Theses and Dissertations

Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Business Administration

First Advisor

Dr. Mohammadali Zolfagharian

Second Advisor

Dr. Michael Minor

Third Advisor

Dr. Reto Felix


Both Service Dominant (SD) logic and transformative service research have received attention from marketing managers and scholars as a result of the expansion of the service sector. However, the SD logic perspective on "the growth of human wellbeing needs more explanation and attention" (Vargo & Lusch, 2016, p. 20). Healthcare is particularly relevant to both streams of research and enables customers to contribute to their wellbeing through cocreation of value. The marketing literature indicates customer value cocreation (CVCC) in healthcare activities enhances service perceptions and quality of life (QoL). However, the healthcare literature demonstrates that cocreation may damage patients' psychological health and wellbeing. Thus, this research explores the mechanism and conditions to determine when and how CVCC may have positive/negative consequences on firms and patients. I study CVCC in the four areas of adherence, communication, goal setting, and decision making, and highlight the roles that anxiety, service quality, and disease severity play in explaining the relationship between CVCC and QoL. The conceptual model of this research is tested in two empirical studies, including a field study among pregnant women and an online survey among individuals with chronic diseases. Furthermore, the model was explored and confirmed using two analytical approaches: partial least square and covariance-based structural equation modeling. The results support in general the proposed conceptual model and reveal the double-edged character of CVCC as capable of producing both positive and negative consequences. Even though anxiety declines with increased CVCC in the areas of adherence, communication, and goal setting, customers feel greater anxiety when they cocreate in decision making, since the latter is perceived as an effortful and difficult activity. Subsequently, anxiety reduces QoL and satisfaction with service through service quality. Disease severity moderates the effect of CVCC on anxiety as well as the effects of service quality and satisfaction on QoL. More specifically, the mitigating effects of adherence, communication, and goal setting on anxiety heighten when disease is highly severe. Interestingly, disease severity flips the escalating effect of decision making on anxiety to a mitigating effect, indicating that in highly severe situations cocreation in decision making reduces anxiety.


Copyright 2017 Arash Hosseinzadeh. All Rights Reserved.