Main Article Content

Abstract

Telemedicine has emerged as a transformative approach in healthcare delivery, particularly in addressing accessibility and efficiency challenges in traditional systems. While prior research has emphasized its technological and operational benefits, studies investigating the intrinsic drivers of patient engagement, especially from a value cocreation perspective remain scant. Grounded in self-determination theory (SDT) and service-dominant logic (SDL), this study investigates how intrinsic motivation, external regulation, and identified regulation influence value cocreation behavior and, subsequently, patient-perceived value and well-being. Data were collected through an electronic survey targeting telemedicine users in Greater Jakarta who had used digital health services within the past six months. Partial least squares structural equation modeling (PLS-SEM) was employed to analyze the data and assess both the measurement and structural models. Results confirm that all hypothesized relationships are significant. Identified regulation demonstrates the strongest influence on value cocreation behavior, followed by intrinsic motivation and external regulation. Furthermore, value cocreation behavior significantly enhances both perceived value and well-being, with perceived value also positively affecting well-being. The model exhibits strong explanatory power and predictive relevance. This study contributes by highlighting the importance of motivational quality in shaping patient engagement and outcomes thus provides actionable insights for healthcare providers aiming to design telemedicine platforms that foster meaningful interaction, improve patient satisfaction, and enhance overall health-related well-being.

Keywords

Telemedicine, patient value cocreation, patient well-being, intrinsic motivation, external regulation, identified regulation

Article Details

How to Cite
Sarwoko, S., Mutaqien, S. M., & Sarfilianty Anggiani. (2025). Towards Well-Being Patients Through Value Cocreation In Healthcare: A Self-Determination Theory Perspective In Telemedicine. Paradoks : Jurnal Ilmu Ekonomi, 8(3), 143–165. https://doi.org/10.57178/paradoks.v8i3.1366

References

  1. Alexandra, S., Handayani, P. W., & Azzahro, F. (2021). Indonesian hospital telemedicine acceptance model: the influence of user behavior and technological dimensions. Heliyon, 7(12). https://doi.org/10.1016/j.heliyon.2021.e08599
  2. Alfian, S. D., Sania, J. A., Aini, D. Q., Khoiry, Q. A., Griselda, M., Ausi, Y., Zakiyah, N., Puspitasari, I. M., Suwantika, A. A., Mahfud, M., Aji, S., Abdulah, R., & Kassianos, A. P. (2024). Evaluation of usability and user feedback to guide telepharmacy application development in Indonesia: a mixed-methods study. BMC Medical Informatics and Decision Making, 24(1). https://doi.org/10.1186/s12911-024-02494-3
  3. Arboleda, A. M. (2023). Satisfaction with life and perception of healthcare services. International Journal of Hospitality Management, 110. https://doi.org/10.1016/j.ijhm.2023.103450
  4. Bandhu, D., Mohan, M. M., Nittala, N. A. P., Jadhav, P., Bhadauria, A., & Saxena, K. K. (2024). Theories of motivation: A comprehensive analysis of human behavior drivers. In Acta Psychologica (Vol. 244). Elsevier B.V. https://doi.org/10.1016/j.actpsy.2024.104177
  5. Beirão, G., Patrício, L., & Fisk, R. P. (2017). Value cocreation in service ecosystems: Investigating health care at the micro, meso, and macro levels. Journal of Service Management, 28(2), 227–249. https://doi.org/10.1108/JOSM-11-2015-0357
