The co learning process in healthcare pr

The co-learning process in healthcare professionals: Assessing usersatisfaction in virtual communities of practice Ana Isabel Jiménez-Zarcoa, Inés González-Gonzálezb,⇑, Francesc Saigí-Ru

The co-learning process in healthcare professionals: Assessing user

satisfaction in virtual communities of practice

Ana Isabel Jiménez-Zarcoa, Inés González-Gonzálezb,⇑, Francesc Saigí-Rubióc, Joan Torrent-Sellensa a

Economics and Business Studies, Open University of Catalonia – I2TIC Research Group-IN3Avda, Tibidabo, 39, 08039 Barcelona, Spain

b

Economics and Business Studies, Pompeu Fabra University – I2TIC Research Group-IN3, Ramón Trias, 27, 08005 Barcelona, Spain

c

Information Sciences and Communication Studies, Open University of Catalonia – I2TIC Research Group-IN3, Tibidabo, 39, 08039 Barcelona, Spain

a r t i c l e i n f o

Article history:

Available online xxxx

Keywords:

Co-learning

Information and communication

technologies (ICT)

Virtual communities of practice

Perceived satisfaction

Healthcare sector

a b s t r a c t

Communities of practice are nowadays an important concept in the healthcare sector Particularly, the intensive use of ICT has allowed their creation into a virtual environment – Virtual Communities of Prac-tice (VCoPs) developing optimal conditions to make possible the collaborative learning process The VCoPs antecedents can be situated on social network phenomenon, where individuals with different traits but a common interest/objective are linked, use ICT potency (especially social media) to inter-change information, experiences and contents among them And as a result, people create and share knowledge, and learn collaboratively VCoP users have a higher satisfaction level in the collaborative learning process when they can: (1) Achieve benefits related to patient diagnosis and treatment (cost reductions, faster management, quality and accuracy of diagnosis, etc.); (2) Increase the share capital

of participants and creating networks of trusted individuals Given the interest in this topic, the objective

of this work is to identify the factors that determine user satisfaction in relation to Community Practice (CoP) and the process of building shared knowledge For this, a sample of 130 Spanish health profession-als participating in an online community, and developed in a virtual community of practice, is discussed The results obtained from an analysis of logistic regression show evidence of the perception of efficiency and effectiveness in collaboration with the members of the VCoP as positively influencing the perceived satisfaction with the CoP Also, the degree of individual participation in the community affects the degree

of perceived satisfaction The conclusions provide interesting strategic recommendations in the manage-ment process of the CoP

Ó 2014 Elsevier Ltd All rights reserved

1 Introduction

Based on the theory of situated learning, where professional

learning occurred through participation in practice and interaction

with colleagues, the term of Communities of Practice (CoP) has

evolved over time to refer to groups of people who share a concern

or problem, and who come together to interact, learn and create a

sense of identity, and in the process, build, share knowledge and

solve problems (Wenger, 1998)

In the business sector, CoPs have gained recognition due to its

capacity to foster the professional development of individuals, as

well as improve business outcomes for organization (

Alicia-Rivera, 2011; Antony, Rosman, Eze, & Gan, 2009; Ardichvili, Page,

& Wentling, 2003; Swan, Scarbrough, & Robertson, 2002) Based

on these claimed benefits of CoPs in the business sector, the crea-tion of CoPs is being promoted in other professional fields, such as the healthcare sector

Initially, CoPs in the health sector have been used as a tool to drive knowledge management But as Díaz-Chao, Torrent, La

obtain other benefits relative to the improvement of: (a) profes-sional practice efficiency and efficacy; and (b) healthcare organiza-tional performance On the other hand, user satisfaction is a term frequently used in marketing area, and in general terms it is defined as a measure of how a products and services supplied by

a company meet or surpass user or customer expectation Relative

to healthcare sector, especially in relation to user VCoP satisfaction, this concept measures the subjective user assessments of the any outcome or experience regarding to a VCoP as a specific technolog-ical tool that makes possible the knowledge creation and sharing, and the collaborative learning process as well

http://dx.doi.org/10.1016/j.chb.2014.11.057

0747-5632/Ó 2014 Elsevier Ltd All rights reserved.

⇑ Corresponding author.

E-mail addresses: ajimenezz@uoc.edu (A.I Jiménez-Zarco), igonzalezgonzal@uoc.

edu , ines.gonzalez@upf.edu (I González-González), fsaigi@uoc.edu (F Saigí-Rubió),

jtorrent@uoc.edu (J Torrent-Sellens).

Contents lists available atScienceDirect

Computers in Human Behavior

j o u r n a l h o m e p a g e : w w w e l s e v i e r c o m / l o c a t e / c o m p h u m b e h

Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual

com-In this sense, literature points out the relationship between

sat-isfaction and users’ personal and sociodemographic characteristics

studies show that users’ profile characteristics influence on their

satisfaction level (Ardichvili, Page V., & T., 2012; Delone &

expecta-tions that users have relative to a VCoP, as well as in how this

tech-nological tool meets or exceed the users’ expected goals

The wide range of benefits offered by the CoPs in the healthcare

sector, and in particular the VCoP, makes it convenient to analyze

the determinants of user satisfaction in relation to the VCoP

regarding the process of building shared knowledge To this end,

this work presents two distinct parts Based on the concept of

VCoP, the theoretical part starts describing some of the main

ben-efits that virtual communities offer to health care organizations

Then, and based on a thorough review of the literature, we present

some of the factors identified as determinants in the degree of

sat-isfaction of VCoPs users as a tool in the process of knowledge

con-struction The factors considered are relative to individuals’

