Co-Creating Health - Examining the Effects of Co-Creation in a Lifestyle Intervention Service Targeting Physical Activity

Aalto University, P.O. Box 11000, FI-00076 Aalto www.aalto. fi Author Karita Reijonsaari Name of the doctoral dissertation Co-Creating Health Examining the Effects of Co-Creation in a Lifestyle Intervention Service Targeting Physical Activity Publisher School of Science Unit Department of Industrial Engineering and Management Series Aalto University publication series DOCTORAL DISSERTATIONS 68/2013 Field of research Service Research Manuscript submitted 30 August 2012 Date of the defence 10 May 2013 Permission to publish granted (date) 12 March 2013 Language English Monograph Article dissertation (summary + original articles) Abstract Health behavior is an important determinant of an individual's health. The increase in chronic diseases in developed countries has been, to a large extent, caused by unhealthy, e.g., sedentary lifestyles. The results are unnecessary suffering and substantial cost to society. Lifestyle interventions as a service seek to co-create improved health behavior with individuals. The objective of using them is to prevent or manage chronic illness. Employers are gradually becoming more interested in investing in the health of their employees and are hoping to capture value from these investments. In this context, value refers to improved health and increased capability. As employers seek these goals, lifestyle interventions are being increasingly implemented in an occupational setting. However, there is limited evidence concerning their effectiveness.Health behavior is an important determinant of an individual's health. The increase in chronic diseases in developed countries has been, to a large extent, caused by unhealthy, e.g., sedentary lifestyles. The results are unnecessary suffering and substantial cost to society. Lifestyle interventions as a service seek to co-create improved health behavior with individuals. The objective of using them is to prevent or manage chronic illness. Employers are gradually becoming more interested in investing in the health of their employees and are hoping to capture value from these investments. In this context, value refers to improved health and increased capability. As employers seek these goals, lifestyle interventions are being increasingly implemented in an occupational setting. However, there is limited evidence concerning their effectiveness. This research examines the effects of co-creation in lifestyle interventions targeting physical activity in an occupational setting. Co-creation of value in a service relationship has been widely discussed by service research, particularly in the domain of Service-dominant logic. Cocreation in the context of health, on the other hand, has received limited attention. This dissertation contributes to the discourse on Service-dominant logic and co-creation of health. It extends conceptual models on co-creation to account for the particular characteristics of a lifestyle intervention service context, as well as the role of an employer as a third party in cocreation. The empirical research was conducted as a randomized controlled trial examining the effects of co-creation in a physical activity intervention. The lifestyle intervention that was examined was found to be ineffective in changing health behavior: no effects of co-creation on physical activity were observed, nor were work-related outcomes of increased productivity or reduced sickness absence seen. This suggests that these types of interventions may not be as effective as popularly believed. This study demonstrates that although interaction takes place in a service relationship, value is not always co-created, and improved health and increased capability may not occur. Thus, co-creation is interaction, but not all interaction is co-creation. The results of this study highlight the idea that employer investments in lifestyle interventions should be based on evidence of their effectiveness in the specific context.