Raphaëlle Laubie

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

Keywords: Patients 2.0, Health 2.0, Virtual Communities, Online Collective Action

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L'auteur de cette dissertation est : • Mon directeur de thèse, Pr. Christophe Elie-Dit-Cosaque, qui n'a jamais douté de la contribution de mon travail et m'a montré le chemin quand j'étais perdue,

• Mes camarades de classe, tous passionnés par la recherche universitaire,

• Pr. Lars Mathiassen, Dr. Gunther Eysenbach et Dr. Larry Chu, qui m'ont permis de parler de mon travail à de prestigieuses conférences et institutions,

• Pr. Véronique Perret, Pr. Pierre Romelaer et Pr. Pierre Volle, qui m'ont permis de mener à bien ce travail et croient fermement aux avantages des contributions des professionnels aux connaissances académiques,

• Patricia et Bénédicte, pour leur enthousiasme et leur dévouement de chaque instant.

Et surtout à Patrick et Ralph, Tom et Lou.

Raphaëlle Laubie -December 21, 2017

Résumé

Au cours des dernières années, les communautés virtuelles de patients se sont énormément développées sur l'Internet. Ces communautés permettent des échanges fréquents entre les patients, qui peuvent partager des informations liées à la santé dans un environnement interactif. Alors que beaucoup s'accordent sur l'opportunité représentée par ces communautés pour ses utilisateurs, les connaissances sur ce qui détermine l'action collective en ligne des patients ainsi que sur les fondamentaux de l'action collective en ligne dans ces espaces virtuels sont relativement peu développées.

En conséquence, ce travail doctoral examine les raisons pour lesquelles les patients interagissent entre eux et comment ils procèdent. En nous appuyant sur le modèle du comportement orienté vers un but, la théorie de la valeur de l'attente, la théorie des forces du champ, les concepts de dons et les interviews menées, nous avons développé un modèle qui examine les interactions en ligne des patients dans un contexte d'action collective en ligne. Une approche multi-méthode, qualitative et quantitative, permet d'explorer les interactions des patients et de mesurer les déterminants de l'action collective en ligne sur ces espaces virtuels. L'analyse qualitative de 54 entretiens menés avec des patients, des proches de patients, des professionnels de la santé 2. Thesis Abstract

Over the last few years, virtual patients' communities have been developing

tremendously over the Internet. These Web 2.0 communities allow frequent interactions among patients, who can share health-related information within an interactive environment. While many agree on the opportunity represented by those communities for its users, we know very little about what determines patients' online collective action, specifically on virtual communities as well as the fundamentals of online collective action in these virtual spaces. Accordingly, this doctoral work examines why patients interact with others and how they interact on topics related to their disease through these virtual communities. Drawing on the goal-directed behavior (MGB), the expectancy-value (EVT) theories, the field force theory, gift concepts and field interviews, we have developed a model for examining patients' online interactions and identified gift-giving behaviors in the context of online collective action. A multi-method, qualitative and quantitative approaches, enables us to explore patients' interactions and measures the determinants of online collective action on these virtual spaces. The qualitative analysis of 54 interviews conducted with patients, patient's relatives, Health 2.0 professionals, doctors and caregivers allows refining the research model, which has then been tested through a survey handled with 269 patients, members of patient's communities. This research contributes to IS research by increasing our knowledge regarding the individual dynamics and interactions that surround online patients' communities.

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

INTRODUCTION

Le comportement des patients face aux informations relatives à la santé a évolué significativement avec les nouvelles technologies [START_REF] Eysenbach | Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness[END_REF][START_REF] Frost | Social Uses of Personal Health Information Within PatientsLikeMe, an Online Patient Community: What Can Happen When Patients Have Access to One Another's Data[END_REF]. Bien que les praticiens de santé restent les interlocuteurs de référence [START_REF] Dedding | How will e-health affect patient participation in the clinic? A review of e-health studies and the current evidence for changes in the relationship between medical professionals and patients[END_REF], de nombreux patients considèrent que les sites traitant des questions de santé offrent une alternative pertinente en cas d'isolement ou de manque d'information pour eux-mêmes ou leurs familles (White and Dorman 2001;Smith and Christakis 2008). Ces mêmes patients regrettent souvent de ne pas être assez bien informés par leurs praticiens, déplorant que ce même système de santé ne prenne pas assez en compte leurs besoins [START_REF] Bos | Patient 2.0 Empowerment[END_REF]. Des réponses à ces besoins sont en partie offertes par des plateformes web qui permettent aux patients d'interagir sur des sujets relatifs aux questions de santé et de devenir acteurs de leur santé (Ajoulat 2007). Les patients y trouvent ainsi le moyen de se libérer d'une dépendance qu'ils pourraient développer visà-vis des professionnels de santé pour mieux vivre avec leur maladie [START_REF] Gagnayre | Apprendre à éduquer le patient[END_REF]. Toutefois, ces plateformes se sont le plus souvent développées sans la prise en compte d'indications précises relatives aux besoins des patients ou à leurs motivations à rejoindre ces dernières. Web 1.0 ou du Web 2.0, autour de la notion de l'utilisation du système [START_REF] Hofmann | Issues in multilevel research: Theory development, measurement, and analysis[END_REF][START_REF] Bokhari | The relationship between system usage and user satisfaction: a meta-analysis[END_REF]Straub and Burton-Jones 2007;[START_REF] Burton-Jones | Toward a deeper understanding of system usage in organizations: a multilevel perspective[END_REF]Usluel and Mazman 2009).

Par exemple, le modèle d'acceptation de la technologie (TAM) [START_REF] Davis | Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology[END_REF]) a été considéré comme un cadre de référence pertinent pour mieux comprendre l'adoption d'outils informatisés, reliant les comportements aux attitudes et aux croyances, notamment en termes de facilité d'utilisation et d'utilité perçue de la technologie. Dans ce modèle, ces déterminants du comportement d'usage sont cohérents avec ce dernier en termes de temporalité, de cible et de contexte [START_REF] Nelson | Antecedents of information and system quality: an empirical examination within the context of data warehousing[END_REF].

La théorie unifiée de l'acceptation et l'utilisation de la technologie (UTAUT) (Venkatesh et al. 2003) modifie le TAM, identifiant quatre déterminants (l'espérance de performance, l'espérance de l'effort, l'influence sociale, et les conditions de facilitation) de l'intention comportementale d'utiliser la technologie, elle-même déterminant de l'utilisation. Le sexe, l'âge, l'expérience, et le caractère volontaire de l'utilisation modèrent l'influence de ces facteurs susmentionnés sur l'intention comportementale.

Puis, sur la base du travail de [START_REF] Shannon | The mathematical theory of communication[END_REF] et [START_REF] Mason | Measuring information output: A communication systems approach[END_REF] ainsi que des recherches sur les systèmes d'information de gestion empiriques (SIG) opérées de 1981 à 1987, la mise à jour du modèle de succès des systèmes d'information (ISM) de Delone et McLean (2003) reconnait que le rôle des systèmes d'information a changé et progressé pendant cette durée de dix ans et dresse un modèle multidimensionnel de succès des systèmes d'information.

Néanmoins, s'agissant du TAM [START_REF] Davis | Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology[END_REF], [START_REF] Burton-Jones | Reconceptualizing system usage: An approach and empirical test[END_REF] expliquent qu'ils doutent que les intentions d'utilisation et les variables dépendantes de systèmes [START_REF] Shin | Applying the technology acceptance model and flow theory to cyworld user behavior: implication of the Web2. 0 user acceptance[END_REF]Shin 2008;Wu et al. 2008). Cependant, lorsque ces phénomènes sont analysés dans des univers connectés, l'ISM, selon la mise à jour de DeLone et McLean (2003), nécessiterait que d'autres dimensions soient prises compte pour comprendre les déterminants de l'adoption des utilisateurs. Par exemple, dans le cas des organisations, le fait de prendre en compte la culture d'entreprise, le soutien de l'encadrement dirigeant, un bon leadership, la communication, la motivation et la formation des utilisateurs finaux devraient être plus étudiés lorsqu'il s'agit de l'action collective en ligne sur le Web (Trkman and Trkman 2009). 2007;Rheingold 2003). En cela, comme évoqué par [START_REF] Lamb | Reconceptualizing users as social actors in information systems research[END_REF], les utilisateurs sont fondamentalement des acteurs sociaux qui interagissent grâce à des technologies et doivent être considérés comme tels.

Deuxièmement, ces modèles ne prennent pas ou peu en compte le rôle des émotions dans le cadre des interactions individuelles avec la technologie. Or, ces émotions jouent un rôle, qu'elles soient positives ou négatives [START_REF] Beaudry | The other side of acceptance: studying the direct and indirect effects of emotions on information technology use[END_REF]. Sans doute, parce qu'elles impliquent des interactions fréquentes entre les personnes, les technologies du Web 2.0 offrent de fréquentes occasions pour les processus émotionnels Raphaëlle Laubie -December 21, 2017 de se développer. Cela semble particulièrement pertinent pour les patients 2.0 puisque les individus sont à la recherche d'informations sur leurs -parfois graves -problèmes de santé [START_REF] Arnst | CAN PATIENTS CURE HEALTH CARE?[END_REF]. En négligeant les émotions, les modèles «traditionnels» d'adoption, tels que TAM, UTAUT, ou ISM, sont insuffisants pour fournir une compréhension en profondeur relatives aux interactions des patients avec la technologie. En revanche, comme il comprend les émotions, en le complétant des composantes affectives du désir orientées vers un objectif, nous croyons que le modèle du comportement orienté vers un but (model of goal oriented behavior -MGB) est plus adapté. Ce modèle fournit des indications supplémentaires par rapport à des modèles tels que TAM pour prédire le comportement des utilisateurs en ligne [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]).

Troisièmement, ces modèles sont silencieux sur la nature des liens que les acteurs entretiennent sur les réseaux sociaux. Les acteurs sociaux qui interagissent sur les sites Web 2.0 ont à la fois des comportements instrumentaux et non instrumentaux dictés par leur désir de partager leur expérience avec d'autres. La collaboration en ligne nécessite de solides liens sociaux entre le « donneur » et le « receveur » et un niveau élevé de confiance entre les acteurs sociaux [START_REF] Bergquist | The power of gifts: organizing social relationships in open source communities[END_REF]. Bien que l'information soit partagée gratuitement, l'action collective en ligne est ainsi riche et précieuse pour les e-patients. Ce concept de don peut dès lors aider à approfondir notre compréhension de ces liens. A notre connaissance, toutefois, la recherche n'a pas examiné suffisamment en profondeur ce concept dans un environnement connecté [START_REF] Bergquist | The power of gifts: organizing social relationships in open source communities[END_REF] s'intéressant initialement aux cultures primitives qui appartiennent à des mondes réels et non connectés [START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF]. Néanmoins, le

Raphaëlle Laubie -December 21, 2017 concept de don reste primordial lors de l'examen des interactions des acteurs sociaux dans les environnements virtuels, en particulier dans le domaine médical.

Quatrièmement, les recherches antérieures ont déjà souligné les limites des modèles traditionnels d'adoption. (Benbasat and Barki 2007a) et Straub et [START_REF] Burton-Jones | Toward a deeper understanding of system usage in organizations: a multilevel perspective[END_REF] par exemple, expliquent que la recherche existante sur l'adoption et l'utilisation de la technologie a étudié un ensemble trop limité de variables autour du concept de l'utilisation du système, qui a été conceptualisée d'une manière très parcimonieuse. (Benbasat and Barki 2007a) soutiennent en outre que la recherche sur l'adoption n'a pas suffisamment analysé les médiateurs ou modérateurs pourtant déterminants de l'utilisation du système tels que ceux du domaine des émotions. Afin de répondre à certaines de ces lacunes, comme mentionné précédemment, [START_REF] Burton-Jones | Reconceptualizing system usage: An approach and empirical test[END_REF] font valoir qu'il est nécessaire de repenser l'utilisation du système et appellent à un développement de variables d'utilisation plus contextualisées. Malheureusement, peu voire aucune indication n'a été donnée afin de mieux comprendre la façon de prendre en compte les contextes du Web 2.0 lors de l'étude de l'utilisation des technologies de l'information.

Motivations et Objets de la Recherche

Afin de répondre à ces lacunes en matière de recherche, mais aussi dans la pratique, cette étude examine les motivations qui poussent les patients à se joindre à ces communautés en ligne et à y participer ainsi que les caractéristiques de leurs comportements dans ces espaces virtuels. En effet, le concept d'action collective en ligne, concernant les patients dans un environnement Web 2.0 a encore été trop peu étudié.

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017

1.2.1 Etude 1 : Forces qui Mènent à l'Action Collective en

Ligne des Patients

Les recherches antérieures ont déjà exploré certains aspects liés aux motivations des utilisateurs à rejoindre des communautés virtuelles. Par exemple, dans leur étude, [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] ont adapté le modèle de comportement orienté vers un but de [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] afin d'examiner l'utilisation de sites communautaires.

Notre première recherche qualitative s'appuie sur le travail de Lewin (1947;[START_REF] Lewin | Field theory and experiment in social psychology: Concepts and methods[END_REF] qui étudie les comportements individuel et social de l'individu et leurs implications sur le changement. Les théories des valeurs de l'espérance -EVT (Eccles et al.1983) -et le modèle du comportement orienté vers un but -MGB [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF]) -nous permettent également d'identifier de premières catégories de forces qui mènent à l'action collective en ligne. En effet, MGB [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF], est un modèle fondé sur les attitudes capables d'expliquer les comportements téléologiques, distinguant les concepts de désir et d'intention. Le désir mène à l'intention, et par conséquent, l'orientation future, dans la poursuite d'un but, en tenant compte des résultats qui seraient considérés comme bénéfiques ou néfastes. À cet égard, les émotions anticipées -positives ou négatives -sont des facteurs prédictifs du désir. Nous suggérons donc que ces déterminants du comportement téléologique soient pris en compte dans le cadre de communautés virtuelles de patients dans le but d'élaborer un modèle d'adoption des communautés virtuelles pour les patients. Les valeurs de l'espérance -EVT (Eccles et al.1983) -et celles issues du terrain viennent compléter les déterminants composant les forces qui mènent à l'action collective en ligne des patients.

Raphaëlle Laubie -December 21, 2017 Le regroupement des patients en ligne s'est tout d'abord organisé en communautés informelles avec peu de moyens regroupant des personnes touchées par les mêmes pathologies pour ensuite se professionnaliser, avec des organisations souvent nationales ou internationales capables de sensibiliser les acteurs des systèmes de santé et offrant une ressource de qualité pour les patients, en particulier pour ceux qui font face à des pathologies inhabituelles ou rares [START_REF] Armstrong | Social networking for patients[END_REF].

Ces communautés offrent ainsi un soutien aux patients et permettent de renforcer leur estime de soi. Même si cette aide en ligne ne vise pas à remplacer les groupes de soutien « en conditions réelles », elle permet aux membres d'accéder à l'information au moment souhaité, sous couvert d'anonymat, évitant tout risque d'être jugé [START_REF] Idriss | The role of online support communities: Benefits of expanded social networks to patients with psoriasis[END_REF]).

Tous ces aspects on fortement motivé la réalisation de cette étude, avec le souhait de mieux comprendre les aspirations des patients connectés. Elle a été menée en deux temps, avec une première série d'entretiens préliminaires avec des médecins, des aidessoignants, des experts de la Santé 2.0 et du Web 2.0, puis une seconde série d'entretiens menés avec des patients et des proches des patients.

Dans cette première approche qualitative, la question de recherche posée est alors la suivante :

Quelles sont les forces qui mènent à l'action collective en ligne et celles qui la freinent dans le cadre de communautés virtuelles de patients? 1986), considéré comme moyen de sortir de l' isolement [START_REF] Hugon | Circumnavigations : L'imaginaire du voyage dans l'expérience Internet[END_REF], à fortiori pour les patients, nous avons exploré le fonctionnement des groupes, influencés par les normes sociales et d'identification [START_REF] Kelman | Compliance, Identification, and Internalization: Three Processes of Attitude Change[END_REF].

Considérant, en outre, certaines des spécificités des membres des communautés de patients qui ont l'intention de participer en ligne, nous avons examiné la littérature sur la notion de don et sa pertinence pour répondre à nos questions de recherche [START_REF] Larsen | A Guide Map to the Terrain of Gift Value[END_REF]. La présentation de ces trois études est résumée dans la Table 1. (1947).

x La Théorie des Valeurs de l'Espérance -EVT (J. S. [START_REF] Eccles | Expectancies values and academic behaviors[END_REF]) et le Modèle du Comportement Orienté vers un But -MGB [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] theorizing.

x L'approche utilitaire du don [START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF][START_REF] Malinowski | Argonauts of the Western Pacific; an Account of Native Enterprise and Adventure in the Archipelagoes of Melanesian New Guinea[END_REF][START_REF] Gregory | Gifts and Commodities[END_REF][START_REF] Bataille | La part maudite[END_REF][START_REF] Godbout | L'esprit du don[END_REF][START_REF] Alter | Donner et prendre[END_REF][START_REF] Camerer | Gifts as economic signals and social symbols[END_REF] x Quelles sont les caractéristiques de comportements relatifs au concept de don dans le cadre de l'action collective en ligne dans les communautés virtuelles ? x Quels sont les comportements des patients relatifs au concept de don dans le cadre de l'action collective en ligne dans les communautés virtuelles de patients ?

Résultats Clés

x Identification des principales forces motrices et restrictives des l'action collective en ligne des patients connectés.

x Création d'un modèle d'adoption des communautés virtuelles pour les patients.

x Détermination des caractéristiques de comportements relatifs au don dans les communautés virtuelles de patients avec contextualisation de ces comportements.

Contributions

Cette recherche fait plusieurs contributions à la recherche et la pratique.

Introduction

Health 2.0 is changing the way patients inform themselves on health related matters [START_REF] Eysenbach | Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness[END_REF][START_REF] Frost | Social Uses of Personal Health Information Within PatientsLikeMe, an Online Patient Community: What Can Happen When Patients Have Access to One Another's Data[END_REF]. Health 2.0 is derived from Web 2.0, or the interactive web. It offers everyone an opportunity to communicate, share information and experiences over the Internet. That interactive aspect of Web 2.0 calls for further examination of online interactions and participation in generating web content, or online collective action. Accordingly, this paper explores some of the factors which contribute to the engagement of patients on online communities.

In spite of some recent developments, though, we know too little about how patients interact over the web and subsequently about online collective action in health communities. Indeed, online patients' communities offer numerous possibilities to Patients 2.0 -or ePatients -for sharing experiences, socializing, getting peer support, breaking isolation, increasing self-disclosure through anonymity [START_REF] Bargh | Can You See the Real Me? Activation and Expression of the "True Self" on the Internet[END_REF][START_REF] Joinson | Self-disclosure in computer-mediated communication: The role of self-awareness and visual anonymity[END_REF], as people do in other virtual communities [START_REF] Mercklé | Sociologie des réseaux sociaux[END_REF] but where common interests are health-related [START_REF] Orizio | The World of e-Patients: A Content Analysis of Online Social Networks Focusing on Diseases[END_REF]. However, the determinants of patients' online commitment remain un-studied.

In "Patients 2.0" we include people who use information and communication to interact with others on health issues [START_REF] Bos | Patient 2.0 Empowerment[END_REF]. A 2010 study based on a sample of adult individuals in the United States shows that about 80% of the population connect to the Based on Lewin's work (Lewin, 1947;[START_REF] Lewin | Field theory and experiment in social psychology: Concepts and methods[END_REF] combined with [START_REF] Eccles | Expectancies values and academic behaviors[END_REF] Expectancy-Value Theory (EVT), we develop a model for understanding patients' online collective action. Following this, we conducted a critical realist (Zachariadis et al., 2010) work which led us to conduct 54 semi-structured interviews [START_REF] Romelaer | L'entretien de recherche[END_REF] with patients, Web 2.0 experts, physicians, and other relevant informants.

Our work is structured as follows. First, we review the relevant literature on collective action, online collective action, Lewin's field forces and the expectancy-value theorizing with some insights on Health 2.0 online community contexts. Following both preliminary insights from the field and the literature, a model is then developed. The model is confronted to emergent insights from the field; for doing so, we developed a qualitative research design. We conducted 54 semi-structured interviews [START_REF] Romelaer | L'entretien de recherche[END_REF] with patients, Web 2.0 experts, physicians, and other relevant informants. So doing, we followed a partially grounded approach. While we believe existing theories provide relevant insights to examine this issue, we also believe they are insufficient to provide a complete account of online collective action in health contexts. That is why we have decided to ground our research on both the field and theory. This allowed us to benefit from emerging insights from the field, while contributing to knowledge in a cumulative way. The results are then discussed and the contributions are described. We conclude with the research limitations and the avenues for further research, together with the perspectives of this work for patients and Health 2.0 environments.

Theoretical Background

The literature review is organized as follows: i) the key concepts of collective action and online collective action; ii) the field force determinant of online collective action.

The work on the literature review allowed us to: i) gain a retrospective overview of key and contiguous concepts in the literature independently of the academic fields; ii) choose the relevant approaches, studies, models and constructs from different areas; iii) identify calls and venues for future research, as well as research gaps pertinent to our field of inquiry; iv) inspire the study framework during the empirical data collection; v) find safeguards in relation to findings, results, limitations, future research and conclusion.

Collective Action and Online Collective Action

Collective Action Concept

An understanding of collective action -and intentions that lead to joint actions -needs a command of many different disciplines and especially philosophy (Tuomela and Miller 1988;[START_REF] Searle | Collective Intentions and Actions[END_REF]Bratman 1993;Miller 2001;[START_REF] Gilbert | Rationality in Collective Action[END_REF], psychology and sociology (Tajfel 1981;Van Zomeren et al. 2008) (see Table 2).

In the area of philosophy, researchers link collective action to joint actions (Tuomela 1995) in order to reach common goals (Miller 2001) implying collective intentions [START_REF] Searle | Collective Intentions and Actions[END_REF]) and shared values (Bratman 1993).

In the area of social psychology, Tajfel (1981) described collective actions as "efforts by large numbers of people, who define themselves and are also often defined by others as a group, to solve collectively a problem they feel they have in common", p. 244. [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF] highlighted in this definition of collective actions the notion of collective social identity (Tajfel and Turner 1979) and shared problem perception. In the collective social identity concept, [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF] explained that "stronger identification with a disadvantaged group is associated with a greater will to participate in a variety of actions aimed at protecting or enhancing the group", p.182. In the shared problem perception concept, [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF] explained that "the traditional beliefs shared by group members may bring them to collectively recognize an event as threatening and worth uniting against", p.183. Van Zomeren et al. (2008) further demonstrated that perceived injustice, perceived efficacy and social identity affected collective action. The latter is also motivated by the perceived value of the outcome (Giguère and Lalonde 2010;

Bandura 1995) "when individuals perceive a valued outcome to result from collective actions, they are more likely to have a favorable attitude toward them and be willing to participate in them" [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF]p.183). This perceived value of the outcome is also posited in the purposive behavior of the model of goal directed behavior (MGB) [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF]; the feeling of injustice that bounds patients can be related to their disease. Still, MGB is complementary to the aforementioned concepts as it includes emotion which has not been studied in the collective action literature (Tang 2008). Furthermore, Lewin (1947) outlined the concepts of change and constancy in group life stating that:

"(a) Change and constancy are relative concepts; group life is never without change, merely differences in the amount and type of change exist;

(b) Any formula which states the conditions for change implies the conditions for no-change as limit, and the conditions of constancy can be analyzed only against a background of "potential" change", p.13.

In the area of sociology, the concept of collective action relates to the motivation of individuals to perform goals set by organizations [START_REF] Olson | The logic of collective action: public goods and the theory of groups[END_REF]. Crozier and Friedberg also emphasized the power relationships behind collective action [START_REF] Crozier | L'acteur et le système: les contraintes de l'action collective[END_REF]. Crozier and Friedberg for example highlighted power as a daily mechanism of the social existence, which is of particular importance for understanding the life of organizations in particular. However, we will leave aside the concept of power behind collective action as it may be less relevant in the context of patients' online interactions.