sociodemographic characteristics – gender, professional

specializa-tion, or workplace On the other hand, there also considered other

factors relative to the VCoP users’ profile, such as, the degree of

implication or knowledge that users have on the VCoP, as well

as- the levels of utility, efficiency or efficacy perceived

We continue the empirical study describing the characteristics

of the study sample of thr 130 Spanish health professionals, active

members in VCoP, as well as the variables used in the statistics The

results obtained after the development of a logistic regression

analysis, show the perception of efficiency and effectiveness in

col-laboration between CoP members, has a positive influence on the

perceived satisfaction in relation to the VCoP In addition, the

degree of individual involvement influences the degree of

per-ceived satisfaction The conclusion shows interesting strategic

rec-ommendations in the management process of VCoP

2 Theoretical background

2.1 The virtual community of practice in the healthcare sector:

outcomes and drivers of user satisfaction

CoP is described as informal groups bound together by a

com-mon interest or passion Wenger (1998)suggests that there are

signs which indicate that a CoP has been formed These signs

include: sustained mutual relations, ways of communications

and sharing information that are facilitated by a common

under-standing that might be unique to the CoP, forms of practice that

assume sharing implicit knowledge of the process and procedures

as well as a sense of ‘‘how things are going’’, a sense of membership

that has arisen from experiences of working together, and the

development of identifiable practice styles and are unique to the

CoP

The intensive use of ITC has favored the development of VCoP A

virtual community is a community of people sharing common

interests, ideas, and feelings over the Internet or other

collabora-tive networks.Alavi (2013)defines VCoPs as a social network of

individuals, who interact through social media, potentially

cross-ing geographical, political and psychological boundaries in order

to pursue mutual interest or goals In the same line, Ramalho,

conversation, a learning environment, and knowledge sharing

VCoP is a community of practice in which links relationships, and

these do not take place in a physical space, but in a virtual space

like the Internet

Individuals use social media in both, personal and professional

area In fact, organizations favor the use of social media as a means

to improve communication, knowledge creation and collaboration among employees.Antony et al (2009)show how the reason why communities of practice are effective in promoting knowledge cre-ation and sharing in organiscre-ations is the fact that most of an orga-nization’s competitive advantage is embedded in the intangible, tacit knowledge of its people and that competencies do not exists apart from people who develop them (Dougherty, 1995) Not only new knowledge can be created through the sharing in community, skills are also discursively produced and disseminated during the conversation and networking activities (Brown & Duguid, 1991; Weick & Westley, 1996)

Therefore, one of the ways to help people share and internalize tacit knowledge is to allow them to talk about their experiences and to exchange their knowledge while working on specific prob-lems Through this process, individual VCoP member’s skills, tal-ents and knowledge will be improved and can be identified This will enhance the community’s effectiveness as they recognize which one among them is an expert in a specific area The commu-nity may save their energy and time since they know the right per-son to refer to and to seek for advice regarding a specific subject matter or problem By having different skills, talents and knowl-edge among community members, the organization may leverage

on its human capital that is the source of its organisational capabil-ities The VCoP may also generate unique ideas for new product and services through the combination of different skills, talents and knowledge that each member possesses (Brown & Duguid, 1991; Weick & Westley, 1996)

Health professionals are using social media tools in a variety of innovative and creative ways – to build and improve social and professional networks and relationships, to share health-related information and to engage with the public, patients and colleagues

in shaping future health policies and priorities Closed online groups are also commonly used for education and peer support

In this sense, literature show how in healthcare sector, social media can offer enormous benefits to different groups, in different professional and social areas.Grajales, Sheps, Ho, Novak-Lauscher,

dimension to health care as it offers a medium to be used by the public, patients, and health professionals to communicate about health issues with the possibility of potentially improving health outcomes In this sense, recent works such asTsuya, Sugawara,

(2014)analyze the use of specific social media in treating of cancer

or diabetes patients But also, social media is a powerful tool, which offers collaboration between users and is a social interaction mechanism for a range of individuals, making possible two impor-tant process development: (1) knowledge creation and sharing, and (2) collaborative learning

Especially, VCoPs have made important progress in the knowl-edge management of health institutions (Nie, 2012) As

repre-sent, possibly the best way to manage knowledge bases in organi-zations, since they integrate the most important dimensions in knowledge management: the technological, strategic, and cultural

or behavioral dimensions

2.2 VCoPs benefits at healthcare organizations The interest in identifying the various benefits that VCoP offers

is relatively new in specialized literature And that is, as pointed out (Chang, Chang, & Jacobs, 2009) the various benefits offered: (a) have different kinds, (b) affect various agents and (c) influence different levels of developed activity

Relative to the benefits nature, Wenger, McDermott, and

assets, such as professional skill and business outcomes, but also

intangible assets such as relationships among people, a sense of

belonging, or professional identity, or the creation of intellectual

and relational or social capital However, it is clear that being able

to share and co-create knowledge is the main objective of VCoP in

healthcare In fact, one could say that this is the reason for

the community, allowing the short term to solve existing

problems both individually and collectively While long term,

it assumes an increase of intellectual capital available

(Alicia-Rivera, 2011)

