Navigating patients’ word-of-mouth: Attribution theory and the dynamics of self-empowerment in elective medicine

Patient self-empowerment has emerged as a central paradigm in modern healthcare, especially in elective services where patients actively participate in decisions and word-of-mouth (WOM) plays a vital role. While empowerment is linked to greater autonomy and engagement, its impact on WOM intention remains underexplored. Drawing on attribution theory, this research investigates how self-empowerment influences WOM through the mediating role of self-attribution and the moderating effect of process versus outcome focus. Across a field survey and two experiments, our findings reveal that self-empowerment can reduce WOM intention, as empowered patients tend to credit treatment success to their own efforts rather than the provider. Notably, process focus enhances provider recognition and WOM among less self-empowered patients, whereas outcome focus neutralizes the negative impact of self-empowerment on WOM. These findings advance understanding of patient empowerment and attribution dynamics, highlight the distinction between satisfaction and WOM as advocacy forms, and offer actionable strategies for fostering WOM in elective healthcare settings.