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Given the progressive rise of online health communities (OHC) that have predominantly changed health delivery services, healthcare organizations still face tremendous challenges of low patient participation and lack of high-quality contribution to OHC. Prior scholars indicated that inducing patient value co-creation behavior (VCB) is substantially beneficial for the sustainable growth of OHCs. However, what drives patients' behavior to co-create value is still unknown. To fill this important gap, this study used the service-dominant logic of value co-creation theory and face (mianzi in Chinese) literature to discover how patient co-creation attitude (CA) affects patient VCB. Also, this study aimed to explore the joint mechanism of how face gain (FG) and face loss (FL) impact patients' VCB in OHCs.

The survey data of 322 patients actively using OHC in China were analyzed via partial least squares structural equation model (PLS-SEM) and fuzzy set qualitative comparative analysis (fsQCA).

The results revealed that patient CA positively influences VCB, that is participation behavior (PB) and citizenship behavior (CB). Face gain (FG) strengthens the impact of CA and patient PB and CB, whereas face loss (FL) weakens the impact of CA and patient PB and CB. Furthermore, the fsQCA findings signify the robustness of the study model.

This study explores the multifaceted mechanism of patient value co-creation in OHC and discloses the crucial role of face for the first time. Further, the novel findings of this study provide a robust framework for advancing the understanding of important drivers of patient VCBs that significantly helps healthcare service providers and OHC managers to sustain OHCs.