The co learning process in healthcare pr

Computers in Human Behavior xxx (2014) xxx–xxx Contents lists available at ScienceDirect Computers in Human Behavior journal homepage: www.elsevier.com/locate/comphumbeh The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Ana Isabel Jiménez-Zarco a, Inés González-González b,⇑, Francesc Saigí-Rubió c, Joan Torrent-Sellens a a Economics and Business Studies, Open University of Catalonia – I2TIC Research Group-IN3Avda, Tibidabo, 39, 08039 Barcelona, Spain Economics and Business Studies, Pompeu Fabra University – I2TIC Research Group-IN3, Ramón Trias, 27, 08005 Barcelona, Spain c Information Sciences and Communication Studies, Open University of Catalonia – I2TIC Research Group-IN3, Tibidabo, 39, 08039 Barcelona, Spain b a r t i c l e i n f o Article history: Available online xxxx Keywords: Co-learning Information and communication technologies (ICT) Virtual communities of practice Perceived satisfaction Healthcare sector a b s t r a c t Communities of practice are nowadays an important concept in the healthcare sector Particularly, the intensive use of ICT has allowed their creation into a virtual environment – Virtual Communities of Practice (VCoPs) developing optimal conditions to make possible the collaborative learning process The VCoPs antecedents can be situated on social network phenomenon, where individuals with different traits but a common interest/objective are linked, use ICT potency (especially social media) to interchange information, experiences and contents among them And as a result, people create and share knowledge, and learn collaboratively VCoP users have a higher satisfaction level in the collaborative learning process when they can: (1) Achieve benefits related to patient diagnosis and treatment (cost reductions, faster management, quality and accuracy of diagnosis, etc.); (2) Increase the share capital of participants and creating networks of trusted individuals Given the interest in this topic, the objective of this work is to identify the factors that determine user satisfaction in relation to Community Practice (CoP) and the process of building shared knowledge For this, a sample of 130 Spanish health professionals participating in an online community, and developed in a virtual community of practice, is discussed The results obtained from an analysis of logistic regression show evidence of the perception of efficiency and effectiveness in collaboration with the members of the VCoP as positively influencing the perceived satisfaction with the CoP Also, the degree of individual participation in the community affects the degree of perceived satisfaction The conclusions provide interesting strategic recommendations in the management process of the CoP Ó 2014 Elsevier Ltd All rights reserved Introduction Based on the theory of situated learning, where professional learning occurred through participation in practice and interaction with colleagues, the term of Communities of Practice (CoP) has evolved over time to refer to groups of people who share a concern or problem, and who come together to interact, learn and create a sense of identity, and in the process, build, share knowledge and solve problems (Wenger, 1998) In the business sector, CoPs have gained recognition due to its capacity to foster the professional development of individuals, as well as improve business outcomes for organization (AliciaRivera, 2011; Antony, Rosman, Eze, & Gan, 2009; Ardichvili, Page, & Wentling, 2003; Swan, Scarbrough, & Robertson, 2002) Based ⇑ Corresponding author E-mail addresses: ajimenezz@uoc.edu (A.I Jiménez-Zarco), igonzalezgonzal@uoc edu, ines.gonzalez@upf.edu (I González-González), fsaigi@uoc.edu (F Saigí-Rubió), jtorrent@uoc.edu (J Torrent-Sellens) on these claimed benefits of CoPs in the business sector, the creation of CoPs is being promoted in other professional fields, such as the healthcare sector Initially, CoPs in the health sector have been used as a tool to drive knowledge management But as Díaz-Chao, Torrent, La Casta, and Saigí (2014) and Ikioda, Kendall, Brooks, de Liddo, and Shum (2013) show, additionally, its usage makes it possible to obtain other benefits relative to the improvement of: (a) professional practice efficiency and efficacy; and (b) healthcare organizational performance On the other hand, user satisfaction is a term frequently used in marketing area, and in general terms it is defined as a measure of how a products and services supplied by a company meet or surpass user or customer expectation Relative to healthcare sector, especially in relation to user VCoP satisfaction, this concept measures the subjective user assessments of the any outcome or experience regarding to a VCoP as a specific technological tool that makes possible the knowledge creation and sharing, and the collaborative learning process as well http://dx.doi.org/10.1016/j.chb.2014.11.057 0747-5632/Ó 2014 Elsevier Ltd All rights reserved Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Computers in Human Behavior (2014), http://dx.doi.org/10.1016/j.chb.2014.11.057 A.I Jiménez-Zarco et al / Computers in Human Behavior xxx (2014) xxx–xxx In this sense, literature points out the relationship between satisfaction and users’ personal and sociodemographic characteristics (Gabbay & Le May, 2009; Vázquez-Bronfman, 2011) Also, some studies show that users’ profile characteristics influence on their satisfaction level (Ardichvili, Page V., & T., 2012; Delone & McLean, 1992) Both of them influence on what are the expectations that users have relative to a VCoP, as well as in how this technological tool meets or exceed the users’ expected goals The wide range of benefits offered by the CoPs in the healthcare sector, and in particular the VCoP, makes it convenient to analyze the determinants of user satisfaction in relation to the VCoP regarding the process of building shared knowledge To this end, this work presents two distinct parts Based on the concept of VCoP, the theoretical part starts describing some of the main benefits that virtual communities offer to health care organizations Then, and based on a thorough review of the literature, we present some of the factors identified as determinants in the degree of satisfaction of VCoPs users as a tool in the process of knowledge construction The factors considered are relative to individuals’ sociodemographic characteristics – gender, professional specialization, or workplace On the other hand, there also considered other factors relative to the VCoP users’ profile, such as, the degree of implication or knowledge that users have on the VCoP, as well as- the levels of utility, efficiency or efficacy perceived We continue the empirical study describing the characteristics of the study sample of thr 130 Spanish health professionals, active members in VCoP, as well as the variables used in the statistics The results obtained after the development of a logistic regression analysis, show the perception of efficiency and effectiveness in collaboration between CoP members, has