Presenting a Model for the Development of Public-Private Partnerships in the Health System through Electronic Word-of-Mouth

Extended Abstract

Background
Financing the health system and using the capacity of the private sector through participation is one of the challenging issues when evaluating the performance of the world's health systems. Today, the model of public-private partnerships is used as one of the methods of doing infrastructural affairs such as health and treatment. These health partnerships not only address the gaps in health infrastructure development, but also offer a wide range of benefits; however, they also present challenges. There is evidence that community’s awareness of the positive social effects of the health system encourages investors, philanthropists, and charitable organizations to continue their activities. Organization managers seek new ways to inform their audience of their plans and projects. One of the most effective methods based on communication among people is word-of-mouth marketing. People ususally pay less attention to the advertisements of companies and organizations and, instead, look for products and services based on information they obtain from their relatives, friends, and trusted market through informal relationships and word-of-mouth conversations. This study aimed to present a model for developing (public-private) health system partnerships through electronic word-of-mouth communication.

Methods
This qualitative study was conducted in two stages. In the first stage, the meta-synthesis method was implemented based on the seven-stage model of Sandelowski and Barroso. The required data were collected using library methods, document review, books, articles, Persian and Latin publications, scientific and research quarterly journals, authoritative Iranian and English websites from the theoretical foundations and empirical background of research in the field of public-private partnerships, and word-of-mouth dialogue. The factors affecting the development of health system partnerships between the years 2012-2022 were collected, studied, identified, and extracted, and their associations with the initial classification were investigated. To monitor the extracted results and reliability assessment, the opinions of an expert member from the academic staff and lecturer of the university were sought. In the second stage of this study, a modified Delphi method was adopted, so that the indicators extracted in the first stage were initially categorized and submitted to experts in the form of a designed template. The experts – a group of health system partnership experts – included university professors, government managers, private sector entrepreneurs, philanthropists, as well as academic and marketing experts, who were selected by using non-random, targeted sampling and snowball methods. To collect the data, a 5-choice Likert scale questionnaire was used, and SPSS software was used for doing calculations. Cronbach's alpha coefficient was performed for assessing the reliability of questionnaire, and the pre-test method was employed for determining the validity.

Results
After searching for 217 articles in the meta-synthesis stage, 27 articles were selected by reviewing the critical appraisal method. Then the content and results of the given articles were examined and, as the result, 66 primary codes were extracted as the indicators and factors affecting the development of partnerships. These indicators were grouped into twelve components by a researcher as well as by an expert member of the academic staff and lecturer of the university. Since the dimensions of word-of-mouth conversation in the field of health and treatment had been already investigated and clustered by Martin (2017) and Pauli (2022), this clustering was set as the basis of our study and the given components in three categories including creation, dissemination and impact, as well as the classification and the initial model were presented. To initiate the Delphi phase of our study, the questionnaire was given to the experts in two rounds. In the first round and after distributing the questionnaire among the members of the expert panel and collecting the information, the statistical indicators of average and standard deviation were calculated. The favourable value of the first round was three and that of the second round was four, the codes whose average was equal to or higher than the favourable value were in the remaining model, and the components with an average of less than four were removed. Kendall's coordination coefficient was used to determine the degree of coordination between the opinions of the panel members and the end of the Delphi rounds. Kendall's coordination coefficients were 0.641 and 0.657 in the first round and second round, respectively. These values indicated a strong agreement regarding the results. Furthermore, the difference between the second round and first round in terms of the Kendall coefficient revealed an increase of 0.016 and a growth of about 2.5%. These amounts showed that the consensus among the panel members was not significantly increased between two consecutive rounds, and that the Delphi steps could be ended. At the end of the experts' consultation and out of 66 primary extracted codes, 30 refined or deleted codes and 36 final codes or indicators in the form of nine components were confirmed by the experts; moreover, three categories of creation factors, diffusion factors, and impact factors remained in the model and were approved by the experts.

Conclusion
The government relative failure in providing the necessary platform for the implementation of health system partnerships as well as the low level of motivation and lack of acceptance of the private sector were found to halt achieving the goals and plans of the vision document of Iran's healthcare sector. This study highlighted the importance and function of word-of-mouth communication in the virtual space for motivating and establishing communication among the government and the private sectors and donors in the field of health and treatment in order to strengthen all kinds of partnerships in the health system. This study, therefore, was able to identify the indicators and components affecting health system partnerships, as well as to present a new model for developing health system partnerships, exploiting the huge economic, cultural, and social potentials of the public, private, and charity sectors, and boosting the productivity of existing assets in the field of health and treatment. Achieving the above-mentioned goal may have helped organizations in charge of health and prosperity to improve the quality of healthcare services.