Introduction & Relevance of Phenomenon

With the evolving patient-centered healthcare and service logic, value co-creation is considered as the key priority within healthcare services. Many researchers explore how healthcare consumer practice value co-creation by integrating resources in different styles and realize their wellbeing. However, the focus of earlier studies is confined to upper section of consumers ignoring the consumers at the 'Bottom of pyramid'. BOP consumers are inherently characterized by scarcity of resources, which in turn could hinder their co-creation efforts. Thus, it becomes imperative to explore how the BOP consumers overcome their resource scarcity and co-create while consuming the healthcare services. Overall, the study adopts a micro resource perspective, thereby exploring the emergent/embedded nature of resources contrary to mere co-creation activities. It looks at the overall co-creation journey (pre-treatment, during treatment, & post-treatment).

Research Question, Theoretical foundation & Contribution

Building on the above background, this study aims to resolve two research questions that subsequently drive the research objectives, i.e., RQ 1: What are the resource-challenges BOP healthcare consumers face during co-creation? RQ 2: How are BOP healthcare consumers accessing, mobilizing, and integrating the resources in the co-creation journey? Consequently, the study has two important objectives. First, understand the nature of challenges (like operant or operand resource constraints) and their impact on co-creation efforts. Second, to understand the source or context from where the resources are accessed and the unique ways through which it is mobilized and integrated.

The study uses the foundational knowledge of operant resources, resource embeddedness, and patient/customer journey. Theoretically, the research contributes to healthcare transformative research at the bottom of the pyramid. In a way, it would help design the 'Transformative Service Initiatives' for vulnerable actors by understanding the BOP patients' resource challenges.

Method

Given the study's exploratory nature, the inductive qualitative approach (Corbin and Strauss, 1990) is used with no prior framework. A conversational style of semi-structured interviews (total 50 patient interviews) is used. Data obtained through an interview is triangulated with non-participant observation and is thematically analyzed using Nvivo12.

Preliminary Findings

The study is in the analysis face where two preliminary findings have emerged. First, the consumer experience more institutional resource constraints than individual resource challenges. To cite a few of them, social stigma attached to service experiences, lack of information platform oriented support, poor cultural health capital, exploitative corporate policies, lack of consumer union/forums, and ; Second, consumers access the resources outside health service space and integrate it creatively. For example, few consumers collectively perform prayers/rituals to impress the deity of health (i.e. using spiritual resources to overcome psycho-social distress experienced in health service encounter) and few consumers reported taking hundis (unconditional credit instrument) from Mafia (criminal) to overcome their financial challenges. Further, the study observes variation in resource constrains as per treatment phase. For example, information access (during pre-treatment), information based shared decision making (during treatment), and information based credence check (post treatment) remains the major issue.

Keywords: Bottom of Pyramid, Resource challenges, Healthcare Consumers, Value Co-creation, Transformative Services.

Have you ever thought about how a bird feels inside a cage? Animal rights organizations (e.g., PETA) would argue that birds kept in captivity may suffer from malnutrition, loneliness, and stress of confinement. From a scientific perspective, studies have demonstrated that caged birds are likely to develop abnormal behavior patterns. And research published in the Applied Animal Behavior Science suggests that the wellbeing of animals is linked to their ability “to adapt behaviorally, emotionally and physiologically to the circumstances of confinement”.

Now imagine, you are forced to confinement in a hotel room for two weeks, usually without access to fresh air. How would you feel physically or mentally? On March 28, 2020, Australia was one of the first countries to implement strict quarantine laws using government-sanctioned hotel facilities for overseas travelers to prevent the spread of COVID-19. Other countries followed, including New Zealand, Taiwan, and South Korea. According to media reports, more than 210,000 travelers have been confined for two weeks in hotel rooms in the first year in Australia. While Australia’s hotel quarantine system has been the focus of criticism and investigation over the past year―reports indicate more than 20 leaks ―the government called the program “99.99-percent effective” to safeguard the public against the pandemic. However, one aspect that has been ignored is the physical and mental wellbeing of the individual in confinement. While the health implications of solitary confinement have received increasing attention in criminal justice, medicine and social science, no research has considered the health impact of government-mandated isolation during the COVID-19 pandemic.

The purpose of this study is to investigate travelers’ perceived isolation during a hotel confinement and its impact on their mental and physical wellbeing. Furthermore, this study aims to explore various coping mechanism that individuals use during their hotel confinement to reduce its negative impact on their wellbeing. This project is work-in-progress. By synthesizing services research (i.e., health and wellbeing, customer experience) with literature of place confinement in epidemics (e.g., people restricted to their place of residence during COVID-19) as well as distress and coping of solitary confinement, this study develops a theoretical framework and then empirically tests it using an online survey data collected from travelers who completed hotel quarantine in Australia. Given the rise of Omicron, the results will provide important contributions to governments and hotel operators to understand the customer side of mandated hotel quarantine and its wellbeing implications, both in Australasia as well as in Europe where countries initially adopted a self-regulated home quarantine system for incoming travelers (e.g., the UK).