a positive influence on the perceived satisfaction in relation to the VCoP In addition, the degree of individual involvement influences the degree of perceived satisfaction The conclusion shows interesting strategic recommendations in the management process of VCoP Theoretical background 2.1 The virtual community of practice in the healthcare sector: outcomes and drivers of user satisfaction CoP is described as informal groups bound together by a common interest or passion Wenger (1998) suggests that there are signs which indicate that a CoP has been formed These signs include: sustained mutual relations, ways of communications and sharing information that are facilitated by a common understanding that might be unique to the CoP, forms of practice that assume sharing implicit knowledge of the process and procedures as well as a sense of ‘‘how things are going’’, a sense of membership that has arisen from experiences of working together, and the development of identifiable practice styles and are unique to the CoP The intensive use of ITC has favored the development of VCoP A virtual community is a community of people sharing common interests, ideas, and feelings over the Internet or other collaborative networks Alavi (2013) defines VCoPs as a social network of individuals, who interact through social media, potentially crossing geographical, political and psychological boundaries in order to pursue mutual interest or goals In the same line, Ramalho, Paulos, and Mesquita (2010) show how VCoP arise as a space for conversation, a learning environment, and knowledge sharing VCoP is a community of practice in which links relationships, and these not take place in a physical space, but in a virtual space like the Internet Individuals use social media in both, personal and professional area In fact, organizations favor the use of social media as a means to improve communication, knowledge creation and collaboration among employees Antony et al (2009) show how the reason why communities of practice are effective in promoting knowledge creation and sharing in organisations is the fact that most of an organization’s competitive advantage is embedded in the intangible, tacit knowledge of its people and that competencies not exists apart from people who develop them (Dougherty, 1995) Not only new knowledge can be created through the sharing in community, skills are also discursively produced and disseminated during the conversation and networking activities (Brown & Duguid, 1991; Weick & Westley, 1996) Therefore, one of the ways to help people share and internalize tacit knowledge is to allow them to talk about their experiences and to exchange their knowledge while working on specific problems Through this process, individual VCoP member’s skills, talents and knowledge will be improved and can be identified This will enhance the community’s effectiveness as they recognize which one among them is an expert in a specific area The community may save their energy and time since they know the right person to refer to and to seek for advice regarding a specific subject matter or problem By having different skills, talents and knowledge among community members, the organization may leverage on its human capital that is the source of its organisational capabilities The VCoP may also generate unique ideas for new product and services through the combination of different skills, talents and knowledge that each member possesses (Brown & Duguid, 1991; Weick & Westley, 1996) Health professionals are using social media tools in a variety of innovative and creative ways – to build and improve social and professional networks and relationships, to share health-related information and to engage with the public, patients and colleagues in shaping future health policies and priorities Closed online groups are also commonly used for education and peer support In this sense, literature show how in healthcare sector, social media can offer enormous benefits to different groups, in different professional and social areas Grajales, Sheps, Ho, Novak-Lauscher, and Eysenhbach (2014) show that social media brings a new dimension to health care as it offers a medium to be used by the public, patients, and health professionals to communicate about health issues with the possibility of potentially improving health outcomes In this sense, recent works such as Tsuya, Sugawara, Tanaka, and Narimatsu (2014), D’Auria (2014) or Kim and Seo (2014) analyze the use of specific social media in treating of cancer or diabetes patients But also, social media is a powerful tool, which offers collaboration between users and is a social interaction mechanism for a range of individuals, making possible two important process development: (1) knowledge creation and sharing, and (2) collaborative learning Especially, VCoPs have made important progress in the knowledge management of health institutions (Nie, 2012) As AliciaRivera (2011) shows, the formation of virtual communities represent, possibly the best way to manage knowledge bases in organizations, since they integrate the most important dimensions in knowledge management: the technological, strategic, and cultural or behavioral dimensions 2.2 VCoPs benefits at healthcare organizations The interest in identifying the various benefits that VCoP offers is relatively new in specialized literature And that is, as pointed out (Chang, Chang, & Jacobs, 2009) the various benefits offered: (a) have different kinds, (b) affect various agents and (c) influence different levels of developed activity Relative to the benefits nature, Wenger, McDermott, and Snyder (2002) shows that VCoPs not simply offer tangible assets, such as professional skill and business outcomes, but also Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Computers in Human Behavior (2014), http://dx.doi.org/10.1016/j.chb.2014.11.057 A.I Jiménez-Zarco et al / Computers in Human Behavior xxx (2014) xxx–xxx intangible assets such as relationships among people, a sense of belonging, or professional identity, or the creation of intellectual and relational or social capital However, it is clear that being able to share and co-create knowledge is the main objective of VCoP in healthcare In fact, one could say that this is the reason for the community, allowing the short term to solve existing problems both individually and collectively While long term, it assumes an increase of intellectual capital available (Alicia-Rivera, 2011) The actual scope of VCoP is high Thus, it is possible to identify three types of benefits depending on the recipient: individual benefits; community benefits, and organizational benefits (Fontaine & Millen, 2004) Also, it shows how the impact of VCoP is different for people than for organizations Regarding individuals, VCoPs affect both professional activity as well as the personal lives of those individuals Furthermore, being members of the VCOP also affects the way in which relationships are established at a group level (Adams, Robert, & Maben, 2012; Barnett et al., 2014) While in