Therefore, to understand the dynamics of group life, one needs to get information about "desire for and resistance to specific change"-namely, in this study, collective action and the associated social forces. Collective Intentionality "Collective intentionality presupposes a Background sense of the other as a candidate for cooperative agency; that is, it presupposes a sense of others as more than mere conscious agents, indeed as actual or potential members of a cooperative activity." (Searle 1990, p.414) [START_REF] Searle | Collective Intentions and Actions[END_REF] Shared Intention "We should, instead, understand shared intention, in the basic case, as a state of affairs consisting primarily of appropriate attitudes of each individual participant and their interrelations" (Bratman 1993, p.99) (Bratman 1993) CET (Collective End Theory) of joint action "Joint actions are a species of interdependent action in which there is little or no conflict; joint actions involve a number of agents performing interdependent actions in order to realise a common goal" (Miller 2001, p.36)

(Miller 2001) Joint Commitment
"Collective action is interpreted as a matter of people doing something together, and it is assumed that this involves their having a collective intention to do that thing together… the parties are jointly committed to intend as a body that such-and-such." (Gilbert 2006, p.3) [START_REF] Gilbert | Rationality in Collective Action[END_REF] Social Psychology

Collective Actions

Collective actions are described as "efforts by large numbers of people, who define themselves and are also often defined by others as a group, to solve collectively a problem they feel they have in common" (Tajfel 1981, p. 244) (H. Tajfel 1981))

SIMCA (Social Identity

Model of Collective Action) Van Zomeren et al. (2008) demonstrate that "the key subjective predictors of collective action as well as their interrelationships" are "subjective injustice, identity, and efficacy", p.504. (Van Zomeren et al. 2008)

Sociology

Social Action

Social action implies that individuals will adapt their behaviors depending on social contexts and actions' results on other people, embedding, therefore, that social action will be correlated with the present, past or future behavior of others. (Weber, Runciman, et (Weber et al.1978) Collective Action "The digital-media environment prompts new and unforeseen opportunities for collective action as people are increasingly immersed in an atmosphere in which it is their routine practice to share ideas, connections, and interests." (Bimber et al.2012) Therefore, "all sorts of organizational structures and processes are implicated in the new technological landscape for collective action" (Bimber et al. 2012, p.6) that can be called organizational fecundity. (Bimber et al.2012)

Online Collective Action Concept

Collective action has also been somewhat examined in the information systems' literature. Prior research for example draw from social theories [START_REF] Coleman | Fondations of Social Theory[END_REF][START_REF] Fishbein | Belief, attitude, intention, and behavior: An introduction to theory and research[END_REF], social scientists and psychologists' reasoning [START_REF] Hardin | The tragedy of the commons[END_REF]; Olson [START_REF] Olson | The logic of collective action: public goods and the theory of groups[END_REF]Sweeney 1973;[START_REF] Schelling | Micromotives and macrobehavior[END_REF][START_REF] Oliver | A theory of the critical mass. I. Interdependence, group heterogeneity, and the production of collective action[END_REF] for example to: i) understand the necessary conditions of collective action [START_REF] Garud | Vicious and virtuous circles in the management of knowledge: The case of Infosys Technologies[END_REF], ii) help explain why individuals engaged in a collective action choose not to free-ride [START_REF] Wasko | WHY SHOULD I SHARE? EXAMINING SOCIAL CAPITAL AND KNOWLEDGE CONTRIBUTION IN ELECTRONIC NETWORKS OF PRACTICE[END_REF], or to iii) highlight the importance of public goods arising from collective and alliance-based collaborative work [START_REF] Monge | Production of collective action in alliance-based interorganizational communication and information systems[END_REF]. In spite of those contributions, the concept of online collective action is still largely unexplored in Information Systems.

Among the major contributions in social psychology, Bagozzi and Dholakia (2006) "Such group intentions are oriented toward shared activity, which requires (1) mutual responsiveness among participants to the intentions and actions of others,

(2) collective commitment to the joint activity, and (3) commitment to support others involved in the activity" (p.1101).

Interactions in online communities are sometimes considered to be based on foundations other than traditional cost-benefit rationality. Researchers argue that online collective action dimensions depend strongly on the virtual community itself, its social identity [START_REF] Allen | Affective, Continuance, and Normative Commitment to the Organization: An Examination of Construct Validity[END_REF]Bergami and Bagozzi, 2000;[START_REF] Luhtanen | A collective self-esteem scale: Self-evaluation of one's social identity[END_REF] and its groups norms [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]) . In recent years, open source software development and open source revolution [START_REF] Bergquist | The power of gifts: organizing social relationships in open source communities[END_REF][START_REF] Bezroukov | Open source software development as a special type of academic research: Critique of vulgar Raymondism[END_REF][START_REF] Feller | A framework analysis of the open source software development paradigm[END_REF][START_REF] Kollock | The economies ol online cooperation[END_REF][START_REF] Mockus | A case study of open source software development: the Apache server[END_REF], have contributed significantly to the interest of online collective action in the literature.

Researchers for example realized that the functioning of virtual communities introduces Raphaëlle Laubie -December 21, 2017

gift relationships and must therefore consider the gift economy [START_REF] Rheingold | The Virtual Community: Finding Connection in a Computerised World[END_REF], which have the potential to frame many online collective actions (Skageby, 2010).

Overall, though, there is no consensus in the literature concerning the role of the technology as a medium of collective action. Walther (1995Walther ( , 1992) ) argues that computer mediated communication has positive outcomes on social relationships as compared to

Face-to-Face meetings. However, the results and conclusions of those aforementioned studies appeared to be strongly linked with the context in which they has been conducted (Walther et al. 2010;Yates and Orlikowski 1992). Therefore, for online communities addressing the sensitive matters of disease, these factors ought to be examined cautiously. where individuals connect with others with similar disease. They share information about symptoms and treatments, along with their thoughts about the way they make their health-related decisions.

Yet, revealing health-related information raises some issues. For example, the related information is often very sensitive, with respect with employment decisions [START_REF] Heeney | Assessing the Privacy Risks of Data Sharing in Genomics[END_REF] "Health social networks are likely to become an important entity of influence in the medicine of the future, as they are generated bottom-up rather than topdown, by those who make medicine exist, namely, patients" (Orizio et al. 2010, p.6).

In fact, in the context of Health 2.0, there are a number of benefits and risks, related with of the use of Computer Mediated Communication (CMC) to support patients' need to interact (White and Dorman 2001). There is no consensus in the literature concerning the influences of the technology as a medium of collective action. Walther (1995Walther ( , 1992) ) argues the positive outcomes of CMC compared to Face-to-Face meetings. However, the

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach context of such studies appeared to be determinants to raise conclusions (Walther et al. 2010;Yates and Orlikowski 1992). For online communities addressing the sensitive matters of disease, these background factors ought to be examined cautiously. As described in Table 3 below, benefits are manifold and represent useful resources for patients' everyday hardship [START_REF] Orizio | The World of e-Patients: A Content Analysis of Online Social Networks Focusing on Diseases[END_REF][START_REF] Bos | Patient 2.0 Empowerment[END_REF][START_REF] Bottles | Patients, Doctors and Health 2.0 Tools[END_REF][START_REF] Diaz | Patients' use of the Internet for medical information[END_REF]. Those benefits mainly relate with overcoming isolation, acting anonymously, the wisdom of crowds, and the possibility to use the online community as a political tool. Despite those benefits, there are also many risks in the use of those communities, such as a digital divide effect, the time consuming use, misinterpretation of information, and the risks of lack of anonymity, as described in Table 4 below. Among the risks of online collective action, for example, the danger of getting wrong medical information/ misinterpreting information then propagated among the Internet users. For this, while mostly absent, a scrupulous control of potential erroneous information should be mandatory to avoid these pitfalls [START_REF] Culver | Medical Information on the Internet A Study of an Electronic Bulletin Board[END_REF]). Some researches suggest that Health 2.0 discussions offer mostly accurate information, especially because corrections may be reported rapidly; some researchers found as rapidly as within five hours [START_REF] Esquivel | Accuracy and self correction of information received from an internet breast cancer list: content analysis[END_REF]). Thus, patients 2.0 may get reliable information by connecting on virtual communities. This virtual communication allows them for example, to maintain a continuous link with the community members (24/7).

They may feel that they do not have to wait for new appointments with their practitioners to be informed on minor issues surrounding their disease and their daily life.

Together, those insights offer contrasting perspectives on the advantages and risks of engaging in online patients' communities. For these reasons, there is a challenge of better understanding the characteristics of online collective action. Further, arguably, the use of online patients' communities is growing over time. In fact, it should probably be encouraged as the sociological, economic and scientific outcomes could help to tackle some of the ageing and dependent population's health challenges. External criteria, as laws that human-beings have to comply with or adapt and which will influence their behavior and perceptions, have been studied by Lewin (1947) in the Field Theory.

The terminology "group dynamics" has been used to relate to dynamic interdependence as a label covering dynamic group properties, where properties are defined as types of reactions or types of influences representing certain types of interdependence.

The concepts examined by Lewin in social psychology experiments, aim at explaining social behavior [START_REF] Lewin | Field theory and experiment in social psychology: Concepts and methods[END_REF]. [START_REF] Lewin | Field theory and experiment in social psychology: Concepts and methods[END_REF] indeed explains that human behavior is influenced, from childhood, by social facts and social relations. This allows him to distinguish warm from unfriendly conduct and to divide social attitudes accordingly.

Therefore, any goal setting will scrutinize social facts and the characteristics of a given situation to anticipate the level of success of a particular action. This level will influence and justify ones' aspiration. Indeed:

"The level of aspiration is greatly influenced by such social facts as the presence or absence of other persons or by the competitive or noncompetitive character of the situation. It has been shown, too, that the goal-setting depends upon certain ideal goals" (Lewin, 1939, p.869).

The Field Forces theory represents a significant contribution to social psychology. It provides a holistic conceptual framework for indentifying driving forces and restraining forces, which picture "the direction and strength of the tendency to change" (Lewin, 1946).

Elie-Dit-Cosaque et al. ( 2011) also drew on social change theory and the abovementioned Lewin concepts, in the context of IT usage, highlighting the distinction between "the driving that leads to locomotion" and "the restraining forces referring to the physical or social obstacles that may hinder locomotion", p.206. However, this study does not address the purposes of collective action.

In summary, this purposive behavior, which reminds us of MGB principles [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF], allows us to adopt a practical approach spurred by the Lewin's fieldtheoretical account. In this respect, the following sections will concentrate on the identification of "the driving forces" and "the restraining forces" of online collective action, once the contextual background has been clearly outlined.

Field Forces Theory in Online Contexts

Social networks and virtual communities often mean the same in the literature.

However, [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] differentiated the two concepts, defining virtual communities as "consumer groups of varying sizes that communicate regularly and for some duration in an organized way over the Internet through a common location or mechanism to achieve personal as well as shared goals of their members", p.241-242. On the other hand, [START_REF] Ellison | Social network sites: Definition, history, and scholarship[END_REF] argued that social network sites "are primarily organized around people, not interests... structured as personal (or egocentric) networks, with the individual at the center of their own community", p.219.

The size of the network is a major factor of these two ways of functioning. Indeed, online social networks gather a broad audience enabling users to articulate and make visible their social networks, but the opportunity to come into contact with strangers usually is of minor importance [START_REF] Ellison | Social network sites: Definition, history, and scholarship[END_REF]Grabner-Kräuter 2009). Putnam (2001) argued that weak ties -referring to social networks -imply a bridging behavior between individuals leaving aside emotional support whereas strong ties -referring to virtual communities -imply a bonding behavior involving strong emotional support between individuals.

Furthermore, Meglino and Korsgaard (2004) argue that "sociality maintains that group members suspend their personal interests in order to ensure their group's continued existence", p.947. Nevertheless, although online social networks and virtual communities are often confused in the literature, this concept will not always apply to both online networks. Virtual communities indeed differ from social networks, in particular because common interest is an important prerequisite for gift-giving culture through the Internet medium [START_REF] Bergquist | The power of gifts: organizing social relationships in open source communities[END_REF]. Therefore, in the context of patients' networks, the first approach described by [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] applies, leading us to focus on patients' virtual communities, instead of that of social networks.

Within these virtual communities, one should consider the differences in the user profiles and their willingness to participate in the group's mission. Janzik and Raasch (2011) Although not referring to Lewin's Field Theory specifically, some driving and restraining forces that would make online communities successful or not have already been discussed by researchers (Toral et al. 2009).

Further, online action of communities' members, which characteristics have been outlined above, also imply system usage issues. In those contexts, for example, a well structured, easy to use website, compliant with the right principles for appropriate visual appeal or navigation will not always be sufficient to ensure active and successful communities (De [START_REF] Souza | A framework for analyzing and understanding online communities[END_REF]. Referring to virtual communities as opposed to social networks, the pervasiveness of social facts remains a crucial characteristic:

"This is because online communities should be understood as a social phenomenon that establishes social networks of people with common interests.

Consequently, success of online communities should be determined by social factors" (Toral et al. 2009, p.379).

Based on the Field Forces theory and Expectancy-Value Theory (EVT), the following sections will concentrate on the identification of the driving and restraining forces of online collective action in an online community context.

Expectancy-Value Theory (EVT) Adapted to Online Contexts

Expectancy-Value Theory (EVT) [START_REF] Eccles | Expectancies values and academic behaviors[END_REF], outlined four components of taskvalue, which have been defined as follows. The first component, social value, draws upon attainment value also related to self-schema and identity theories [START_REF] Markus | The Dynamic Self-Concept: A Social Psychological Perspective[END_REF], which reflects on oneself and one self's relevance of engaging in a task (Eccles & Raphaëlle Laubie -December 21, 2017[START_REF] Eccles | Motivational beliefs, values, and goals[END_REF]. It also includes "the personal importance of doing well on a task" (Eccles & Wigfield, 2002, p.119). In virtual environments, [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] defined it as a means to "understand and deepen salient aspects of one's self through social interactions" (p.144).

The second component, utilitarian value, refers to the determination of the task itself and its relation to future goals' achievement. "A task can have positive value to a person because it facilitates important future goals" [START_REF] Eccles | Motivational beliefs, values, and goals[END_REF], p.120.

The third component, hedonic value, draws upon intrinsic value or "the enjoyment the individual gets from performing the activity or the subjective interest the individual has in the subject" (Eccles & Wigfield, 2002, p.120). It is also a determinant for participation in virtual communities [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF].

The fourth component, cost value, reflects the negative aspects of engaging in the task" (Eccles & Wigfield, 2002, p.120). In social exchange theory, trust is a core component of a cost-benefit analysis with respect to social interaction [START_REF] Roloff | Interpersonal Communication: The Social Exchange Approach[END_REF]. For interactions that take place in online communities, many researchers associate trust concerns with privacy concerns (e.g., [START_REF] Dong-Hee | The effects of trust, security and privacy in social networking: A security-based approach to understand the pattern of adoption[END_REF][START_REF] Fogel | Internet social network communities: Risk taking, trust, and privacy concerns[END_REF][START_REF] Dwyer | Trust and privacy concern within social networking sites: A comparison of Facebook and MySpace[END_REF] or quality of information [START_REF] Kwon | An empirical study of the factors affecting social network service use[END_REF].

Following those insights, the present research draws on the functioning of groups through social influence and social identity, exploring the role of positive emotions in behavioral action. We will focus on the driving forces of the value of online collective action -namely social, utilitarian and anticipated positive emotions of EVT [START_REF] Eccles | Expectancies values and academic behaviors[END_REF]) -and the restraining forces of online collective action -namely cost value of EVT -to establish the design of our critical realism research (Zachariadis et al. 2010).

All these concepts were brought by the literature but influenced, from the very start of this research, by our field experience as well as during the interview process.

Driving and Restraining Forces of Online Collective

Action: First Draft Model of Online Collective Action Following Lewin's framework, EVT theorizing, and prior insights from the field qualitative interviews, a generic, synthetic conceptual model (Figure 1 below) has been developed. Specifically, drawing on the functioning of groups through social influence and social identity, the model depicts the expectancy values' "driving" and "restraining" forces (Lewin 1947) and its role in the dynamics of online collective action in online community contexts. Also based on EVT [START_REF] Eccles | Expectancies values and academic behaviors[END_REF], the model aims to help better acknowledging in particular the role of social, utilitarian and anticipated positive emotions in the development of collective action on the one hand; that of cost value on the other hand. The qualitative inquiry presented hereafter helps in particular to identify which facets of the expectancy values specifically emerge in the dynamics of online collective action on online communities and appear to be the most relevant ones.

Design and Methods

In order to respond to our research question, we applied a qualitative approach following the tradition of qualitative methods in information systems (IS) (Trauth 2001).

We chose direct contact, close listening, dialogue and conversation with patients and stakeholders for our exploratory approach in order to better understand the recent phenomenon of engaging in virtual communities [START_REF] Branthwaite | The power of qualitative research in the era of social media[END_REF].

Research Field

It was important to make a cautious identification of the relevant patient populations.

Indeed, the condition of the patient is likely to contribute to his/her need for information sharing and exchange between people affected by the same disease. Further, the desires of interaction between patients on sporadic concerns are fundamentally different from the concerns of patients with acute or chronic disease (PwC 2012). We

Procedures

In order to mitigate the way data collection and interpretation activities could affect both the researcher and the interviewee [START_REF] Klein | A set of principles for conducting and evaluating interpretive field studies in information systems[END_REF] we chose to conduct semistructured interviews [START_REF] Romelaer | L'entretien de recherche[END_REF]. These added rigor and consistency across interviews to the data collection [START_REF] Myers | Qualitative Research in Business and Management[END_REF], "where the researcher urges the Raphaëlle Laubie -December 21, 2017 respondent to communicate many, detailed and quality information on topics related to the research, with limited influences that guarantee the absence of bias and serve a good scientificity" ( Romelaer 2005, p.102). Therefore, interview guides (see Table 6,7 Our motivations to use such interviews were multiple. Firstly, we felt the existing theories were insufficient in some respects to examine engagement in online communities and consequently had to be adapted to the selected field of inquiry.

Secondly, we were further expecting that some constructs regarding determinants of online collective action could potentially emerge from the patients' experiences. Thirdly, we were convinced that our specific field of inquiry required this partly inductive approach. Hence, this method was expected to contribute to i) the content validity for the constructs in the subsequent quantitative part and to ii) enrich the conceptual framework, which is grounded in both theory and actual human thoughts. -Ethnographic research approach in order to gain preliminary insights on patients' sociological typology as well as driving and restraining forces for online collective action.

-25 preliminary semi-structured interviews with Doctors and caregivers, Health 2.0 experts and Web 2.0 experts, users of patients' social networks.

-29 subsequent interviews conducted with participants who had to deal with their own health issues or that of relatives.

We proceeded in two steps. First in order to obtain insights into patients' social characteristics as well as on the factors that can potentially foster or hinder their interactions on online communities we conducted a preliminary series of interviews.

Interviews were conducted with Doctors and caregivers (5 persons), Health 2.0 experts (13 persons) and Web 2.0 experts (7 persons). Of the 25 persons interviewed for these preliminary interviews, 11 were female and 14 were male. The preliminary interview guide is provided in Table 6 below. To identify a patient panel to address for the study Are there patients' networks that are more suitable for some patients than other To identify a patient's panel that would not be relevant for the study What would be the patients' motives for online engagement?

To compare the feedback of experts about determinants for patients' online engagement against the literature What would be some hindrances to engagement?

To compare the feedback of experts about hindrances to patients' online engagement against the literature What about privacy and data protection?

To compare the feedback of experts about hindrances for patients' online engagement against the literature Do you think these portals help patients during the healing process?

To compare the feedback of experts about positive psychology and patients' online engagement against the literature Raphaëlle Laubie -December 21, 2017

The preliminary investigations provided us insights into the most relevant patient profiles to interview for the main study. Some testimonies reassured us of the need to address specific categories of virtual communities: "Virtual communities are probably not for all patients, but they are particularly suitable for two categories of patients: chronic patients and patients suffering from rare diseases. They also cater to families. The greatest proof of the usefulness of virtual communities for health matters lies in the categorization." "The sites are especially suitable for chronic diseases. And patients need to be informed ... I do think that one is informed when a chronic patient, when one has a rare disease he may know it better than his doctor."

In particular, the information obtained revealed that, in accordance with the main topic of the targeted communities, patients with chronic diseases, severe diseases and patients' relatives were the most relevant persons to participate in the research.

As mentioned above, patients' families are also involved in the problems of everyday life experienced by their loved ones and are conscious of the crucial importance of the feedback coming from others with similar problems (PwC 2012).

We then proceeded by interviewing selected patients (21 persons) and patients relatives (8 persons) irrespective of whether they were willing or reluctant to join these virtual spaces. We included in our sample patients who were reluctant to join online

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017 communities, women engaged in a breast cancer community, and relatives of autistic children engaged in a rare disease community.

In completing the interviews, we have been cautious in taking into account some potential bias, such as elite bias, Hawthorne effects [START_REF] Parsons | What happened at Hawthorne?[END_REF] and construction of knowledge [START_REF] Myers | The qualitative interview in IS research: Examining the craft[END_REF]. The anonymity of the respondents was also guaranteed.

The interviews have been conducted while the literature was still being analyzed. This allowed developing an online collective action (OCA) model through a constant a back and forth process between the literature and the field. In this, the model is in part grounded on the field: while the broad EVT categories came from the literature, the expectancy value facets, which make sense in an online community context, have emerged from the analysis of the interviews. So doing, this approach allowed us to let some concepts coming from the field and be compared with the literature in an exploratory approach [START_REF] Mingers | The contribution of critical realism as an underpinning philosophy for OR/MS and systems[END_REF]Mingers, 2004). The interview guide for patients and patient's relatives is given in Table 7 below. Once we had collected enough material and semantic saturation was reached -i.e. when the last of our 54 interviews' coding didn't make any further category emerge [START_REF] Glaser | The Discovery of Grounded Theory: Strategies for Qualitative Research[END_REF], we conducted the data analysis in two steps.

Coding and Analysis Sequencing Perspective: Critical

Realism Paradigm

Before coding interview data, we defined an initial set of themes drawn from the literature. The aim of interview coding was to identify the value dimensions of online collective action from the literature and interviewees' day-to-day experiences of virtual communities. Hence, we also expected unknown or new categories to emerge from interviewees' accounts.

Raphaëlle Laubie -December 21, 2017 During the course of the interviews, and throughout the transcripts' analysis and coding, new codes and concepts emerged and the list of themes grew accordingly [START_REF] Mason | Qualitative researching[END_REF].

The coding has been completed through the use of NVivo 9 and 10. Thematic coding and data mapping have been completed [START_REF] Bazeley | Qualitative data analysis with NVivo[END_REF]. We proceeded in two steps.

First and before coding the data obtained in interviews, we set broad categories as explained above. The initial dictionary of categories was drawn from the literature study resulting in 10 a priori themes (See § 2.5.2).

Second and as an ongoing process we created categories from the data itself and established coherent links between all these categories. The approach considered both prior theoretical insights and interview data. It was an incremental approach to data gathering, as, throughout the transcripts' analysis and coding process, new categories were added when related to our study issues. "A key to this process is to consider a broad range of literature" (Eisenhardt 1989, p.544).

This first coding process ended up in a dictionary of themes comprising 28 themes. This was done in light of our goal to follow the critical realist paradigm (Zachariadis et al. 2010;[START_REF] Mingers | The contribution of critical realism as an underpinning philosophy for OR/MS and systems[END_REF], implying that since, in this Web 2.0's research, "IS is conducted within social organizations, social science is also of relevance" (Mingers 2004, p.91). Mingers (2004) further argues on this philosophical position stating that:

"critical realism asserts that the conditions for knowledge do not arise in our minds but in the structure of reality, and that such knowledge will not be universal and ahistorical", p.92.

Raphaëlle Laubie -December 21, 2017

Therefore, aware of intransitive objects of knowledge -namely non-human-invented-, our work on the field was intended to discover the transitive dimension of knowledge helped by social sciences theories and their potential human-invented alterations (Bhaskar 2010). In this regard, Mingers states that:

"This distinction allows us to admit the epistemic relativity of science, the fact that knowledge is always historically and socially located, without losing the ontological dimension" (2004, p.299).

Indeed, the list of categories and its principal theme were developed according to prior literature, but we changed this list during the course of the interviews following this critical realist perspective. Thus, in this research, we sought theoretical emergence through an exploratory process and analysis of the production of concepts by social actors in real settings and specific fields of inquiry-i.e., transitive dimension of knowledge. We examined how well data either fits or shapes conceptual categories we identified from the literature, in an iterative back and forth work between the research field and literature.

After the entire coding process and through interview analysis, some categories were restructured -and some were dropped when considered as non relevant -as follows [START_REF] Bhaskar | The Possibilities of Naturalism[END_REF].

The Table 9 below give details about the different driving and restraining forces of online collective action, which have been identified and coded, whether they have been identified from the literature or emerged from the interviews.

Therefore, constantly attentive to both sources, we revisited the literature accordingly and enriched the model subsequently.

Following the chronology of our findings, this section is organized as outlined below.

Firstly, we address each construct of driving forces enumerated by [START_REF] Eccles | Expectancies values and academic behaviors[END_REF] EVT -namely: social, utilitarian and anticipated positive emotions -applied to online contexts, in search of existing and new concepts.

So, we listened to patients' testimonies concerning IT artifacts and the notions of habits and consulted the relevant literature.

Thereafter, we address EVT construct of restraining forces -namely cost value -applied to online contexts, in search of existing and new concepts.

Finally, we completed our model with every sub-dimension gathered by this constant toand-from between the literature and patients' testimonies.

Driving Forces of Online Collective Action

Social Values

Pursuant to the already mentioned three components of task-value of [START_REF] Eccles | Expectancies values and academic behaviors[END_REF] that may spur online collective action, we will seek, helped by both field and literature review in our critical realism research design, what concepts and dimensions they may refer to for online users and especially patients connected on virtual communities. These components are comprised of social value, utilitarian value and anticipated positive emotions.

Raphaëlle Laubie -December 21, 2017

2.4.1.1.1 Functioning of Groups through Social Influence: Introducing Social

Identity and Group Norms

In the context of patients' communities, we find it relevant to explore social influence literature about the driving forces for online collective action. [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF], drawing on [START_REF] Kelman | Compliance, Identification, and Internalization: Three Processes of Attitude Change[END_REF] perceptions of interpersonal influences, categorize social influence's variables for online participants. The latter are comprised of social identity and group norms' constructs, observing that face-to-face social context cues differ with media communication (Sproull et Kiesler 1986).

Compliance, the Kelman's third variable of social influence, has been left behind by Dholakia et al. being considered of minor importance in the case of online communities.

Indeed, participants do not feel the need to conform to the online group, expecting rewards or fearing punishment, as the possibility to leave the virtual engagement can easily be done, as the feeling of freedom is high.

Identification or Social Identity

Social identity comprises the psychological and sociological aspects of individuals' conducts in a group entity embracing three components that explain social cognition and behavior. Group identification or social identity requires: i) cognitive component (awareness of membership), ii) evaluative component (value connotations), iii) emotional component (as an investment).

