JMIR Publications

ABSTRACT

Background:

Over the past 50 years, patient non-compliance has appeared as a major public health issue, because it endangers patients’ recovery and imposes a considerable financial burden on healthcare systems. Meanwhile, online health communities (OHCs) have known considerable developments and have been posited as facilitating compliance. D espite the growing popularity and seemingly positive impact on compliance of peer-to-peer Online Health Communities (OHCs), little is known about patient compliance predictors for OHCs users.

Objective:

This study aims at filling this gap by investigating to what extent participating in OHCs triggers higher levels of compliance. Furthermore, this research identifies three inter-related predictors that may affect patient compliance: Patient empowerment gained on peer-to-peer OHCs, satisfaction with the physician and commitment to the physician.

Methods:

A Web-based survey design was used to test the conceptual model and assess the effects of patient empowerment gained on OHCs on patient satisfaction and commitment to the physician, as well as the effects of these three predictors on patient compliance with the proposed treatment. A questionnaire was developed and submitted online to members of peer-to-peer OHCs. A convenience sample of 420 patients experiencing a chronic illness and using peer-to-peer OHCs were surveyed in August 2018 in Québec, Canada. A path analysis using Structural Equation Modelling (SEM) tests the proposed relationships between the predictors and their respective paths on patient compliance. The mediation effects of these predictor variables on patient compliance were estimated with the Macro PROCESS.

Results:

The findings indicate that patient empowerment gained on OHCs is positively related to patient commitment to the physician (β = 0.69, < .001) and patient compliance to the proposed treatment (β = 0.35, p < 0.001). Patient commitment also positively influences patient compliance (β = 0.74, p < 0.001). Interestingly, patient empowerment does not exert a significant influence on patient satisfaction with the physician (β = 0.02, p = 0.769), and satisfaction does not affect compliance (β = -0.07, p = 0.05), while patient satisfaction positively relates to patient commitment to the physician (β = 0.14, p < 0.01). More specifically, the impact of empowerment on compliance, is mediated indirectly by commitment to the physician (β = 0.32, [0.22, 0.44]) and not satisfaction.

Conclusions:

Overall, this study highlights the importance of peer-to-peer OHCs for two main reasons. First, our results show that patient empowerment gained on peer-to-peer OHCs enhances both directly and indirectly patient compliance with proposed treatment. Second, we show the underlying mechanisms of these effects. In particular, commitment to the physician plays a more critical role than satisfaction with the physician in determining patient-physician relationship quality. Overall, our findings support the assumption that healthcare stakeholders should use peer-to-peer OHCs to favor patient empowerment and patient commitment to the physician in order to increase patient compliance with proposed treatment.