relation to organizations, the impact consists of four levels: activities, output, value and business results (Berraies & Chaher, 2014; Chandler & Fry, 2009; Chang et al., 2009; Milne & Lalonde, 2007) Ranmuthugala et al (2011) show that VCoP supports practitioners to change practice to implement evidenced based practice, or to enhance performance Among the observed effects include improving the quality of care (Jiwa et al., 2009; Ramalho et al., 2010); reducing diagnostic time, or the establishment of new treatments and protocols in emergency situations (Swan et al., 2002) In fact, VCoPs facilitate management processes and innovation in the health institution Work likes that of Long, Cunningham, Carswell, and Braithwaite (2014), Schenkel and Teigland (2008) indicate that VCoP makes it possible to generate ideas for new services, practices and products Communities of practice address complex dilemmas, such as improving quality and safeguarding high standards of care by fostering an environment for clinical care (Fung-Kee et al., 2008; Jiwa et al., 2009) Fung-Kee et al (2008) indicate benefits directly related to activity and the outcome of the health institution, such as increasing productivity and saving time and economic costs (Díaz-Chao et al., 2014; Massingham & Massingham, 2014; Ranmuthugala et al., 2011; Schenkel & Teigland, 2008) Meanwhile, at the strategic level, developing intellectual capital (Paype et al., 2014ß Parboosingh, 2002) and relational capital (Adams et al., 2012; Egan & Jaye, 2009; Ryan, Puri, & Liu, 2013) in the institution favors the increase of involvement of health personnel, and the level of competitiveness of the institution Belonging to a VCoP also favors the creation of social capital, derived from the network of people who make up the community, and between which creates trust and commitment In relation to the health institution, Lesser and Storck (2001) suggest that social capital generates between VCoP members, favors knowledge, trust, reciprocity, co-operation and behavioral changes that enhance VCoP performance Fang and Chiu (2006) demonstrate that the stronger emotional links are between community members, the greater the knowledge is shared between them The relationship can be so intense that community members can create a sense of belonging and identity through shared activity and purpose (Adams et al., 2012; Wenger, 1998) The latter is especially relevant in the professional field, such as professional staff, to highlight the role of VCoP as a tool to alleviate the degree of isolation experienced by the healthcare professional Barnett et al (2014) and Rolls, Kowal, Elliott, and Burrell (2008) among others, show that the changes in training from hospital to general practice can contribute to the development of different types of isolation; which in turn, leads to the decrease of knowledge sharing (Cooper & Kurland, 2002) and lowered intention to work in rural areas and change of career choice (Williams et al., 2001) These claims have led to VCoP being promoted in healthcare as a tool to enhance knowledge, improve practice, and in general, increase the individual and organizational performance (Le May, 2009) Nevertheless, the real and bigger challenge in fostering a VCoP is the need to continuously supply knowledge, i.e., the willingness to continue knowledge-sharing Most scholars dealing with this issue in relation to VCoPs have focused on the diverse perspectives in order to explain what encourages VCoP members to voluntarily and continuously help one another through continuous knowledge-sharing Among newer lines, that focus highlights on the análisis of the degree of user satisfaction with the VCoP, in relation to the process of shared knowledge building in the healthcare sector So far, few papers have been published (De Valck, Van Bruggen, & Wierenga, 2009) But the first results obtained show how the identification of the drivers of satisfaction can help improve and increase the knowledge creation process of VCoP 2.3 VCoP user satisfaction Satisfaction is possibly one of the concepts that has received most attention by academics and professionals Plentiful jobs from the field of management, and consumer behavior have dealt with providing a definition of this concept, and to identify the drivers of user satisfaction (Powers & Dawn, 2009) However, in relation to the health sector, there are few studies that analyze the satisfaction of healthcare professionals, especially in VCoPs (De Valck et al., 2009) Some of the work done in the field of VCoPs has analyzed user satisfaction from a social and relational perspective (Sun, Fang, & Lim, 2014) Thus, virtual community members get involved in acts of knowledge creation, motivated by factors related to their personality and the satisfaction they feel when sharing their knowledge or collaborating with others (Ramalho et al., 2010) As Sun et al (2014) shows, under those perspectives, knowledge exchange processes is not based on monetary returns But also, authors as Ammenwerth, Graber, Herrmann, Burkle, and Konig (2003) and Bourhis and Dubé (2010) show that there are other factors, that are relative to: (a) the profile and usage habits of healthcare professionals, and (b) technology effects can influence VCoP user satisfaction Thus, it is because sometimes users are involved in some knowledge exchange processes, due to hoping to get some kind of benefit or reward, which is not of an economic or social nature The combination of both technical and human factors is relatively new That is why following the previous idea, in this paper we propose a model that jointly considers factors relating to the professional’s user profile, their technological habits, and the degree of knowledge they have on VCoP In addition, also considered are the benefits that the VCoP user provides and how the level of efficiency and effectiveness with which they are achieved Generally, satisfaction measures subjective user assessments of any outcome or experience regarding a specific technological tool or information system (Hsiu-Fen, 2008) User satisfaction is a determinant of the level of use of a technological tool (Delone & McLean, 1992), but also, it is a key factor in its success (Bourhis & Dubé, 2010) In the present case, as the clinician is satisfied with VCOP as a knowledge management system, the greater the degree of participation (De Valck et al., 2009; Hsiu-Fen, 2008) Health staff participates voluntarily and with different degrees of intensity in the VCoP The reasons for the user to approach and participate in it may be different in each case Although there is a high degree of consensus regarding the motivation to participate in the VCoP, it is related to the need to create or acquire the knowledge necessary to quickly and accurately solve a problem Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Computers in Human Behavior (2014), http://dx.doi.org/10.1016/j.chb.2014.11.057 A.I Jiménez-Zarco et al / Computers in Human Behavior xxx (2014) xxx–xxx (Cheung, Lee, & Lee, 2013; Sun et al., 2014; De