The second proposition developed for the qualitative research was:
Qualitative Proposition 2: The initial adherence process derived from S- D Logic provides a foundation for the final qualitative process.
The approach taken was first to establish a potential positioning of adherence factors within the initial process and then to assess this positioning through interviews.
It is necessary to consider the six factors of motivation, beliefs, agency, affordance, consumption context and norms. Some of these factors may be applied to the initial view in multiple places while some elements of the process may support more than one factor being applied. Each factor will be positioned in turn.
Firstly, motivation. This is an attribute of the patient which contributes to their agency. It may therefore be placed within the process prior to Agency. It may also be present in the decision on whether to consume so could therefore also be placed on the A-C value ex ante assessment, and be present in the ex post
assessment also. Because motivation is likely to affect earlier decisions, additionally it may be present in the choice as to whether to obtain the medicine.
Secondly, beliefs. This is a rule within the patient which contributes to their agency and so may be placed in the same places as motivation. It may also be present in the decision on whether to consume so could therefore also be placed
on the A-C value ex ante assessment, and in the ex post value assessment. As with motivation, it may contribute to whether the medicine is obtained.
Thirdly, agency. This the source of the patient’s resources which are brought into the consumption context and so can be placed on Agency. It may also be present in the decision on whether to consume and whether to consume again so could therefore also be placed on the A-C value ex ante and ex post assessments. It may also be involved in actually identifying the appropriate medicine to obtain, and therefore may be placed between the medicine’s Value Proposition and its Affordances.
Fourthly, affordance. This is the source of the medicine’s resources which are brought into the consumption context and so may be placed on Affordances. Since affordance also includes costs, both financial and access-related, it may also be present in the medicine’s Value Proposition. Also, since costs may be included in the ex post assessment of value, affordance may also be placed at this point.
Fifthly, norms. These are rules within the context which are taken into account by the patient when making a decision to consume and so may be overlaid onto the picture of service ecosystems. The positioning of service ecosystems within the consumption Context was done in order to emphasise that they are part of that context, but they contribute to the A-C value ex ante assessment and potentially the ex post assessment also. Therefore although the placement of norms appears to be correct it may be appropriate to consider it to be part of that ex ante
and ex post assessments and so be placed there instead.
Sixthly, context. This is obviously the consumption Context. It also encompasses contributions to context of other value propositions required to consume the medicine.
Seventh and finally, the process of value cocreation must be brought into the picture since this represents consumption. This is present as Adherence in the view of the process.
These possibilities can be enumerated, if necessary grouped, and then tentatively applied to the initial process ready for testing their alignment with interview content. The resulting application can be seen in Figure 23, and are described in detail below.
Group 1 represents the costs of obtaining the medicine and relates to the medicine’s value proposition, leading to its affordance. It also represents the levels of motivation and beliefs of the patient.
Group 2 represents the patient’s motivations and beliefs as they are applied to medicine consumption.
Group 3 represents the agency of the patient in being able to identify the correct medicine, and the affordability of the medicine which therefore contributes to its affordance.
Number 4 represents the sum total of the patient’s agency brought into the medicine consumption context.
Number 5 represents the contribution of all the value propositions other than the medicine which are required for the patient to consume the medicine.
Number 6a represents the norms which contribute to the consumption decision. Norms is part of the context but also contributes to the decision so number 6 is split into two parts.
Group 6b represents the motivation, beliefs and agency which contribute to the consumption decision in relation to the medicine’s affordance, perception of the norms and the anticipated context. Considering number 6 as being in two parts shows that both parts operate together.
Number 7 represents the actual consumption event, or value cocreation. This entails a coming-together of patient and medicine in context, thus engaging all factors at once.
The three purposes of the qualitative research as related to these factors are to investigate whether these placements are valid, to determine whether they represent the three constructs in a feasible way, and to explore them in depth. The interviews will contribute to this by helping to ascertain whether the suggested factors are present in each group, thus supporting the alignment of Qualitative Proposition 2 with the reality of the interviews.
As a working model of these placements, Figure 23 represents the foregoing groupings which can now be assessed qualitatively.
Figure 23: Initial process with group placements
More formally, Qualitative Proposition 2 can be allocated its own subordinate propositions within the overall proposition. Since these placements represent potential inhibitors or enablers of adherence, these subordinate propositions will take that perspective in order to evaluate the underlying reasons for each, thus linking each with the factors that they include. Therefore the subordinate propositions propose that each of the placements is correct and are made up of the factors discussed. This approach leads to the subordinate propositions listed in Table 7. These are referred to as “S1”, “S2”, etc. These subordinate propositions were used as input to the interviews.
Table 7: Subordinate propositions for Qualitative Proposition 2
No. Stage in the process Enabler/inhibitor
S1 Obtaining the medicine The costs of obtaining the medicine, both money and time – medicine affordance, patient motivation and beliefs
S2 Contribution to agency The patient’s motivations and beliefs S3 Identification of
medicine
The patient’s agency identifying the correct medicine/affordances of the medicine
S4 Perception of agency Total of agency
S5 Availability of items in context
The context containing all required for medicine consumption
S6a S6b
A-C value assessment ex ante
The patient’s recognition of norms in taking the consumption decision
The patient’s motivation, beliefs and agency in taking the consumption decision, in relation to the medicine’s affordance and the context
S7 Value cocreation (P-C value)
The patient’s motivation, beliefs and agency The medicine’s affordances
The context and norms
S8 A-C value assessment
ex post
The patient’s motivation, beliefs and agency with respect to the medicine’s affordances, and the context and norms