  6. Benitez, J., Henseler, J., Castillo, A., & Schuberth, F. (2020). How to perform and report an impactful analysis using partial least squares: Guidelines for confirmatory and explanatory IS research. Information & Management, 57(2), 103168. https://doi.org/10.1016/j.im.2019.05.003
  7. Bradshaw, J., Siddiqui, N., Greenfield, D., & Sharma, A. (2022). Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care. Journal of Patient Experience, 9. https://doi.org/10.1177/23743735221092627
  8. Çakmak, C., & Uğurluoğlu, Ö. (2024). The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye. Cancer Control, 31. https://doi.org/10.1177/10732748241236327
  9. Cosme, D., & Berkman, E. T. (2020). Autonomy can support affect regulation during illness and in health. Journal of Health Psychology, 25(1), 31–37. https://doi.org/10.1177/1359105318787013
  10. Cui, T., & Aulton, K. (2023). Conceptualizing the elements of value in public services: insights from practitioners. Public Management Review. https://doi.org/10.1080/14719037.2023.2226676
  11. Deci, E. L., & Ryan, R. M. (2012). Self-determination theory in health care and its relations to motivational interviewing: A few comments. In International Journal of Behavioral Nutrition and Physical Activity (Vol. 9). https://doi.org/10.1186/1479-5868-9-24
  12. Eletti, F., Tagi, V. M., Greco, I. P., Stucchi, E., Fiore, G., Bonaventura, E., Bruschi, F., Tonduti, D., Verduci, E., & Zuccotti, G. (2025). Telemedicine for Personalized Nutritional Intervention of Rare Diseases: A Narrative Review on Approaches, Impact, and Future Perspectives. In Nutrients (Vol. 17, Issue 3). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/nu17030455
  13. El-Tallawy, S. N., Pergolizzi, J. V., Vasiliu-Feltes, I., Ahmed, R. S., LeQuang, J. A. K., Alzahrani, T., Varrassi, G., Awaleh, F. I., Alsubaie, A. T., & Nagiub, M. S. (2024). Innovative Applications of Telemedicine and Other Digital Health Solutions in Pain Management: A Literature Review. In Pain and Therapy (Vol. 13, Issue 4, pp. 791–812). Adis. https://doi.org/10.1007/s40122-024-00620-7
  14. Ezeamii, V. C., Okobi, O. E., Wambai-Sani, H., Perera, G. S., Zaynieva, S., Okonkwo, C. C., Ohaiba, M. M., William-Enemali, P. C., Obodo, O. R., & Obiefuna, N. G. (2024). Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care. Cureus. https://doi.org/10.7759/cureus.63881
  15. Fusco, F., Marsilio, M., & Guglielmetti, C. (2023). Co-creation in healthcare: framing the outcomes and their determinants. In Journal of Service Management (Vol. 34, Issue 6, pp. 1–26). Emerald Publishing. https://doi.org/10.1108/JOSM-06-2021-0212
  16. Galletta, M., Piazza, M. F., Meloni, S. L., Chessa, E., Piras, I., Arnetz, J. E., & D’Aloja, E. (2022). Patient Involvement in Shared Decision-Making: Do Patients Rate Physicians and Nurses Differently? International Journal of Environmental Research and Public Health, 19(21). https://doi.org/10.3390/ijerph192114229
  17. Grenier, S., Gagné, M., & O’Neill, T. (2024). Self-determination theory and its implications for team motivation. In Applied Psychology. John Wiley and Sons Inc. https://doi.org/10.1111/apps.12526
  18. Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate Data Analysis. In Vectors. https://doi.org/10.1016/j.ijpharm.2011.02.019
  19. Hair, J. F., Hult, G. T. M., Ringle, C. M., Sarstedt, M., Danks, N. P., & Ray, S. (2021a). Evaluation of Reflective Measurement Models (pp. 75–90). https://doi.org/10.1007/978-3-030-80519-7_4
  20. Hair, J. F., Hult, G. T. M., Ringle, C. M., Sarstedt, M., Danks, N. P., & Ray, S. (2021b). Evaluation of the Structural Model (pp. 115–138). https://doi.org/10.1007/978-3-030-80519-7_6