Valck et al., 2009; Ramalho et al., 2010) As the user to respond to the need that leads to approach the VCOP, will be satisfied In This sense, Adams et al (2012) and Ardichvili et al (2012) note that members sometimes feel the need to get involved in acts of knowledge creation, due that they feel the moral obligation to share they knowledge, or repay what they have gained from the VCoP (Chiu, Hsu, & Wang, 2006) In other cases, users need to access to information and to specialist in certain field (Chandler & Fry, 2009; Knoben & Oerlemans, 2006; Long et al., 2014) Chang et al (2009), Gabbay and Le May (2009) and VázquezBronfman (2011), among others, show that members may participate in a VCoP differently Some people devote more to learning from and connecting to other members, while others only want to become informed through the results of the VCoP These authors suggest that there are three levels of community participation based on the level of participation in VCoP The first level consists of the core or leaders or core group, it is a small group-above 10% or 15% of the total, which is called the core of the community Then there are the active members – active group – who participate regularly, but with a lower level of intensity than the previous group Finally, there are the other members, or peripheral group – called lukkers or peripheral group – who not actively participate, but at the periphery, are limited to read and use the information available in the VCOP Abundant studies point to the relationship between level of use and satisfaction is directly and positively Delone and McLean (1992) argue that system usage and user’s satisfaction affect each other simultaneously and that the type of relationship between them is reciprocal, In the same lime, Anandarajan, Igbaria, & Anakwe, 2002, have found that usage is directly and positive related to user satisfaction However, some studies indicate that the relationship between the two is not significant (Al-Gahtani & King, 1999; Torkzadeh & Dwyer, 1994) H1 The degree of user involvement in the VCoP has a positive influence on satisfaction The professional user’s profile has a significant impact on the reasons for participating in the VCoP and in the level of satisfaction (Ikioda et al., 2013) In particular, the degree of specialization of health professionals, and the place where they work, determine: (a) the professional skills of the individual (Adams et al., 2012.) As well as (b) the knowledge that has and the needs of new knowledge (Chandler & Fry, 2009; Cook-Craig & Sabah, 2009) Hopefully those professionals with a lower level of specialization, participate in VCoP in search of knowledge; while highly skilled professionals, foster knowledge creation Also, where the professional conducts business may also affect the role the professional plays in VCoP Larkins et al (2004), Cooper and Kurland (2002) show how those primary care professionals, use the VCoP for knowledge or gather information needed to provide more accurate diagnoses H2 The degree of professional specialization the VCoP user has a positive influence on the degree of satisfaction H3 The VCoP user’s workplace has a positive influence on the degree of satisfaction Another characteristic feature of health professionals is gender In recent years, there has been an increase in the number of women entering the medical profession About 47% of the professionals are women (Lamber & Holmboe, 2005) Meanwhile, in the group of nurses, the percentage of women is much higher, at nearly 90% in total (Kelly, 2010) This imbalance is also seen in terms of the presence of women in positions of responsibility, as well as the performance of certain medical specialties (Pastor-Gosalbez, Belzunegui-Eraso, & Ponton-Merino, 2012) However, in relation to the existence of differences in the use of technology, and the attitude and satisfaction with it, studies show no conclusive results Esteves, Bohórque, and Souza (2008) indicate that women have a lower predisposition to studies online However, the above study, as that made by Riahinezhad, Samavatian, Yousefi, Hashemi, and Aghaei (2012) found that women not show a different attitude or level of satisfaction than men Also Oliffe and Greaves (2011) note that there are no differences in the degree of female participation in VCoPs H4 The VCoP user’s gender does not influence the degree of satisfaction The degree of user involvement in the VCOP is also largely determined by the frequency and where ICT use The presence of technological resources can facilitate collaborative learning, but cannot guarantee that it will occur at VCoP (Cook-Craig & Sabah, 2009) It is necessary that the user routinely utilizes technology, both in the professional field and personally It should be noted that physicians use ICTs in their professional and personal lives As ICT users, healthcare professionals may use technology in different places and with differing degrees of frequency When it comes to defining the profile of an ICT user, cultural and social aspects clearly have a role to play (Ammenwerth et al., 2003), as other circumstantial variables such as experience and training (Agarwal & Prasad, 1999) That is why we incorporated the physician’s ICT usage habits as an explanatory factor of the healthcare professional satisfaction It is expected that the professional make greater use of ICT in the workplace This is especially relevant in relation to the use of VCoP, since this approach is highly professional (Chandler & Fry, 2009; Gabbay & Le May, 2009) Also considered is the professional using ICT often, because that user will be a regular user of VCOP and will develop an active role in it (Baroudi, Olson, Ives, & Davis, 1986) H5 The place where the VCoP user uses ICT has a positive influence on the level of satisfaction H6 The frequency with which the VCoP user uses ITC has a positive influence on the level of satisfaction The clinician makes the decision to be a member of the VCoP and then actively participates in it, and is conditioned by the degree of knowledge he has of the VCoP (Gabbay & Le May, 2009) The greater degree the knowledge, the greater the user’s ability to set realistic expectations about the benefits to the VCoP (Gustafsson, Johnson, & Ross, 2005) Furthermore, also a high degree of knowledge about VCoP, favors the development of the activity within community, both in terms of the interaction between members (Fang & Chiu, 2006), as the technological tools that are available (Cheung et al., 2013) Finally, Chang et al (2009), Cheung et al (2013) and De Valck et al (2009) indicate that a high degree of knowledge about VCOP makes results easier and more objective H7 The degree of knowledge that the user has on the VCoP positively influences the degree of satisfaction Along with professional features, technology is also a key factor in the level of user satisfaction VCoP (Hsiu-Fen, 2008) Since the 1970s, various theoretical models have been developed with the aim of explaining the user’s attitude and acceptance of new information