The actual scope of VCoP is high Thus, it is possible to identify

three types of benefits depending on the recipient: individual

ben-efits; community benefits, and organizational benefits (Fontaine &

for people than for organizations Regarding individuals, VCoPs

affect both professional activity as well as the personal lives of

those individuals Furthermore, being members of the VCOP also

affects the way in which relationships are established at a group

level (Adams, Robert, & Maben, 2012; Barnett et al., 2014) While

in relation to organizations, the impact consists of four levels:

activities, output, value and business results (Berraies & Chaher,

2014; Chandler & Fry, 2009; Chang et al., 2009; Milne & Lalonde,

2007)

practitio-ners to change practice to implement evidenced based practice, or

to enhance performance Among the observed effects include

improving the quality of care (Jiwa et al., 2009; Ramalho et al.,

2010); reducing diagnostic time, or the establishment of new

treat-ments and protocols in emergency situations (Swan et al., 2002) In

fact, VCoPs facilitate management processes and innovation in the

health institution Work likes that ofLong, Cunningham, Carswell,

VCoP makes it possible to generate ideas for new services, practices

and products Communities of practice address complex dilemmas,

such as improving quality and safeguarding high standards of care

by fostering an environment for clinical care (Fung-Kee et al., 2008;

Jiwa et al., 2009)

Fung-Kee et al (2008)indicate benefits directly related to

activ-ity and the outcome of the health institution, such as increasing

productivity and saving time and economic costs (Díaz-Chao

et al., 2014; Massingham & Massingham, 2014; Ranmuthugala

et al., 2011; Schenkel & Teigland, 2008) Meanwhile, at the

strate-gic level, developing intellectual capital (Paype et al., 2014ß

Egan & Jaye, 2009; Ryan, Puri, & Liu, 2013) in the institution favors

the increase of involvement of health personnel, and the level of

competitiveness of the institution

Belonging to a VCoP also favors the creation of social capital,

derived from the network of people who make up the community,

and between which creates trust and commitment In relation to

the health institution,Lesser and Storck (2001)suggest that social

capital generates between VCoP members, favors knowledge, trust,

reciprocity, co-operation and behavioral changes that enhance

VCoP performance

links are between community members, the greater the knowledge

is shared between them The relationship can be so intense that

community members can create a sense of belonging and identity

through shared activity and purpose (Adams et al., 2012; Wenger,

1998) The latter is especially relevant in the professional field,

such as professional staff, to highlight the role of VCoP as a tool

to alleviate the degree of isolation experienced by the healthcare

professional.Barnett et al (2014) and Rolls, Kowal, Elliott, and

from hospital to general practice can contribute to the

develop-ment of different types of isolation; which in turn, leads to the

decrease of knowledge sharing (Cooper & Kurland, 2002) and

lowered intention to work in rural areas and change of career choice (Williams et al., 2001)

These claims have led to VCoP being promoted in healthcare as

a tool to enhance knowledge, improve practice, and in general, increase the individual and organizational performance (Le May,

2009) Nevertheless, the real and bigger challenge in fostering a VCoP is the need to continuously supply knowledge, i.e., the will-ingness to continue knowledge-sharing Most scholars dealing with this issue in relation to VCoPs have focused on the diverse perspectives in order to explain what encourages VCoP members

to voluntarily and continuously help one another through continu-ous knowledge-sharing

Among newer lines, that focus highlights on the análisis of the degree of user satisfaction with the VCoP, in relation to the process

of shared knowledge building in the healthcare sector So far, few papers have been published (De Valck, Van Bruggen, & Wierenga,

2009) But the first results obtained show how the identification

of the drivers of satisfaction can help improve and increase the knowledge creation process of VCoP

2.3 VCoP user satisfaction Satisfaction is possibly one of the concepts that has received most attention by academics and professionals Plentiful jobs from the field of management, and consumer behavior have dealt with providing a definition of this concept, and to identify the drivers

of user satisfaction (Powers & Dawn, 2009) However, in relation

to the health sector, there are few studies that analyze the satisfac-tion of healthcare professionals, especially in VCoPs (De Valck

et al., 2009)

Some of the work done in the field of VCoPs has analyzed user satisfaction from a social and relational perspective (Sun, Fang, &

of knowledge creation, motivated by factors related to their per-sonality and the satisfaction they feel when sharing their knowl-edge or collaborating with others (Ramalho et al., 2010) AsSun

processes is not based on monetary returns But also, authors as

are relative to: (a) the profile and usage habits of healthcare profes-sionals, and (b) technology effects can influence VCoP user satisfac-tion Thus, it is because sometimes users are involved in some knowledge exchange processes, due to hoping to get some kind

of benefit or reward, which is not of an economic or social nature The combination of both technical and human factors is rela-tively new That is why following the previous idea, in this paper

we propose a model that jointly considers factors relating to the professional’s user profile, their technological habits, and the degree of knowledge they have on VCoP In addition, also consid-ered are the benefits that the VCoP user provides and how the level

of efficiency and effectiveness with which they are achieved Generally, satisfaction measures subjective user assessments of any outcome or experience regarding a specific technological tool

or information system (Hsiu-Fen, 2008) User satisfaction is a determinant of the level of use of a technological tool (Delone & McLean, 1992), but also, it is a key factor in its success (Bourhis

& Dubé, 2010) In the present case, as the clinician is satisfied with VCOP as a knowledge management system, the greater the degree

of participation (De Valck et al., 2009; Hsiu-Fen, 2008)

Health staff participates voluntarily and with different degrees

of intensity in the VCoP The reasons for the user to approach and participate in it may be different in each case Although there

is a high degree of consensus regarding the motivation to partici-pate in the VCoP, it is related to the need to create or acquire the knowledge necessary to quickly and accurately solve a problem

Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual

com-(Cheung, Lee, & Lee, 2013; Sun et al., 2014;De Valck et al., 2009;

Ramalho et al., 2010)

