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Patient-centric exchanges, a major type of Health Information Exchange (HIE), empower patients to aggregate and manage their health information. This exchange model helps patients access, modify and share their medical information with multiple healthcare organizations. Although existing studies examine patient engagement, more research is required to investigate patients' attitudes and willingness to play an active role in patient-centered information exchange. The study's main objective is to develop a model based on the belief-attitude-intention paradigm to empirically examine the effects of patients' attitudes toward engagement in care on their willingness to participate in patient-centric HIE.

The authors conducted an online survey study to identify the antecedents and consequences of patients' attitudes toward engagement in care. To empirically test the research model, the authors collected data from a national sample (n = 357) of individuals in the United States. The data were analyzed using structural equation modeling (SEM).

The proposed model categorizes the antecedents to patients' attitudes toward engagement in patient-related and healthcare system factors. The results show that patient-related factors (perceived health literacy and perceived coping ability) and health system factors (perceived experience with the healthcare organization and perceived patient-provider interaction) significantly shape patient attitude toward care management engagement. The results indicate that patients' attitudes toward engaging in their healthcare significantly contribute to their willingness to participate in medical information sharing through patient-centric HIE initiatives. Moreover, the authors’ findings also demonstrate that the link between patient engagement and willingness to participate in HIE is stronger for individuals who perceive lower levels of privacy and security concerns.

The authors validate the proposed model explaining patients' perceptions about their characteristics and the healthcare system significantly influence their attitude toward engaging in their care. This study also suggests that patients' favorable attitude toward engagement can bring patient-centric HIE efforts onto a path to success. The authors’ research attempts to shed light on the importance of patients' roles in adopting patient-centric HIE initiatives. Theoretical and practical contributions of this study are noticeable since they could result in a deeper understanding of the concept of patient engagement and how it may affect healthcare services in an evolving digital world. The authors’ findings can help healthcare organizations provide public citizen-centric services by introducing user-oriented approaches in healthcare delivery systems.

The purpose of this study is to understand the effect of different brand positions (underdog vs top dog) and comparative advertising on consumers’ brand attitudes. Additionally, this study also aims to demonstrate the effects of inspiration, self-relevance and empathy on the relationship between brand positioning and comparative advertising.

A two-by-three factorial design was employed with brand positions (underdog vs top dog) and three types of comparative advertising (noncomparative, indirect comparative and direct comparative) as the independent variables. Inspiration serves as the mediator, while self-relevance and empathy act as moderators and brand attitude is the dependent variable.

The results show that different brand positions significantly affect brand attitudes, with respondents having a better brand attitude toward the underdog brand. Brand attitude is partially mediated by inspiration. Self-relevance moderates the relationship between brand positioning and brand attitude. However, brand positioning, comparative advertising and empathy do not have interaction effects.

This study contributes to a better understanding of the effect of psychological variables on brand positioning and comparative advertising.

The results suggest that the underdog setting requires a real and honest story because consumers will spot a fake underdog story, which will damage consumer trust in the brand and harm the brand image.

There is a lack of research using psychological variables to demonstrate the effect of being the underdog brand. This study contributes to the literature by employing psychological variables to illustrate the effect of underdog positioning. These findings can help brands develop branding positioning strategies.