Positive feedback or indifference? Investigating the impact of gamification strategy on patient gift-giving behaviour in E-consultations

In the context of gamification strategy, online health communities (OHCs) have introduced patient feedback mechanisms, enabling patients to contribute to doctors’ success in gamified systems by offering gifts. However, the impact of doctors’ performance in online services on patients’ gift-giving behaviour and the underlying mechanisms driving this impact are relatively under-explored. Based on the expectancy violations theory, this study constructed a research model to examine how doctors’ e-consultation performance and the progress bar influence patients’ gift-giving behaviour and investigated the moderating role of the progress bar. Using the data collected from an OHC, the proposed hypotheses were empirically tested through regression analysis. The empirical results showed that doctors’ performance—both instrumental and socio-emotional—positively affected patients’ gift-giving behaviour, whereas the length of the progress bar had a negative effect. The progress bar strengthened the effect of socio-emotional performance on patients’ gift-giving behaviour, but its interaction with instrumental performance was not statistically significant. Theoretically, this study extends EVT by demonstrating how publicly visible gamification cues systematically elevate observers’ baseline expectations, thereby compressing positive violation magnitudes. The findings offer valuable insights for OHC designers and managers to optimise gamification design in order to enhance doctors’ online services.