title: Health care encounters in Danish chiropractic practice from a consumer perspectives - a mixed methods investigation.
abstract: BACKGROUND
  Perceived value is the key ingredient to carving and maintaining a competitive business niche. The opportunities to interact with consumers to understand and enhance perceived value are termed 'touch points'. Due to the out-of-pocket expense incurred by patients, Danish chiropractors are subject to consumer trends and behaviors. The purpose of this investigation was to explore and describe consumer touch points relevant to perceived value through healthcare journeys in chiropractic practices.
  
  
  METHODS
  We designed a convergent parallel, mixed methods study. Our purposive sampling framework identified 11 chiropractic clinics from which we collected observational field notes, video recordings and face-to-face interviews.
  
  
  RESULTS
  Data was collected between April 14(th) and June 26(th) 2014. We described the exteriors and interiors of all participant clinics, interviewed 32 staff members, 12 new patients and 36 follow-up patients and finally video recorded 11 new and 24 follow-up consultations. Categorization and analysis led to the emergence six consumer touch point themes: 'the internet', 'the physical environment', 'practice models', 'administrative staff', 'the consultation sequence and timing' and 'a consultation that adds value'. The Internet functions as a tool when choosing/confirming a clinic as appropriate, developing and initial image and managing appointments. The administrative hub appears integral to the shaping of positive consumer experiences outside of the consultation. Clinic location, practice model and interior design may contribute to context effects and thus may influence value perception during the clinical encounter. The duration of hands-on treatment received from the chiropractor is not an apparent consumer focus point. Rather, through a seven stage clinical procedure patients value consultations with clinicians who demonstrate professional competence by effective communication diagnosis/management and facilitating satisfactory treatment outcomes.
  
  
  CONCLUSIONS
  At least six consumer touch points add/detract from value-related experiences in chiropractic practices. The duration of hands-on treatment per se does not appear to be a particular focus point. More research is required to explore this issue.
authors.affiliation: Department of Sports and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230 Denmark.
authors.forename: Corrie
authors.initials: C
authors.lastname: Myburgh
authors.affiliation: Department of Sports and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230 Denmark ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Boyle
authors.affiliation: Department of Sports and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230 Denmark.
authors.forename: Johanne Brinch
authors.initials: JB
authors.lastname: Larsen
authors.affiliation: Nordic Insitute for Chiropractic and Clinical Biomechanics, Odense M, Denmark.
authors.forename: Henrik Wulff
authors.initials: HW
authors.lastname: Christensen
keywords: Chiropractic; Consumer behaviour; Health care encounters