Introduction to the research problem and literature review
In the current literature, there are two types of well-being: hedonic well-being and eudaimonic well-being. Hedonic well-being is human’s positive feelings that reflect happiness, comfort, and easy-going state; meanwhile, in order to reach eudaimonic well-being, people have to experience a meaningful and purposeful life (Diener, 2018; Ryan and Deci, 2001; Ryff and Keyes, 1995). Caring is one of the mechanisms that can impact positively on the welfare of the individuals who are cared for (Beane, 1990). Lavy and Naama-Ghanayim (2020) identify that students’ feelings about teachers’ caring towards them have a link with students’ well-being. In addition, Suldo et al. (2009) figure out that going along with the university’s environmental factors, youth’s perception regarding teachers’ support account for 16% in the variance of learners’ well-being. Professors’ positive discipline and high teaching performance have relationship with youngsters’ welfare. DeWall et al. (2012) prove that teachers’ application of positive discipline in the training program can bring about happy feelings for the young, make them love studying or show gratitude and satisfaction to teachers’ efforts. Wang and Kuo (2019) conclude that teachers’ positive discipline can promote well-being and efficiency of students’ teaching effectiveness, and students’ well-being plays a mediating role in the relationship between positive discipline and teaching effectiveness.
The main purpose of this paper is to explore how educators such as professors, lecturers and teachers can maximize students, society’s and their own well-being via the teaching and learning process while placing the students at the centre of this process. It implies a specific application of TSR in the education sector. The project will tackle the problem of enhancing learners’ well-being via education while allowing them to play the central role in the learning process.
The study presents four following hypotheses:
Hypothesis 1: Teachers’ positive discipline leads to students’ well-being.
Hypothesis 2: Teachers’ emotion regulation leads to students’ well-being.
Hypothesis 3: Teachers’ caring leads to students’ well-being.
Hypothesis 4: Teachers’ development leads to students’ well-being.
Methods/Approach
We conducted a survey at National Economics University in Hanoi, Vietnam. 200 students who participated in the Services Marketing and Principles of Marketing courses of the Department of Marketing during the spring semester 2021-2022 responded to our questionnaires. The data were analyzed using IBM SPSS25 and structural equations modeling on AMOS25.
Preliminary Findings and Contributions
Teachers’ positive discipline and caring lead to students’ well-being while teachers’ emotion regulation and development do not lead to students’ well-being. Distinct from Transformative Consumer Research, TSR is still in its infancy stage and requires a lot more research efforts should we want it to survive. Previous researchers have mainly analyzed TSR in healthcare, financial and social services. However, there is a pronounced need to further explore TSR in the educational context. This research project fills this gap in the existing TSR literature by examining practical methods to create uplifting changes and improvements in the learning community’s welfare.

Transformative Service Research (TSR) is any research with its core that investigates the relationship between service and well-being (Ostrom et al., 2010; Anderson and Ostrom, 2015). Well-being represents the uplifting changes improving the lives of different stakeholders from consumers, employees, families, communities, and our society at large (Anderson et al., 2013).

Prior TSR research primarily focuses on several critical themes, namely, the nature of negative services (Spanjol et al., 2015; Hsu et al., 2021); services, and well-being at collective levels (Blocker and Barrios, 2015; Boenigk et al., 2021), and the customers’ partial-employee-role and well-being (Plé and Cáceres, 2015; Plé, 2017).

However, the research on collectively social-level TSR has still been ignored to a certain extent because it’s challenging to factor out the transformative service elements in the context of the whole society (Anderson and Ostrom, 2015; Vargo, 2018). Even a holistic framework evaluating TSR at collective structure is under-researched. Thus, motivated this study to continue to answer the research question “What are the drivers mediating the relationship between service and human’s well-being at the collectively social level?”

The study delves into more collective analysis levels of TSR from interdisciplinary angles, service research, and policy research. The paper is a bold move to add nuances to the breadth of the current line of TSR. In particular, the study conceptualizes TSR in a new framing: Human Development Approach, responding to the latest call from United Nations Development Program organization (UNDP). To do so, a systematic evaluation of the extant literature on TSR and annual UNDP Human Development Reports was conducted.
In the center of the human development approach, transformation is defined as the means to redesign systems to have social balance and planet balance at their core rather than to gradually adjust systems to be less bad, which increases human development at the end (UNDP, 2020).

The paper identifies complex and interdependent relationships between socioeconomic factors (social justice) and natural systems (planet balance), which interact and reinforce each other. As long as social inequality and planet imbalances persist, they engender the risks that harm the relationship between service and humans’ well-being at a complex aggregation level. In other words, when service actors reciprocally consider the fairness for others and perform sustainable practices, the whole service ecosystem’s well-being is improved.

The proposed framework contributes to the extant TSR research at the collectively social level in the sense that transformative service should serve humans equally and protect our planet's resources for future generations. To transformative service practitioners, putting human development at the core along with service and well-being, the service provisions can empower people to make their own choices to reduce planetary pressures and to advance social justice, ultimately increasing the overall well-being.


Keywords: Transformative Service Research, Well-being, Human Development, Social Justice, Planet Balance