As the user to respond to the need that leads to approach the

VCOP, will be satisfied In This sense, Adams et al (2012) and

to get involved in acts of knowledge creation, due that they feel the

moral obligation to share they knowledge, or repay what they have

gained from the VCoP (Chiu, Hsu, & Wang, 2006) In other cases,

users need to access to information and to specialist in certain field

(Chandler & Fry, 2009; Knoben & Oerlemans, 2006; Long et al.,

2014)

partici-pate in a VCoP differently Some people devote more to learning

from and connecting to other members, while others only want

to become informed through the results of the VCoP These authors

suggest that there are three levels of community participation

based on the level of participation in VCoP The first level consists

of the core or leaders or core group, it is a small group-above 10%

or 15% of the total, which is called the core of the community Then

there are the active members – active group – who participate

reg-ularly, but with a lower level of intensity than the previous group

Finally, there are the other members, or peripheral group – called

lukkers or peripheral group – who do not actively participate,

but at the periphery, are limited to read and use the information

available in the VCOP

Abundant studies point to the relationship between level of use

and satisfaction is directly and positively Delone and McLean

other simultaneously and that the type of relationship between

them is reciprocal, In the same lime, Anandarajan, Igbaria, &

related to user satisfaction However, some studies indicate that

the relationship between the two is not significant (Al-Gahtani &

King, 1999; Torkzadeh & Dwyer, 1994)

H1 The degree of user involvement in the VCoP has a positive

influence on satisfaction

The professional user’s profile has a significant impact on the

reasons for participating in the VCoP and in the level of satisfaction

(Ikioda et al., 2013) In particular, the degree of specialization of

health professionals, and the place where they work, determine:

(a) the professional skills of the individual (Adams et al., 2012.)

As well as (b) the knowledge that has and the needs of new

knowl-edge (Chandler & Fry, 2009;Cook-Craig & Sabah, 2009) Hopefully

those professionals with a lower level of specialization, participate

in VCoP in search of knowledge; while highly skilled professionals,

foster knowledge creation Also, where the professional conducts

business may also affect the role the professional plays in VCoP

primary care professionals, use the VCoP for knowledge or gather

information needed to provide more accurate diagnoses

H2 The degree of professional specialization the VCoP user has a

positive influence on the degree of satisfaction

H3 The VCoP user’s workplace has a positive influence on the

degree of satisfaction

Another characteristic feature of health professionals is gender

In recent years, there has been an increase in the number of

women entering the medical profession About 47% of the

profes-sionals are women (Lamber & Holmboe, 2005) Meanwhile, in the

group of nurses, the percentage of women is much higher, at nearly

90% in total (Kelly, 2010) This imbalance is also seen in terms of

the presence of women in positions of responsibility, as well as the performance of certain medical specialties (Pastor-Gosalbez, Belzunegui-Eraso, & Ponton-Merino, 2012)

However, in relation to the existence of differences in the use of technology, and the attitude and satisfaction with it, studies show

no conclusive results.Esteves, Bohórque, and Souza (2008)indicate that women have a lower predisposition to studies online How-ever, the above study, as that made byRiahinezhad, Samavatian,

show a different attitude or level of satisfaction than men Also

the degree of female participation in VCoPs

H4 The VCoP user’s gender does not influence the degree of satisfaction

The degree of user involvement in the VCOP is also largely determined by the frequency and where ICT use The presence of technological resources can facilitate collaborative learning, but cannot guarantee that it will occur at VCoP (Cook-Craig & Sabah,

2009) It is necessary that the user routinely utilizes technology, both in the professional field and personally It should be noted that physicians use ICTs in their professional and personal lives

As ICT users, healthcare professionals may use technology in differ-ent places and with differing degrees of frequency When it comes

to defining the profile of an ICT user, cultural and social aspects clearly have a role to play (Ammenwerth et al., 2003), as do other circumstantial variables such as experience and training (Agarwal

& Prasad, 1999) That is why we incorporated the physician’s ICT usage habits as an explanatory factor of the healthcare professional satisfaction

It is expected that the professional make greater use of ICT in the workplace This is especially relevant in relation to the use of VCoP, since this approach is highly professional (Chandler & Fry, 2009; Gabbay & Le May, 2009) Also considered is the professional using ICT often, because that user will be a regular user of VCOP and will develop an active role in it (Baroudi, Olson, Ives, & Davis, 1986)

H5 The place where the VCoP user uses ICT has a positive influence on the level of satisfaction

H6 The frequency with which the VCoP user uses ITC has a posi-tive influence on the level of satisfaction

The clinician makes the decision to be a member of the VCoP and then actively participates in it, and is conditioned by the degree of knowledge he has of the VCoP (Gabbay & Le May, 2009) The greater degree the knowledge, the greater the user’s ability to set realistic expectations about the benefits to the VCoP (Gustafsson, Johnson,

& Ross, 2005) Furthermore, also a high degree of knowledge about VCoP, favors the development of the activity within community, both in terms of the interaction between members (Fang & Chiu,

2006), as the technological tools that are available (Cheung et al.,

2013) Finally,Chang et al (2009), Cheung et al (2013)and De

VCOP makes results easier and more objective

H7 The degree of knowledge that the user has on the VCoP positively influences the degree of satisfaction

Along with professional features, technology is also a key factor

in the level of user satisfaction VCoP (Hsiu-Fen, 2008) Since the 1970s, various theoretical models have been developed with the aim of explaining the user’s attitude and acceptance of new infor-mation technologies in the professional sphere (Davis & Venkatesh,

theoretical proposal most widely applied into healthcare sector

(Hsiu-Fen, 2008; Jennett, Hall, Hailey, Ohinmaa, et al., 2003;

Palmas, Shea, Starren, et al., 2010; Wu, Chaudhry, & Wang,

2006) Thus, it has the capacity to robustly explain the intention

to use ICTs, taking into account individuals’ perceptions of

technol-ogy: (1) perceived usefulness and (2) perceived ease-of-use

From the above two factors, the work byAlavi (2013)and

in the degree of satisfaction obtained by the VCoP user In

particu-lar, perceived usefulness refers to the degree to which users

per-ceived a subjective probability that the virtual community will

increase its performance in information exchange Thus, profits

or the value obtained by the user is higher, thereby achieving

increase satisfaction (Rouibah & Hamdy, 2009)

