Exploring the determinants of patients’ continuance intentions in online health communities from the network effects perspective

<b>Objectives:</b> Online health communities (OHCs) facilitate patient-physician interaction and the adoption of online health services. However, few studies explored the impact of network effects on patients' continuance intentions in OHCs. This study aims to explore the determinants affecting OHC patients' continuance intentions based on the network effects theory and expectation confirmation model (ECM). <b>Methods:</b> An integrated research model and relative hypotheses are proposed. A total of 420 valid responses are collected through an online questionnaire survey to test the research framework using structural equation modeling. <b>Results:</b> The results reveal that direct network effect, cross network effect, and indirect network effect all positively affect perceived ease of use, and the latter two also positively affect perceived usefulness that further affect continuance intention. In addition, other results are consistent with the ECM-based hypotheses and the positive impact of perceived e-health literacy on continuance intention is also explained. <b>Conclusion:</b> Patients' continuance intention to use OHCs can be improved by network effects through direct, cross, and indirect formats. ECM-based determinants, including confirmation, perceived usefulness, and satisfaction, provide valuable insights for OHC patients' continuous use. Enhancing e-health literacy helps maintain patients' intention to continue using OHCs.