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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.

Online health communities (OHCs) have been recognized as emerging platforms on the Internet used for health purposes. Despite its emergence, developing a successful OHC is still a challenge. Prior studies identified that value co-creation behavior (VCB) of members is an essential factor for sustaining OHCs; however, little is known about how members’ behavior drives to co-create value? Therefore, this study aims to discover the inclusive mechanism for members’ VCB in OHCs.

The authors develop the study model and hypothesis based on the service-dominant logic of value co-creation theory and social support (SS) literature. The survey data of 608 active OHCs users in China were analyzed using partial least squares structural equation modeling (PLS-SEM).

The results revealed that SS positively affects members’ VCBs. Ethical aspects; Trust and ethical interaction (EI) partially mediate their relationships. In addition, community members’ current health status (CHS) negatively moderates the relationships between SS and VCB. From the findings, it becomes evident that only SS is not enough; developing an ethical environment in OHCs, i.e. trust and ethically rich interactions among members, significantly helps OHCs to promote co-creation. Also, the negative moderation of CHS findings provides novel insights when cramming health conditions.

Exploring the complex mechanism of co-creation in OHC, the authors illustrate the potential of service-dominant logic to create new theoretical insight for healthcare and provide the framework of co-creation with ethics for the first time. This will extend the application of ethics in healthcare services and offer a robust platform from which the understanding of drivers of members’ VCB can be advanced in the OHC context.