  21. Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. In Sensors International (Vol. 2). KeAi Communications Co. https://doi.org/10.1016/j.sintl.2021.100117
  22. Hau, L. N., & Thuy, P. N. (2022). Enabling customer co-creation behavior at a distance: the case of patients using self-monitoring handheld devices in healthcare. Service Business, 16(1), 99–123. https://doi.org/10.1007/s11628-021-00451-y
  23. Henseler, J., Ringle, C. M., & Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43(1), 115–135. https://doi.org/10.1007/s11747-014-0403-8
  24. Hickmann, E., Richter, P., & Schlieter, H. (2022). All together now – patient engagement, patient empowerment, and associated terms in personal healthcare. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08501-5
  25. Keelson, S. A., Addo, J. O., & Amoah, J. (2024). The impact of patient engagement on service quality and customer well-being: an introspective analysis from the healthcare providers’ perspective. Cogent Public Health, 11(1). https://doi.org/10.1080/27707571.2024.2340157
  26. Khomkham, P., & Kaewmanee, P. (2024). Patient motivation: A concept analysis. Belitung Nursing Journal, 10(5), 490–497. https://doi.org/10.33546/bnj.3529
  27. Knittle, K., Fidrich, C., & Hankonen, N. (2023). Self-enactable techniques to influence basic psychological needs and regulatory styles within self-determination theory: An expert opinion study. Acta Psychologica, 240. https://doi.org/10.1016/j.actpsy.2023.104017
  28. Kock, N. (2021). Harman’s single factor test in PLS-SEM: Checking for common method bias. In Data Analysis Perspectives Journal (Vol. 2, Issue 2). https://www.scriptwarp.com,
  29. Kres, H. (1983). The Mardia-Test for Multivariate Normality, Skewness, and Kurtosis: Tables by K. V. Mardia (pp. 420–431). https://doi.org/10.1007/978-1-4612-5609-0_27
  30. Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging patients in decision-making and behavior change to promote prevention. 240, 284–302.
  31. Liu, S., Hu, Y., Lu, C., Li, D., & Zhang, Z. (2023). Identifying patient perceived values during outpatient encounters: an empirical study from Chinese public hospitals. BMC Health Services Research, 23(1). https://doi.org/10.1186/s12913-023-09817-6
  32. Liu, S., Hu, Y., Pfaff, H., Feng, X., Xie, J., Zhang, Z., & Li, D. (2024). Evaluating perceived value and expected value gaps based on patient experience during outpatient encounters: An empirical study in China. Heliyon, 10(18). https://doi.org/10.1016/j.heliyon.2024.e37766
  33. Madanian, S., Nakarada-Kordic, I., Reay, S., & Chetty, T. (2023). Patients’ perspectives on digital health tools. PEC Innovation, 2. https://doi.org/10.1016/j.pecinn.2023.100171
  34. Mao, B., Morgan, S. E., Peng, W., McFarlane, S. J., Occa, A., Grinfeder, G., & Byrne, M. M. (2021). What Motivates You to Share? The Effect of Interactive Tailored Information Aids on Information Sharing about Clinical Trials. Health Communication, 36(11), 1388–1396. https://doi.org/10.1080/10410236.2020.1754588
  35. Moulaei, K., Sheikhtaheri, A., Fatehi, F., Shanbehzadeh, M., & Bahaadinbeigy, K. (2023). Patients’ perspectives and preferences toward telemedicine versus in-person visits: a mixed-methods study on 1226 patients. BMC Medical Informatics and Decision Making, 23(1). https://doi.org/10.1186/s12911-023-02348-4
  36. Nariswari, A., & Vargo, S. L. (2024). Service-Dominant Logic: Theoretical Foundations and Directions (pp. 153–186). https://doi.org/10.1007/978-3-031-67155-5_8
