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ABSTRACTBecause of the limitation of time and resources, health professionals are often not able to provide support for consumers via personal communication. Consumers are increasingly active in managing their own health. E‐word‐of‐mouth (eWOM), or consumer‐generated content, on health social networking sites (SNSs) provides a new opportunity for health communication tailored to consumers' personal needs. Using netnography, a well structured internet‐based ethonography, we analyze discussion threads posted to an obesity support group on a popular health SNS based in the US. We classify e‐group members as support seekers and providers. Our results identify two major features of eWOM on health SNSs that facilitate tailored health communication. First, eWOM on health SNSs provides the types of support (informational and emotional) that help support seekers actively cope with heath‐related problems and strains. Second, eWOM on health SNSs contains massages rich with personal experiences of support providers that offer solutions for problems that support seekers face in everyday situations. As support seekers participate in SNSs, their opportunity for learning means that they can become 'information elite', evolving from support seekers to support providers. We discuss important implications for policymakers and marketers for learning from and participating in eWOM on health SNSs. Copyright © 2011 John Wiley & Sons, Ltd.

In health care, a high-emotion service, unintended consequences can be especially problematic. People's physical, psychological, and financial well-being—even their lives—are at stake. As scientific, technological, and demographic changes make health care a much more complex service to deliver, efforts to anticipate, avoid, and correct unintended consequences become more crucial. Using narrative examples and an extensive review of the data and the literature, we explore these efforts in four domains of U.S. health care: (1) the increasingly widespread, often challenging use of electronic health records; (2) the threat to the patient-clinician relationship from a greater, sometimes narrow emphasis on productivity metrics; (3) the culture of medicine's frequently misguided prioritizing of treatment over true healing; and (4) the overreliance on family caregivers who are often poorly prepared to care for the seriously ill. We then apply lessons from health care's unintended consequences to non-health-care services and suggest opportunities for service researchers to contribute to improving health care delivery, a service that all of us need.

Care management (CM) is a promising team-based, patient-centered approach "designed to assist patients and their support systems in managing medical conditions more effectively." As little is known about its implementation, this article describes CM implementation and associated lessons from 12 Agency for Healthcare Research and Quality–sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s). Successful implementation was characterized by resource availability (both monetary and nonmonetary), identifying as well as training employees with the right technical expertise and interpersonal skills, and embedding CM within practices. Our findings facilitate future context-specific implementation of CM within medical homes. They also inform the development of medical home recognition programs that anticipate and allow for contextual variation.