For patients 2.0 as for members of non-patient groups, social identity refers to a strong sentiment of group belongingness comprised of an affective commitment (Bergami and Bagozzi 2000), a self-awareness of community membership [START_REF] Ashforth | Social Identity Theory and the Organization[END_REF] and a self-worth evaluation as group member [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]). As chosen by Dholakia et al., in terms of terminology development, we will adopt the term belongingness needs. Therefore:

Proposition 1: Belongingness Needs is positively related to online action regarding virtual patients' communities.

(Social Value of Online Collective Action's Driving Forces)

Group Norms or Internalization

In collective or shared intention, participants' attitudes need consistency in order to face reasoning and coherence towards collective planning and future shared activity (Bratman 1999). Collective intention -aka we-intentions -implies commitment and agreement to joint-activity from each protagonist (Tuomela 1995). [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] include these aspects in their model of group norms related to Kelman's concept of internalization, when an individual accepts influence from others towards a behavior because it is congruent with his/her value system [START_REF] Kelman | Compliance, Identification, and Internalization: Three Processes of Attitude Change[END_REF].

Drawing on Tajfel (1982) theories, -illustrating common interest, interlocking roles, influencing each other, and shared goals- [START_REF] Postmes | The formation of group norms in computermediated communication[END_REF] investigated the formation of group norms in CMC, positing that group norms have to be understood as emergent properties of the group that organize behavior and that "social and normative context has a substantial impact on CMC use", p.366.

We will further study this CMC use in the following section in the "IT artifacts"

paragraph, but first, the aforementioned points allow us to state that in the context of patients' communities:

Proposition 2: Group Norms is positively related to online action regarding virtual patients' communities.

(Social Value of Online Collective Action's Driving Forces)

Exclusive Value from Patients' Perspective

To our knowledge, absent from the literature addressing determinants of online action, we however identified the notion of exclusive value. Exclusive value would be referring to Baumeister and Leary's approach on interactions stating that:

"Interactions with a constantly changing sequence of partners will be less satisfactory than repeated interactions with the same person(s), and relatedness without frequent contact will also be unsatisfactory" (1995, p.497).

Indeed, many patients were arguing about their need to interact with exclusive partners, meaning with those that share the same disease, in the case of patients' communities, because:

"When the site is dedicated to a specific category of patients, if I may say so, they have a stronger relationship; there is a very important community effect tenfold The notion of information, nurturing and occasionally flooding virtual spaces has often been covered in the above sections.

Besides, information needs and instrumental needs have raised significant interest in Dholakia et al.'s (2004) research as well as in previous studies [START_REF] Bagozzi | Goal setting and goal striving in consumer behavior[END_REF]. Gathering these two concepts under a single denomination purposive value,

Dholakia et al. defined it as follows:

''the value derived from accomplishing some pre-determined instrumental purpose (including giving or receiving information)" through virtual community participation", (2004, p.244).

Unquestionably of relevance in the context of patients' communities, according to patients' testimonies, we however suggest to keep the two concepts separate for a better understanding of patients' functioning. Therefore: Another dimension that seems to be important in communities of patients relates to the emotions conveyed. As it seemed to be a predominant dimension of online collective action from the patients' standpoint, we conducted an in-depth literature review of the emotions construct and its various aspects.

We will come back to the fundamental of action to explore it. Engaging in collective action supposes first being determined to engage in personal action. Previously, philosophers and researchers emphasized the dynamics of reason and passion for understanding action. Pascal, in 1670, exposed the contradiction between passion and reason (Genet 1983[START_REF] Pascal | Blaise Pascal: Thoughts, Letters, and Minor Works[END_REF][START_REF] Cottingham | Philosophy and the Good Life: Reason and the Passions in Greek, Cartesian, and Psychoanalytic Ethics[END_REF]. Differently, Descartes, in 1649, postulated on the supremacy of reason over passion [START_REF] Descartes | The Passions of the Soul: Les Passions De Lame[END_REF][START_REF] Cottingham | Philosophy and the Good Life: Reason and the Passions in Greek, Cartesian, and Psychoanalytic Ethics[END_REF] while Hume, in 1739, advocated a theory in which reason is governed by passion [START_REF] Hume | A Treatise of Human Nature[END_REF]) [START_REF] Beauchamp | David Hume: A Dissertation on the Passions[END_REF]).

In his model, [START_REF] Hume | A Treatise of Human Nature[END_REF] asserted that reason does not by itself constitute grounds for an action of volition, and that reason only intervenes to explain passion's impulses to action's proceedings and thus connecting between the two elements. However, Hume also stated that reason cannot oppose passion for directing the will for action:

"Reason is, and ought only to be the slave of the passion, and can never pretend to any other office than to serve and obey them" (2004, p. 375) .

By passion, Hume categorizes the following feelings: i) direct passions (desire, aversion, joy, hope and fear), ii) indirect passions (pride, humility, love, hatred, vanity, envy, pity, malice, esteem, benevolence, respect and compassion).

While exploring other research areas, we found that positive psychology literature highlighted that "positive emotions broaden the scope of attention, cognition and action" [START_REF] Fredrickson | The broaden-and-build theory of positive emotions[END_REF](Fredrickson , p. 1369)), and "improve psychological well-being, and perhaps also their psychological health" [START_REF] Fredrickson | The broaden-and-build theory of positive emotions[END_REF](Fredrickson , p. 1371;;2000). Clinicians, using the benefits of positive psychology with depressed people by questioning their recalling of events responsible for positive emotions, saw improvements in their condition. Indeed, faster healing but also greater autonomy from the disease is experienced [START_REF] Boeck | Treating Suicidal Behavior: An Effective, Time-Limited Approach[END_REF].

Therefore, positive emotions contribute to their welfare and its optimal function in the present moment [START_REF] Diener | Happiness is the frequency, not the intensity, of positive versus negative affect[END_REF]. Positive emotions also encourage stepping back in the face of upcoming events, avoidance of negative thoughts, emotional resilience and the development of resources in times of trial (B. [START_REF] Fredrickson | The broaden-and-build theory of positive emotions[END_REF]. A responsible environment provides further positive emotions to the patients, his/her relatives and other patients 2.0; not only for the immediate satisfaction it provides but also because it endows them with a force that will be of help in future battles and will increased level of dopamine in the brain, developing the capacity of flexible and creative thought patterns in respect and response to the problems encountered [START_REF] Ashby | A neuropsychological theory of positive affect and its influence on cognition[END_REF][START_REF] Isen | Positive Affect, Cognitive Processes, and Social Behavior[END_REF]. Positive emotions are also presented in marketing literature, as [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] relate to entertainment value, "derived from fun and relaxation through playing or otherwise interacting with others", p.244.

Referring to gift concept, [START_REF] Chakrabarti | Gift giving and social emotions: experience as content[END_REF] also argued that "in order to understand the total gift-giving experience, researchers should emphasize more on the intangible thoughts and emotions over the tangible object of the gifts per se", p.155, referring to the positive anticipated emotions of our levels of value of online collective action (see Figure 1) .

The Role of Emotions in IS Research

All these studies, from researchers in fields other than IT, urge us to pay thorough attention to emotions in order to better understand patients 2.0 behavior.

In online context, researchers demonstrated that, besides decreased isolation, patients' virtual communities fostered emotional support while interactions and shared experiences (White et Dorman 2001). The CMC offers convenience for collective action and "50% of postings concerned socio-emotional exchanges" (White and Dorman 2001, p.700).

Coming back to IT use, the literature demonstrated the relationship between emotions and IT through intermediate adaptation behaviors [START_REF] Beaudry | The other side of acceptance: studying the direct and indirect effects of emotions on information technology use[END_REF].

However, to our knowledge, prior research didn't address the context of patients' usage of online communities. Therefore, we will further explore the patients' behaviors in the context of virtual communities, drawing on Beaudry and Pinsonneault's statement:

"emotions are a mental state of readiness for action that promote behavioral activation" (2010, p. 690), therefore: Internet users are exposed to so many different choices and are becoming reluctant to noise and time wasting. Indeed, meeting system usage concepts of TAM [START_REF] Davis | Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology[END_REF]), [START_REF] Shackel | Human Factors for Informatics Usability[END_REF] explained that usability "is not only conceived of as ease of use but also equally involves efficacy i.e., effectiveness in terms of measures of (human) performance", p.24. However, the question opens a wide field of research with an extensive set of usability and performance measures (Benbunan-Fich 2001, Van Waes 2000[START_REF] Benbunan-Fich | Methods for evaluating the usability of web-based systems[END_REF][START_REF] Fang | An empirical study of web site navigation structures' impacts on web site usability[END_REF] considering the variety of online websites categories themselves dedicated to different audiences and purposes. [START_REF] Phillips | Visual appeal vs. usability: which one influences user perceptions of a website more[END_REF] noticed that when users appreciated the visual appearance of a website at first glance, they may continue the browsing experience regardless the website's usability, and as a result, perceived usability can be more influential on the intention to use than ease of use and efficacy [START_REF] Kurosu | Apparent usability vs. inherent usability: experimental analysis on the determinants of the apparent usability[END_REF], [START_REF] Brady | Aesthetics and usability: a look at color and balance[END_REF]. Other researchers demonstrated that visual appeal influences users rating of perceived usability, sometimes in contradiction with actual usability (Tractinsky, Katz, et Ikar 2000).

Therefore, we drew on [START_REF] Nelson | Antecedents of information and system quality: an empirical examination within the context of data warehousing[END_REF] to select navigational structure as a system quality parameter that affects trust in the IT artifact (e.g.,(Vance, Elie-Dit-Cosaque, et Straub 2008) Wang et al. 2008;Loiacono et al. 2007;[START_REF] Montoya-Weiss | Determinants of online channel use and overall satisfaction with a relational, multichannel service provider[END_REF]Wolfinbarger and Gilly 2003). Visual appeal has also been widely studied as a website quality dimension (Vance et al. 2008;Loiacono et al. 2007;Tseng and Fogg 1999;Wagner 2005), and together with navigational structure, both these attributes may be leading to attitudes, intentions and ultimately behaviors (M. Fishbein et [START_REF] Fishbein | Belief, attitude, intention, and behavior: An introduction to theory and research[END_REF] (see Table 10). For the specific population of patients, the usability of e-health web sites as information providers has been studied, examining authority of source, layout and appearance, advertising presence and aspect, readability, etc. [START_REF] Eysenbach | How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews[END_REF][START_REF] Curtis | Exploring the Usability of E-Health Websites[END_REF][START_REF] Sillence | Please advise: using the internet for health and financial advice[END_REF][START_REF] Sillence | Please advise: using the internet for health and financial advice[END_REF]. Researchers have been exploring some of these aspects and developed dedicated scales such as the Perceived Health Web Site Usability Questionnaire (PHWSUQ), which includes 25 principles in 4 categories: (1) readability,

(2) presentation of information, (3) incorporation of other media, (4) ease of navigation [START_REF] Nahm | Usability of health Web sites for older adults: a preliminary study[END_REF]. However, research lacks information about health-related virtual communities and the role of emotions in their rating of perceived usability, with regard to visual appeal that may influence the usability perception of users.

Therefore, we will add to our study the two aforementioned categories -namely navigational structure as a utilitarian value as it refers to "how well a task relates to current and future goals" (Eccles and Wigfield 2002, p.120) and visual appeal as a anticipated positive emotions as it refers to "the enjoyment the individual gets from performing the activity" (Eccles and Wigfield 2002, p.120) would not be a relevant predictor of action according to TPB.

However, many researchers have examined this factor in greater depth [START_REF] Ouellette | Habit and intention in everyday life: The multiple processes by which past behavior predicts[END_REF][START_REF] Aarts | Predicting Behavior From Actions in the Past: Repeated Decision Making or a Matter or Habit?[END_REF][START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF]. Some specifically expanded the subject to IT use focusing on habits, and found a significant effect of the latter "triggered by environmental cues" (Ortiz de Guinea and Markus 2009, p.440).

Past Behavior can be conceptualized in many different ways, such as frequency of behavior, recent behavior [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] or habits. Habits have been defined

as "the tendency to repeat past behavior in a stable context" (Ajzen 2002, p. 108;[START_REF] Ouellette | Habit and intention in everyday life: The multiple processes by which past behavior predicts[END_REF]. Thus, even when it deals with IT use, habits refer to habitual behaviors, rather than to behaviors guided by intentions [START_REF] Limayem | Force of Habit and Information Systems Usage: Theory and Initial Validation[END_REF]Kim and Malhotra 2005). In this regard, goal-directed behaviors differ from intentions in terms of appreciation and consciousness of decision [START_REF] Ahuja | Moving beyong intentions and toward the theory of trying: effects of work environment and genderon post-adoption information technology use[END_REF]. Indeed, as primary reasons induce action in the concept of intention, goal-directed-behavior theory suggests that goals can be reached without individuals being fully conscious of his Raphaëlle Laubie -December 21, 2017

or her thoughts. This occurs especially when the goal-directed-behaviors encounter frequent repetitions and thus action is performed in a familiar environment as habits.

Aarts and Djiksterhuis further assert that habits can be considered as links between goals and actions, activated by the environment, and which contributes to reaching these goals through automatic behavior. Therefore, the more often the activation of a goal conducts to the same behavior, the stronger the unconscious processes (Aaarts and Dijksterhuis 2000; [START_REF] Heckhausen | Intentional Action and Action Slips[END_REF][START_REF] Reason | Human Error[END_REF]).

Habits from Patients' Perspective

Concerning patients, the phenomenon of addiction that relates to the development of habits, outlined above, was demonstrated to be of relevance by White and Dorman (2001) in CMC patients' support groups.

We acknowledge that the repeated connection of the patient may lead to the Internet addiction, implying an extensive level of virtual community interactions [START_REF] Beard | Modification in the proposed diagnostic criteria for Internet addiction[END_REF]Young 2004), and thereby of online collective action (Laubie et Elie-Dit-Cosaque 2012).

However and despite the above mentioned inputs taken from the literature, the automatic nature of this concept questions the relevance of its introduction in our model.

Drawing on Ajzen's (2005) statement about background factors -that will be further explained in a following section -we will include habits in the background factors category, as past experiences that may be related to or influence users' beliefs. Therefore, we will study and code it but put it apart from our research model, namely driving forces of online collective action.

Raphaëlle Laubie -December 21, 2017

Restraining Forces of Online Collective Action

In the same perspective and taking into account the above mentioned last component of task-value of [START_REF] Eccles | Expectancies values and academic behaviors[END_REF] that may hinder online collective action, we will seek, through the literature review as well as helped by patients' inputs, what concepts and dimensions ought to be included in our model concerning the cost value.

Cost Value

The Role of Trust in Behavioral Action

As already described, cost value relates to "negative aspects of engaging in the task" (J. S.

W. Eccles et Wigfield 2002).

In online community interactions, many researchers associated the cost value with trust, referring to privacy concerns [START_REF] Metzger | Privacy, trust, and disclosure: Exploring barriers to electronic commerce[END_REF][START_REF] Dwyer | Trust and privacy concern within social networking sites: A comparison of Facebook and MySpace[END_REF][START_REF] Dong-Hee | The effects of trust, security and privacy in social networking: A security-based approach to understand the pattern of adoption[END_REF][START_REF] Fogel | Internet social network communities: Risk taking, trust, and privacy concerns[END_REF]. On this subject, the press related several users' unfortunate experiences with personal data disclosure [START_REF] Read | Think before You Share[END_REF]. As Peter Steiner put in the caption to a cartoon: "on the Internet, nobody knows you're a dog" and from the very beginning of online chat services, the "Joan and Alex" story featured the case of a psychiatrist who pretended to be a young disabled woman (Van Gelder 1991). Some years later "a rape in cyberspace" was depicted [START_REF] Dibbell | My tiny life: Crime and passion in a virtual world[END_REF] as well as the social networking website Bebo's privacy issues [START_REF] Eriksen | Glitch ons Bebo users' private details to others[END_REF], Facebook being used by students to mislead campus police [START_REF] Hass | In Your Facebook.com[END_REF] or Friendster-at-that-time's new feature: "Who's Viewed Me" highlighting "Friendster's own insecurity" [START_REF] Mintz | Friendster's "Eww" Moment[END_REF].

Raphaëlle Laubie -December 21, 2017

Trust from Patients' Perspective

In the specific context of online patients' communities (Laubie and Elie-Dit-Cosaque 2012), trust is also an essential dimension of cost.

Indeed, on the Internet, patients will be the very first population concerned about the respect of privacy [START_REF] Goldberg | Privacy-enhancing technologies for the Internet[END_REF]):

"Yes, I think one must still be wary of Internet. You quickly forget that everything can be seen there that it seems to be a sphere of confidence." (Breast cancer community patient)

Secondly, the accuracy of information (Williams et al. 2003;[START_REF] Diaz | Patients' use of the Internet for medical information[END_REF][START_REF] Dickerson | Therapeutic connection: help seeking on the Internet for persons with implantable cardioverter defibrillators[END_REF] will be of significant importance, especially when they interact online with groups of people concerning very personal issues, such as health [START_REF] Coulson | Receiving social support online: an analysis of a computer-mediated support group for individuals living with irritable bowel syndrome[END_REF]; White and Dorman 2001)::

"The misinformation fear still remains." (Breast cancer community patient)

Lastly, any negative emotion that can be triggered by online comment could have dreadful impacts, so much so that some patients would prefer leaving these virtual spaces for a period of time or even indefinitely:

"Sometimes we read very difficult stories.

Emerging Model of Online Collective Action

All the variables and propositions discussed in the above sections have to be taken into account and considered for further analysis in the emerging model of patient's online collective action (See Figure 2).

After the complete analysis of the interviews and the closing of the coding, some slight changes in the model occurred, that would then be further identified in figure 2.

Indeed, the underlying framework and our research design allowed us to let any new concept emerge during the data collection and analysis process and to identify regularities and demi-regularities pursuant to the design of critical realism research (Zachariadis, Scott, et Barrett 2010). Lawson defined demi-regularity as follows:

"A demi-regularity … is precisely a partial event regularity which prima facie indicates occasional, but less than universal, actualization of a mechanism or tendency, over de definite region of space-time'' (1998, p.149).

We will follow this thought, even if "Lawson's examples of demi-regularities include cases that are much more conducive to statistical modeling" (Pratschke 2003, p.25). All the more so as [START_REF] Bhaskar | The Possibilities of Naturalism[END_REF]

Model Analysis

In this section we argue our research's coding methodology that led to the final dictionary of theme building and the final drawing up of the model.

Through all that work, we kept in mind that researchers agree on what is needed to produce a good qualitative research design: "a skilled activity requiring critical and creative thinking" (Mason 2002, p.46); "a dynamic, intuitive and creative process of inductive reasoning, thinking and theorising" (Basit 2003, p.143). As a result, driving and restraining forces of online collective action were first classified according to the EVT [START_REF] Eccles | Expectancies values and academic behaviors[END_REF] underlying framework, but also inferred by [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] determinants for participation in virtual communities. The remaining categories were coded to bring contextual information about background factors and benefits of online collective action as a willingness to add rigorousness to the research and to provide possible managerial contributions.

At the beginning of the interviews, we developed an initial list of themes drawn from the literature that allowed us to create the interview guide (See Table 6). During the course of the interviews, new codes and concepts emerged and the list of themes grew accordingly. We explain the choice and in-depth process of his methodology in the paragraphs below. Mason (2002, p.74), on qualitative research strategy's discussion, outlined three ways of deriving data from interviews: literal, interpretive or reflexive.

Literal reading of interviews derives data "in a literal manner", where attention is focused on literal dialogue and substance, its form and sequence. Interpretive reading of interviews allows the researcher to "read the interviews for what they mean", i.e. draw inference from the content itself.

Reflexive reading of interviews goes beyond the two preceding ways and allows the researcher to read something about his role and his contribution to the data creation and analysis process.

From our critical realism perspective, we chose the interpretive reading manner of our data, not to be confused with purely interpretive approaches where the researcher "not only sees people as primary data source, but seeks their perceptions…the 'inside view' rather than imposing an 'outsider view" (Mason 2002, p.56). Therefore, as critical realism imposes itself "between empiricism and positivism on the one hand and represent" and accepted to be engaged in a "reading through or beyond the data in some way, be they texts, artefacts, visual images or whatever" (Mason 2002, p.149).

Besides, our coding was multidimensional, allowing us to apply "multiple codes to the same passage of text" (Saldaña 2012, p.83).

Most of the interviewees were female, and all were adults. The anonymity of the respondent was guaranteed, and the interviews conducted were recorded and fully retranscribed.

The responses provided us with primary information about individual motives for online collective action. It also helped us to identify the most relevant expectancy values to be included in the research model. To do so, the NVivo9 software was used to proceed to the thematic coding and data mapping of the interview material. We coded the interviews after having set broad a priori categories, according to the draft research model and theoretical background.

As we were also looking for potentially new concepts by examining how well data fit with the conceptual categories identified in the literature, we also allowed for the possible emergence of other categories. In this ongoing coding we hence created new categories drawn from the interviews themselves. This process was repeated three times in order to ensure the nodes' relevance. Recurrent interactions with the research supervisor also ensured the accuracy of the coding process.

Model Illustration: Categorization Results

Before launching the interviews, the dictionary of a priori themes was comprised of:

x 7 categories for the driving forces of online collective action (See x 1 category for the background factors of online collective action (See Table 12.1); x No category for benefits of online collective action (See Table 12.2). As shown in the second version of the dictionaries of themes , 5 categories for the driving forces of online collective action (See Table 13.1) and 2 categories for the restraining forces of online collective action (See Table 13.2) emerged from the field through the interview interpretive approach [START_REF] Mason | Qualitative researching[END_REF]. Besides, we added 3 categories for the benefits (See Table 14) and 4 categories for the background factors of online collective action (See Table 15). Habits "risk of addiction", "I do not spend a day without connecting", "automatic", "automatic behavior", "I don't realize I got connected", "every day" 29 Females Disinhibition "There are women really them talking about their womb", "women express their emotions more easily", "women may reveal more of themselves" Finally and after the entire coding process and through interview analysis, categories were restructured as follows [START_REF] Bhaskar | The Possibilities of Naturalism[END_REF]):

x 5 categories were dropped for the driving forces of online collective action, leaving 7 categories (See Table 16.1); Habits "risk of addiction", "I do not spend a day without connecting", "automatic", "automatic behavior", "I don't realize I got connected", "every day" 29 Females Disinhibition "There are women really them talking about their womb", "women express their emotions more easily", "women may reveal more of themselves" x The 3 categories for benefits of online collective action were left unchanged (See Table 18). The following sections explain, for each category, the reasons for the changes introduced.

Dropped Themes

This section refers to the codes and themes that were dropped. The reason why these concepts were left aside is twofold. Firstly, it was not possible to reconcile these codes with other existing codes. Secondly, the occurrences of associated codes were too few to be taken into account. Without these strong expressions of feelings on forums, design or navigational structure won't appeal much to them, as feedback on the positive or neutral role of these two variables were somewhat mitigated (see Table 19). So, although navigation shouldn't be an obstacle to browse fluently on the site, patients reported they paid more attention to what makes the sites warm and welcoming.

Resulting Model Variables

The below tables 20.1, 20.2 and 21 detail the different facets of the constructs that were identified and kept according to both the whole aforementioned coding process and the inputs of literature. "The belongingness hypothesis is that human beings have a pervasive drive to form and maintain at least a minimum quantity of lasting, positive, and significant interpersonal relationships." (Baumeister and Leary 1995, p.497).

SV** Exclusive Value

"Interactions with a constantly changing sequence of partners will be less satisfactory than repeated interactions with the same person(s), and relatedness without frequent contact will also be unsatisfactory" (Baumeister and Leary 1995, p.497).

HV*** Positive Emotions "Positive (anticipated) emotions refer to success in achieving a goal" (Perugini and Bagozzi 2001, p.83). In online communities' contexts, it refers to "fun and relaxation through playing or otherwise interacting with others" (Dholakia et al. 2004, p.244 (Perugini and Bagozzi 2001, p.83). In online communities' contextual background, it can refer to stress and anxiety through interacting with other patients.

Privacy Protection "On the Internet, individuals may trust others to keep private information confidential" (Green 2007, p.44). For health purposes, privacy protection may be of relevance due to patients' conditions [START_REF] Goldberg | Privacy-enhancing technologies for the Internet[END_REF] as well as the privacy policies of health Web sites [START_REF] Graber | Reading level of privacy policies on Internet health Web sites[END_REF].

Inaccurate Medical Information

"On the Internet, individuals may trust others to provide honest and accurate information" (Green 2007, p.44). In the context of health purposes, there is a risk of dangerous and inaccurate medical information appearing online (Williams et al. 2003;[START_REF] Diaz | Patients' use of the Internet for medical information[END_REF][START_REF] Dickerson | Therapeutic connection: help seeking on the Internet for persons with implantable cardioverter defibrillators[END_REF] Based on the insights brought by the critical realism approach, the draft and then emerging research models have been enriched and contextualized as exhibited in the figure 3 below. Furthermore, the content validity of the model-variables has been improved, as we have identified multiple sub-facets of expectancy values with 4 dimensions for social value (group norms, belongingness needs, exclusive value, and giving-help), 3 dimensions for utilitarian value (information needs, instrumental needs, overcoming isolation), and 1

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach dimension for anticipated positive emotions (positive emotions). We have also identified 3 dimensions for cost (inaccuracy of medical information, privacy protection, and negative emotions) and were able to contextualize online collective action.

Model Results

Together with the field forces of online collective action, the interviews led to important insights, such as the benefits of online collective action and the categorizations of background factors being as expected and outlined in tables 17 and 18.