  37. Nohutlu, Z. D., Englis, B. G., Groen, A. J., & Constantinides, E. (2023). Innovating With the Customer: Co-Creation Motives in Online Communities. International Journal of Electronic Commerce, 27(4), 523–557. https://doi.org/10.1080/10864415.2023.2255111
  38. Olowoyo, K. S., Esan, D. T., Olowoyo, P., Oyinloye, B. E., Fawole, I. O., Aderibigbe, S., Adigun, M. O., Olawade, D. B., Esan, T. O., & Adeyanju, B. T. (2025). Treatment Adherence and Outcomes in Patients with Tuberculosis Treated with Telemedicine: A Scoping Review. In Tropical Medicine and Infectious Disease (Vol. 10, Issue 3). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/tropicalmed10030078
  39. Osei-Frimpong, K. (2017). Patient participatory behaviours in healthcare service delivery: Self-determination theory (SDT) perspective. Journal of Service Theory and Practice, 27(2), 453–474. https://doi.org/10.1108/JSTP-02-2016-0038
  40. Osei-Frimpong, K., Wilson, A., & Owusu-Frimpong, N. (2015). Service experiences and dyadic value co-creation in healthcare service delivery: A CIT approach. Journal of Service Theory and Practice, 25(4), 443–462. https://doi.org/10.1108/JSTP-03-2014-0062
  41. Patrick, H., & Williams, G. C. (2012). Self-determination theory: Its application to health behavior and complementarity with motivational interviewing. In International Journal of Behavioral Nutrition and Physical Activity (Vol. 9). https://doi.org/10.1186/1479-5868-9-18
  42. Paukkonen, L., Oikarinen, A., Kähkönen, O., & Kyngäs, H. (2021). Patient participation during primary health-care encounters among adult patients with multimorbidity: A cross-sectional study. Health Expectations, 24(5), 1660–1676. https://doi.org/10.1111/hex.13306
  43. Peng, J., Fu, C., Guo, Y., & Huang, L. (2025). The impact of customer value co-creation in online medical consultation on customer service well-being. Journal of Research in Interactive Marketing. https://doi.org/10.1108/JRIM-06-2024-0280
  44. Peng, Y., Wu, T., Chen, Z., & Deng, Z. (2022). Value Cocreation in Health Care: Systematic Review. In Journal of Medical Internet Research (Vol. 24, Issue 3). JMIR Publications Inc. https://doi.org/10.2196/33061
  45. Pham, T. A. N., Le, H. N., Nguyen, D. T., & Pham, T. N. (2022). Customer service co-creation literacy for better service value: evidence from the health-care sector. Journal of Services Marketing, 36(7), 940–951. https://doi.org/10.1108/JSM-09-2021-0323
  46. Ruggeri, K., Garcia-Garzon, E., Maguire, Á., Matz, S., & Huppert, F. A. (2020). Well-being is more than happiness and life satisfaction: A multidimensional analysis of 21 countries. Health and Quality of Life Outcomes, 18(1). https://doi.org/10.1186/s12955-020-01423-y
  47. Ryan, R. M., & Deci, E. L. (2020). Intrinsic and extrinsic motivation from a self-determination theory perspective: Definitions, theory, practices, and future directions. Contemporary Educational Psychology, 61. https://doi.org/10.1016/j.cedpsych.2020.101860
  48. Sagen, J. S., Smedslund, G., Simonsen, A. E., Habberstad, A., Kjeken, I., Dagfinrud, H., & Moe, R. H. (2023). Patient engagement in the development and delivery of healthcare services: a systematic scoping review. In BMJ Open Quality (Vol. 12, Issue 2). BMJ Publishing Group. https://doi.org/10.1136/bmjoq-2023-002309
  49. Šakan, D., Žuljević, D., & Rokvić, N. (2020). The Role of Basic Psychological Needs in Well-Being During the COVID-19 Outbreak: A Self-Determination Theory Perspective. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.583181
  50. Salsabila, S., & Dachyar, M. (2024). Increasing telemedicine adoption in Indonesia using extended UTAUT2 model. 020018. https://doi.org/10.1063/5.0218883
