Crisis of confidence : re-narrating the consumer-professional discourse

The professional-consumer relationship in professional services has undergone unprecedented change. Relationships which were traditionally dominated by respect for professional status are in flux as increasingly educated consumers challenge the professional establishment. This paper considers the nature of the professional service consumer and the implications for professional service encounters. Based on qualitative interviews we identify four patterns of consumer-professional interaction, compliant, collaborative, confirmatory, and consumerist, which reflect the nature of the discourse between consumer and professiona

Talking together : consumer communities in healthcare

Consumer involvement in computer mediated communities (CMCs) is increasing particularly in high involvement services such as healthcare. This paper examines the role of CMCs as providers of patient information and support and the subsequent effect on the relationship between 'informed' consumers and health care providers. The evolving dialogue between consumers in virtual communities provides one key axis along which professional service consumption will evolve. The challenge for service consumers is to develop frameworks that facilitate robust dialogue and exchange of information and emotional support to complement their rising authority. The parallel challenge is for the established medical profession to recognise the consequences of this evolving dialogue and develop approaches to service delivery that effectively engage with consumers on the basis of this increasing authority

The development of professional short term reinsurance in South Africa : 1950-1985

This thesis covers the history of short term reinsurance in South Africa from 1950 to 1985 and shows how it developed from a very limited market in which insurers generally relied on British and European professional reinsurers to a viable local market albeit with strong foreign support. The study demonstrates that the local reinsurance market grew in parallel with the development of the South African economy and the consequent need for extensive cover arising from the country's industrial expansion. It considers the different problems of the two waves of locally established reinsurers and the different circumstances prevailing in the two distinct eras of South African short term reinsurance. The conclusion reached is that, notwithstanding the varied results of individual reinsurers and the collapse of two local reinsurance companies, the market performed well and succeeded in meeting the needs of the South African short term insurance marke

Patients, Professionals and the Internet: Renegotiating the Healthcare Encounter

The aim of this research was to examine how patient use of internet information impinges on the utilisation of healthcare services. The research had the following objectives: + to quantify the extent, and patterns, of patients use of the internet as a health information resource and identify the factors leading to variations in behaviour. + to identify the search strategies employed by patients in accessing internet health information internet and the evaluative approaches used in assessing information quality. + to analyse the content and dynamics of virtual health communities and how participation in such communities is integrated into engagement with health services. + to document the evolving nature of patient-professional interaction arising from patient access to health information and the subsequent format of the healthcare encounter. + to assess the effect of changing patient access to information and changes in the healthcare encounter on patterns of patient decision making and health behaviours

Technology push without a patient pull: examining Digital Unengagement (DU) with online health services

Purpose Policymakers push online health services delivery, relying on consumers to independently engage with online services. Yet, a growing cluster of vulnerable patients do not engage with or disengage from these innovative services. There is a need to understand how to resolve the tension between the push of online health service provision and unengagement by a contingent of health-care consumers. Thus, this study aims to explore the issue of digital unengagement (DU) (i.e. the active or passive choice to engage or disengage) with online health services to better inform service design aligned to actual consumer need. Design/methodology/approach Adopting a survey methodology, a group of 486 health services consumers with a self-declared (acute or chronic) condition were identified. Of this group, 110 consumers were classified as digitally unengaged and invited to write open-ended narratives about their unengagement with online health services. As a robustness check, these drivers were contrasted with the drivers identified by a group of digitally engaged consumers with a self-declared condition (n = 376). Findings DU is conceptualized, and four levels of DU drivers are identified. These levels represent families of interrelated drivers that in combination shape DU: subjective incompatibility (misalignment of online services with need, lifestyle and alternative services); enactment vulnerability (personal vulnerabilities around control, comprehension and emotional management of online services); sharing essentiality (centrality of face-to-face co-creation opportunities plus conflicting social dependencies); and strategic scepticism (scepticism of the strategic value of online services). Identified challenges at each level are the mechanisms through which drivers impact on DU. These DU drivers are distinct from those of the digitally engaged group. Research limitations/implications Adding to a nascent but growing literature on consumer unengagement, and complementing the engagement literature, the authors conceptualize DU, positioning it as distinct from, not simply a lack of, consumer engagement. The authors explore the drivers of DU to provide insight into how DU occurs. Encapsulating the dynamic nature of DU, these drivers map the building blocks that could help to address the issue of aligning the push of online service provision with the pull from consumers. Practical implications This paper offers insights on how to encourage consumers to engage with online health services by uncovering the drivers of DU that, typically, are hidden from service designers and providers impacting provision and uptake. Social implications There is a concern that there will be an unintentional disenfranchisement of vulnerable segments of society with a generic policy emphasis on pushing online services. The paper sheds light on the unforeseen personal and social issues that lead to disenfranchisement by giving voice to digitally unengaged consumers with online health services. Originality/value Offering a novel view from a hard-to-reach digitally unengaged group, the conceptualization of DU, identified drivers and challenges inform policymakers and practitioners on how to facilitate online health service (re)engagement and prevent marginalization of segments of society

Health communities as permissible space: supporting negotiation to balance asymmetries