Data outlined evidence that Perugini and Bagozzi's model needs adaptation when it comes to patients' communities, as well as Bagozzi and Dholakia's succeeding studies (see Figure 3). The results revealed emerging concepts that are frequently cited by interviewees, such as exclusive value, i.e. not mixing purposes or common interests of the communities, and thus offering a specific disease forum in the case of patients. Some categories need to be integrated into a dedicated model for patients' engagement in virtual communities to complete existing ones, such as the matter of privacy, or being confronted with inaccurate medical information or negative emotions and, as a result, the cost of engaging in online collective action.

The following section will present the answers to our research question. Information needs was the most salient driving force of patients engagement in virtual communities. For both communities investigated, the quality and relevance of the advice, as well as its easiness to understand, satisfy this need to be informed (see Table 16.1).

Indeed, interviews confirmed the importance of informational needs as a leading factor for patients to engage in virtual communities. For both communities, quality and relevance of advice or flows of information, as well as its ease of understanding, satisfy this need to be informed:

Raphaëlle Laubie -December 21, 2017

"Yes. In fact, every time I had a question, every time I asked a question, I got the answer." (Breast cancer community patient)

However, depending of which community was questioned, the incentives for the exchanges were not the same.

For breast cancer patients, motives reside in the information value, but also its immediate access made feasible through the IT tools:

"Between Doctor's appointments, we have time to get anxious. On the network, we can speak freely whenever we need it." (Breast cancer community patient)

For the relatives of patients with rare diseases, healthcare professionals may understandably lack answers for the families, due to the lack of scientific and medical knowledge itself. Therefore, virtual communities can represent a unique and important source of information for families:

"When I'm looking for information myself, I reach the Rett syndrome's group. In here, technical information is really at a top level ... when I have a question, I ask my question and I still have girls or guys who will answer me and much better than a practitioner. There is no doubt. What's more, they will respond on all levels to questions practitioners would be unable to answer to." (Rare Disease

Community patient family member)

Second, virtual communities also offer patients valuable psychological support available on demand, which contributes to overcoming their isolation, as well as the restoration of a social life, which has often been put on hold because of the disease: It also discloses important benefits of these communities, which we will describe below, such as the rapid sense of belonging and its strength. Besides, strong ties between online patients highlight the patients' needs to be connected to their networks, in order to share experiences about the course of their illness -which refers to the concept of giving-help, an actual component of online collective action, but not necessary a driving force of patients' engagement. We label this phenomenon exclusive value:

"So why did I make a blog on that issue after so long time? This is what I am often asked. Because, ultimately, it shouldn't be forgotten. Furthermore, it's because we never forget and because I really wanted to tell myself that I can testify." (Breast cancer community patient)

Access to multiple feedback and support groups provide patients with shared anecdotes about their disease. Moreover, interviews showed that, while living difficult times, they do not have the mental availability to listen to stories that are too different from theirs.

Indeed, they fear getting lower quality information and they don't want to share their disorders and day-to-day stories with 'strangers', preferring to exclude patients with other diseases from their platform:

"When it's opened to everyone, as a result, it loses in terms of information. While in our site, we know that we will inevitably connect with sharp people sharing our concerns… and it is very reassuring." (Breast cancer community patient)

Finally, group norms, the concept of people sharing norms concerning matters of common interest (Tajfel 1982), binds patients and fosters their participation in the online action as well as their long term dedication to the group:

"We realize that we share the same vision with these other women, the same thoughts, perhaps because we share the same problems. This is why we got there;

it's mostly why we stayed there." (Breast cancer community patient) Patients also join these platforms to find emotional assistance to help them overcome the hardship of everyday life. Furthermore, some believe that these emotions help them to live better during their illness, as others think that it may even help them to heal:

"Emotions are present, regularly. In fact, when I'm in low spirits, I go on the network and it goes away." (Breast cancer community patient) While less salient in the interviews, anticipated positive emotions is, nevertheless, an essential value that needs to be taken into account when virtual patients' communities launch and further studied in the academic area (See Table 24). Sometimes, any negative emotion that can be triggered by online comment could have dreadful impacts, so much so that some patients could prefer leaving these virtual spaces for a period of time or even indefinitely:

Raphaëlle Laubie -December 21, 2017 "When a person does his check-up and returns with a negative diagnosis, then you get a punch in your stomach because your fear is coming back and spreading…" (Breast cancer community patient)

In online community interactions, many researchers associated the cost value with trust, referring to privacy concerns [START_REF] Metzger | Privacy, trust, and disclosure: Exploring barriers to electronic commerce[END_REF][START_REF] Dwyer | Trust and privacy concern within social networking sites: A comparison of Facebook and MySpace[END_REF][START_REF] Dong-Hee | The effects of trust, security and privacy in social networking: A security-based approach to understand the pattern of adoption[END_REF][START_REF] Fogel | Internet social network communities: Risk taking, trust, and privacy concerns[END_REF]. In the specific context of online patients' communities, trust is also an essential dimension of cost. Indeed, on the Internet, patients will be the very first population concerned about the respect of privacy [START_REF] Goldberg | Privacy-enhancing technologies for the Internet[END_REF]. However, even if for some patients the struggle to preserve confidentiality is a minor battle compared to the one they face with their illness, privacy protection remains an important issue when interacting online on the daily experiences of their illness: "In fact, at one point, the shock of news exposes you. Because what you live is very scary, so scary that you're not afraid any longer to give up confidential information." (Breast cancer community patient) "Control is important, as is the confidentiality of data. It was a prerequisite for me, if I was asked my name, I would be gone, because the Internet is risky" (Breast cancer community patient)

Finally, the accuracy of information (Williams et al., 2003;[START_REF] Diaz | Patients' use of the Internet for medical information[END_REF][START_REF] Dickerson | Therapeutic connection: help seeking on the Internet for persons with implantable cardioverter defibrillators[END_REF] will be of significant importance, especially when they interact online with groups of people concerning very personal issues, such as health [START_REF] Coulson | Receiving social support online: an analysis of a computer-mediated support group for individuals living with irritable bowel syndrome[END_REF] "The big problem on the forum is that only patients participate with their own feelings, with their own knowledge… And they aren't necessarily enlightened patients…" (Breast cancer community patient) Occurrences of the dimension of cost value prove its high relevancy and a vast room for improvement that would benefit patients' well-being during their online experience (see Table 25). Recurrent values emerged from testimonies, such as the strong feeling of belonging, as well as its speed, the patients' expertise about their disease and related issues, the positive impact of online exchanges on patients' well-being.

Belongingness Speed and Strength

The peculiarity of these communities' approach, with regard to patients, is probably the speed and strength of bonds it creates. The users, upon entering this virtual world, feel These benefits (See Table 26) have to be differentiated from drivers for online collective action as they are caused by patient collaboration. Besides, although well documented and discussed in the above literature review [START_REF] Fredrickson | The broaden-and-build theory of positive emotions[END_REF][START_REF] Fredrickson | Cultivating positive emotions to optimize health and well-being[END_REF], one should remain -not to argue the obvious -cautious about the impact of online collaboration on healing. Due to our field of inquiry, we were mainly faced with females' on line behavior and from a consensual perspective, they are much more likely to reveal their feelings and tell their own stories when online:

"Women have much less difficulty in expressing their emotions, especially when online." (Health 2.0 expert)

Information Control

When considering background factors, patients called for the development of a better environment for these patients' online communities. As a result, the needs to be addressed would be: i) information to be better controlled, ii) online clinical advice to be provided.

Even if self-moderation does occur thanks to the wisdom of crowds, control of the released information about patients' everyday life is often considered inadequate.

Patients often fear the presence of inaccurate information, which frequently caused anxiety, particularly among the silent crowd of the community.

"After, it's always the same problem, depending on who manages the sites. We really need to be very strict and sites have to be moderated." (Breast cancer community patient)

Online Clinical Advices Requirement

In the wake of the fear of being misinformed by wrong statements, patients are demanding a professional presence that would certify the information's veracity on these platforms.

"I was also looking for people who had authority, people who seemed to be certified, licensed, relevant and legitimate with all the scientific and medical background." (Breast cancer community patient) "This is where there should be scientific profiles, from the medical sector to speak on the subject, to provide expertise, to take time to answer questions online."** 12 * Quotes from interviews with breast cancer community patients ** Quotes from interviews with parents of autistic children

Summary of Results

Among the participants, information needs and belongingness needs remain the main reasons to reach and collaborate in virtual communities. However, testimonies also showed the emergence of new factors, such as the need to give-help, the desire for positive emotions, and the wish for platform exclusivity.

Conversely, fear of negative emotions, privacy protection and inaccurate medical information are major hindrances for patients who would otherwise be willing to join virtual spaces. Characteristics related to social behavior have also emerged from interviews, including psychosocial impacts resulting from membership of these communities. Benefits from this commitment are noticeable, namely enhancement of decision-making processes and choices and the role in healing.

The needs and the perceived breaches of these platforms have also been underlined, highlighting the need for moderation of irrelevant comments coupled with a professional medical presence.

Many outcomes are drawn by the interviews and among the most important is the one that allows us to design a model of online collective action (See Figure 3). But we also stressed managerial contributions that can practically inform industry stakeholders about the reality from the inside.

Discussion and Conclusion

This study's main objective was to examine the determinants of online collective action on patients' communities, given the specificities of a patients' community typology that was chosen for this purpose.

Based on the Field Theory of Lewin (1947), the Expectancy-Value Theory (EVT) [START_REF] Eccles | Expectancies values and academic behaviors[END_REF], the model of goal directed behavior ( MGB) [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] and [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] online resulting study; together with insights and knowledge accumulated from the field (Bhaskar 2010); we conceptualized a model to predict online collective action on patients' virtual communities (See Figure 3).

When engaging in a patients 2.0-related research topic, we knew that the study would require specific attention on the diseases to be addressed. The preliminary interviews with experts suggested which way we should focus. The feedback was consensual and chronic or rare diseases were indicated to be suitable for such investigation.

Although we decided to focus on French participants, research performed in the US confirmed this choice, with Internet users living with chronic disease being more likely than other Internet users to access health information online: "Living with chronic disease is also associated, once someone is online, with a greater likelihood to access user-generated health content such as blog posts, hospital reviews, doctor reviews, and podcasts. These resources allow an internet user to dive deeply into a health topic, using the internet as a communications tool, not simply an information vending machine" (Pew Internet Research 2010).

Understandably, the condition of rare disease patient also amplifies this need to spread their network far and wide and online connection will provide some answers: "In rare disease communities, each person is an expert in observing the effects of a disease or a treatment on their own or a loved one's body or mind. In this way, rare disease patients and caregivers who gather together online are an example of a "smart" group…They are diverse and decentralized, yet able to pool knowledge and summarize their observations" (Pew Internet Research 2010).

Although this research was conducted in both communities, one should recall that, out of the 37 interviews, 8 were performed on a rare disease community patient family member, 21 on a breast cancer community patient.

Overall, the results show that information needs and belongingness needs are important reasons for collaborating in virtual communities. However, testimonies have also shown the emergence of new factors, such as the desire for positive emotions, and the willingness for platform exclusivity. Conversely, the fear of negative emotions, privacy protection and inaccurate medical information are major hindrances for patients who would otherwise be willing to join virtual spaces. The needs and the perceived breaches of these platforms have also been underlined, highlighting the need for moderation of irrelevant comments coupled with a professional medical presence. The driving forces for online collective action were distinguished into three dimensions: utilitarian value, social value and anticipated positive emotions in accordance with EVT.

Among the ones that were the most salient and frequently quoted, the need to give and to get information (information needs) and the need to belong to the community of peers (belongingness needs) were the main driving forces among the participants.

Raphaëlle Laubie -December 21, 2017 Another category, related to the social dimension of the motivation to participate in the community, actually emerged from the analysis of the interview transcripts namely exclusive value. As a matter of fact, it was quite unexpected that, on the one hand, patients would be inclined to give online support to others and, on the other hand, that "the others" would be carefully restricted to strictly the same categories of patients for providing this help.

Finally and among the driving forces that were expected to be found based on the literature, the positive emotions' category was relatively less salient, contrary to our expectations, as were group norms. These somewhat mitigated results do not remove the relevant aspect of these latter variables. Though, further analyses may provide further on these concepts.

Restraining Forces of Patients' Online Activity and Emergent Categories

The interviews have shown that, cost value of online collective action is related with the concept of trust.

Trust relates to a specific field of inquiry and would involve different facets depending on the actors and their environment.

The insights found on trust support the emphasis of the importance of privacy concerns and fear of inaccurate medical information found in the literature.

It is therefore important to account for the role of trust in patients' communities in particular [START_REF] Dwyer | Trust and privacy concern within social networking sites: A comparison of Facebook and MySpace[END_REF][START_REF] Fogel | Internet social network communities: Risk taking, trust, and privacy concerns[END_REF][START_REF] Luhmann | Trust and power[END_REF]. Indeed, trust is relevant in particular regarding the investment in personal relationships in a virtual context, including a reciprocal approach (Grabner-Kräuter, 2010).

Therefore, this variable needs to be implemented in the patient engagement model with respect to the dimensions revealed by the interviews, namely, inaccurate medical information and privacy issues. Therefore, we cannot really argue the emergence of new categories when aggregating literature's constructs. But considering that these literature insights came from different fields and that our underlying frameworks (Field Theory, EVT) were non health-related, many aspects appeared to bring new values, inspired from the field and in compliance with the general and stringent scope of models.

As a result, models and conclusions taken singly failed to draw the complete picture we depicted in the above sections, but this study remedies such breach.

Contribution

This study makes three major contributions to research and practice.

First, this research emphasizes the main expectancy-value factors, which determine online collective action on patients' virtual communities. It further enriches the literature through the use of Lewin's force field theory and EVT, applied to online environments.

A broad literature review and interview evidence help examine new concepts that add to social value dimensions -exclusive value -, to utilitarian value dimensionsovercoming isolation -and to cost value dimensions -inaccurate medical information.

In this regard, from theories taken from the social psychology arena, as well as considering insights provided by the field, we developed a model of online collective action for patients who meet on virtual communities (See Figure 3).

From guidance provided by interviews' feedback, we chose to focus on patient's virtual communities rather than patient's social networks. Indeed, as virtual communities imply strong ties between individuals, bonding value and emotional support, and as the sense of belongingness is a key determinant of online collective action, these community virtual spaces for patients were indicated to be relevant for our study.

Second, we examined OCA beyond the use of the community platform, considering users as social actors [START_REF] Lamb | Reconceptualizing users as social actors in information systems research[END_REF] and in order to frame interdependencies-in-use.

We contextualized IT use in the e-health domain, and contributed to the analysis of online collective action of patients. The research design helped us get insights from both the field and the literature to build knowledge. This helped understanding why patients are motivated to act online and interact with other patients through technology, and the role of non-IT determinants in this process.

As a result, system usage and IT artifacts have to be learned but do not contribute a response to the research questions. For that purpose, knowledge of social psychology is

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017 also needed in order to draw the right field forces of online collective action, especially with a population of patients. Furthermore, on one hand, one can notice the correspondence between the hedonic driving force for online collective action -positive emotions -and the emotional support activity that does actually result from patients' activity. On the other hand, there is also a correspondence between the utilitarian driving force for online collective action -information needs -and the sharing of information, whether health-related or from a general perspective, that can be found on patient's virtual spaces.

Finally, the research highlights the cost-value or trust aspects that are relevant in patients' virtual worlds. The study shows that the need for patients to contribute to the others' well-being is rooted in their behavior. It also shows that inaccurate medical information and privacy concerns decrease interaction with peers through the online communities. In the particular case of patients often experiencing the burden of loneliness when faced with illness, the possible lack of medical accuracy of information or privacy protection can demotivate patients and dampen their strength or capability to recover in the best possible conditions. Managers should address those issues

The study applies a rigorous exploratory approach, which makes the results relevant because they specifically take into account the context of patients' use of health-related virtual communities. This approach also helps emphasize contributions of the research for managers. In particular, the results should help Health 2.0 practitioners to better address the issues of individual engagement on online communities and interpret the factors they can leverage in order to encourage experience sharing among patients.

Raphaëlle Laubie -December 21, 2017 In this regard, insightful comments were received, such as the need for information control, the need for online clinical advice that would be performed by health professionals and the wish to leave virtual spaces open. The first two would imply a more involved medical presence in patients' platforms, which is already the case in many examples, but not always systematic. The last point would need confirmation and has been dropped by our interpretive research approach, due to the very few references to this matter as well as to weak or unfounded claims from patients' perspectives, and understandable ethical issues. Furthermore, it goes against the common practice. Indeed, patients' platforms often require users to log in to be allowed to read forum contents.

To conclude, a major concern should be highlighted behind these trust issues, with a growing and ageing worldwide population, and growing Internet use. In the particular case of patients often experiencing the burden of loneliness when faced with illness, these issues, designed in this research by the possible lack of medical accuracy of information or privacy protection can demotivate them and dampen their strength or capability to recover in the best possible conditions.

Limitations and Future Research

We conducted a high number of interviews, due to our volition to operate preliminary ones in order to get to know what patients would be more concerned with by our research, and in order to reach semantic saturation. Despite this fact, we consider this qualitative research as an intermediate exploratory phase that would require a Raphaëlle Laubie -December 21, 2017 quantitative phrase in order to be able to draw further conclusions as well as a complete model of patients' online collective action (Laubie and Elie-Dit-Cosaque 2012).

From its inception, this research has been designed to be the first part of an ongoing research process, whose aim is to further validate the insights brought by both the literature exploration and the interviews.

Indeed, this research presents limitations and therefore opportunities for further investigations.

Firstly, we targeted French patients in order to avoid introducing biases from multicultural settings. Therefore, future research may explore differentiations and/or similarities of behavior of patient's online collective action.

Secondly, preliminary interviews suggested focusing on specific patients' virtual communities. It may also be relevant to investigate populations other than the breast cancer community and a community of parents of autistic children, whether mixed or exclusive types of patients gathered on the same platform. It may also be advisable to explore the attributes of social networks in order to compare the results to those of virtual communities when it comes to patients as users.

Thirdly, our patients interviewed were mostly female. Extending this study to both genders or exclusively to male patients may drive interest for comparing results.

Finally, all concepts that were considered secondary would have to be carefully taken into account in order to make conclusions on their relevance, i.e.: the influence of IT artifacts and background factors.

Raphaëlle Laubie -December 21, 2017

Indeed, we account for the role of a number of background factors in the model that would require investigation in a possible follow-up quantitative study. Ajzen has posited that:

"a multitude of variables may be related to or influence the beliefs people hold, such as: age, gender, ethnicity, socio-economic status, education, nationality, religious affiliation, personality, mood, emotion, general attitudes and values, intelligence, group membership, past experiences, exposure to information, social support, coping skills, and so forth" (Ajzen 2005, p.134).

Ajzen has thus distinguished between the categories of personal, social and informational factors.

Prior research has identified a number of virtual communities' [START_REF] Lin | Determinants of successful virtual communities: Contributions from system characteristics and social factors[END_REF]) and patients' [START_REF] Rahmqvist | Patient Satisfaction in Relation to Age, Health Status and Other Background Factors: A Model for Comparisons of Care Units[END_REF] characteristics that are relevant to the quantitative phase of the research.

These factors have to be included as control variables in the model. Demographics comprise age, gender, education, socio-economic status, and marital status. General individual factors comprise general attitudes about interacting with online communities, computer anxiety, perceived behavioral control about the online community, Internet experience, media exposure and habits. Health-related individual factors comprise disease handicap and disease stage. IT Factors comprise the perceived ease of use and the perceived usefulness of the online community.

Future research may hence try to identify variations across these background factors regarding the determinants of online collective action on patient's online communities.

Raphaëlle Laubie -December 21, 2017

Conclusion

EVT, following Lewin's underlying framework, applied to virtual communities, offer important information concerning the leading determinants of online collective actions for patients. However some adjustments have to be made to fit our field of enquiry in patients' virtual communities. Indeed, our community-based background of patient members includes a large number of users, most often weakened by their disease, seeking interaction on these platforms.

Although the emotional dimension remained meaningful in patients' motives for joining online communities, the findings suggest that the MGB failed to offer a relevant model for predicting intentional action to engage online. The social values complete the lack of an explanation, highlighting the notion of bonding values that are comprised of determinants such as belongingness needs or exclusive value. Furthermore, the interviews demonstrate that the model was still lacking variables concerning the cost that explains patients' reluctance to join these communities. Indeed, the concept of trust embodied by the relevant medical information has to be considered as a predictive variable together with the concept of security of use embodied by a privacy protection concept. Other utilitarian values, such as information, needs to be integrated in the model, as they are in the adaption of MGB in [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] past study.

These above mentioned aspects contribute to expand this trend of developing virtual spaces for people seeking information and support online. The Internet and patients' initiatives are changing the face of medical practice, previously limited to a top-down approach where health professionals and third parties involved communicated a restricted amount of information to patients.

Hopefully connecting to virtual communities, patients may improve their quality of life, for the benefits provided by online collective action, which are often different from those they would get from traditional collective action in social groups acting face to face. This research hopefully helps to better take into account important issues for the ageing population's health challenges and emphasizes how patient's virtual communities can help support patient's concerns. , 2011). For health-related issues in particular, people browse the Internet in order to find information (68%), self-diagnose (46%) or look for other patients' testimonials (39%) (Bupa Health Pulse 2010). In this, patients are empowered by health-related, web 2.0 information technologies (IT) [START_REF] Eysenbach | Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness[END_REF]). In addition to those individual benefits, these IT are expected to contribute to public health by helping reducing the number of consultations with healthcare professionals, especially those regarding minor health nuisances. They can also help making health professionals becoming more available to patients suffering from more severe diseases [START_REF] Bhatia | Telemedicine endurance-empowering care recipients in Asian Telemedicine setup[END_REF]. Eventually, those capabilities may contribute to substantial cost savings on the behalf of patients [START_REF] Baker | Effect of an Internet-based system for doctor-patient communication on health care spending[END_REF]).

-THE

Overall, the information delivered on some famous health virtual communities (e.g., MedHelp or PatientsLikeMe in USA, Les Impatientes or Vivre Sans Thyroïde in France) has, in many instances, been demonstrated to be accurate [START_REF] Esquivel | Accuracy and self correction of information received from an internet breast cancer list: content analysis[END_REF]. Arguably, such communities may hence be regarded as ready and useful sources of information for

patients. Yet, a number of risks of using the Internet for health purposes have already been noticed. For example, being misinformed, being exposed to outdated information or evaluating online medical information is still in question [START_REF] Diaz | Patients' use of the Internet for medical information[END_REF].

In this context, as those websites bring their value from patients' interactions, health professionals wish to better know what determines or impede interactions, or online collective action (OCA) within health-related virtual communities. Accordingly, this research explores the determinants of online collective action in the course of patients' interactions on virtual communities.

Better acknowledging the development of Online collective action is important for both researchers and practitioners in IS. This, this research helps respond to two main knowledge gaps. 2007), further allows individuals to interact one another. A large part of its benefits stems from its collaboratively generated content, which helps enriching the information made available to web users. In those contexts, formal organizations are often no longer critical for fostering collective action among individuals with an interest in shared goals [START_REF] Bimber | Collective Action in Organizations: Interaction and Engagement in an Era of Technological Change[END_REF]). On another and, many researchers display synthesized coherence [START_REF] Locke | Constructing opportunities for contribution: Structuring intertextual coherence and "problematizing" in organizational studies[END_REF], coming from different fields of expertise, considering that the Web 2.0 has significantly changed the way people seek, discover, and redistribute information [START_REF] Ganley | The ties that bind: Social network principles in online communities[END_REF][START_REF] Borland | A Smarter Web[END_REF][START_REF] Eysenbach | Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness[END_REF]). It has also profoundly changed the way people build relationships and interact with one another [START_REF] Boyd | Friends, friendsters, and myspace top 8: Writing community into being on social network sites[END_REF]. The social web reflects in fact a radical paradigm shift, which consequences depend on users and usage contexts. In this context, examining online collective action in the context of Web 2.0 may help better reflecting the success of such IT implementations.

Second, in the specific context of virtual communities, such as patients' virtual communities, the utilitarian perspectives of most of the extent adoption models (e.g., [START_REF] Davis | Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology[END_REF]Venkatesh et al. 2003) are probably not the most relevant for better understanding online collective action. In such communities, being meaningful for other community actors is often more important than obtaining any economic reward. The determinants of altruistic action may also reflect a quest for the sense of self, belonging and ownership [START_REF] Abma | Seeking Connections, Creating Movement: The Power of Altruistic Action[END_REF]. For those reasons, we may, expect that individuals interacting on hedonic virtual communities differ from other users in more traditional settings of technological interaction, such as in organizations. For example, patients may be significantly influenced by emotional factors due to some concerns

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach about their illness, or by their trust on the platform when very private information is shared. Prior research has for example attempted to explain how collective action may contribute to knowledge creation, at the network level, in online contexts such as with communities of practices dedicated to legal professionals [START_REF] Wasko | WHY SHOULD I SHARE? EXAMINING SOCIAL CAPITAL AND KNOWLEDGE CONTRIBUTION IN ELECTRONIC NETWORKS OF PRACTICE[END_REF]Wasko et al. 2004). Relatedly, research has also examined how social actors decide about to what issues they will be willing to contribute in knowledge sharing and why, among engineering consultants through on online discussion tools [START_REF] Haas | Which problems to solve? Online knowledge sharing and attention allocation in organizations[END_REF]; or why social actors will engage in knowledge sharing, showing that the greater centrality in the network, the ability to share knowledge, and the motivation of the actor, the greater his/her propensity to share knowledge [START_REF] Reinholt | Why a central network position isn't enough: the role of motivation and ability for knowledge sharing in employee networks[END_REF]. While together those research offer important insights that may be useful for the study of collective action in organizational contexts, to our knowledge, research does not provide a comprehensive model that may help better explain the individual and social determinants of collective action in more altruistic contexts. Overall, due to the paucity of research in this domain, we therefore still know very little about why patients engage in online collective action through these communities, and what their motivations are. Meanwhile, the interactions among collectives of patients on virtual communities has grown tremendously in recent years [START_REF] Eysenbach | Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness[END_REF]Smith and Christakis 2008;[START_REF] Orizio | The World of e-Patients: A Content Analysis of Online Social Networks Focusing on Diseases[END_REF], which makes practitioners ask for more guidance in the way to manage and ensure the success of their online communities, while collective action is seen as a way to encourage knowledge sharing and reduce "free riding" behaviors.