  51. Samsa, Ç., & Yüce, A. (2022). Understanding customers hospital experience and value co-creation behavior. TQM Journal, 34(6), 1860–1876. https://doi.org/10.1108/TQM-09-2021-0282
  52. Shirazi, F., Wu, Y., Hajli, A., Zadeh, A. H., Hajli, N., & Lin, X. (2021). Value co-creation in online healthcare communities. Technological Forecasting and Social Change, 167. https://doi.org/10.1016/j.techfore.2021.120665
  53. Shmueli, G., Sarstedt, M., Hair, J. F., Cheah, J.-H., Ting, H., Vaithilingam, S., & Ringle, C. M. (2019). Predictive model assessment in PLS-SEM: guidelines for using PLSpredict. European Journal of Marketing, 53(11), 2322–2347. https://doi.org/10.1108/EJM-02-2019-0189
  54. Sikander, S., Biswas, P., & Kulkarni, P. (2023). Recent advancements in telemedicine: Surgical, diagnostic and consultation devices. Biomedical Engineering Advances, 6, 100096. https://doi.org/10.1016/j.bea.2023.100096
  55. Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if Telehealth Can Reduce Health System Costs: Scoping Review. In Journal of Medical Internet Research (Vol. 22, Issue 10). JMIR Publications Inc. https://doi.org/10.2196/17298
  56. Su, Z., Li, C., Fu, H., Wang, L., Wu, M., & Feng, X. (2024). Development and prospect of telemedicine. In Intelligent Medicine (Vol. 4, Issue 1, pp. 1–9). Chinese Medical Association. https://doi.org/10.1016/j.imed.2022.10.004
  57. Sun, L., & Buijsen, M. (2024). Challenges of shared decision-making in virtual care: Whom should we care for, and how? Health Policy and Technology, 13(6). https://doi.org/10.1016/j.hlpt.2024.100931
  58. Urhahne, D., & Wijnia, L. (2023). Theories of Motivation in Education: an Integrative Framework. In Educational Psychology Review (Vol. 35, Issue 2). Springer. https://doi.org/10.1007/s10648-023-09767-9
  59. Valencia-Arias, A., Gallegos, A., Aliaga Bravo, V. D. C., Victoria Mori, F. L., Uribe-Bedoya, H., & Palacios-Moya, L. (2024). Understanding telemedicine adoption: evidence, gaps, and future perspectives for sustainable healthcare. Cogent Social Sciences, 10(1). https://doi.org/10.1080/23311886.2024.2306712
  60. Vandenabeele, W., & Breaugh, J. (2024). It takes two to tango: concepts and evidence of further integration of public service motivation theory and self-determination theory. International Public Management Journal. https://doi.org/10.1080/10967494.2024.2386292
  61. Wang, S., & Zhang, X. (2024). Exploring the Impact of Online Medical Team Engagement on Patient Satisfaction: A Semantic Features Perspective. Healthcare (Switzerland), 12(11). https://doi.org/10.3390/healthcare12111113
  62. Westerink, H. J., Garvelink, M. M., van Uden-Kraan, C. F., Zouitni, O., Bart, H. A. J., van der Wees, P. J., & van der Nat, P. B. (2024). Evaluating patient participation in value-based healthcare: Current state and lessons learned. Health Expectations, 27(1). https://doi.org/10.1111/hex.13945
  63. Wu, C., Jiang, S., Zhou, Y., & Yuan, Q. (2024). Consumer engagement behavior in the value co-creation process of healthcare services: a scoping review. Aslib Journal of Information Management, 76(5), 822–841. https://doi.org/10.1108/AJIM-10-2022-0443
  64. Wu, D., Gu, H., Gu, S., & You, H. (2021). Individual motivation and social influence: a study of telemedicine adoption in China based on social cognitive theory. Health Policy and Technology, 10(3). https://doi.org/10.1016/j.hlpt.2021.100525
  65. Zhang, W., Xuan, J., Cai, M., Kludacz-Alessandri, M., & Evans, R. (2025). Impact of patient engagement types on doctors’ service provision in online health communities. Patient Education and Counseling, 134, 108700. https://doi.org/10.1016/j.pec.2025.108700