H8 The level of utility the VCoP user perceives positively

influ-ences the degree of satisfaction

In addition to being received as highly useful, user satisfaction

is also influenced by the degree of perceived effectiveness and

effi-ciency in the VCoP In this regard, the work of Barnett, Jones,

Bennet, Iverson, & Bonney (2013, 2014)indicates that the VCoPs

are listed as a highly effective and efficient means in the

knowl-edge creation and sharing processes VCoPs not only favor the

development of the above processes, but in addition, are shown

as a means that can effectively deal with isolation processes that

professionals suffer from (Larkins et al., 2004; Rolls et al., 2008)

Also, since they are based on intensive use of ICT, VCoP allows

the above benefits to be obtained quickly, simply and

inexpen-sively (Anandarajan & Anandarajan, 2010)

H9 The level of effectiveness that the VCoP user perceives

positively influences the degree of satisfaction

H10 The level of efficiency that the VCoP user perceives positively

influences the degree of satisfaction

In summary,Fig 1shows the developed model:

3 Empirical analysis

3.1 Data collection, empirical methodology and validation

This paper analyzes the determinants of user satisfaction in

relation to the VCoP regarding the process of shared knowledge

building To confirm the proposed hypotheses, we proceeded to

conduct an exploratory analysis on a sample of 130 Spanish health professionals who actively participate in a VCoP (seeTable 1) Created in 2013 to VCoP, consists of a total of 160 primary care physicians and specialty They voluntarily chose to participate in the VCoP in order to manage medical knowledge and, not only to bring benefits to both patients indirectly but to the professionals involved in health and the healthcare system The VCoP is managed

by a multidisciplinary team but with common objectives and high levels of trust (seeTable 2)

Since its creation, VCoP has received a total of 6,349 consulta-tions generated 439 contribuconsulta-tions VCoP registered high activity for the months of April, May and June It can be considered that space has become a tool of communication and generation of knowledge among primary care and hospital care professionals

at a national level

All variables were measured directly through the questionnaire The obtained information was analyzed using bivariate and multi-variate techniques, such as the binary logistic regression analysis

4 Preliminary evidences 4.1 Physician’s profile The health professionals involved in the VCoP are mostly women, 77.3% of the total sample, with a highly specialized med-ical training (67.0%), and are active in the professional group of pri-mary care (90.8%)

Gender does not influence significantly the participation in VCoP (p = 0.23) whereas the activity performed and where one practices has a significant influence on the degree of participation The relationship between participation in the VCoP and the profes-sion is statistically significant at a 99% confidence level (p = 0.0001) Nurses make up 33% of the participants in the VCoP, while the remaining 67.0% are doctors However, the same partic-ipants in the VCoP do not maintain the same ratio of shares, as 91.6% are held by the group of doctors

As occurred in the previous case, the relationship between the degree of participation and the location where the activity is devel-oped is statistically significant at a 99%confidence level (p = 0.0001) Of the participants, 9.2% are active in hospitals, carry-ing 42% of the total shares in the VCoP While 58% of the participants is held by primary care professionals (90.8%) (see

Table 3)

Fig 1 Theoretical model.

Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual

com-Regarding the use of technology, 35.8% of VCoP users indicate

they use a computer at least once a week, while 64.2% use it

daily Users that use the computer both from home and from

work make up 80.6%, while only 19.4% only use it at home or

at work

Finally, in relation to the VCoP, 34.3% of VCoP users indicate

being highly satisfied with the virtual community However, it

must be noted that although all individuals interviewed are

mem-bers of the virtual community, levels of knowledge and confidence

are relatively low Of the total respondents, only 34.6% admit to

having a high level of knowledge of the community, compared to

65.4% indicating that they have a low level Also, 32.4% indicated

that they trusted the usefulness of the community, while 67.6%

indicated that their confidence level is low However, the perceived

effectiveness and efficiency in the VCoP rises to 43.3% of

respondents, who perceive highly the efficiency and effectiveness

in the use of the VCoP

4.2 Drivers of VCoP user’s satisfaction

In order to test the hypotheses proposed above, a binary logistic regression analysis was performed (seeTable 4) This statistical technique measures the relationship between a categorical able (nominal o nonmetric), and one or more independent vari-ables, which are usually (but not necessarily) continuous, by using probability scores as the predicted values of the dependent variable The goodness-of-fit of is high as are confirmed by the val-ues and levels of significance reached by the Chi-square statistic and the Hosmer–Lemeshow test Thus both are significant at 99%

of confident level Both measures are similar, and indicate the extent to which the model provides better fit than a null model with no predictors, or, in a different interpretation, how well the model fits the data, as in log-linear modeling (Cox & Snell, 1989) Moreover, the values of Nagelkerke’s statistic indicated that the sample had explanatory power The value of this statistic was 79.3% Note that Naglekerke R2coefficient summarizes the propor-tion of variance in the dependent variable associated with the pre-dictor (independent) variables Thus, with larger R2 values indicating that more of the variation is explained by the model (Nagelkerke, 1991) All variables considered in the analysis, except genre and frequency of use of ICT influence the degree of satisfac-tion obtained by the healthcare professional The perceived effectiveness, followed by the degree of knowledge of VCoP are the two variables that have a greater influence on clinician satisfac-tion Both variables are significant at respectively 99% and 95%

Table 1

Technical specifications of the study.