In order to respond to those knowledge gaps, based on Expectancy Values theorizing [START_REF] Eccles | Motivational beliefs, values, and goals[END_REF] and the Model of Goal Oriented Behavior [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF], this research examines the determinants of patients' engagement in OCA.

Accordingly, OCA is conceptualized as being influenced by task values beliefs, expectancy values beliefs [START_REF] Eccles | Motivational beliefs, values, and goals[END_REF], emotions and past behavior.

The research questions tackled in this paper are the following:

1) What are the relevant expectancy values in the course of patients' interactions with virtual communities?

2) Do these expectancy values predict patients' desires and intentions regarding virtual communities' usage, and subsequently their engagement with online collective action?

The expectancy-value Theory -EVT [START_REF] Eccles | Expectancies values and academic behaviors[END_REF] This research contributes to both the literature and practice within the domain of Health Information Systems and IT adoption. By conceptualizing and validating an enriched model of virtual communities' adoption, it allows better acknowledging Web 2.0 success.

It uncovers the determinants of patients' engagement in interactions with and through virtual communities. So doing, it helps practitioners identifying the factors on which they may act to leverage the benefits of Web 2.0. A particular strength of this research is its grounded, multi-method approach, which helps going beyond some method issues, and allows to subsequently gain a better and more practical understanding of patients' engagement in online collective action.

The paper is organized as follows. In the first section, we discuss our main theoretical anchor -the EVT and MGB -as applied to patients' online virtual communities. In order to answer our research questions, we then conceptualize a model and accordingly develop hypotheses. Following this, we explain the design and methods for the research.

The different determinants of online collective action are then described and discussed.

Following this, the contributions and implications of the results for e-health and ITadoption research and practice are emphasized. We then conclude the paper.

Online Social Networks and Virtual Communities

Online social networks and virtual communities have often been defined the same way in the literature. [START_REF] Ellison | Social network sites: Definition, history, and scholarship[END_REF] defined social network websites as web-based services that allow individuals to: (1) construct a public or semi-public profile within a bounded system, (2) articulate a list of other users with whom they share some connections, and (3) view and traverse their list of connections and those made by others within the system. A major feature of web-based social networks compared with real-life ones, is the opportunity for anyone to meet new contacts from other's current visible contacts. These connections may differ in nature and strengths, depending on websites'

objectives and on the nature of the ties developed between users, whether they are strong or weak [START_REF] Granovetter | The strength of weak ties: A network theory revisited[END_REF]. They also allow content's streams generated by users, which may differ in terms of types, frequency, intimacy or duration [START_REF] Haythornthwaite | Social networks and Internet connectivity effects[END_REF]. These latent relations are important resources for the development of crowds' wisdom and use generated content [START_REF] Nov | What motivates wikipedians?[END_REF]. Furthermore, they result in the creation of individuals' social capital. This social capital is considered to be the goodwill, which is engendered by the creation of social relations, and, which can facilitate action [START_REF] Adler | Social Capital: Prospects for a new Concept[END_REF].

While most of those features seem common between social networks and online communities, some differences, however, can be noticed. For example, Dholakia et al.

(2004) have defined virtual communities as "consumer groups of varying sizes that communicate regularly and for some duration in an organized way over the Internet through a common location or mechanism to achieve personal as well as shared goals of their members" (p.241-242). In contrast, [START_REF] Ellison | Social network sites: Definition, history, and scholarship[END_REF] consider that social network sites are primarily organized around people rather than around interests, structured as egocentric networks, with the individual at the center of their own community. The size of the network is also a major determinant of these two ways of functioning. Online social networks are dedicated to a broader audience than virtual communities and enable users to emphasize their social networks, whereas contacts with strangers are of minor importance [START_REF] Ellison | Social network sites: Definition, history, and scholarship[END_REF][START_REF] Grabner-Kräuter | Web 2.0 Social Networks: The Role of Trust[END_REF].

Raphaëlle Laubie -December 21, 2017

In spite of the benefits of those Web 2.0 technologies, early predictions regarding computer-mediated interactions were warning against potentially unethical behaviors and low-level of communication [START_REF] Short | The social psychology of telecommunications[END_REF]Sproull and Kiesler 1986). Nowadays, however, online communication seems to be installed as a common endeavor in both the corporate and the private worlds, overcoming geographical barriers [START_REF] Haythornthwaite | The Internet in everyday life: An introduction[END_REF][START_REF] Salaff | Where home is the office: the new form of flexible work[END_REF]. Specifically, observers argue that Web 2.0 technologies enable social network websites and social capital expansion through social interaction tools and are easily accessible. Indeed, Web 2.0 is "both an outcome gained by individuals in an online community and a tool for facilitating the governance of such spaces" (Ganley and Lampe 2009).

Patient's Engagement in Virtual Communities

The interest in social networks has grown over years, with sometimes the expectation that online communication would result in transforming virtual connections into reallife contacts [START_REF] Rheingold | The virtual community: Homesteading on the electronic frontier[END_REF]Rheingold 2003;[START_REF] Kendall | Hanging out in the virtual pub: Masculinities and relationships online[END_REF]. In virtual life, specifically, social networks change the way people represent themselves, communicate and interact with the real world. Activities may also change, based on users' objectives.

Those objectives range from broadening their network or social capital to serving a specific goal, depending on users' willingness to go beyond geographic barriers, to discuss sensitive issues, to address similar problems or to decrease isolation (White and Dorman 2001). They are sometimes reached at the cost of privacy [START_REF] Donath | Public Displays of Connection[END_REF]). Dorman 2001). This is due, for example, to the patients /user conditions, their battle against the illness, their level of isolation, even when they are well-surrounded by their relatives. A more complete view of the factors that influence patients' adoption and forms of interactions with medical interactive websites would therefore call for a more integrative, multidisciplinary approach.

Online Collective Action on Virtual Communities

Collective action has been the focus of many different disciplines, such as philosophy (Tuomela and Miller 1988;[START_REF] Searle | Collective Intentions and Actions[END_REF]Bratman 1993;Miller 2001;[START_REF] Gilbert | Rationality in Collective Action[END_REF], social psychology (Tajfel 1981; [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF]Tajfel and Turner 1979;Van Zomeren et al. 2008) and sociology [START_REF] Olson | The logic of collective action: public goods and the theory of groups[END_REF][START_REF] Dimaggio | THE IRON CAGE REVISITED: INSTITUTIONAL ISOMORPHISM AND COLLECTIVE RATIONALITY IN ORGANIZATIONAL FIELDS[END_REF][START_REF] Bimber | Collective Action in Organizations: Interaction and Engagement in an Era of Technological Change[END_REF]) (See Table 28). Collective Intentionality "Collective intentionality presupposes a Background sense of the other as a candidate for cooperative agency; that is, it presupposes a sense of others as more than mere conscious agents, indeed as actual or potential members of a cooperative activity." (Searle 1990, p.414) [START_REF] Searle | Collective Intentions and Actions[END_REF] Shared Intention "We should, instead, understand shared intention, in the basic case, as a state of (Bratman 1993) affairs consisting primarily of appropriate attitudes of each individual participant and their interrelations" (Bratman 1993 Collective Action "The digital-media environment prompts new and unforeseen opportunities for collective action as people are increasingly [START_REF] Bimber | Collective Action in Organizations: Interaction and Engagement in an Era of Technological Change[END_REF] The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach immersed in an atmosphere in which it is their routine practice to share ideas, connections, and interests." (Bimber et al. 2012, p.5) Therefore, "all sorts of organizational structures and processes are implicated in the new technological landscape for collective action" (Bimber et al. 2012, p.6) that can be called organizational fecundity.

In the IS domain specifically, prior IS acceptance and adoption models have been 2009). Collective action has also been discussed, referring principally to social theories [START_REF] Coleman | Fondations of Social Theory[END_REF][START_REF] Fishbein | Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research[END_REF]) and social scientists and psychologists' reasoning [START_REF] Hardin | The tragedy of the commons[END_REF][START_REF] Olson | The logic of collective action: public goods and the theory of groups[END_REF]Sweeney 1973;[START_REF] Schelling | Micromotives and macrobehavior[END_REF][START_REF] Oliver | A theory of the critical mass. I. Interdependence, group heterogeneity, and the production of collective action[END_REF].

Social teams and dynamics of knowledge development and transfer in both "more and less" virtual teams have also been studied, highlighting the assets of virtual work resulting from information technology use [START_REF] Griffith | Virtualness and knowledge in teams: Managing the love triangle of organizations, individuals, and information technology[END_REF].

For conceptualizing online collective action, we first draw on the We Intentions concept, leveraged in Tuomela (1995) andTajfel's (1978;1981) (Table 28) underlying frameworks to conceptualize online collective action [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]). We-intention, have been defined as "a collective intention rooted in a person's self-conception as a member of a particular group (e.g., an organization) or social category (e.g., one's gender, one's ethnicity), and action is conceived as either the group acting or the person acting as an agent of, or with, the group." (Bagozzi 2005, p.18).

Raphaëlle Laubie -December 21, 2017 Notwithstanding those contributions, the paucity of the developments in IS research on the OCA concept calls for further analyzing emerging collective action phenomena from the field. Accordingly, in addition to those aforementioned theoretical insights, we also confront the theoretical accounts to emerging field accounts. According to Zachariadis: al:

"There are two sides of knowledge… the transitive and intransitive objects of knowledge. Intransitive objects of knowledge are the ones that don't depend on human activity. In other words, it is the knowledge of things which are not invented by humans e.g. gravity, death etc. On the other hand, transitive phenomenon are "artificial objects fashioned into items of knowledge by the science of the day" (2010, p.7;Bhaskar 1998).

Indeed, this "science of the day" is expected to complete the theoretical inputs from research, benefitting from relevant contextual information about patients.

Overall, we lack a precise description of the concept of online collective action in the context of virtual communities as it would depend on the specificities of the community: i) its social identity [START_REF] Allen | Affective, Continuance, and Normative Commitment to the Organization: An Examination of Construct Validity[END_REF]Bergami and Bagozzi 2000;[START_REF] Luhtanen | A collective self-esteem scale: Self-evaluation of one's social identity[END_REF] and ii) its group norms [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]). In the context of virtual communities, our approach to online collective is closed to the concept of contribution behavior, such as "contribution activities in virtual communities often require multiple members to act in concert in a particular way to be meaningful", (Tsai and Bagozzi 2014, p.145).

Model Development and Hypotheses

In conceptualize a model to predict patients' engagement in online communities, we articulate the Model of Goal-directed Behavior (MGB) [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF]) and the Expectancy-Value Theory (EVT) [START_REF] Eccles | Expectancies values and academic behaviors[END_REF]. The literature offers some insights on individual's motives to engage in collective action, and some studies have focused on virtual communities. Though, we believe that the combination of these models offers greater insights than each model taken separately. The MGB and EVT offer complementary perspectives for providing a richer view on patient's interactions with virtual communities. The resulting research model, which we describe in the following section, is shown in Figure 4 below. Both those theories aim at explaining individual, volitional behavior.

The MGB draws on the Theory of Planned Behavior -TPB [START_REF] Ajzen | The theory of planned behavior[END_REF], itself inspired by the Theory of Reasoned Action -TRA [START_REF] Fishbein | Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research[END_REF]. Essentially, the TRA explains a behavioral intention via the influence of subjective factors, such as one's attitude towards an action to be performed (Behavioral Beliefs) or beliefs about others'

attitudes regarding an action or subjective norms [START_REF] Ajzen | Understanding Attitudes and Predicting Social Behavior[END_REF]. The TPB partially adopts the TRA's conceptual framework. In fact, [START_REF] Ajzen | The theory of planned behavior[END_REF] introduced an additional predictor of intention and behavior, i.e. perceived behavioral control (PBC),

or "the perceived ease or difficulty of performing the behavior, [which is] assumed to reflect past experience as well as anticipated impediments and obstacles" (Ajzen 1991, p.188). PBC is inspired by Bandura's self-efficacy theory (SET) (1977). Then, the intention and ability to perform the behavior will depend on one's expectations and selfefficacy judgment [START_REF] Bandura | Self-efficacy: toward a unifying theory of behavioral change[END_REF].

MGB comes from multiple research domains such as "attitude theory, motivational research and social identity research" (Bagozzi and Dholakia 2002, p.4). This theory has facilitated the expansion of the TPB [START_REF] Ajzen | The theory of planned behavior[END_REF]) by introducing behavioral desire as a mediator of the influence of anticipated emotions on behavioral intentions [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF]. In this, the MGB introduces emotions as a "new decision criteria with respect to a person's goal" (p.80). Anticipated emotions are indeed posited to predict one's behavioral desire to perform an action, which determines his/her behavioral intention and finally the behavior itself. To be applied to predict the Internet and other social media usage behaviors and other forms of interactions, however, MGB must be adapted. Indeed, as explained by [START_REF] Hartwick | Explaining the Role of User Participation in Information System Use[END_REF], the use of IT can be inferred only by considering the contextual background of the target users.

As it explicitly includes emotions, we believe that the MGB is arguably more appropriate than the TPB or than other adoption models such as TAM [START_REF] Davis | Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology[END_REF] or UTAUT (Venkatesh et al. 2003) for examining individual interactions with patients' virtual communities. Further, Bagozzi and Dholakia have demonstrated the relevance of this model and its ability to "explicate the individual and social variables that shape the member's we-intention to participate in virtual community interaction" (2002, p.4).

In spite of the predicting power of MGB in many contexts, [START_REF] Bagozzi | Intentional social action in virtual communities[END_REF] identify only three antecedents of intentions to engage in virtual communities: positive emotions, social identity and desires. Later on, Tsai and Bagozzi (2014) identify cognitive, emotional and social drivers to contribute to virtual communities. In the specific context of patients' virtual web-based communities, arguably, MGB should be enriched using, at least, this triple perspective.

In order to provide this more complete view, we combine MGB with the expectancy value model by including task values -namely: attainment value, intrinsic value, utility value and cost, where expectancies are defined as "individuals' beliefs about how well they will do on upcoming tasks" (Eccles et al. 1983, p.119). EVT helps distinguishing between the different values that will predict intentions, while in the same time accounting for the influence of the factors identified by [START_REF] Bagozzi | Intentional social action in virtual communities[END_REF].

Drawing on [START_REF] Bandura | Self-efficacy: toward a unifying theory of behavioral change[END_REF] theorizing about personal efficacy expectation (which focuses on outcome expectations), [START_REF] Eccles | Expectancies values and academic behaviors[END_REF] have defined "beliefs about ability" as the "individuals' evaluations of their competence in different areas" (Eccles and Raphaëlle Laubie -December 21, 2017 Wigfield 2002, p.119). They have subsequently identified four components related to these beliefs: attainment value, intrinsic value, utility value and cost, namely task values.

Those four components appear to be particularly relevant in the assessment of patients' online collective action in virtual communities, considering the latest research in the domain (White and Dorman 2001; Tsai and Bagozzi 2014).

Model Formulation and Hypotheses

Following MGB and EVT, this study examines users' motives for joining online patients' communities. In accordance with our theoretical background, the research model articulates virtual communities' expectancy values as determining online collective action through the patients' intentional action and desires. Patients fulfill their motivations such as feeling emotions described in MGB but also social values, utilitarian value and trust, that is to say in a goal-directed way. Past behavior is posited to directly impact online collective action. We explain the rationale for these relationships below.

Online Collective Action in Health 2.0 environments

In the area of social psychology, Tajfel (1981) described collective actions as "efforts by large numbers of people, who define themselves and are also often defined by others as a group, to solve collectively a problem they feel they have in common", p. 244. [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF] highlighted in this definition of collective actions the notion of collective social identity (Tajfel and Turner 1979) and shared problem perception. In the collective social identity concept, [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF] explained that "stronger identification with a disadvantaged group is associated with a greater will to participate in a variety of actions

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach aimed at protecting or enhancing the group", p.182. In the shared problem perception concept, [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF] explained that "the traditional beliefs shared by group members may bring them to collectively recognize an event as threatening and worth uniting against", p.183. Van Zomeren et al. (2008) further demonstrated that perceived injustice, perceived efficacy and social identity affected collective action. The latter is also motivated by the perceived value of the outcome (Giguère and Lalonde 2010;

Bandura 1995) "when individuals perceive a valued outcome to result from collective actions, they are more likely to have a favorable attitude toward them and be willing to participate in them" [START_REF] Giguère | The influence of traditions on motivated collective actions: A focus on Native land reclamation[END_REF]p.183). This perceived value of the outcome is also posited in the purposive behavior of MGB [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF]; the feeling of injustice that bounds patients can be related to their disease.

In Health 2.0 arena, it has been proven that discussions barely suffer from misinformation, especially since corrections may be reported as rapidly as within five hours [START_REF] Esquivel | Accuracy and self correction of information received from an internet breast cancer list: content analysis[END_REF]). Thus, patients 2.0 may get an improved quality of life by connecting on virtual communities for the many benefits provided. This virtual communication allows them, for example, to maintain a continuous link with the community members (24/7). They are therefore no longer forced to wait between appointments with their practitioners to be informed about aspects of their daily life, to be reassured about their symptoms or to wait for actions to be taken. It also allows them to find their own rhythm in the Internet asynchronous mode. This allows them to accommodate conversations to their needs and to relieve their anguish at any time of the day or night.

Raphaëlle Laubie -December 21, 2017

The overall approach and the proliferation of testimonies allow patients to expand significantly their perspectives and feedback. This is also the case for information about rare diseases, whereby those platforms offer important advantages on very specific issues.

However, patients' online collective action also carries its risks. Among them, for example, the danger of wrong medical information being propagated among the Internet users. Furthermore, while mostly absent, a scrupulous control of potential erroneous information should be mandatory to avoid these pitfalls [START_REF] Culver | Medical Information on the Internet A Study of an Electronic Bulletin Board[END_REF]).

Past Behavior: Habits and Use Frequency

Past behaviors pertain to the domain of post-adoptive behaviors, which refers to a stage of routinization [START_REF] Hsieh | UNDERSTANDING POST-ADOPTIVE USAGE BEHAVIORS: A Two-Dimensional View[END_REF],implying the frequency use of technology as well as the habits [START_REF] Jasperson | A Comprehensive Conceptualization of Post-Adoptive Behaviors Associated with Information Technology Enabled Work Systems[END_REF], moving through the stage "where alterations to the system ensure that IT is no longer perceived as new or out of the ordinary" (Ahuja and Thatcher 2005, p.430). Therefore, past adoptive behaviors imply that the individual's cognition that leads to usage dissipates over time along with intention to use, when an ultimate state reached (Kim et al. 2005), leading to an automatic behavior.

Past behavior can be conceptualized in many different ways, such as frequency of behavior, or habits [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF][START_REF] Jasperson | A Comprehensive Conceptualization of Post-Adoptive Behaviors Associated with Information Technology Enabled Work Systems[END_REF]. Both concepts "predict the occurrence of future behavior over and above established antecedents of behavior such as attitudes and intentions" [START_REF] Aarts | Predicting Behavior From Actions in the Past: Repeated Decision Making or a Matter or Habit?[END_REF]Orbell 2003, p.1313;[START_REF] Ouellette | Habit and intention in everyday life: The multiple processes by which past behavior predicts[END_REF]. However, use frequency differs from habits as it does not respond to specific cues and doesn't imply a mental representation of an association Hypothesis 1b: Use Frequency is positively related to online collective action regarding virtual patients' communities.

Intentional Collective Action

According to Baggozzi and Dolhakia (2002), individual participation in online community websites reflects intentional (social) action, or intentional collective action in the context of this study. These researchers assert that "the community member acts intentionally and that these actions have a collective basis in that both what is done and why it is done in the virtual community are determined by the community's social characteristics" (p. 7). In the context of virtual communities, intentional actions predict online collective action [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]). It implies a commitment and an agreement from each protagonist to participate in joint-activity (Tuomela 1995;Tuomela 2005). As a result, intentional collective action will predict behavior or online collective action [START_REF] Bagozzi | Intentional social action in virtual communities[END_REF] in the context of patients' communities since "it has already been stressed that intention is the central factor in personal causality, that is the intention of a person that brings order into the wide variety of possible action sequences by coordinating them to a final outcome (Heider 2013, p.112). Therefore:

Hypothesis 2: Intentional collective action is positively related to online collective action regarding virtual patients' communities.

Desires

While intentions drive the action, desires are only conducive to the course towards it [START_REF] Bratman | Intention, Plans, and Practical Reason[END_REF]). how to achieve this desire. For example, a person's primary reason for getting medical information will necessarily imply two elements, 1) the desire to get medical information and 2) the belief that connecting to a medical information-related website is a means of obtaining medical information. [START_REF] Davidson | Essays on Actions and Events: Philosophical Essays[END_REF] further stresses that intentions can be influenced, depending on the conditioned evaluative judgments that may alter the appreciation of the situation. For example, a patient's evaluative judgment on medical information will be achieved by connecting on patient's virtual communities. Therefore:

Hypothesis 3: Desires are positively related to intentional collective action.

We conceive desires as a mediating variable that transform motivational antecedents of online collective action into reasons for action [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]). Task values, anticipated emotions, and trust -namely expectancy values -are among such antecedents. We review these next.

Expectancy Values

Expectancy values are likely to determine the desires regarding the interactions with patients' virtual communities. The subcategories of the four expectancy values will be grouped under the same hypothesis, because those hypotheses share a similar conceptual rationale.

Social Value

Social values relate to ideas that are shared in communal and non-competitive ways, which results in the social experience as an aggregation of the social participation [START_REF] Kim | Social Values and economic dynamics[END_REF]. A number of such values have been identified; for example, social values Raphaëlle Laubie -December 21, 2017 such as the attainment value are described by Eccles and Wigfield as "the personal importance of doing well on a task" [START_REF] Eccles | Motivational beliefs, values, and goals[END_REF][START_REF] Eccles | Expectancies values and academic behaviors[END_REF]. This concept, linked by [START_REF] Markus | The Dynamic Self-Concept: A Social Psychological Perspective[END_REF] to one's self-schema, is defined by [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] as a means to "understand and deepen salient aspects of one's through social interactions" (p.144).

The social influence literature [START_REF] Kelman | Compliance, Identification, and Internalization: Three Processes of Attitude Change[END_REF]) brings insights about categorization to be drawn to better acknowledge social value formation, namely: i) compliance or normative influence of others' expectations which is proven irrelevant in the case of virtual communities [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF], ii) internalization/group norms or congruence of one's goals with those of group members, iii) identification/social identity or conception of one's self in terms of the group's defining features [START_REF] Bagozzi | Intentional social action in virtual communities[END_REF].

Compliance, the Kelman's first variable of social influence, has been considered to be of minor importance in the case of online communities by [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]. Indeed, participants do not feel the need to conform to the online group, expecting rewards or fearing punishment. Rather, they have the possibility to leave the virtual engagement easily and the feeling of freedom is high.

Group norms features the influence performed by the group towards an individual because of shared values among the community [START_REF] Kelman | Compliance, Identification, and Internalization: Three Processes of Attitude Change[END_REF].

Social identity, which concept relates to the belonging of a group, involves i) an affective sub-facet characterized by the affective commitment to the group [START_REF] Bergami | Self-categorization, affective commitment and group self-esteem as distinct aspects of social identity in the organization[END_REF], ii) an cognitive sub-facet characterized by the self-awareness of community membership [START_REF] Ashforth | Social Identity Theory and the Organization[END_REF] and iii) an evaluative sub-facet useful health-related information and tools that will allow them to considerably reduce their level of isolation (White and Dorman 2001). We therefore, posit:

Hypothesis 5a: Isolation rupture is positively related to desires regarding the participation in virtual patients' communities.

Hypothesis 5b: Information needs are positively related to desires regarding the participation in virtual patients' communities.

Hypothesis 5c: Instrumental needs are positively related to desires regarding the participation in virtual patients' communities.

3.2.1.5.3 Anticipated Emotions [START_REF] Deci | Intrinsic motivation and self-determination in human behavior[END_REF] highlighted the intrinsic motivation concept, which refers to doing something because it is inherently interesting or enjoyable. Positive anticipated emotions also relate to [START_REF] Eccles | Motivational beliefs, values, and goals[END_REF] intrinsic value -or "the enjoyment the individual gets from performing the activity or the subjective interest the individual has in the subject", (p.120). These values have also been shown to determine participation in virtual communities [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF], have been referred to as feeling dimensions (Sweeney and Soutar 2001), or anticipated emotions (Grabner-Kräuter 2010, [START_REF] Bagozzi | Goal-directed Emotions[END_REF]Tsai and Bagozzi 2014), where negative anticipated emotions are added. These anticipated emotions values -anticipated positive that capture the action's pleasure and satisfaction [START_REF] Chiu | Understanding customers' repeat purchase intentions in B2C e-commerce: the roles of utilitarian value, hedonic value and perceived risk[END_REF]) but also negative emotions -were also studied by [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] and have been adapted from the MGB, and help to create the link between the MGB and EVT.