technologies in the professional sphere (Davis & Venkatesh, 1996; Venkatesh & Morris, 2000) Among them, TAM is the theoretical proposal most widely applied into healthcare sector Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Computers in Human Behavior (2014), http://dx.doi.org/10.1016/j.chb.2014.11.057 A.I Jiménez-Zarco et al / Computers in Human Behavior xxx (2014) xxx–xxx (Hsiu-Fen, 2008; Jennett, Hall, Hailey, Ohinmaa, et al., 2003; Palmas, Shea, Starren, et al., 2010; Wu, Chaudhry, & Wang, 2006) Thus, it has the capacity to robustly explain the intention to use ICTs, taking into account individuals’ perceptions of technology: (1) perceived usefulness and (2) perceived ease-of-use From the above two factors, the work by Alavi (2013) and HsiuFen (2008) highlight the fundamental role of perceived usefulness in the degree of satisfaction obtained by the VCoP user In particular, perceived usefulness refers to the degree to which users perceived a subjective probability that the virtual community will increase its performance in information exchange Thus, profits or the value obtained by the user is higher, thereby achieving increase satisfaction (Rouibah & Hamdy, 2009) H8 The level of utility the VCoP user perceives positively influences the degree of satisfaction In addition to being received as highly useful, user satisfaction is also influenced by the degree of perceived effectiveness and efficiency in the VCoP In this regard, the work of Barnett, Jones, Bennet, Iverson, & Bonney (2013, 2014) indicates that the VCoPs are listed as a highly effective and efficient means in the knowledge creation and sharing processes VCoPs not only favor the development of the above processes, but in addition, are shown as a means that can effectively deal with isolation processes that professionals suffer from (Larkins et al., 2004; Rolls et al., 2008) Also, since they are based on intensive use of ICT, VCoP allows the above benefits to be obtained quickly, simply and inexpensively (Anandarajan & Anandarajan, 2010) H9 The level of effectiveness that the VCoP user perceives positively influences the degree of satisfaction H10 The level of efficiency that the VCoP user perceives positively influences the degree of satisfaction In summary, Fig shows the developed model: Empirical analysis 3.1 Data collection, empirical methodology and validation This paper analyzes the determinants of user satisfaction in relation to the VCoP regarding the process of shared knowledge building To confirm the proposed hypotheses, we proceeded to conduct an exploratory analysis on a sample of 130 Spanish health professionals who actively participate in a VCoP (see Table 1) Created in 2013 to VCoP, consists of a total of 160 primary care physicians and specialty They voluntarily chose to participate in the VCoP in order to manage medical knowledge and, not only to bring benefits to both patients indirectly but to the professionals involved in health and the healthcare system The VCoP is managed by a multidisciplinary team but with common objectives and high levels of trust (see Table 2) Since its creation, VCoP has received a total of 6,349 consultations generated 439 contributions VCoP registered high activity for the months of April, May and June It can be considered that space has become a tool of communication and generation of knowledge among primary care and hospital care professionals at a national level All variables were measured directly through the questionnaire The obtained information was analyzed using bivariate and multivariate techniques, such as the binary logistic regression analysis Preliminary evidences 4.1 Physician’s profile The health professionals involved in the VCoP are mostly women, 77.3% of the total sample, with a highly specialized medical training (67.0%), and are active in the professional group of primary care (90.8%) Gender does not influence significantly the participation in VCoP (p = 0.23) whereas the activity performed and where one practices has a significant influence on the degree of participation The relationship between participation in the VCoP and the profession is statistically significant at a 99% confidence level (p = 0.0001) Nurses make up 33% of the participants in the VCoP, while the remaining 67.0% are doctors However, the same participants in the VCoP not maintain the same ratio of shares, as 91.6% are held by the group of doctors As occurred in the previous case, the relationship between the degree of participation and the location where the activity is developed is statistically significant at a 99%confidence level (p = 0.0001) Of the participants, 9.2% are active in hospitals, carrying 42% of the total shares in the VCoP While 58% of the participants is held by primary care professionals (90.8%) (see Table 3) Fig Theoretical model Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Computers in Human Behavior (2014), http://dx.doi.org/10.1016/j.chb.2014.11.057 A.I Jiménez-Zarco et al / Computers in Human Behavior xxx (2014) xxx–xxx 4.2 Drivers of VCoP user’s satisfaction Table Technical specifications of the study Sampling universe Sample Interview Margin of error Fieldwork 160 doctors 130 Online 3.7% p = q = 95% confidence level April–June 2014 Regarding the use of technology, 35.8% of VCoP users indicate they use a computer at least once a week, while 64.2% use it daily Users that use the computer both from home and from work make up 80.6%, while only 19.4% only use it at home or at work Finally, in relation to the VCoP, 34.3% of VCoP users indicate being highly satisfied with the virtual community However, it must be noted that although all individuals interviewed are members of the virtual community, levels of knowledge and confidence are relatively low Of the total respondents, only 34.6% admit to having a high level of knowledge of the community, compared to 65.4% indicating that they have a low level Also, 32.4% indicated that they trusted the usefulness of the community, while 67.6% indicated that their confidence level is low However, the perceived effectiveness and efficiency in the VCoP rises to 43.3% of respondents, who perceive highly the efficiency and effectiveness in the use of the VCoP In order to test the hypotheses proposed above, a binary logistic regression analysis was performed (see Table 4) This statistical technique measures the relationship between a categorical variable (nominal o nonmetric), and one or more independent variables, which are usually (but not necessarily) continuous, by using probability scores as the predicted values of the dependent variable The goodness-of-fit of is high as are confirmed by the values and levels of significance reached by the Chi-square statistic and the Hosmer–Lemeshow test Thus both are significant at 99% of confident level Both measures are similar, and indicate the extent to which the model provides better fit than a null model with no predictors, or, in a different interpretation, how well the model fits the data, as in log-linear modeling (Cox & Snell, 1989) Moreover, the