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Item Consumer value and value co-creation in complementary and alternative medicine (CAM) health services : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Marketing at Massey University, Albany, New Zealand(Massey University, 2015) Dodds, Sarah LouiseThis thesis contributes to an emergent area on consumer value co-creation in a rapidly growing and exciting ‘new’ service market, Complementary and Alternative Medicine (CAM) health services. The market for CAM health services is experiencing strong growth as consumers look for greater value, choice and control in managing their health. Despite the growth in this large health service market there is a paucity of research from a service marketing and consumer behaviour perspective. Yet, understanding what CAM consumers’ value and how they co-create value with CAM health services has important managerial implications. The purpose of this research is to explore what value CAM consumers’ gain and how they co-create value from their consumption experiences with CAM health services. The research adopts an interpretive approach employing an exploratory case study research strategy, using qualitative methods and an adapted version of the visual elicitation technique ZMET. The research process is semi-longitudinal and is conducted in three phases over a 12 month period. Sixteen CAM consumers with ‘lifestyle’ health complaints who use CAM health services participated in the study. The findings reveal eight consumer value components including: quality of care, treatment efficiency, physical environment, esteem value, social value, spiritual value, ethics and play. A consumer value model for CAM health services and potentially all health care services is proposed. Significantly this research found that CAM consumers co-create value on three levels according to their: approach to health care, preferred ‘consumer value co-creation relationship styles’ and engagement in ‘consumer value co-creation activities’. Consequently this thesis presents a typology of consumer value co-creation in CAM health services and develops a consumer value co-creation framework that can potentially be used for all health services. This research contributes to service marketing and consumer behaviour theory by extending the concepts of ‘consumer value’ and ‘value co-creation’ to incorporate findings from the CAM health service sector. The managerial implications of this research could help guide both CAM health care and mainstream medical practices to provide better health services and ultimately improved health outcomes for health care consumers. Future research could implement the unique three phase semi-longitudinal process and visual methods developed in this research, in various health care and service settings.Item Integrative medicine : a contested practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand(Massey University, 2012) Madden, HelenIn contemporary Western society, the healthcare arena has become increasingly technology-based, rationalised and specialised with alternative forms of medicine being taken up alongside orthodox medicine. This shifting healthcare terrain has brought forth challenges to practitioners' and patients' identity and to the practitioner-patient relationship. Today, the expertise and autonomy underpinning general practitioners' professional identity has been challenged. In parallel, patients have become reconceptualised from subjects in need of medical expertise, to 'informed' and 'active' health consumers. Within this fluid healthcare arena integrative medicine (IM) is emerging, a practice which amalgamates orthodox medicine with forms of alternative medicine. This emerging form of healthcare produces a number of paradoxes. These occur around the paradigm clash between treatment philosophies, issues of professionalism and the standardisation of treatments, power relationships and debates around dominance and subordination, and issues relating to patient autonomy and treatment responsibility. A discursive analysis of IM practitioners' and patients' talk reveals that the practice of IM gives rise to a number of contradictions and challenges for both IM practitioners and patients. Practitioners draw on discourses of holism, liberal humanism, spirituality and empowerment to construct IM as a healthcare model which maintains elements of both allopathic and alternative medicine in place, but also to legitimate practices inherent in IM. Through doing so, they reconstruct their medical professional identity. In conjunction, patients' draw on practitioners' extended knowledge-base and open-mindedness to construct IM practitioners as trustworthy professionals and to legitimate their own engagement in exploratory forms of treatment. This has implications for patients' and practitioners' subjectivity. Patients become individuals who deserve to be understood on a multitude of levels: psychologically, spiritually, emotionally and physically through which they gain recognition. Concurrently, practitioners' become placed in a paradoxical position with respect to their practice. They resolve this by resisting the position of biomedical expert and by incorporating a range of alternative medicine treatments to extend the healthcare they offer to patients. In conclusion, the practice of IM is shown to legitimate patients' engagement in self-reflexivity practices and to reproduce Cartesian dualism. Further, the research reveals how discourses of holism and empowerment, that are held to represent the fundamental difference between allopathic and alternative medicine, are drawn on by practitioners to legitimate a more in depth practice and a deeper level of engagement with patients. Finally, the research questions whether IM constitutes a truly 'integrative' medicine.