Following this, anticipated emotions are likely to foster desires in participating in virtual communities. Indeed, patients will use websites in order to contribute to the generation of positive or negative emotions, such as the emotional betrayal [START_REF] Joinson | The Oxford Handbook of Internet Psychology[END_REF]) for the latter. Therefore, and further confirmed by the interviews' results:

Hypothesis 6a: Anticipated positive emotions are positively related to desires regarding the participation in virtual patients' communities.

Hypothesis 6b: Anticipated negative emotions are negatively related to desires regarding the participation in virtual patients' communities.

Trust

In social exchange theory, trust is a core "cost" component of a cost-benefit analysis with respect to social interaction [START_REF] Roloff | Interpersonal Communication: The Social Exchange Approach[END_REF]. Cost relates to the "negative aspects of engaging in the task" [START_REF] Eccles | Motivational beliefs, values, and goals[END_REF]. Although trust is often related with the notion of risk [START_REF] Deutsch | Cooperation and trust: Some theoretical notes[END_REF][START_REF] Mayer | An integrative model of organizational trust[END_REF][START_REF] Corritore | On-line trust: concepts, evolving themes, a model[END_REF]. For interactions that take place in online community contexts, many researchers associate trust concerns with privacy concerns (e.g.; Dong-Hee 2010; Fogel and Nehmad 2009), while the press sometimes reports the unfortunate disclosure of several users' personal data [START_REF] Read | Think before You Share[END_REF]). In fact, in those contexts, patients are likely to be very concerned with the respect of privacy [START_REF] Goldberg | Privacy-enhancing technologies for the Internet[END_REF]) especially when they interact online with groups of people concerning very private issues, such as health [START_REF] Coulson | Receiving social support online: an analysis of a computer-mediated support group for individuals living with irritable bowel syndrome[END_REF]White and Dorman 2001). They are also concerned by the accuracy of information made available (Williams et al. 2003;[START_REF] Diaz | Patients' use of the Internet for medical information[END_REF][START_REF] Dickerson | Therapeutic connection: help seeking on the Internet for persons with implantable cardioverter defibrillators[END_REF] because "trust or lack of trust may be a key factor in determining whether online relationships will thrive and move to deeper levels" (Joinson et al. 2007, p.43) and foster or hinder the desires to participate in online collective action. Accordingly, in this study we focus on inaccurate medical information and privacy concerns as surrogates of trust.

Indeed, researchers argue that risks induced by trust on the Internet take place "when individuals follow advice that they receive online; if this information is inaccurate, as a variety of costs may be incurred, depending on the domain of the advice (health, travel, finances, etc.)" (Joinson et al. 2007, p.44). Therefore, when the medical information is perceived inaccurate, the reliability of the patients' virtual community is at stake and challenged by users ending up in a lower desire to interact or to follow advices.

Hypothesis 7a: Inaccurate medical information is negatively related to desires regarding the participation in virtual patients' communities.

The purpose of online interaction is closely related and dependent to trust. Online interactions are indeed "conditions that foster high disclosure may also be those that evoke greater trust" (Joinson et al. 2007, p.45) and therefore, higher collective action.

When patients have the feeling that their private information can be used by others in an unethical way, this can result in a lower desire to interact in a social way. Therefore, and further supported by the interviews' results:

Hypothesis 7b: Privacy concerns are negatively related to desires regarding the participation in virtual patients' communities.

Background Factors

In addition to these variables, we account for the role of a number of background factors in the model. Ajzen indeed argues that "a multitude of variables may be related to or Prior research has identified a number of virtual communities' [START_REF] Lin | Determinants of successful virtual communities: Contributions from system characteristics and social factors[END_REF]) and patients' [START_REF] Rahmqvist | Patient Satisfaction in Relation to Age, Health Status and Other Background Factors: A Model for Comparisons of Care Units[END_REF] characteristics that need to be controlled when examining patients' interactions on virtual communities. We choose to include several of them in the model in order to control their potential influence on online collective action. Those variables are age, education, the Internet experience of the patients, and gender.

Regarding the latter, however, researchers have found that gender may be less influential in the access to the Internet, other demographics such as age or education and the IT experience lead to disparities (Walsh et al. 2001;Katz and Rice 2002;[START_REF] Joinson | The Oxford Handbook of Internet Psychology[END_REF].

In order to empirically test the research model, a multi-method approach has been applied [START_REF] Creswell | Research Design: Qualitative, Quantitative, and Mixed Methods Approaches[END_REF]Venkatesh et al. 2013).

Design and Methods

Research design

In order to answer to the research questions and to test the aforementioned hypotheses, we have applied a sequential, mixed-method design [START_REF] Creswell | Research Design: Qualitative, Quantitative, and Mixed Methods Approaches[END_REF]Venkatesh et al. 2013). To do so, we followed Venkatesh et al. ( 2013) guidelines for mixed methods' approaches in IS. We specifically considered i) the appropriateness of the approach, given our willingness to both consider the context of patient's online community and provide a holistic understanding of it, ii) our willingness to develop meta-interferences to derive theoretical statements from both qualitative and quantitative results regarding patients' online collective action and iii) our willingness to assess the quality of metainterferences through integrated findings' assessment in both qualitative and quantitative approaches.

From an epistemological point of view, our approach somewhat goes beyond a 'pure' positivist approach, sometimes depicted as naïve realism "in which reality is comprehensible and knowledge can easily be captured and generalized in a context-free form" (Zachariadis et al. 2010, p.5), or a 'pure' interpretive approach that excludes causal explanation "in early debates in the philosophy of social science concerning understanding versus explanation and on whether reasons could be causes" (Sayer 2000, p.96). Indeed, specifically defining critical realism's scope Zachariadis et al. state:

"Instead of looking for social laws we should be looking for causal mechanisms and how they work. According to critical realists, consistent regularities are only likely to arise under special circumstances in closed systems" (2010, p.5).

We believe critical realism helps addressing some of the ontological and epistemological limitations of positivism Zachariadis et al. ( 2010), consistent with the way we consider how knowledge is constructed.

Accordingly, we proceeded in two sequential steps. In the first, qualitative step, a partially grounded approach has been applied in order to further investigate online collective action in Web 2.0 contexts. While we believe existing theories provide relevant insights to examine this issue, we also believe they are insufficient to provide a complete account of online collective action in health contexts. That is why we have decided to ground our research on both the field and theory. This approach allowed us to benefit from emerging insights from the field, while contributing to knowledge in a cumulative way. We conducted a review of the relevant literature on collective action and on patients' interactions on online communities along with interviews with patients from online patients' communities. In practice, the constant back and forth between the patients' inputs, which emerged from the interview analyses and the insights brought by the literature, have participated in knowledge construction consistent with our critical realist approach [START_REF] Mingers | The contribution of critical realism as an underpinning philosophy for OR/MS and systems[END_REF]Mingers 2004).

The second step of our design was the quantitative approach, implemented in order to test the research model. A survey has been conducted with patients who interact on online patients' communities. The key elements of the design for this research are summarized in Table 29 below. x Ethnographic research approach in order to get preliminary insights on patients' sociological typology as well as motives for online engagement. x 25 preliminary semi-structured interviews) with Doctors and caregivers, health 2.0 experts and web 2.0 experts, users of patients' virtual communities. x 29 subsequent interviews conducted (including the preceding participants) who had to deal with their own health issues or that of relatives.

Step 2: Quantitative Approach

x Contextualizing the research model to accurately reflect actual

Qualitative Approach

In the qualitative part, we proceeded with semi-structured interviews [START_REF] Romelaer | L'entretien de recherche[END_REF] in order to glean any materials that would emerge from patients' testimonies and supplement our theoretical framework.

The interviews were conducted with French Doctors and caregivers, health 2.0 and web 2.0 experts, patients and patients' relatives as shown in Table 30 below. The patients who participated in the study were members of a breast cancer community and parents of autistic children.

The breast cancer community's initial aim is to help patients finding information about their disease, to share their struggle in understanding it, and to help them make decisions thoughtfully, such as which surgical method should be preferable or which practitioner should be recommended, It comprises approximately 10,000 French patients, located all over the world. Participation in the community is anonymous (if desired), free, and the platform is independent of any other renowned social networks.

In contrast, the community of parents of autistic children is a small, closed, Facebook group, which consists of 97 persons. Its aims are similar as those of the breast cancer community members, with a careful focus on privacy protection allowing new entry on demand and acceptance after review only. Considering participants from these two

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach different communities helped us to increase the variety of the user conditions that we could observe. Most of the 54 interviewees were female (49) -we conducted 5 males' interviews -, and all were adults. The anonymity of the respondents was guaranteed in order to reduce their apprehension [START_REF] Podsakoff | Common method biases in behavioral research: A critical review of the literature and recommended remedies[END_REF]). The interviews have been recorded and fully retranscribed. The responses provided us primary information about individual motives for online collective action. It also helped us identify the most relevant expectancy values to be included in the research model.

In order to do so, the NVivo9 software was used to proceed to the thematic coding and data mapping [START_REF] Bazeley | Qualitative Data Analysis With NVivo[END_REF] of the interview material. We coded the interviews after having set broad a-priori categories, according to the research model and theoretical background. We also looked for potentially new concepts by examining how well data fit with the conceptual categories identified in the literature (Suddaby 2006). We further allowed new categories to emerge. In this ongoing coding process, we followed a grounded approach [START_REF] Glaser | The Discovery of Grounded Theory: Strategies for Qualitative Research[END_REF], and hence created new categories from

Cognitive

Social Identity "Interactions with a constantly changing sequence of partners will be less satisfactory than repeated interactions with the same person(s), and relatedness without frequent contact will also be unsatisfactory" (Baumeister and Leary 1995, p.497). In the case of patients' communities, websites will be dedicated to one disease only. "In a cognitive sense, social identity is evident in categorization processes, whereby the individual forms a self-awareness of virtual community membership, including components of both "When it's opened to everyone, as a result, it loses in terms of information. While in a site like Les Impatientes, we know that we will inevitably connect with sharp people sharing our concerns… and it is very reassuring." [START_REF] Baumeister | The need to belong: Desire for interpersonal attachments as a fundamental human motivation[END_REF][START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF][START_REF] Ashforth | Social Identity Theory and the Organization[END_REF] similarities with other members, and dissimilarities with nonmembers." (Dholakia et al. 2004, p.245 (Perugini and Bagozzi 2001, p.83). In online communities' contexts, it refers to "fun and relaxation through playing or otherwise interacting with others" (Dholakia et al. 2004, p.244) (Green 2007, p.44). In the context of health purposes, there is a risk of dangerous and inaccurate medical information appearing online (Williams et al. 2003;[START_REF] Diaz | Patients' use of the Internet for medical information[END_REF][START_REF] Dickerson | Therapeutic connection: help seeking on the Internet for persons with implantable cardioverter defibrillators[END_REF] "The big problem on the forum is that only patients participate with their own feelings, with their own knowledge… And they aren't necessarily enlightened patients…" New Dimension Privacy Concerns "On the Internet, individuals may trust others to keep private information confidential" (Green 2007, p.44). For health purposes, privacy protection may be of relevance due to patients' conditions [START_REF] Goldberg | Privacy-enhancing technologies for the Internet[END_REF] as well as the privacy policies of health Web sites [START_REF] Graber | Reading level of privacy policies on Internet health Web sites[END_REF].

"Control is important, as is the confidentiality of data. It was a prerequisite for me, if I was asked my name, I would be gone, because the Internet is risky" New Dimension * Quotes from interviews with Breast Cancer Community's patients

Online Collective Action

Drawing on "the psychological processes underlying attitudebehavior Relationships" (Eagly and Chaiken 1993, p.299), enriches by joint-activity concept (Tuomela 1995; Tuomela 2005) and online context [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]), online collective action indicates the commitment and agreement to be joint-activity from patients' virtual communities users.

"Well, I am determined to act by providing information and answers to people who ask questions, testifying that there is life after cancer. Yes, there is also the testimony that counts. Yes, there is the testimony that you can live well with illness..." [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] * Quotes from interviews with Breast Cancer Community's patients.

The preliminary results of the exploratory, qualitative approach helped us identify the main determinants of online collective action. The subsequent confirmatory,

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017

quantitative approach was expected to help determining whether the model accurately predicts online collective action. We discuss this next.

Quantitative approach

Based on the insights from the qualitative approach, the research model has been conceptualized, enriched and contextualized. Furthermore, the content validity of the model-variables has been improved, as we have identified multiple sub-facets of expectancy values with 4 dimensions for social value (group norms, affective social identity, cognitive social identity, evaluative social identity), 3 dimensions for utilitarian value (information needs, instrumental needs, isolation rupture), and 2 dimension for anticipated emotions values (anticipated positive emotions and anticipated negative emotions). We have also identified 2 dimensions for trust (inaccurate medical information and privacy concerns). We were able to contextualize online collective action and desires.

In practice, and whenever possible, constructs' measures have been adapted from prior research. Following this, a questionnaire has been developed. A survey [START_REF] Pinsonneault | Survey Research Methodology in Management Information Systems: An Assessment[END_REF] has then been conducted over the Internet with patients of three different virtual communities in French language. The number of patients registered amounts around 15,000 persons that are not always active, though.

Measures

The questionnaire was initially developed in English and then translated into French by experts in both languages. The measures, provided in Tables 32. 1, 32.2, 32.3, 32.4

and

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017

32.5, used a seven-point Likert scales [START_REF] Joinson | The Oxford Handbook of Internet Psychology[END_REF]. Participants were asked to visualize the average participants of their virtual community and to write their names (or pseudos) and a description of each participant up to five persons (See Table 32.1 and Annex 6.3.1.4) Several constructs have been modeled as second order formative constructs with reflective subconstructs. Others are reflective constructs, following both the literature and the insights which emerged from the qualitative study.

For instance, habits is a reflective construct that measures to what extent patients' logging onto patients' virtual community is an automatic behavior. We used the metrics of [START_REF] Chiu | Re-examining the influence of trust on online repeat purchase intention: The moderating role of habit and its antecedents[END_REF] for this construct.

Use frequency is a formative construct that measures how often patients join the virtual communities to satisfy various needs. We used the metrics of [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] for this construct.

Intentional collective action is a formative construct that measures to which degree patients might intend to interact together on the Internet with the group during the next two weeks, based on Dholakia et al. ( 2004)'s metrics. Similarly, desires is a formative construct that measures to which degree patients might desire to act in the same way, using the same metrics.

Affective social identity, cognitive social identity and evaluative social identity are formative constructs that also used the metrics of [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] to measure: i) how attached are patients to the group, ii) to what degree patient's self-image overlaps with the group and iii) to what extend the patient considers being a valuable member of the group.

Group norms is a formative construct that used the metrics of [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] relating to the shared agreement among patients to participate online in the next two weeks following the question.

Isolation rupture is a reflective construct using the metrics of [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] that measures how often patients connect on virtual communities to feel less lonely.

Information needs and instrumental needs are reflective constructs using the metrics of [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] that measures how often patients connect on virtual communities to: i) get information and ii) solve problems.

Raphaëlle Laubie -December 21, 2017

Anticipated positive emotions and anticipated negative emotions are formative constructs using the metrics of [START_REF] Bagozzi | Goal-directed Emotions[END_REF] that measure whether patients will experience positive or negative feelings while interacting together on the Internet with the group during the next two week following the question.

Inaccurate medical information is a reflective construct based on the metrics of Vance et al. ( 2008) that measures to what extent patients face errors in the medical information from the patients' virtual communities web site.

Privacy concerns is a reflective construct based on the metrics of [START_REF] Dinev | Internet privacy concerns and their antecedents-measurement validity and a regression model[END_REF] that measures, to what extent, patients are concerned that the information they submit on the Internet could be misused.

Finally, online collective action is a formative construct. It measures how committed patients are to interact online, together as a group in the next two weeks following the question. For this construct, we used the metrics of [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF].

Sampling

Patients suffering from cancer from three different virtual communities were being solicited to participate in the study. The community managers posted the invitation to participate in the survey online that stayed on the sites' homepage during two months for the first community and couple of weeks for the others. In order to reduce the risk of common method bias, the anonymity of the participants was guaranteed, and they were recalled that their answers wouldn't be analyzed individually, and that they wouldn't be identified personally [START_REF] Podsakoff | Common method biases in behavioral research: A critical review of the literature and recommended remedies[END_REF]. There was no reward of any nature offered

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017 in return of their participations. The participants were informed that there were no right or wrong questions and that only their sincere answers were required.

The first community (122 participants), comprised around 10,000 subscribers, is the domain of breast cancer. The second community (102 participants), comprised around 15,000 subscribers, is the domain of thyroid disorders, including thyroid cancer. The third community (45 participants), comprised around 5,000 subscribers, is the domain of cancers.

Overall, 269 participants completed the questionnaire survey. There were 782 clicks on the survey's link, including 282 responses. Out of the 282 responses obtained, 13 were poorly completed and thus deleted due to too many incomplete answers. (See Table 33)

Of the 269 participants, 98% were female. 17% of the participants were in 41-45 range age, 22,1% were in 46-51 range age and 22,1% were in 51-55 range age. Only 2,47% of the participants were self educated. 61,1% of the participants were married, versus 19,8 widowed. 52,2% of the participants had a good skill in the Internet use.

Analysis

formative constructs and for the exploratory nature of our research (Straub et al. 2008;[START_REF] Marcoulides | A critical look at partial least squares modeling[END_REF]Ringle et al. 2012). We began by examining the measurement properties of the instrument. For this, we conducted typical tests, including convergent validity, discriminant validity, and construct reliability [START_REF] Boudreau | Validation in information systems research: A state-of-the-art assessment[END_REF].

Construct Validity and Reliability

Convergent Validity

Convergent validity was evaluated by examining the cross-loading values (See Table 33).

The results indicate that all items load cleanly on their intended constructs, with values higher than 0,80 for all constructs. Further, the analysis of the outer model loadings allows assessing the significance of item loadings on their intended constructs. It shows that the t values are higher than 1.96 and hence that all the items do load significantly (e.g., at p<.05) on their reference construct. Therefore, we can conclude that convergent validity meets the generally accepted standards [START_REF] Gefen | Structural equation modeling and regression: Guidelines for research practice[END_REF] for these constructs.

Discriminant Validity

Discriminant validity of reflective constructs is achieved when items from a given construct correlate more highly with their construct than with any other construct. In order to test discriminant validity, we first computed the root square of the average variance extracted for each construct (highlighted on the diagonal of Table 35). We then verified that these values were higher than any off-diagonal values. Since this condition was met, we could thus conclude that reflective constructs have good discriminant validity [START_REF] Gefen | Structural equation modeling and regression: Guidelines for research practice[END_REF].

Construct Reliability

We checked the internal consistency of our constructs with composite reliability [START_REF] Fornell | Evaluating structural equation models with unobservable variables and measurement error[END_REF]) and Cronbach's alpha measurement. All values for these calculations were higher than 0.70 [START_REF] Boudreau | Validation in information systems research: A state-of-the-art assessment[END_REF] demonstrating that conditions for internal consistency are met.

Overall, convergent validity, discriminant validity and reliability analyses showed that our instrument has good psychometric properties.

Common Methods Variance Analyses

In order to check whether the common methods have influence on the results of the study, we completed the Haman's single factor test as recommended by Podsakof et al. (2003). To do so, we performed a Principal Component Analysis. The results (See Table 36) show that more than one factor emerges from the PCA, which indicates that common method variance is not a serious concern.

Results

We tested the aforementioned hypotheses running a bootstrap analysis with 500 resamples. Our model explained a substantial amount of the variance of online collective action (R² = 0.753), of intentional online collective action (R² = 0.400) and of desires (R² = 0.628). The results are highlighted in Table 37.

Relationships between past-adoption behavior and online collective action

As expected in H1b, the use frequency AE online collective action link was found to be positive and significant (β = 0.168, p < 0.05). However, unexpectedly, the habits AE online collective action link was not significant (β = 0.028, n.s. [nonsignificant]), which invalidated H1a.

Relationships between expectancy values and desires

As expected in H4c and H5a, the links evaluative social identity AE desires (β = 0.245. p < 0.001) and isolation rupture AE desires (β = 0.333, p < 0.01) were found to be significant. To a lesser extent, in H4d and H6a, the links group norms AE desires (β = 0.194, p < 0.01) and anticipated positive emotions AE desires (β = 0.122, p < 0.05) were validated.

The links affective social identity AE desires (β = 0.083, n.s.), cognitive social identity AE desires (β = -0.031, n.s.), information needs AE desires (β = -0.04, n.s.), instrumental needs AE desires (β = 0.024, n.s.) and anticipated negative emotions AE desires (β = 0.055, n.s.) were not significant, invalidating H4a, H4b, H5b, H5c and H6b.

Discussion and contributions

Given the context of usage of health virtual communities, the utilitarian perspectives of many of the extent adoption models (e.g., [START_REF] Davis | Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology[END_REF]Venkatesh et al. 2003) determinants of altruistic action may also reflect the quest for the sense of self, belonging and ownership [START_REF] Abma | Seeking Connections, Creating Movement: The Power of Altruistic Action[END_REF]. More specifically, we may, for example, expect that patients differ from other users in more traditional settings of technological interaction. For example, patients may be significantly influenced by emotional factors due to some concerns about their illness. Further, the sensitivity of the information shared -especially when very personal, may for example raise concerns about the trust on the platform.

The purpose of this study was to examine the determinants of online collective action on patients' communities. It makes four major contributions to research and practice.

Firstly, it helps to create a rich, contextualized social media adoption model for health purposes. The multi-method, critical realist approach contributes to the study's relevance -with a qualitative approach that enriches the research model with insights from patients' experiences, and rigor -with a subsequent quantitative study to measure the impacts of the determinants of online collective action. We demonstrate the relevance of combining MGB and EVT for developing a model for examining the determinants of patients' online collective action. Doing so, we enriched the underlying framework of MBG -established by [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] and adapted to virtual communities by [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] -by offering a holistic understanding of the determinants of desires to participate in online collective action based on EVT's [START_REF] Eccles | Expectancies values and academic behaviors[END_REF]) tasks values. The qualitative approach allowed us to provide a deep understanding of the context of our research and the quantitative approach enabled us to conceptualize a model, which could be tested or augmented in other fields of inquiry.

The quantitative also allows data triangulation. It helps confirm the qualitative field's findings about desires being a determinant of intentional collective action, itself a determinant of online collective action. Besides, we enhance those findings by identifying the determinants of online collective action. Online collective action is a function of past behavior. Specifically, use frequency, explains this collective action, as a direct determinant, while habits, an automatic behavior activated by the environment (Ortiz de Guinea and Markus 2009), has no influence on OCA. OCA is also a function of intentional collective action.

Desires is a function of social values, utilitarian values, and anticipated positive emotions, in line with the latest findings on virtual communities (Tsai and Bagozzi 2014). However the results show that patients' desires to interact are not significantly constrained by anticipated negative emotions as many patients were either prepared to it or able to cope with it. Similarly, information and instrumental needs were not found to be significant, even if information are exchanged on the platforms, they are not the main reason why patients are willing to interact with each other compared to their needs for isolation rupture or anticipated positive emotions. Specifically, the evaluative component of social identity influences desires to interact online for patients, contrary to the affective and the cognitive ones. This result should be further clarified for any type of communities as, to our knowledge, it has not been demonstrated in other research [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]Tsai and Bagozzi 2014) and as they may differ depending on the communities' participants.

We then focused on collective action and intention, in contrast with personal action and intention as behavior and behavior's determinant. The results confirmed the importance of desires and their capability to "convert reasons for action into intention to act" (Tsai and Bagozzi 2014, p.157).

Secondly, this study responds to key challenges in IS adoption research, which has long been examining usage with less consideration paid to other kinds of interactions with and around the IT (Benbasat and Barki 2007b), e.g. online collective action. For example, research has been conducted on the determinants of social networks' usages (Sledgianowski and Kulviwat 2009;[START_REF] Lankton | Predicting Facebook Continuance Intention: The Roles of Interpersonal and Technology Trust[END_REF]Steinfield et al. 2008;[START_REF] Ross | Personality and motivations associated with Facebook use[END_REF][START_REF] Mlaiki | Facteurs psychosociaux et continuité d'utilisation des réseaux sociaux numériques: le cas de facebook[END_REF][START_REF] Baker | Predicting adolescents' use of social networking sites from an extended theory of planned behaviour perspective[END_REF]. However, it has mostly applied lean IT adoption measures [START_REF] Burton-Jones | Reconceptualizing system usage: An approach and empirical test[END_REF]Straub and Burton-Jones 2007), sometimes very far from what is experienced on the field (Straub et al. 1995). Further, it often lacks a contextualized approach, which would enable one to create and to test richer usage-related constructs based on specific common interest exchange on virtual communities -in our case, patients' communities -with narratives and quantitative data. In this process, the critical realist perspective helped us get insights from the field along with a literature review, exploring different arenas and articulating theories relevant for examining patients' online usage -EVT and MGB.

Overall, the research helps understand why patients are motivated to act and interact with other patients through technology, and what the role of non-IT determinants is in this process.

From an e-health practice standpoint, a third contribution of this research regards how individuals respond to isolation feelings. They see virtual worlds as a means to reduce perceived isolation and improve their capability to face day-to-day hardships. A major concern is that patients often feel alone, helpless and unmotivated when confronted with illness. In this context, virtual communities can be viewed as a support for maintaining patients' ties and social relationships. The results of this study are important because they will help Health 2.0 stakeholders to better acknowledge issues such as that of the kind of social community platforms that ought to be designed in order to respond to patients' needs and, therefore, foster their engagement, the social media policy that may or should be applied, the messages that they may diffuse, or the factors they should influence so as to deliver the best social experience possible to patients in virtual communities. Eventually, the study's results will help to more effectively take the disabled and ageing population's health challenges into consideration.