values of Nagelkerke’s statistic indicated that the sample had explanatory power The value of this statistic was 79.3% Note that Naglekerke R2 coefficient summarizes the proportion of variance in the dependent variable associated with the predictor (independent) variables Thus, with larger R2 values indicating that more of the variation is explained by the model (Nagelkerke, 1991) All variables considered in the analysis, except genre and frequency of use of ICT influence the degree of satisfaction obtained by the healthcare professional The perceived effectiveness, followed by the degree of knowledge of VCoP are the two variables that have a greater influence on clinician satisfaction Both variables are significant at respectively 99% and 95% Table Variables of the study Model variable Definition Satisfaction Gender Profession The dichotomous variable indicates whether the user is satisfied with the VCoP The variable takes the value = yes and = no The dichotomous variable indicates whether the user is satisfied with the VCoP The variable takes the value = woman and = man The dichotomous variable indicates whether the user is in a practice as a doctor or nurse The variable takes the value = doctor, nurse and = The dichotomous variable indicates whether the user works in a primary or hospital care setting The variable takes the value = primary care, and = hospital Frequency of the use of technology by the healthcare professional The variable has the value of if ICT is used at least once a day, and if ICT is used at least once a week Location where the professional uses the technology = home, = workplace, = public places, = different places Professional level of knowledge about the VCoP The variable has the value if a high degree of knowledge, and if the level of knowledge is low Level of usefulness the professional perceives the VCoP to be The variable has the value of if has a high degree of knowledge, and if the level of knowledge is low Level of effectiveness the professional perceives the VCoP to be The variable has the value of if has a high degree of knowledge, and if the level of knowledge is low Level of efficiency the professional perceives the VCoP to be The variable has the value if a high degree of knowledge, and if the level of knowledge is low Number of consultations performed by the professional using VCoP The variable has the value = never, = between and 5; = 5– 10; = more than 10 Place of activity Frequency of use ICT Location of ICT use Degree of VCoP knowledge Degree of perceived VCoP utility Degree of perceived VCoP effectiveness Degree of perceived VCoP efficiency Number interconsultations made Table Descriptive variables of the sample Variable Participants Contribution Significance Gender Woman Man 77.3% 22.7% 72.3% 27.7% NS Profession Nurse Doctor 33.0% 67% 8.4% 91.6% *** Work place Primary Hospital 90.8% 9.2% 58% 42% *** 130 439 Total NS: Not significant Significant at 90% confidence level Significant at 95% confidence level *** Significant at 99% confidence level ⁄ ⁄⁄ Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Computers in Human Behavior (2014), http://dx.doi.org/10.1016/j.chb.2014.11.057 A.I Jiménez-Zarco et al / Computers in Human Behavior xxx (2014) xxx–xxx Table Relationships between the explanatory variables and VCoP users’ satisfaction Professional specialization Work place Gender VCoP participation level Frequency of ICT use Location of ICT use Level of VCoP knowledge Level of perceived usefulness on VCoP Degree of perceived VCoP effectiveness Level of perceived VCoP efficiency Constant B S.E Wald Df Sig Exp(B) 2.944 4.273 À.337 2.057 1.253 À1.217 1.254 4.584 9.395 4.045 2.266 743 1.434 301 753 1.158 420 427 1.800 2.820 2.312 2.471 15,686 8.878 1.249 7.467 1.171 8.374 8.625 6.487 11,103 3.062 841 1 1 1 1 1 000 003 264 006 279 004 003 011 001 080 359 053 71,740 714 7.821 3.500 296 3.503 97,897 000 57,136 9.637 Chi-square: 94,739, sig 0.000 Hosmer–Lemeshow test: 19.273, sig 0.018 Nagelkerke R square 793 Table Contrast of hypothesis Hypothesis H1: The degree of user involvement in the VCoP has a positive influence on satisfaction H2: The degree of professional specialization the VCoP user has a positive influence on satisfaction H3: The VCoP user´s workplace has a positive influence on satisfaction H4: The VCoP user´s gender does not influence the degree of satisfaction H5: The place where the VCoP user uses ICT has a positive influence on satisfaction H6: The frequency with which the VCoP user uses ICT has a positive influence on satisfaction H7: The degree of knowledge that the user has on the VCoP positively influences the degree of satisfaction H8: The level of utility the user perceives the VCoP to be positively influences the degree of satisfaction H9: The level of effectiveness the user perceives the VCoP to be positively influences the degree of satisfaction H10: The level of efficiency the user perceives the VCoP to be positively influences the degree of satisfaction YES YES YES YES YES NO YES YES YES YES confidence level Next in importance, work place (p = 0.003) and perceived efficiency (p = 080) Finally, the profession (p = 0.003), the number of consultations in the VCoP (p = 006), perceived usefulness (p = 003), and where ICT (p = 004) use, have a relatively low level of influence on user satisfaction The results obtained confirm the great majority of proposed hypotheses (H1, H2, H3, H4, H5, H7, H8, H9, H10) In this senseand as shown in Table 5-confirms that the professional profile of the user and their usage habits in relation to technology influence their degree of satisfaction with the VCoP Moreover, it also confirms how their perceptions regarding the benefits of VCoP and how efficiency and effectiveness influence on satisfaction Only hypothesis No (H6) related to the frequency of technology use is not confirmed Here, note that the vast majority of users use technology frequently (once a week) or very frequent daily) Discusion The knowledge society has promoted a change of scenery as far as the culture of knowledge is concerned This is summarized in the enhancement of exchange among peers, in a system where the value created is not dependent on hours worked, but in terms of knowledge provided Premium quality over quantity, hence it is necessary to organize the overall time efficiency criteria Also, the workplace is irrelevant, since the technology eliminates barriers of space and time, while access to resources, and the development of collaborative processes becomes possible Finally, in this time of innovation for the first time, the experience is a tool for improving worker efficiency by allowing: (a) reducing the time required to solve problems; (b) increase the degree of flexibility; (c) the promotion of collaboration with other agents In this context, communities of practice provide a useful model for knowledge management of the health organization; but also a mechanism that facilitates and promotes a new way of working and learning based on collaborative work and the use of collective intelligence