Sampling universe 160 doctors

Interview Online

Margin of error 3.7% p = q = 95% confidence level

Fieldwork April–June 2014

Table 2

Variables of the study.

Model variable Definition

Satisfaction The dichotomous variable indicates whether the user is satisfied with the VCoP The variable takes the value 1 = yes and 0 = no Gender The dichotomous variable indicates whether the user is satisfied with the VCoP The variable takes the value 1 = woman and 0 = man Profession The dichotomous variable indicates whether the user is in a practice as a doctor or nurse The variable takes the value 1 = doctor, nurse

and 0 = Place of activity The dichotomous variable indicates whether the user works in a primary or hospital care setting The variable takes the value

1 = primary care, and 0 = hospital Frequency of use ICT Frequency of the use of technology by the healthcare professional The variable has the value of 1 if ICT is used at least once a day, and

0 if ICT is used at least once a week Location of ICT use Location where the professional uses the technology 1 = home, 2 = workplace, 3 = public places, 4 = different places

Degree of VCoP knowledge Professional level of knowledge about the VCoP The variable has the value 1 if a high degree of knowledge, and 0 if the level of

knowledge is low Degree of perceived VCoP

utility

Level of usefulness the professional perceives the VCoP to be The variable has the value of 1 if has a high degree of knowledge, and 0 if the level of knowledge is low

Degree of perceived VCoP

effectiveness

Level of effectiveness the professional perceives the VCoP to be The variable has the value of 1 if has a high degree of knowledge, and 0

if the level of knowledge is low Degree of perceived VCoP

efficiency

Level of efficiency the professional perceives the VCoP to be The variable has the value 1 if a high degree of knowledge, and 0 if the level of knowledge is low

Number interconsultations

made

Number of consultations performed by the professional using VCoP The variable has the value 0 = never, 1 = between 1 and 5; 2 = 5– 10; 3 = more than 10

Table 3

Descriptive variables of the sample.

NS: Not significant.

⁄

Significant at 90% confidence level.

⁄⁄

Significant at 95% confidence level.

*** Significant at 99% confidence level.

confidence level Next in importance, work place (p = 0.003) and

perceived efficiency (p = 080) Finally, the profession (p = 0.003),

the number of consultations in the VCoP (p = 006), perceived

use-fulness (p = 003), and where ICT (p = 004) use, have a relatively

low level of influence on user satisfaction

The results obtained confirm the great majority of proposed

hypotheses (H1, H2, H3, H4, H5, H7, H8, H9, H10) In this

sense-and as shown inTable 5-confirms that the professional profile of

the user and their usage habits in relation to technology influence

their degree of satisfaction with the VCoP Moreover, it also

con-firms how their perceptions regarding the benefits of VCoP and

how efficiency and effectiveness influence on satisfaction Only

hypothesis No 6 (H6) related to the frequency of technology use

is not confirmed Here, note that the vast majority of users use

technology frequently (once a week) or very frequent daily)

5 Discusion

The knowledge society has promoted a change of scenery as far

as the culture of knowledge is concerned This is summarized in

the enhancement of exchange among peers, in a system where

the value created is not dependent on hours worked, but in terms

of knowledge provided Premium quality over quantity, hence it is

necessary to organize the overall time efficiency criteria Also, the

workplace is irrelevant, since the technology eliminates barriers of

space and time, while access to resources, and the development of

collaborative processes becomes possible Finally, in this time of

innovation for the first time, the experience is a tool for improving worker efficiency by allowing: (a) reducing the time required to solve problems; (b) increase the degree of flexibility; (c) the pro-motion of collaboration with other agents

In this context, communities of practice provide a useful model for knowledge management of the health organization; but also a mechanism that facilitates and promotes a new way of working and learning based on collaborative work and the use of collective intelligence If communities the virtual component is incorporated, increase both the type of benefits, such as the type of agents that perceive

People, communities and organizations are tangible and intan-gible benefits through participation in VCoPs.Fontaine and Millen

how, personal productivity, job satisfaction and personal reputa-tion and sense of belonging); community benefits (knowledge sharing, expertise and resources, collaboration, consensus and problem solving and trust between members), and organizational benefits (operational efficiency, cost savings level of service or sales, speed of service or product, and employee retention)

par-ticipation, including knowledge effects (externalization, preserva-tion, documentation and distribution of knowledge), business performance effects (improved business process, enhanced pro-ductivity, and innovation-enhancing effects) and socialization effects (collective sense making and common language)

The real and bigger challenge in fostering a VCoP is the need to continuously supply knowledge, i.e., the willingness to continue knowledge – sharing Diverse perspectives have been used to explain what encourages VCoP members to voluntarily and contin-uously help one another through continuous knowledge-sharing One line of novel work is based on the analysis and identification

of the drivers of user satisfaction with VCoP

In line with the previous proposal, this paper tries to explain user satisfaction with VCOP through a model that combines factors relating to the user and technology To do this, following an explor-atory analysis, the professional user’s profile, their technology hab-its, and the degree of knowledge you have about VCoP are analyzed Further, also considered the role of technology, so that

it takes into consideration the benefits of VCoP offers the user how the level of effectiveness and efficiency with which they are obtained

The results obtained show that the variables are considered drivers of clinician satisfaction with VCoP The two most important factors are the effectiveness and perceived usefulness in VCoP Both factors are related to the perception on the technology-partic-ularly on VCoP – user has Perceived usefulness refers to the value,

or set of benefits that the user expects to receive the VCoP Mean-while, the efficiency is the ability, or degree of effectiveness of

Table 4

Relationships between the explanatory variables and VCoP users’ satisfaction.