Finally, the research highlights the trust aspects in patients' virtual worlds. The study shows that online collective action among patients is not a matter of trust. Patients are willing to contribute in others' well-being for social, utilitarian values, and positive reasons. Privacy issues and the fear of facing inaccurate medical information do not prevent them from interacting with peers through the online communities. However, these results shouldn't clear Health 2.0 practitioners of any responsibility regarding these issues, for two main reasons. First, the fact that trust does not impact desires means that patients are also likely to interact with an insufficient consideration made to confidentiality issues. Second, during the qualitative phase, patients expressed their need for information control and for online clinical advice that would be performed by health professionals. The first two may imply the need for a more significant medical presence in patients' platforms, which is already the case in many communities, but not systematic. The latter would require making mandatory users' need to log in to be allowed to read forum contents. Those issues also imply that online community Raphaëlle Laubie -December 21, 2017 designers should be cautious in integrating appropriate security features on their platforms. A cautious approach should be observed behind these trust issues, with a growing and ageing worldwide population, and growing Internet use.

Limitations and Future Research

A multi-method qualitative and quantitative approach has been conducted for this research. Interviews have been conducted in order better understand what patients would be more concerned with, and in order to reach semantic saturation. Our specific field of inquiry required this partly inductive approach. Then we conducted a quantitative phrase in order to be able to draw conclusions as well as a complete model of patients' online collective action. Although we presented a generic model that can be studied in specific virtual communities and cultural settings' communities within the same epistemological guidelines, we needed, in order to avoid flawed contributions and conclusions' research, to contextualize our work.

Therefore, this research presents limitations which are also opportunities for further investigations.

Firstly, we have developed and tested a research model in a French context, in order to avoid introducing biases from multicultural settings. Though, so doing, the results are probably not generalizable to patients from other countries, as the digital divide between developed and developing countries still exclude some users due to the limitations of the Internet or exclusion of some social strata -with 4 billion people not yet using the Internet, and more than 90% of them located in developing countries (ITU 2014) -, therefore, impacting their collective action, online [START_REF] Joinson | The Oxford Handbook of Internet Psychology[END_REF]. Therefore, future research may explore differentiations and/or similarities of behavior of patient's online collective action.

Secondly, the research has been conducted on specific cancer-suffering patients' virtual communities in both the qualitative and the quantitative phase. It would also be relevant to investigate populations other than cancer communities. As well, populations other than patients' communities, sharing diverse concerns or interests, ought to be examined.

Therefore, future research can build on the research model of social media adoption.

While some variables could be applied as is, others, such as trust, may be adapted with the more holistic concept of cost, which offers a wide range of factors (including trust) to be explored in a given community [START_REF] Eccles | Expectancies values and academic behaviors[END_REF].

Thirdly, the patients' sample comprises a large majority of women. It may therefore not be possible to extrapolate the results to both genders, indeed previous research show that women (65%) are more likely than men (53%) to look online for health information (Pew Research 2011). Future research may hence try to identify variations across genders regarding the determinants of online collective action on patient's online communities.

Finally, the impact of time over social identity or emotions' determinants for patients should be considered depending on the disease evolution. Indeed, patients can become experts or leaders in their own communities, raise their voices and become a role model for newcomers for the sake of these environments. They can also bridge patientspractitioners or pharmaceutical stakeholders' communication gap. Therefore, the study of their attachment to the communities, long after remission in some cases, would greatly benefit to knowledge.

Conclusions

EVT, MGB's underlying framework, applied to virtual communities, offer important grounding concerning the leading determinants of online collective actions for patients.

A multimethod approach has been applied in order to account for the specific context of patients' virtual communities. The community-based background of patient members includes a large number of users, most often weakened by their disease, seeking interaction on these platforms.

Although the emotional dimension remained significant in patients' motives for joining online communities, the findings suggest that the MGB contributed to offer a relevant model for predicting intentional action to engage online. All these variables were validated by the quantitative analysis. However, some utilitarian values, such as information needs and instrumental needs were integrated in the model as they are in the adaption of MGB in [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] past study, but were not validated by our study.

The Internet and patients' initiatives are changing the face of medical practice, previously limited to a top-down approach where health professionals and third parties involved communicated a restricted amount of information to patients. The research suggests that virtual communities are an opportunity to develop virtual spaces for people seeking information and support online.

Arguably, by connecting to virtual communities, patients may improve their quality of life, for to the benefits provided by discussions with others. This is even more the case when those patients cannot interact in more traditional social groups in real life. In this, online communities are likely to bring social benefits such as reduced isolation, which e-health professionals should leverage. Health professionals and third parties have long been those who communicate (a limited amount of) information to patients in a topdown way. The Web 2.0 fosters online collective action, and subsequently the participation of patients in generating useful content in virtual communities. Eventually this research emphasizes the need for researchers and practitioners to better take into account the ageing population's health challenges. It also shows how patient's virtual communities can help support patient's concerns. In Web 2.0 contexts such as online communities, more than system usage, collective action reflects the success of technology artefacts [START_REF] Eysenbach | Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions[END_REF]White and Dorman 2001). While critical in collective action in Web 2.0 contexts, however, little do we know about the characteristics of gift-giving behaviors and how social actors perform it. Accordingly, this study examines the characteristics and dynamics of gift-giving behaviors in online community environments.

The technology acceptance model (TAM) [START_REF] Davis | Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology[END_REF]) is a widely applied framework for describing users' adoption of IT, linking behaviors to attitudes and beliefs, namely ease of use and usefulness "that are consistent in time, target, and context with the behavior of interest" (Wixom and Todd 2005, p.85). Later on, UTAUT (Venkatesh et al. 2003) augments TAM, identifying four determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) of behavioral intention, itself a determinant of usage. In spite of the interest of such models for better acknowledging technology adoption, [START_REF] Burton-Jones | Reconceptualizing system usage: An approach and empirical test[END_REF] explain that they doubt that usage intentions and behavior in TAM capture the very notion of acceptance. They urge "researchers to provide systematic evidence for which usage measures, if any, are valid proxies for related constructs and to determine which other constructs, if any, are good proxies for system usage" (Burton-Jones and Straub 2006, p.241). [START_REF] Bokhari | The relationship between system usage and user satisfaction: a meta-analysis[END_REF] further highlights that research does not offer congruent conclusions linking system usage and user satisfaction. Regarding the IS Success Model (Delone and McLean, 2003), [START_REF] Hofmann | Issues in multilevel research: Theory development, measurement, and analysis[END_REF] warns about the implications of collective phenomena appending a multilevel nature for system usage. Some researches drew on several of the aforementioned IS adoption models to explain user adoption through the impact of ease of use and usefulness in the Web 2.0 context. They demonstrated that some variables such as usefulness may contribute to the gathering of a critical mass of users [START_REF] Shin | Applying the technology acceptance model and flow theory to cyworld user behavior: implication of the Web2. 0 user acceptance[END_REF]Shin 2008;Wu et al. 2008).

Nevertheless, the collective phenomena per se are not conceptualized into those models. Burton-Jones and Gallivan (2007) also emphasize concerns about the lack of consideration for several levels of analysis in a theory such as UTAUT as constructs are conceptualized mostly at the individual level. As a result, for not considering the group level for example, and in spite of the conceptual strength of all those models for understanding system usage, we believe that, alone, they do not provide a sufficient basis for examining online collective action (OCA) in Web 2.0 contexts.

In sum, those models fail to address four main gaps. First, they all focus on a usercentric approach of the interaction between users and IT, which remains silent on the fundamentally collective nature of the usage and of the benefits of Web 2.0 technologies.

In contrast to Web 1.0 IT, Web 2.0 IT usage underlies collective action. For this, conceptualizing Web 2.0 system success through the concept of system usage would not be fully satisfying, as its fundamental benefits lie in the collective use of the technology [START_REF] Burton-Jones | Toward a deeper understanding of system usage in organizations: a multilevel perspective[END_REF]Rheingold 2003). In this, as argued by [START_REF] Lamb | Reconceptualizing users as social actors in information systems research[END_REF], users can fundamentally be seen as social actors who interact through technologies and should be treated as such. Benbasat and Barki (2007a) or Straub and Burton-Jones (2007) further explain that existing research on technology adoption and usage has studied a too narrow set of variables around the concept of system usage, (Skageby 2015), that adoption research has hardly sought to examine important mediators or moderators of system usage such as those in the realm of emotions.

Accordingly, [START_REF] Burton-Jones | Reconceptualizing system usage: An approach and empirical test[END_REF] argue that it is necessary to reconceptualize system usage and call for the development of more contextualized usage variables. Skageby (2015) explains that digital ecosystem offer new perspectives combining gift behaviors and media technologies. Unfortunately, little-to-no indications have been given to better understand how to account for Web 2.0 contexts, and what system usage is in those contexts.

Second, those models do not or hardly account for the role of emotions in the course of individual interactions with technology and whether those positive or negative emotions play a role in the results of IT introductions to people [START_REF] Beaudry | The other side of acceptance: studying the direct and indirect effects of emotions on information technology use[END_REF].

Arguably, as they imply frequent interactions and interdependencies-in-use among people, Web 2.0 technologies are frequent occasions for emotional processes to occur (Tang et al. 2012) and gift-giving behaviors to develop (Skageby 2010). This is especially the case of patients 2.0 contexts, where people are looking for information about theirsometimes severe -health issues [START_REF] Arnst | CAN PATIENTS CURE HEALTH CARE?[END_REF]. By neglecting emotions and gift concepts, "traditional" adoption models such as TAM, UTAUT, or ISM, are insufficient to provide in-depth insights about patients' interactions with IT.

Third, interestingly, all those models are very silent on the nature of the links among actors of social websites. Social actors interacting on Web 2.0 websites have both instrumental and non-instrumental behaviors led by their desire to share their experience with others. Online collaboration requires social ties between the giver and the receiver and a high level of trust between social actors [START_REF] Bergquist | The power of gifts: organizing social relationships in open source communities[END_REF]. While information is shared for free, intense collective action results in rich and valuable website information content for e-patients. Arguably, the concept of gift may therefore help to further our understanding of those links. However, to our knowledge, IS research has not examined in sufficient depth that concept and the characteristics of gift-giving behaviors in online environments [START_REF] Bergquist | The power of gifts: organizing social relationships in open source communities[END_REF].

The gift concept is a critical one when examining social actors' interactions in virtual environments, especially in the medical sphere.

For all those reasons, we argue that the existing theoretical frameworks have to be adapted, specifically concerning the role of gift in online collective action. In order to address those research gaps, our research questions are, therefore:

1. What are the characteristics of gift-giving behaviors in the context of online collective action in virtual communities? 2. How do patients perform gift-giving behaviors in the context of online collective action in patients' virtual communities?

In order to respond to those research questions, a qualitative exploratory study has been conducted. We investigated the role of gifts, from Mauss' (2002) initial perspective, which has earlier been leveraged in works dealing with open source communities, in order to explain the successes of collaborative artefacts, work and outputs [START_REF] Bergquist | The power of gifts: organizing social relationships in open source communities[END_REF]. Interviews with Web 2.0 experts, patients, and patients' relatives, have been conducted. This study provides additional knowledge about gift-giving behaviors and online collective action in the context of patients' virtual communities. This chapter is organized as follows. In the first section, we discuss the challenges and issues related with system usage in Web 2.0 contexts. We then discuss the gift concepts in the context of online collective action, as applied to Health 2.0 virtual communities and virtual spaces. Following this, we explain the design and methods for the research.

The different characteristics of online collective action regarding the gift-giving concepts are then described and discussed. Following this, the contributions and implications of research are emphasized. We then conclude the chapter.

Theoretical Background

Users as Social Actor

Examining such social behavior when studying system usage underlies a social actor approach of the 'system user'. This is why [START_REF] Lamb | Reconceptualizing users as social actors in information systems research[END_REF] also appeal for a reconceptualization of the user as a social actor, pointing out that: "the theories that shape this understanding and influence the design and use of ICTs rely primarily on cognitive social psychology and cybernetic models that are contextually underdeveloped leaving nearly all of the organizational and environmental context outside the model", p.198. Therefore, users' comprehension needs further in-depth analysis, considering the cognitive processes system usage may require and social dynamics they are faced with [START_REF] Orlikowski | The duality of technology: Rethinking the concept of technology in organizations[END_REF].

Drawing on [START_REF] Delone | The DeLone and McLean model of information systems success: a ten-year update[END_REF] and [START_REF] Morgeson | The Structure and Function of Collective Constructs: Implications for Multilevel Research and Theory Development[END_REF]Hofmann (1999) studies, Burton-Jones and[START_REF] Burton-Jones | Toward a deeper understanding of system usage in organizations: a multilevel perspective[END_REF] investigated the 'multilevel nature of system usage or collective usages of information systems, highlighting "the fundamental difference between individual and collective phenomena", p.663: "The structure of individual ability refers to scripts, schema, and other cognitive and biological factors, whereas the structure of ability for higher level aggregates not only includes these cognitive and biological factors (since collectives are composed of individuals), but they also involve something more. This something more is the interaction between these individuals'' [START_REF] Hofmann | Issues in multilevel research: Theory development, measurement, and analysis[END_REF].

Burton-Jones and Gallivan (2007) further posited: "Collective usage is not simply the sum of its parts (i.e., the sum of members' usage) because it also comprises interactions", p.663.

Going beyond this notion of interdependencies-in-use, they developed a multilevel theory of system usage, where levels are individual, group and organization and dimensions are function of usage, structure of usage and context of usage. Structure of usage is comprised of two sub-dimensions, interdependencies-in-use and form of collective use: "Because we wish to focus on interactions that are inexorably part of collective usage, rather than general social or task-related interactions, we focus on interdependencies-in-use, that is, dependencies among members of a collective that relate to their use of a system. Accordingly, we suggest that the first step in determining whether collective usage exists is to identify the presence of interdependencies-in-use", (Burton-Jones and Gallivan 2007, p.663).

Collective usage needs to take into account social value such as interdependencies-in-use (Burton-Jones and Gallivan 2007) that highlight these interactions. These interdependencies-in-use can be reflected in the gift-giving behaviors as the functioning of virtual communities relies on gift relationships and the gift economy [START_REF] Rheingold | The Virtual Community: Finding Connection in a Computerised World[END_REF], which have the potential to frame many online collective actions (Skageby 2010).

Interactions in online communities are indeed based on foundations other than traditional cost-benefit rationality.

The concept of online collective action, though, still lacks elaboration in the literature.

Its nature depends on the virtual community's characteristics, its social identity, its members [START_REF] Allen | Affective, Continuance, and Normative Commitment to the Organization: An Examination of Construct Validity[END_REF][START_REF] Bergami | Self-categorization, affective commitment and group self-esteem as distinct aspects of social identity in the organization[END_REF][START_REF] Luhtanen | A collective self-esteem scale: Self-evaluation of one's social identity[END_REF] and its groups norms [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]. Besides, there is interest in the literature for this concept, with the emergence of open source software development and open source revolution [START_REF] Bergquist | The power of gifts: organizing social relationships in open source communities[END_REF][START_REF] Bezroukov | Open source software development as a special type of academic research: Critique of vulgar Raymondism[END_REF][START_REF] Feller | A framework analysis of the open source software development paradigm[END_REF][START_REF] Kollock | The economies ol online cooperation[END_REF][START_REF] Mockus | A case study of open source software development: the Apache server[END_REF] as well as virtual communities' expansion (Skageby 2010;Skageby 2015;[START_REF] Faraj | Leading Collaboration in Online Communities[END_REF]. In the aforementioned prior research, the interdependencies-in-use, which are identified in "collective usage" are poorly reflected in technology system usage theories. In that respect, we believe that gifts theories can improve our understanding of such interdependencies in-use.

We further introduce these concepts below.

Gift Concepts

The gift-giving literature analysis allows to identify concepts that may be relevant for explaining social actors' behavior in virtual communities. Gift-giving behaviors shape social activities and bounds [START_REF] Komter | Reciprocity as a principle of exclusion: Gift giving in the Netherlands[END_REF] even if they are determined by rational or mechanical rules (A. [START_REF] Komter | Gifts and social relations: The Mechanisms of Reciprocity[END_REF]. Some research highlight two main perspectives in the concept of gift: the utilitarian one [START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF][START_REF] Malinowski | Argonauts of the Western Pacific; an Account of Native Enterprise and Adventure in the Archipelagoes of Melanesian New Guinea[END_REF][START_REF] Gregory | Gifts and Commodities[END_REF][START_REF] Bataille | La part maudite[END_REF][START_REF] Godbout | L'esprit du don[END_REF][START_REF] Alter | Donner et prendre[END_REF][START_REF] Camerer | Gifts as economic signals and social symbols[END_REF]) and the social one [START_REF] Hyde | The Gift: How the Creative Spirit Transforms the World[END_REF][START_REF] Bollier | The cornucopia of the commons[END_REF]Skageby 2010) (see Table 39.1, 39.2) . Other researchers highlight the role of emotions depicting individuals' other-orientation motivations in order to contribute to others' well-being in a non-utilitarian way [START_REF] Ruffle | Gift giving with emotions[END_REF][START_REF] Komter | Gifts and social relations: The Mechanisms of Reciprocity[END_REF][START_REF] Komter | Reciprocity as a principle of exclusion: Gift giving in the Netherlands[END_REF]. We will describe these three main perspectives in the following sections.

Utilitarian Value

The utilitarian perspective of gift-giving behaviors has been studied in different disciplines such as sociology [START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF][START_REF] Gregory | Gifts and Commodities[END_REF][START_REF] Godbout | L'esprit du don[END_REF][START_REF] Alter | Donner et prendre[END_REF][START_REF] Camerer | Gifts as economic signals and social symbols[END_REF]) and anthropology [START_REF] Malinowski | Argonauts of the Western Pacific; an Account of Native Enterprise and Adventure in the Archipelagoes of Melanesian New Guinea[END_REF][START_REF] Bataille | La part maudite[END_REF]) (see Table 39.1).

This utilitarian perspective has several preconditions associated with gift-giving behaviors, namely to give, to receive and to repay [START_REF] Clarke | The Four 'S's' of experience gift giving behaviour[END_REF]. These preconditions involve the notion of a reciprocal dependence and therefore a return where gifts create a debt for the receiver [START_REF] Gregory | Gifts and Commodities[END_REF]. [START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF], through ethnographic studies of primitive societies, defined the gift as the action, from a person representative of the community, to give by offering something valuable to someone in order to seal a relationship in a mutual indebtedness. Therefore, the gift, through its specificities, embodies the power that compels the recipient to give back, in this utilitarian perspective. In this regard, social bounds and relationships are established and maintained as gifts are made and reciprocated with interest. [START_REF] Alter | Donner et prendre[END_REF] highlights the notion of gift-giving in business cooperation, where the gift is never free as it obliges the person who received it. Therefore, altruism is excluded from theses environments, leaving room for strategic means that allow individuals to reach their hidden goals. Alter explains that corporate relationships are not all governed by contracts, but by cooperation, in which it is necessary to give, receive and give back. This cooperation induces employees' feelings that exclude pure market logic but still remain rational. Indeed, those who have been helped will have to repay their donor. [START_REF] Malinowski | Argonauts of the Western Pacific; an Account of Native Enterprise and Adventure in the Archipelagoes of Melanesian New Guinea[END_REF] further stressed the concept of bond created, especially between individuals, thanks to these gift-giving experiences. Although critics argue that some goods create "a political dependency on inalienable possessions" (Weiner 1992, p.39) drawing on the "paradox of keeping while giving", we believe that these specific cases don't contradict the Mauss and Malinowski general notion of reciprocity as the implicit and core ingredient of a sustainable relation offered by the gift-giving experience (Skageby 2010).

Therefore, and concerning the implication of the utilitarian approach of the concept of gift for online collective action, these theories highlight that giving consists in taking the initiative in the exchange that seals a relationship in a mutual indebtedness. Reciprocity is an implicit and essential condition of the gift-giving experience that will induce the quality and sustainability of collective action. Sociology "The variety of sociological explanations for gift giving suggests a second explanation, that gifts might serve multiple signaling purposes simultaneously -signaling "willingness" to invest in a relationship while also conveying meaning about the giver's tastes or identity or beliefs about receivers" (Camerer 1988, p.199) [START_REF] Camerer | Gifts as economic signals and social symbols[END_REF]

Social Value

In media and communication literature, gift-giving will benefit to social relationship and bonds, as the foundation of social exchange that will foster community-building processes (Skageby 2010). Indeed, some studies emphasize the human relationships and emotions within the gift-giving experiences [START_REF] Chakrabarti | Gift giving and social emotions: experience as content[END_REF],

highlighting "the connection between giver and receiver is the inescapable backdrop within which a gift-giving experience must be examined'' (Larsen and Watson 2001, p. 894). They are closely related to the strength of ties [START_REF] Granovetter | The strength of weak ties: A network theory revisited[END_REF]. [START_REF] Bollier | The cornucopia of the commons[END_REF] also supports the social value behind the gift-giving experiences, thus contradicting market economy principles, as the members of gift economy value individuals, places and shared experiences and not monetary benefits.

In anthropology and psychology literature, Hyde (2007a) argues that a true gift shouldn't imply any obligation and that the social and personal bounds that connect givers and receivers don't respond to market needs or spheres that remain impersonal by nature. As a result, " it is true that something often comes back when a gift is given, but if this were made an explicit condition of the exchange, it wouldn't be a gift" (Hyde 2007b, p.11). Derrida's work follows this path stating that "for there to be a gift, there must be no reciprocity, return, exchange, countergift, or debt" (1992, p.12).

Therefore, and concerning the implication of social value of gift concepts for online collective action, these theories highlight that giving, whether considered as selfcentered or other-oriented, when present in a community context creates a dynamic that leads to a sharing spirit supporting online collective action. "If we take the synthetic power of gifts, which establish and maintain the bonds of affection between friends, lovers, and comrades, and if we add to these a circulation wider than binary give-and-take, we shall soon derive society, or at least those societies -family, guilt, fraternity, sorority, band, community -that cohere through faithfulness and gratitude. While gifts are marked by motion and momentum at the level of the individual, gift exchange at the level of the group offers equilibrium and coherence, a kind of anarchist stability." (Hyde 2007, p.96) (Hyde 2007a) Media and Communication "Gift economies are potent systems for eliciting and developing behaviors that the market cannot -sharing, collaboration, honor, trust, sociability, loyalty. In this capacity, gift economies are an important force in creating wealth, both the material kind prized by the market and the social and spiritual kind needed by any happy, integrated human being." (Bollier 2001, p.3 (Camerer 1988, p.180). For example, according to Larsen and Watson, the gift-giving experience is comprised, first, of an economic value where "participants do not give gifts out of altruism, but rather because they expect to receive something at a later date" (Larsen and Watson 2001, p.891). This dimension disputes the concept of pure gifts, where seen as "the logical opposite of commodity exchange and necessarily personal, reciprocal, and socially binding" (Laidlaw 2000, p.618). This dimension may also conflict with the emotionally-loaded intangible aspect, conveyed by the meaning the gift discloses over the tangible object per se [START_REF] Chakrabarti | Gift giving and social emotions: experience as content[END_REF].

Secondly, the gift-giving experience involves a functional value (Sheth et al. 1991), where gifts' utilitarian performance remains the driver of the individuals' perception of the value of gifts. However the functional value is often of minor relevance in gift-giving experiences [START_REF] Larsen | A Guide Map to the Terrain of Gift Value[END_REF], and one should not mistake the utilitarian performance of the gift itself for the utilitarian perspective designed by the giver as highlighted above and in Table 39.1, in Mauss and Malinowski's definition of the gift.

Thirdly, the gift-giving experience encompasses a social value, symbolizing and conveying meaning [START_REF] Camerer | Gifts as economic signals and social symbols[END_REF], indebtedness and social ties and where "gift exchange is an exchange of inalienable objects between people who are in a state of reciprocal dependence that establishes a qualitative relationship between the transactors" (Gregory 1982, p.101).

Fourthly, the gift-giving experience entails an expressive value as the expression of the giver's self is contained by the gift as a recipient of donor's self-identity (Sherry et al. 1993) as "giving one is giving oneself" (Mauss 1922, p.59) and "to make a gift of something to someone is to make a present of some part of oneself" (Mauss 1922, p.16).

Besides these aforementioned values, researches demonstrated that emotions can also be part of the gift giving experiences [START_REF] Ruffle | Gift giving with emotions[END_REF] which is not always related to a hidden or instrumental agenda and that are mostly motivated by other-orientation's attributes, whether pure or moderate, where contributing to others' well-being can be considered as primary incentives and rewards without thoughts of a reciprocal obligation [START_REF] Komter | Gifts and social relations: The Mechanisms of Reciprocity[END_REF].

Emotions can trigger gift-giving behaviors when the giver anticipates the receiver's positive emotions' effects such as love, happiness or esteem [START_REF] Belk | Gift giving as agapic love: An alternative to the exchange paradigm based on dating experiences[END_REF][START_REF] Otnes | The Pleasure and Pain of Being Close: Men's Mixed Feelings About Participation in Valentine's Day Gift Exchange[END_REF][START_REF] Komter | Gift Giving and the Emotional Significance of Family and Friends[END_REF].

As a result of the gift-giving behavior, the giver may feel happiness or pride [START_REF] Otnes | Gift Giving: A Research Anthology[END_REF] or avoid the burden of guilt of selfishness (Wolfinbarger 1990) Therefore, these feelings combined with other positive emotions, such as pride or confidence [START_REF] Mick | Consumer self-gifts in achievement contexts: the role of outcomes, attributions, emotions, and deservingness[END_REF], balance the givers' efforts [START_REF] Belk | Gift giving as agapic love: An alternative to the exchange paradigm based on dating experiences[END_REF].