If communities the virtual component is incorporated, increase both the type of benefits, such as the type of agents that perceive People, communities and organizations are tangible and intangible benefits through participation in VCoPs Fontaine and Millen (2004) reports three benefits: individual benefits (skills, and know how, personal productivity, job satisfaction and personal reputation and sense of belonging); community benefits (knowledge sharing, expertise and resources, collaboration, consensus and problem solving and trust between members), and organizational benefits (operational efficiency, cost savings level of service or sales, speed of service or product, and employee retention) Zboralski, Solomo, and Gemuenden (2006) reported outputs of participation, including knowledge effects (externalization, preservation, documentation and distribution of knowledge), business performance effects (improved business process, enhanced productivity, and innovation-enhancing effects) and socialization effects (collective sense making and common language) The real and bigger challenge in fostering a VCoP is the need to continuously supply knowledge, i.e., the willingness to continue knowledge – sharing Diverse perspectives have been used to explain what encourages VCoP members to voluntarily and continuously help one another through continuous knowledge-sharing One line of novel work is based on the analysis and identification of the drivers of user satisfaction with VCoP In line with the previous proposal, this paper tries to explain user satisfaction with VCOP through a model that combines factors relating to the user and technology To this, following an exploratory analysis, the professional user’s profile, their technology habits, and the degree of knowledge you have about VCoP are analyzed Further, also considered the role of technology, so that it takes into consideration the benefits of VCoP offers the user how the level of effectiveness and efficiency with which they are obtained The results obtained show that the variables are considered drivers of clinician satisfaction with VCoP The two most important factors are the effectiveness and perceived usefulness in VCoP Both factors are related to the perception on the technology-particularly on VCoP – user has Perceived usefulness refers to the value, or set of benefits that the user expects to receive the VCoP Meanwhile, the efficiency is the ability, or degree of effectiveness of Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Computers in Human Behavior (2014), http://dx.doi.org/10.1016/j.chb.2014.11.057 A.I Jiménez-Zarco et al / Computers in Human Behavior xxx (2014) xxx–xxx VCoP to achieve the goals that the user searches the VCoP While perceived usefulness The user approaches the VCOP with the aim of providing or obtaining a knowledge that is needed to solve a problem (Ramalho et al., 2010) In addition, you can also find other kinds of benefits can range from improving their professional practice (Ranmuthugala et al., 2011), to solve problems related to their isolation (Barnett et al., 2014) In relation to professional practice, it is observed VCOP That supports practitioners to evidenced based practice in Place to Enhance or performance In line with the work of Jiwa et al (2009), Ramalho et al (2010), improvement of professional practice involves improving the quality of care, reducing the time of diagnosis, or the establishment of new treatments and protocols in emergency situations In addition, improvement of professional practice facilitates management processes and innovation in the health institution VCoP makes possible generate ideas for new services, practices and products Communities of practice address complex dilemmas, such as improving quality and safeguarding high standards of care by fostering an environment for clinical care (Fung-Kee et al., 2008; Jiwa et al., 2009) Isolation is one of the main problems faced by health professionals The changes in training form hospital to general practice can contribute to the development of different types of isolation; that in turn lead to decrease knowledge sharing (Cooper & Kurland, 2002) lowered intention to work in rural areas and change of career choice (Williams et al., 2001) Social isolation, is described as a kind of loneliness occurs more commonly during rural terms (Larkins et al., 2004) Structural isolation results from a single doctor consulting with a single patient in a close room, with appointments often not in synchrony with other doctors, leading to lack of interaction with colleagues, and can occurs in both urban and rural placements Finally professional isolation is associated with barriers to knowledge sharing, including access to networking and training events The place where professional operates, along with the perceived efficiency, are the variables that have a high degree of importance on VCoP customer satisfaction Next in importance are the degree of professional expertise, the level of participation and the degree of knowledge that the user has the VCoP Finally, the place where the professional use of ICT is the variable with the lowest degree of influence on the level of satisfaction The place where the healthcare professional operates is strongly influenced by the degree of specialization that this presents Both variables have a strong influence on relationship, both in relation to the decision to participate in the VCoP, and in relation to the benefits sought As Larkins et al (2004) indicated, it is expected that those professionals with a lower level of specialization and operating in hospitals and research centers They are highly skilled professionals who have great knowledge, and who are at the forefront of specialization So it is very likely to participate in the VCoP in order to assist and support other professionals less qualified Meanwhile, primary care physicians or nurses, given their lower level of education, may access the VCoP intending to access the knowledge needed to address certain problems At other times, and as Williams et al (2001) the intention to participate in the VCoP seeks to minimize the problems of isolation they may suffer; both derived from the characteristics of the workplace for lack of a more specialized or current education The degree of perceived VCoP efficiency influences the degree of shown satisfaction The efficiency is the result of the relationship between the resources used in a project and achievements with it In line with the work of Massingham and Massingham (2014) and Zboralski et al (2006), the user perceives the VCOP as efficient in the moment: (a) the resources used to achieve the objectives which are less used with another type of system, medium or tool (including another VCoP); or (b) when using mime resources, VCoP yields better results In this sense, the virtual dimension of the VCoP favors the efficiency of this tool, it favors the development of relations between actors in the community, while streamlining the processes developed within With this, VCoP members can