Professional specialization 2.944 743 15,686 1 000 053

VCoP participation level 2.057 753 7.467 1 006 7.821 Frequency of ICT use 1.253 1.158 1.171 1 279 3.500

Level of VCoP knowledge 1.254 427 8.625 1 003 3.503 Level of perceived usefulness on VCoP 4.584 1.800 6.487 1 011 97,897 Degree of perceived VCoP effectiveness 9.395 2.820 11,103 1 001 000 Level of perceived VCoP efficiency 4.045 2.312 3.062 1 080 57,136

Chi-square: 94,739, sig 0.000.

Hosmer–Lemeshow test: 19.273, sig 0.018.

Nagelkerke R square 793.

Table 5

Contrast of hypothesis.

Hypothesis

H1: The degree of user involvement in the VCoP has a positive influence on

satisfaction

YES H2: The degree of professional specialization the VCoP user has a positive

influence on satisfaction

YES H3: The VCoP user´s workplace has a positive influence on satisfaction YES

H4: The VCoP user´s gender does not influence the degree of satisfaction YES

H5: The place where the VCoP user uses ICT has a positive influence on

satisfaction

YES H6: The frequency with which the VCoP user uses ICT has a positive

influence on satisfaction

NO H7: The degree of knowledge that the user has on the VCoP positively

influences the degree of satisfaction

YES H8: The level of utility the user perceives the VCoP to be positively

influences the degree of satisfaction

YES H9: The level of effectiveness the user perceives the VCoP to be positively

influences the degree of satisfaction

YES H10: The level of efficiency the user perceives the VCoP to be positively

influences the degree of satisfaction

YES

Please cite this article in press as: Jiménez-Zarco, A I., et al The co-learning process in healthcare professionals: Assessing user satisfaction in virtual

com-VCoP to achieve the goals that the user searches the com-VCoP While

perceived usefulness

The user approaches the VCOP with the aim of providing or

obtaining a knowledge that is needed to solve a problem

(Ramalho et al., 2010) In addition, you can also find other kinds

of benefits can range from improving their professional practice

(Ranmuthugala et al., 2011), to solve problems related to their

iso-lation (Barnett et al., 2014) In relation to professional practice, it is

observed VCOP That supports practitioners to evidenced based

practice in Place to Enhance or performance In line with the work

ofJiwa et al (2009), Ramalho et al (2010), improvement of

profes-sional practice involves improving the quality of care, reducing the

time of diagnosis, or the establishment of new treatments and

tocols in emergency situations In addition, improvement of

pro-fessional practice facilitates management processes and

innovation in the health institution VCoP makes possible generate

ideas for new services, practices and products Communities of

practice address complex dilemmas, such as improving quality

and safeguarding high standards of care by fostering an

environ-ment for clinical care (Fung-Kee et al., 2008; Jiwa et al., 2009)

Isolation is one of the main problems faced by health

profes-sionals The changes in training form hospital to general practice

can contribute to the development of different types of isolation;

that in turn lead to decrease knowledge sharing (Cooper &

Kurland, 2002) lowered intention to work in rural areas and change

of career choice (Williams et al., 2001) Social isolation, is described

as a kind of loneliness occurs more commonly during rural terms

(Larkins et al., 2004) Structural isolation results from a single

doc-tor consulting with a single patient in a close room, with

appoint-ments often not in synchrony with other doctors, leading to lack of

interaction with colleagues, and can occurs in both urban and rural

placements Finally professional isolation is associated with barriers

to knowledge sharing, including access to networking and training

events

The place where professional operates, along with the perceived

efficiency, are the variables that have a high degree of importance

on VCoP customer satisfaction Next in importance are the degree

of professional expertise, the level of participation and the degree

of knowledge that the user has the VCoP Finally, the place where

the professional use of ICT is the variable with the lowest degree

of influence on the level of satisfaction

The place where the healthcare professional operates is strongly

influenced by the degree of specialization that this presents Both

variables have a strong influence on relationship, both in relation

to the decision to participate in the VCoP, and in relation to the

benefits sought AsLarkins et al (2004) indicated, it is expected

that those professionals with a lower level of specialization and

operating in hospitals and research centers They are highly skilled

professionals who have great knowledge, and who are at the

fore-front of specialization So it is very likely to participate in the VCoP

in order to assist and support other professionals less qualified

Meanwhile, primary care physicians or nurses, given their lower

level of education, may access the VCoP intending to access the

knowledge needed to address certain problems At other times,

and as Williams et al (2001)the intention to participate in the

VCoP seeks to minimize the problems of isolation they may suffer;

both derived from the characteristics of the workplace for lack of a

more specialized or current education

The degree of perceived VCoP efficiency influences the degree of

shown satisfaction The efficiency is the result of the relationship

between the resources used in a project and achievements with

it In line with the work ofMassingham and Massingham (2014)

andZboralski et al (2006), the user perceives the VCOP as efficient

in the moment: (a) the resources used to achieve the objectives

which are less used with another type of system, medium or tool (including another VCoP); or (b) when using mime resources, VCoP yields better results In this sense, the virtual dimension of the VCoP favors the efficiency of this tool, it favors the development

of relations between actors in the community, while streamlining the processes developed within With this, VCoP members can access or collaboratively foster a greater amount of developed knowledge Furthermore, it is also possible that all the above pro-cesses develop faster and safer, yet less expensive

Factors such as the degree of knowledge or the level of user involvement in the VCoP also mark the level of satisfaction obtained It is clear that the level of user involvement in the VCOP

is largely determined by the level of knowledge Knowledge not only is to be limited to identifying the potential benefits that the VCoP provides But as Egan and Jaye (2009) and Wenger E (2009)it also involves knowing the different technological applica-tions and virtual spaces with which it has A VCoP incorporates technological applications such as blogs and wikis are able to facil-itate communication and the exchange of knowledge These pro-cesses are the basis for the development of collaborative learning processes The greater the degree of user knowledge and a more streamlined and efficient process of knowledge creation and shar-ing, the higher the obtained performance will be So when the user knows the usefulness of each tool available in the VCoP, the higher the level of participation

