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Online health communities (OHC) offer a platform for users to exchange health information and emotional support (Liu et al., 2020b). Due to the advantages such as ubiquity and convenience, OHC have received wide adoption among users. A report indicated that about 28.9% of internet users have ever used online health services in China (CNNIC, 2022). A few OHC such as Haodf and Chunyu Doctor have achieved great success. Especially, the COVID-19 pandemic has promoted OHC development as users try to search for health information and services on the Internet. Users can acquire free health information by interacting with other members in OHC. As a return, they also need to share their health knowledge with those in need. With the development of OHC, health knowledge becomes a commodity (Qi et al., 2019). Users often need to pay for online consultation services as health knowledge entails doctors’ effort and time investment. For example, doctors may go through multiple rounds of questions and answers (Q&A) before ending the interactions. They also need to scrutinize the symptoms and descriptions posted by users when offering their advice and suggestions.
OHC are composed of three types, which include patient-to-doctor, patient-to-patient, and doctor-to-doctor (Atanasova et al., 2018). In the patient-to-doctor community, users can interact with doctors and acquire valuable health information and services. In the patient-to-patient community, users interact between each other and exchange health information. The doctor-to-doctor community is a professional community supporting doctors’ interactions. This research focused on the patient-to-doctor community, which provides online consultation services that enable users to seek health information and advice from doctors. In the early stage, these services are often free in order to attract users and facilitate their adoption and usage. OHC platforms need to subsidize doctors for their health information and services. Otherwise, doctors may be unwilling to spend their time and effort on offering health knowledge to users. Due to the profit burden, OHC began to charge users for these consultation services when they have developed a large user base. In other words, users need to pay for these online health services, which create benefits for both doctors and OHC. For doctors, they can earn money by contributing their knowledge, which in turn encourages their contribution. For OHC, they can make the profit and realize the sustainable development of the platforms. For users, on one hand, they expect to obtain quality information from doctors in OHC. On the other hand, they often lack the motivation to pay for these online services, as they are used to free information and services. Thus, OHC managers need to understand the factors affecting users’ payment intention and adopt effective measures to facilitate their payment behaviour.
Previous research has focused on OHC users’ sharing behaviour (Yan et al., 2016; Zhang et al., 2017c; Meng et al., 2021), personal health information (PHI) disclosure (Kordzadeh and Warren, 2017; Zhang et al., 2018), and health information seeking and adoption (Fan and Lederman, 2018; Li and Wang, 2018; Wu et al., 2018). Various factors such as social support, social capital, motivations, privacy concern and trust are found to affect OHC user behaviour. However, it has seldom examined users’ payment intention, which is critical to the success of OHC. When users consider paying for online health information and services, they may balance the benefits and costs. The benefits are the quality information and services obtained in OHC, whereas the costs are the fees they need to pay for these information and services. When the benefits exceed costs, they may obtain the value and engender payment intention. In addition, users may perceive significant uncertainty and risk when they adopt the health information in OHC (Mpinganjira, 2018). They may doubt the reliability and credibility of this health information. Thus, they need to build trust in order to mitigate perceived risk and facilitate their payment intention.