access or collaboratively foster a greater amount of developed knowledge Furthermore, it is also possible that all the above processes develop faster and safer, yet less expensive Factors such as the degree of knowledge or the level of user involvement in the VCoP also mark the level of satisfaction obtained It is clear that the level of user involvement in the VCOP is largely determined by the level of knowledge Knowledge not only is to be limited to identifying the potential benefits that the VCoP provides But as Egan and Jaye (2009) and Wenger E (2009) it also involves knowing the different technological applications and virtual spaces with which it has A VCoP incorporates technological applications such as blogs and wikis are able to facilitate communication and the exchange of knowledge These processes are the basis for the development of collaborative learning processes The greater the degree of user knowledge and a more streamlined and efficient process of knowledge creation and sharing, the higher the obtained performance will be So when the user knows the usefulness of each tool available in the VCoP, the higher the level of participation Regarding the participation of users, the results obtained indicate the existence of three different groups Within them, there is a different level of satisfaction, such as a greater degree of participation and a higher level of achieved satisfaction This conclusion fully agrees with the results shown by Vázquez-Bronfman (2011), Chang et al (2009) and Gabbay and Le May (2009) Among others, who indicated that each group of VCoP users display behaviors and seek different goals through their participation in the VCoP The leaders or core group represent a very small percentage of the total participants in the community, but play a more active role Mainly they are related as highly specialized professionals who carry out their main activity in hospitals or in research On the contrary, the peripheral group is composed of a high percentage of individuals who simply consult and use the information available in the VCoP The majority it comes from individuals with a lower degree of specialization of primary care-doctors, and nurses looking at the information needed to resolve questions or problems regarding a diagnosis en the VCoP Finally, the place indicated where the professional use of ICT is the variable with the lowest degree of influence on user satisfaction 80.6% of users use the technologies recognized in both the workplace and at home This is an individual who use ICT technology intensively, both professionally and personally But above all, it is a user who highly values the capacity of the VCOP to establish asynchronous communication, and to be able to overcome the barriers of space and time The frequency of ICT use and gender are the only variables that show no influence on the level of satisfaction In relation to the frequency of use, the results not meet expectations Academic literature suggests the existence of a positive relationship between frequency of use and satisfaction (Chandler & Fry, 2009; Gabbay & Le May, 2009) However, considering the high frequency of ICT use makes the group of medical professionals expect the lack of significance in the relationship Furthermore, in relation to gender and user, the results confirm the hypothesis As noted previously, the work done not show conclusive results on the sign and strength of the relationship between gender and satisfaction The group of health professionals shows significant differences in gender But these differences are Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual communities of practice Computers in Human Behavior (2014), http://dx.doi.org/10.1016/j.chb.2014.11.057 A.I Jiménez-Zarco et al / Computers in Human Behavior xxx (2014) xxx–xxx not maintained in relation to the participation of these professionals in a VCoP In relation to the gender of the members of the sample, we note the high percentage of women who make up – 77.3% of the total This fact does not influence the non-significance of the variable gender; however it does have to be recognized as one of the limitations of the study, which is necessary to consider the conclusions presented here as a first approximation to the analysis of VCoP in healthcare Other limitations to consider are the limited sample size due to the newness of the VCoP, with some limitations arising from the use of measurement scales used in the questionnaire This study constitutes an initial approach to this line of research The exploratory nature of the study influences on the size of the sample, which are users of an only VCoP, or on the statistical technique used Therefore, despite the interesting findings obtained, they must be considered with caution Thus, the nature of the analysis makes it advisable to propose future research in relation to the analysis of new drivers in satisfaction, or use of metric scales to measure the variables analyzed It is also of interest to identify how the degree of user satisfaction significantly influences on the long-term behavior that shows VCoP user As a conclusion, show that hardly the results of our research cannot conclude to some design guidelines for future generation systems for collaborative learning in the healthcare Nevertheless they show some evidence about what are some of the reason for using social media – especially VCoP – for health communication, as well as what are the benefits and the limitations that this technological tool offers to users Among the reasons for using social media for health communication we can identify the next: (a) provide health information on a range of conditions; (b) facilitating dialogue between different groups of health professionals (c) collect data on professionals’ experiences and opinions On the other hand, it is possible to identify some benefits and limitations relative to VCoP use Among the benefits, note: (a) the increase of interaction among healthcare professionals, (b) the knowledge creation and sharing process; (c) peer/social/emotional support, (d) public health surveillance, and (e) potential to influence health policy Finally, among the limitation, we can identify the next: (a) lack of reliability, confidence and privacy; (b) risks associated with communicating harmful or incorrect advice; (c) information overload References Academic and estrategic implications 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Among them, TAM is the theoretical proposal most widely applied into healthcare sector Please cite this article in press as: Jiménez-Zarco, A I., et al The co- learning process in healthcare professionals:... satisfaction The conclusion shows interesting strategic recommendations in the management process of VCoP Theoretical background 2.1 The virtual community of practice in the healthcare sector: outcomes... to the CoP The intensive use of ITC has favored the development of VCoP A virtual community is a community of people sharing common interests, ideas, and feelings over the Internet or other collaborative