Regarding the participation of users, the results obtained indi-cate the existence of three different groups Within them, there

is a different level of satisfaction, such as a greater degree of partic-ipation and a higher level of achieved satisfaction This conclusion fully agrees with the results shown byVázquez-Bronfman (2011),

who indicated that each group of VCoP users display behaviors and seek different goals through their participation in the VCoP The leaders or core group represent a very small percentage of the total participants in the community, but play a more active role Mainly they are related as highly specialized professionals who carry out their main activity in hospitals or in research On the contrary, the peripheral group is composed of a high percent-age of individuals who simply consult and use the information available in the VCoP The majority it comes from individuals with

a lower degree of specialization of primary care-doctors, and nurses looking at the information needed to resolve questions or problems regarding a diagnosis en the VCoP

Finally, the place indicated where the professional use of ICT is the variable with the lowest degree of influence on user satisfac-tion 80.6% of users use the technologies recognized in both the workplace and at home This is an individual who use ICT technol-ogy intensively, both professionally and personally But above all, it

is a user who highly values the capacity of the VCOP to establish asynchronous communication, and to be able to overcome the bar-riers of space and time

The frequency of ICT use and gender are the only variables that show no influence on the level of satisfaction In relation to the fre-quency of use, the results do not meet expectations Academic lit-erature suggests the existence of a positive relationship between frequency of use and satisfaction (Chandler & Fry, 2009; Gabbay

& Le May, 2009) However, considering the high frequency of ICT use makes the group of medical professionals expect the lack of significance in the relationship

Furthermore, in relation to gender and user, the results confirm the hypothesis As noted previously, the work done do not show conclusive results on the sign and strength of the relationship between gender and satisfaction The group of health professionals shows significant differences in gender But these differences are

not maintained in relation to the participation of these

profession-als in a VCoP

In relation to the gender of the members of the sample, we

note the high percentage of women who make up – 77.3% of

the total This fact does not influence the non-significance of

the variable gender; however it does have to be recognized as

one of the limitations of the study, which is necessary to consider

the conclusions presented here as a first approximation to the

analysis of VCoP in healthcare Other limitations to consider are

the limited sample size due to the newness of the VCoP, with

some limitations arising from the use of measurement scales used

in the questionnaire

This study constitutes an initial approach to this line of

research The exploratory nature of the study influences on the size

of the sample, which are users of an only VCoP, or on the statistical

technique used Therefore, despite the interesting findings

obtained, they must be considered with caution Thus, the nature

of the analysis makes it advisable to propose future research in

relation to the analysis of new drivers in satisfaction, or use of

met-ric scales to measure the variables analyzed It is also of interest to

identify how the degree of user satisfaction significantly influences

on the long-term behavior that shows VCoP user

6 Academic and estrategic implications

The conclusions have important implications in academic and

professional fields In academia this work not only provides a

def-inition of the concept of VCoP, but also clearly establishes the main

differences between physical and virtual communities

The analysis presented in this article, shows that VCoP are

organic systems that emerge and are constantly constituted and

evolve through interaction among community members This

par-ticular way of understanding VCoP enables the building of a

con-ceptual framework that explains user satisfaction of VCoP, based

on individual factors and technology This also identifies how the

drivers of individual satisfaction are determinants of behavior

and community involvement

The subsequent empirical validation of the proposed model

evidence that specific points on VCoP managers and health

institu-tions can make decisions to improve the success and results of the

VCoP

Variables such as effectiveness, efficiency and the degree of

knowledge that the user perceives the technology to be that

sup-ports VCoP is key to the degree of user satisfaction Thus, in order

to encourage participation in the VCoP, it is highly recommended

to encourage actions to identify the usefulness and usability of

tech-nology The potential user needs to know the benefits that the VCoP

offers; and also must be able to assess the reasons that make it the

best and most accurate tool to be more precise These

recommenda-tions have been in line with those offered by some theoretical

mod-els such as TAM, or Normalization Process Theory, describing how to

ensure success with the adoption and diffusion of technology tools

and systems, both individually and organizational

Finally, a second strategic recommendation to managers of

VCoP consists of analyzing the social network of the most active

members of the community The existence of different levels of

participation in the VCoP identifies three different groups of users

The most active – the leaders – are actually participating in the

construction of knowledge and offer value to the community The

identification of users with each of the leaders establishes contacts

(the different sub-networks within the VCoP), making it possible to

design and implement custom actions for each of these

sub-networks them

As a conclusion, show that hardly the results of our research cannot conclude to some design guidelines for future generation systems for collaborative learning in the healthcare Nevertheless they show some evidence about what are some of the reason for using social media – especially VCoP – for health communication,

as well as what are the benefits and the limitations that this tech-nological tool offers to users Among the reasons for using social media for health communication we can identify the next: (a) pro-vide health information on a range of conditions; (b) facilitating dialogue between different groups of health professionals (c) col-lect data on professionals’ experiences and opinions

On the other hand, it is possible to identify some benefits and limitations relative to VCoP use Among the benefits, note: (a) the increase of interaction among healthcare professionals, (b) the knowledge creation and sharing process; (c) peer/social/emo-tional support, (d) public health surveillance, and (e) potential to influence health policy Finally, among the limitation, we can iden-tify the next: (a) lack of reliability, confidence and privacy; (b) risks associated with communicating harmful or incorrect advice; (c) information overload

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