Online communities provide promising opportunities to support patient–professional negotiations that address the asymmetries characterizing health services. This study addresses the lack of in-depth understanding of these negotiations, what constitutes successful negotiation outcomes, and the potential impact of negotiation on offline health behaviors. Adopting a netnographic approach, two threads were observed from each of the four online health communities focusing on breast cancer, prostate cancer, depression, and diabetes, respectively. This analysis was supplemented with 45 in-depth interviews. The evidence suggests that online health communities can be constructed as permissible spaces. Such virtual spaces facilitate the type of patient–professional negotiations that can redress asymmetries. The critical elements of the negotiation process are identified as occupation, validation, advocacy, and recording. These support patients and professionals as they debate and resolve conflicts in how they experience health. Direct tangible offline negotiation outcomes are reported (e.g., changes in treatment plans). Implications for professional–patient partnerships are also explored

The customer experience of town centres

The UK’s shoppers have not yet deserted their local High Street. But once consumers no longer achieve what they want in town centre visits, its oft-predicted death is liable to become a self-fulfilling prophecy. The High Street is likely to survive only for as long as consumers enjoy the town centre customer experience. This is the stark message that emerges from our research. The growth of out-of-town stores, the convenience of supermarkets and the rise of online retailing have not yet delivered a fatal blow to the town centre, but the window of opportunity to ensure that most people still continue to shop in the heart of their own communities is becoming smaller. By tracking shoppers over a period of time, thus producing a uniquely detailed picture of consumer behaviour, we have shown that the town centre is still the UK’s favourite shopping destination. In other words, despite mounting competition, the High Street retains our patronage. This in itself is hugely significant, but it is no cue for complacency – quite the opposite. It is a cue for action. The fact remains that the town centre is only just ahead of the supermarkets as the closest competitor, while online retailing, although attracting fewer visits, already generates more spending. The competition is intensifying and it will only increase with advances in mobile technology. Crucially, our study provides a comprehensive analysis of how and why consumers use the town centre. For the first time we have been able to break down the consumer “journey” to identify town centre “touch points”; the key moments of interaction with the retail environment, to develop a much more precise and nuanced understanding of what makes people come back, what compels them to go elsewhere, what they value and what they dislike. This unprecedented insight into the customer experience, drawn from both quantitative and qualitative data, highlights the enormous challenges and opportunities that now confront town centres. Perhaps most importantly, it offers empirical proof that it is the town centre customer experience, above all, that translates into greater consumer spend. Consequently, we argue that it is by developing the fullest possible understanding of the customer experience and using it to attract customers to visit and return, that our town centres are most likely to survive. Ultimately, although they may be acutely aware of its failings, UK consumers still want their town centres to work. This study explains how and why the customer experience is key to granting them their wish. We hope our findings and recommendations will help to make the necessary transformation possible

Effect of Pulsed or Continuous Delivery of Salt on Sensory Perception Over Short Time Intervals

Salt in the human diet is a major risk factor for hypertension and many countries have set targets to reduce salt consumption. Technological solutions are being sought to lower the salt content of processed foods without altering their taste. In this study, the approach was to deliver salt solutions in pulses of different concentrations to determine whether a pulsed delivery profile affected sensory perception of salt. Nine different salt profiles were delivered by a Dynataste device and a trained panel assessed their saltiness using time–intensity and single-score sensory techniques. The profile duration (15 s) was designed to match eating conditions and the effects of intensity and duration of the pulses on sensory perception were investigated. Sensory results from the profiles delivered in either water or in a bouillon base were not statistically different. Maximum perceived salt intensities and the area under the time– intensity curves correlated well with the overall perceived saltiness intensity despite the stimulus being delivered as several pulses. The overall saltiness scores for profiles delivering the same overall amount of sodium were statistically not different from one another suggesting that, in this system, pulsed delivery did not enhance salt perception but the overall amount of salt delivered in each profile did affect sensory perception

Identification of a novel prophage regulator in Escherichia coli controlling the expression of type III secretion

This study has identified horizontally acquired genomic regions of enterohaemorrhagic Escherichia coli O157:H7 that regulate expression of the type III secretion (T3S) system encoded by the locus of enterocyte effacement (LEE). Deletion of O-island 51, a 14.93 kb cryptic prophage (CP-933C), resulted in a reduction in LEE expression and T3S. The deletion also had a reduced capacity to attach to epithelial cells and significantly reduced E. coli O157 excretion levels from sheep. Further characterization of O-island 51 identified a novel positive regulator of the LEE, encoded by ecs1581 in the E. coli O157:H7 strain Sakai genome and present but not annotated in the E. coli strain EDL933 sequence. Functionally important residues of ECs1581 were identified based on phenotypic variants present in sequenced E. coli strains and the regulator was termed RgdR based on a motif demonstrated to be important for stimulation of gene expression. While RgdR activated expression from the LEE1 promoter in the presence or absence of the LEE-encoded regulator (Ler), RgdR stimulation of T3S required ler and Ler autoregulation. RgdR also controlled the expression of other phenotypes, including motility, indicating that this new family of regulators may have a more global role in E. coli gene expression