influence medication adherence. The messages will be developed based upon the Elaboration Likelihood Model (ELM). ELM is a theory about individual processes responsible for making communication more or less persuasive. The model holds that there are two relatively distinct routes to persuasion: core processing and peripheral processing. The wording of the messages being developed in this study will be manipulated to focus on logical message content (for core processing) or emotional cues (for peripheral processing). A rigorous, multi-phase message development plan is currently underway and presented in this research-in-progress paper. The results of the research will be presented at the AMCIS 2013 conference.