Gift Concepts in Online Contexts

Although the different conceptualizations of the gift concepts /behaviors may diverge, the literature provides interesting dimensions of values that can be taken into account in online environments. Indeed, for connected individuals, an additional difficulty lies in the context in which gift-giving behaviors are experienced (i.e., anonymity, exchanges shared between multiple individuals ...), and, as a result, [START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF] approach, which has been applied to societies from the early 19', may not be directly applicable in online contexts.

Gift-giving experiences on the Internet indeed differ from face to face experiences. For example, the recipient of useful information may be operating under anonymity and never be met again. Therefore a balanced reciprocity performed on a one-to-one basis loses significance and momentum, and the gifts are conducted for the benefit of the group as a whole. This network-wide accounting system (Smith and Kollock 1999) that allows the giver to receive back from another actor of the system introduces the concept of generalized reciprocity (Skageby 2010), which remains unknown or hardly conceivable in real life and offline exchanges. As a result, online gift-giving experiences foster higher generosity, as the giver does not have the guarantee of immediate reciprocation and faces the risk of free-riding behavior that can end up in social dilemmas (Kollock 1998, Yamagishi and Cook 1993[START_REF] Kollock | An eye for an eye leaves everyone blind": Cooperation and Accounting Systems[END_REF].

Some researches demonstrate that patients, confined in virtual worlds, can "gift-give" as follows:

i) although not similar to pure gifts (White and Dorman 2001) their virtual behaviors don't embed an economic value, due to the context itself of their actions,

ii) while "it is less common for the functionality of a product to be central in gift exchanges" (Larsen and Watson 2001, p.893), patients perform peer-to-peer approach (Trauth 2001), has been applied. The steps that have been followed are explained in the Figure 6 below: When engaging in a patients 2.0-related research topic, specific attention should be paid to the diseases addressed by the online communities investigated, as it can potentially influence the results. Preliminary interviews conducted with Doctors, caregivers, Health 2.0 experts and Web 2.0 experts helped us choose the appropriate kind of virtual communities and patients' categories to focus on. The feedback was consensual and chronic or rare diseases were indicated to be suitable for such investigation.

Although we focused on French participants; research performed in the US further confirmed our online community choice. Indeed, Internet users living with chronic disease are more likely than other Internet users to access health information online:

"Living with chronic disease is also associated, once someone is online, with a greater likelihood to access user-generated health content such as blog posts, hospital reviews, doctor reviews, and podcasts. These resources allow an internet user to dive deeply into a health topic, using the internet as a communications tool, not simply an information vending machine" (Pew Internet Research 2010).

Understandably, the condition of rare disease patient also amplifies this need to spread their network far and wide and online connection will provide some answers:

"In rare disease communities, each person is an expert in observing the effects of a disease or a treatment on their own or a loved one's body or mind. In this way, rare disease patients and caregivers who gather together online are an example of a "smart" group…They are diverse and decentralized, yet able to pool knowledge and summarize their observations" (Pew Internet Research 2010).

We therefore led our research to chronic and rare diseases' virtual communities, in compliance with insights brought by testimonies: "In the selection of virtual communities I would give priority to the chronic or rare diseases. And I think that the networks in connection with rare or orphan diseases are among the most dynamic, one feels the need to find good information and share it with other patients." (Health 2.0 expert) Chronic diseases (21 patients) and rare diseases (8 patients' relatives) patients' communities were therefore chosen as backgrounds of our research with 25 females and 4 males online users. Preliminary interviewees were chosen for their command of social medias and connected spaces as well as their expertise of Health 2.0 arena (See Table 41,42). x Ethnographic research approach in order to gain preliminary insights on patients' sociological typology as well as the characteristics of their giftgiving behaviors. x 25 preliminary semi-structured interviews with Doctors and caregivers, Health 2.0 experts and Web 2.0 experts, users of patients' social networks. x 29 subsequent interviews conducted with participants who had to deal with their own health issues or that of relatives. As a result, a breast cancer virtual community gathering 10,000 patients and a rare disease community for patients' relatives gathering 97 users were studied. Both communities are non-profit associations and operate through a forum for the breast cancer community and using Facebook's features for the rare disease closed group.

Members are free to display their identity on the first community and whereas only coopted users are accepted in the Facebook group.

The interview guides (see Table 43, 44) were built in compliance with DeMarrais (2004)'s prerequisites in order to collect any materials that would emerge from patients' narratives. It was built to determine segmentation and behaviors of patients' online.

Hence, the choices of virtual communities to be studied resulted from the insights brought by these initial interviews, as well as the size and longevity of the virtual spaces.

For each group, we stopped conducting interviews when semantic saturation was reached.

Table 43. Interview Guide in Preliminary SDCI Questions Objectives Is there an existing patient typology for a focus group whether they gather online or offline?

To identify a patient sample to address for the study Are there patients' networks that are more suitable for some patients than other To identify a patient's panel that would not be relevant for the study What would be the patients' activities, online?

To compare the feedback of experts about activities for patients' online against the literature What would be some hindrances to these online activities?

To compare the feedback of experts about hindrances to patients' online activities against the literature What about privacy and data protection?

To compare the feedback of experts about hindrances for patients' online activities against the literature Do you think these portals help patients during the healing process?

To compare the feedback of experts about positive psychology and patients' online activities against the literature Table 44 indicates the questions patients and patients' relatives were asked regarding the literature's value dimensions investigated. We then proceeded to analyses after we gathered enough information in order to reach semantic saturation [START_REF] Glaser | The Discovery of Grounded Theory: Strategies for Qualitative Research[END_REF]. We examined the interview data in an interpretive way where "you want to 'read' the interviews for what you think they mean, or possibly for what you think you can infer about something outside of the interview interaction itself" (Mason 2002, p.78). Furthermore we followed the principles for interpretive studies posited by [START_REF] Klein | A set of principles for conducting and evaluating interpretive field studies in information systems[END_REF] such as the principle of abstraction where the researcher relate the idiographic details revealed by the testimonies to more general level concepts. This approach led us to read through the data lines and to reach and understand the actual meaning of what was said. Besides, the multidimensional coding of the data allowed us to assign different codes to same testimonies' passages [START_REF] Saldaña | 2&dq=Manual +or+electronic%3F+The+role+of+coding+in+qualitative+data+analysis[END_REF].

Results

The interviews led to important insights, such as the contextual designations for giftgiving behaviors in the context of online collective action. The data analysis confirms the meaningfulness of concepts that are frequently cited by interviewees, such as help-giving that relates to the gift concepts, which are too little in evidence in the literature. The following sections will present the answers to our research questions.

"We can feel the state of mind and emotions of the girls by the way they answer or don't. It's easy to feel it and support the ones we know. It also very rewarding for the one who gives this help." (Breast cancer community patient)

In return they are inclined to be there and comprehensive listeners for the sake of Three main contextual designations were identified: i) other-orientation concept relating to the emotional support activity without demand of a return, ii) bonding value concept relating to the information sharing activity about practical advice that will help patients cope with day-to-day health situations, iii) generalized reciprocity concept relating to the flows of general information and social exchange activity, whether it concerns medical knowledge or other purposes.

Other-orientation mainly occurred through the manifestation of emotional support, when patients did care for others with the desire to relieve their suffering and to solace anxieties. The testimonies didn't show any hidden agenda or any expectation of a return. These actions were sufficient for patients to gain social assets and values out of them.

"When I feel down I know that I can get support from females sharing the same problems and, as a result, I do the same. It gives me confidence and makes me feel better." (Breast cancer community patient) Bonding-value was illustrated by the sharing of one-to-one advices that fitted specific concerns and matched pertinent needs, that were, most of the time, health-related. The very purpose of these actions was to answer utilitarian patients' needs and help them navigate through the hardship they're enduring.

"Many girls are experienced patients and can give you good advices about your condition that will answer your questions or solve some of your problems. That's very useful and comforting." (Breast cancer community patient) Generalized reciprocity referred to the sharing of one-to-many advices and supports. The very purposes of these exchanges weren't consistently health-related and the concept of hidden agenda absent.

"Any matter can be discussed or addressed online on these communities. That's useful and supportive and can be shared with the large majority." (Breast cancer community patient) Overall, the results of the categorization of gift-giving behaviors, as shown in table 47, stressed the importance of emotional support in patients' online interaction.

One should notice that among gift-giving behaviors' contextual designations, otherorientation dimension of giving-help is the most frequently quoted form of interaction.

Online communities foster and welcome the discussion of sensitive issues, encouraged by peer support, whether performed under anonymity or not. "We asked each other about health topics, we give opinions on practitioners, the good and the less good, the health system, on trials, sometimes on the academic literature. There will always be patients of high expertise to consult in the community."** 31 * Quotes from interviews with breast cancer community patients ** Quotes from interviews with parents of autistic children

Summary of Results

Among the participants, helping others through emotional support remains the main characteristic of gift-giving behaviors in virtual communities, then creating social links through the sharing of specific health-related information that will help others cope with day-to-day health situations, and, finally, more generalized exchanges of different kinds that will build the foundation of the group reciprocity in compliance with mutual selfinterests.

Characteristics related to social behavior have also emerged from interviews, including psychosocial impacts resulting from membership of these communities. Benefits from this commitment are noticeable, namely enhancement of decision-making processes and choices and the role in healing.

The needs and the perceived breaches of these platforms have also been underlined, highlighting the need for moderation of irrelevant comments coupled with a professional medical presence.

Discussion and Conclusion

This study's central purpose was to examine the characteristics of gift-giving behaviors in the context of online collective action on patients' communities. We did this taking into account the specificities of the chosen patients' community.

Based on the model of goal directed behavior (MGB) [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] and [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] online resulting study and the gift-giving concepts (Skageby 2010); we highlighted the categories and specific values of gift-giving behaviors (See Patients' testimonies highlighted that online interactions are highly related to the concepts of giving-help in online contexts. Prior research identified three main dimensions of giving-help online: other-orientation, bonding value and generalized reciprocity (See Table 47).

As a result the emotional support, the other-orientation dimension of giving-help contextualized within patients' virtual spaces, prevails. What may be striking is that this dimension of gift-giving behaviors, i.e. the willingness to provide positive emotions, is actually the most frequent social behavior among the actors, according to interviews.

Moreover, the giving-help through practical advice given for coping with day-to-day health situations, as well as general information providing, are the two other ways these gift-giving behaviors are emphasized in patients' feedback.

One should notice that, as they may be acting online in a greater wish to give information than positive emotions, emotional support seems to be predominating in their actual social behavior. Indeed, the need to give help was often expressed where we were expecting the need to get help. This highlights the principles of the gift economy as the foundation and cement of online communities that apply for diverse populations, including patients in the typologies studied.

As a result, patients grouped in large online communities and sharing very similar dayto-day issues, demonstrate behaviors that apply to gift economies and sharing spirit. The cost-benefit rationality does not guide their gift-giving behaviors through otherorientation characteristics. The willingness to help-back, even years after a remission, is not rare and emphasizes the importance for them to contribute to the group. The gift culture, highlighted by [START_REF] Rheingold | The Virtual Community: Finding Connection in a Computerised World[END_REF], is significant for patients' communities, where the bonding between participants is often immediate and especially of relevance, as the disease stigmatizes them.

Consequently, the bonding value and the need to bond profoundly shape their social relationships. New patients reaching the communities are adopted rapidly and with the confidence that s/he, sharing the group illness, belongs to the community. The bond formed is solid and will last for years, and often stays strong after the patient's recovery.

Group norms and its social value are strengthened by social exchange among actors characterized by the reciprocity and gift-givng behaviors. It goes beyond the notion of interdependencies-in-use and reveals the collective form of action. Therefore, the aspects of reciprocity give to the group its social value. Molm et al. (2007, p.200) define reciprocity by two dimensions: i) its instrumental or utilitarian value or human capital, ii) its symbolic and communicative value or social capital, where "the symbolic or communicative value is the value conveyed by the act of reciprocity itself, over and above the instrumental value of the benefit provided". Therefore, beyond the benefits provided to others during the act of reciprocity, the action itself, with uncertainty of other's reciprocity, brings value to the group, guides its norms and characteristics of patients' gift-giving behaviors in the context of online collective action.

Contribution

This study makes three major contributions to research and practice.

Firstly, this research highlights the characteristics of online collective action on patients' virtual communities relating to gift-giving concepts. From guidance provided by initial interviews we chose to focus on patient's virtual communities rather than patient's social networks. Indeed, as virtual communities imply strong ties between individuals, bonding value and emotional support, and as the sense of belongingness is a key determinant of gift-giving behaviors, these community virtual spaces for patients were indicated to be relevant for our study. As a result, we demonstrated that gift-giving behaviors are meaningful endeavors in the context of online collective action in these communities.

Secondly, we performed analyses beyond the frame offered by traditional IS adoption models, which do not see users as social actors and do not frame interdependencies-inuse. We contextualized IT use in the e-health domain, and contributed to the analysis of gift-giving behaviors of patients, enabling the drawing of online collective actions specificities using both literature and field knowledge. Using a critical realist design helped us get insights from the field along with a literature review exploring different arenas and combining complete theories well suited for patients' online usage (Field Theory, MGB and the gift concepts). This helped to understand what kind of actions and interactions with others patients were performing online through technology, but driven by determinants other than the IT tools themselves. Traditional system usage research and IT artifacts offer a very partial view of how social actors interact in web 2.0 contexts.

For that purpose, multidisciplinary knowledge from social psychology, sociology and anthropology is also needed in order to examine the various facets of online collective action, in given online communities populations.

Thirdly, we were able to reveal contextual designations behind patients' gift-giving behaviors. Indeed, from the literature we already discovered that the functioning of virtual communities relies on gifts as a way of: i) helping others and their well-being (other-orientation), ii) developing strong ties (bonding value), iii) creating mutual satisfaction which doesn't depend on who gives or who gets as long as exchanges endure (generalized reciprocity). So, the present research offers the contextual designations for these three dimensions in the context of patients' communities. The values that emerged from the field were compliance with literature underlying framework and are as follows: i) emotional support activity (other-orientation), ii) sharing information about practical advice (bonding value), iii) giving general information and social exchange activity (generalized reciprocity).

Limitations and Future Research

This research has several limitations. Those limitations are also opportunities for further investigations.

Firstly, we targeted French patients in order to avoid introducing biases from multicultural settings, as multiculturalism can influence people, and in particular self and group identity [START_REF] Fernback | Virtual Communities: Abort, Retry, Failure?[END_REF]. Future research may explore differentiations and/or similarities of behavior of patient's online collective action.

Secondly, preliminary interviews suggested focusing on specific patients' virtual communities. It may also be relevant to investigate populations other than the breast cancer community and a community of parents of autistic children, whether mixed or exclusive types of patients gathered on the same platform. It may also be advisable to explore communities gathering users that share different concerns or interests, from shared hobbies or passions to communities of professionals comprised of persons in the same occupation or industry. Thirdly, our patients interviewed were mostly female. Extending this study to both genders or exclusively to male patients may drive interest for comparing results.

Conclusion

The gift concepts and MGB's underlying framework, applied to virtual communities, offer important conceptual foundations for examining the characteristics of gift-giving behaviors on patients' online communities.

Although the emotional dimension remained meaningful in patients' motives for interacting online, the gift concepts complete the lack of an explanation, highlighting the notion of help-giving and the social value, predominant in their actions.

These above-mentioned aspects contribute to expand the development of virtual spaces for people seeking information and support online. The Internet and patients' initiatives contribute to make medical practice evolve. While previously limited to a top-down approach where health professionals and third parties communicated a restricted amount of information to patients, online communities allow a greater access to information and more relational support.

Hopefully, by connecting to virtual communities, patients will have an improved quality of life, due to the benefits provided, which are often different from those they would get from traditional social groups operating in real life. We urge researchers and stakeholders to contribute to further research in this domain. The current research helps to better take into account the ageing population's health challenges and emphasizes how patient's virtual communities can help support patient's concerns.

DISCUSSION AND CONCLUSION

This study's central purposes was: i) to examine the underlying determinants of online collective action on patients' communities, ii) to conceptualize a model that predicts intentional action and subsequently online collective action during users' interactions and iii) to identify the characteristics of gift-giving behaviors in the context of online collective action, given the specificities of a patients' community typology that was chosen for this purpose.

Based on the Field Theory of Lewin (1947), the Expectancy-Value Theory (EVT) [START_REF] Eccles | Expectancies values and academic behaviors[END_REF], the model of goal directed behavior ( MGB) [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] and [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] online resulting study; together with insights and knowledge accumulated from the field (Bhaskar 2010); we conceptualized a model to predict online collective action on patients' virtual communities (See Figure 4). Based on the gift concepts (Skageby 2010) and the implications of collective phenomena for system usage [START_REF] Benbasat | a. « Quo vadis, TAM[END_REF]Straub and Burton-Jones 2007;[START_REF] Burton-Jones | Toward a deeper understanding of system usage in organizations: a multilevel perspective[END_REF]Usluel and Mazman 2009), we determined the characteristics of online collective action regarding the gift-giving concepts (See Table 48).

Theories

x Expectancy-value -EVT [START_REF] Eccles | Expectancies values and academic behaviors[END_REF], the model of goal directed behaviors -MGB [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] and Lewin (1947) Field Theory.

x Expectancy-value -EVT [START_REF] Eccles | Expectancies values and academic behaviors[END_REF]) and the model of goal directed behaviors -MGB [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] theorizing.

x First model creation that predicts intentional action and subsequent online collective action during users' interactions with patients' virtual communities.

x Gift-giving utilitarian value [START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF][START_REF] Malinowski | Argonauts of the Western Pacific; an Account of Native Enterprise and Adventure in the Archipelagoes of Melanesian New Guinea[END_REF][START_REF] Gregory | Gifts and Commodities[END_REF][START_REF] Bataille | La part maudite[END_REF][START_REF] Godbout | L'esprit du don[END_REF][START_REF] Alter | Donner et prendre[END_REF][START_REF] Camerer | Gifts as economic signals and social symbols[END_REF]), Giftgiving social value [START_REF] Hyde | The Gift: How the Creative Spirit Transforms the World[END_REF][START_REF] Bollier | The cornucopia of the commons[END_REF]Skageby 2010) and Gifting concepts as social behavior when online (Skageby 2010).

Approaches Qualitative Quantitative Quantitative

Research Questions

x What are the individual and social driving and restraining forces of patients' online collective action?

x What are the relevant expectancy values during the course of patients' interactions with virtual communities? x Do these expectancy values predict patients' desires and intentions regarding virtual communities' usage, and subsequently their engagement with online collective action?

x What are the characteristics of gift-giving behaviors in the context of online collective action in virtual communities? x How do patients perform giftgiving behaviors in the context of online collective action in patients' virtual communities?

Coming back to the research questions

In order to respond to the research questions, a mixed method has been applied [START_REF] Creswell | Research Design: Qualitative, Quantitative, and Mixed Methods Approaches[END_REF]Venkatesh et al. 2013). Qualitative, partially grounded, exploratory approaches have been applied in the current research. Interviews have been conducted

with doctors and caregivers, Health 2.0 and Web 2.0 experts, patients and patients' relatives. A survey has then been conducted with 269 participants in patients' online communities. The objectives and procedures of our mixed methods approach adopted for this research are summarized in Table 49 below. When engaging in a patients 2.0-related research topic, we knew that the study would require specific attention on the diseases to be addressed. The preliminary interviews with experts suggested which way we should focus. The feedback was consensual and chronic or rare diseases were indicated to be suitable for such investigation.

Although we decided to focus on French participants, research performed in the US confirmed this choice, with Internet users living with chronic disease being more likely than other Internet users to access health information online:

"Living with chronic disease is also associated, once someone is online, with a greater likelihood to access user-generated health content such as blog posts, hospital reviews, doctor reviews, and podcasts. These resources allow an internet user to dive deeply into a health topic, using the internet as a communications tool, not simply an information vending machine" (Pew Internet Research 2010).

Understandably, the condition of rare disease patient also amplifies this need to spread their network far and wide and online connection will provide some answers:

"In rare disease communities, each person is an expert in observing the effects of a disease or a treatment on their own or a loved one's body or mind. In this way, rare disease patients and caregivers who gather together online are an example of a "smart" group…They are diverse and decentralized, yet able to pool knowledge and summarize their observations" (Pew Internet Research 2010).

Although this research was conducted in both communities, one should recall that, out of the 37 interviews, 8 were performed on a rare disease community patient family member, 21 on a breast cancer community patient. The social media adoption model for patients highlighted the determinants of patients' online collective action, namely i) evaluative social identity and group norms for social values, ii) isolation rupture for utilitarian values and iii) anticipated positive emotions for anticipated emotions. The exclusive value (cognitive social identity) that was reported during the interviews wasn't proven significant by the quantitative analysis.

However, for this value as well for the other determinants tested in our research, we advise them to be tested for any type of communities as the results may differ from one to another. MGB [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF]) and EVT's [START_REF] Eccles | Expectancies values and academic behaviors[END_REF]) theoretical frameworks allowed us to build a social media adoption model in the context of patients' virtual communities where desires is a determinant of intentional collective action, itself a determinant of online collective action. We also identified that use frequency is also a determinant of patients' online. We intentionally focused our approach on a specific type Bergquist and Ljungberg's (2001) theory, implying that the concept of giving-help online is comprised of three dimensions -other-orientation, bonding value and generalized reciprocity -was confirmed by patients' testimonies. Among all actions performed online by patients, the most recurrent occurrences were concerning this very concept of giving-help, even if, we could have expected the opposite considering the patients in the need for help, fighting for their health. To the previous results, we could add contextual designations to patients' online behaviors; namely: i) other-orientation concept relating to the emotional support activity without demand of a return, ii) bonding value concept relating to the information sharing activity about practical advice that will help patients cope with day-to-day health situations, iii) generalized reciprocity concept relating to the flows of general information and social exchange activity, whether it concerns medical knowledge or other purposes.

Out of these three contextual designations, patients' testimonies show that emotional support is of the utmost importance, as highlighted in Table 47.

Contribution

The purpose of this study was to examine the underlying determinants of online collective action on patients' communities, as well as to highlight the characteristics of gift-giving behaviors in virtual communities. Regarding the findings, it makes four major contributions to research and practice that are highlighted in Table 50. x This study contributes to responding to key challenges in IS adoption research, which has mainly examined usage without considering sufficiently other kinds of interactions with and around the IT [START_REF] Benbasat | a. « Quo vadis, TAM[END_REF], e.g. online collective action. x The critical realist perspective helped us to understand why patients are motivated to act online and interact with other patients through technology, highlighting insight from the field, while contributing to knowledge in a cumulative way.

x We contextualized IT use in the e-health domain, and contributed to the analysis of giftgiving behaviors in the context of online collective action, highlighting gift-giving behaviors online as well as contextual designations to patients' online action.

Practice

x From an e-health practice standpoint, this research concerns how virtual worlds can help to reduce perceived isolation and to improve patients' condition and day-today hardships.

x The results of this study are important because they will help Health 2.0 stakeholders to better acknowledge issues such as that of the kind of social community platforms that ought to be designed.

x Eventually, the study's results will help us to more effectively take the disabled and ageing population's health challenges into consideration.

x The study shows that the need for patients to contribute to the others' well-being is rooted in their behavior and of the utmost importance.

x The study shows that, despite that trust aspects, privacy concerns and their fear of facing inaccurate medical information, they still intend to interact with peers through the online communities.

x During the qualitative phase, insightful comments were received, such as the need for information control, the need for online clinical advice that would be performed by health professionals and the wish to leave virtual spaces closed. The gift concepts, EVT, MGB, following Lewin's underlying framework, applied to virtual communities, offer important information concerning the leading determinants of online collective actions for patients and its contextual designations. However some adjustments have to be made to fit our field of enquiry in patients' virtual communities.

Conclusion

Indeed, our community-based background of patient members includes a large number of users, most often weakened by their disease, seeking interaction on these platforms.

Although the emotional dimension remained meaningful in patients' motives for joining online communities, the findings suggest that the MGB failed to offer a relevant model for predicting intentional action to engage online. The gift concepts complete the lack of an explanation concerning the activities performed online and the social value comprised of determinants such as evaluative social identity and group norms, the utilitarian value comprised of the determinant isolation rupture and the anticipated emotions via the anticipated positive emotions were proven significant in their relation to desires regarding virtual patients' communities.

These above mentioned aspects contribute to expand this trend of developing virtual spaces for people seeking information and support online. The Internet and patients' initiatives are changing the face of medical practice, previously limited to a top-down approach where health professionals and third parties involved communicated a restricted amount of information to patients.

We hope that by connecting to virtual communities patients will have an improved quality of life, due to the benefits provided, which are often different from those they would get from traditional social groups operating in real life. We hope that researchers To identify a patient sample to address for the study Are there patients' networks that are more suitable for some patients than other To identify a patient's panel that would not be relevant for the study What would be the patients' activities, To compare the feedback of experts about online?

activities for patients' online against the literature What would be some hindrances to these online activities?

To compare the feedback of experts about hindrances to patients' online activities against the literature What about privacy and data protection?

To compare the feedback of experts about hindrances for patients' online activities against the literature Do you think these portals help patients during the healing process?

To compare the feedback of experts about positive psychology and patients' online activities against the literature questionnaire, as all responses will be kept strictly anonymous and confidential. For statistical purposes, we really need your frank and honest responses, so that we can gain a real understanding of group interactions on the Internet. We expect people to differ in their true reactions and we ask you to be totally honest. We are looking for your own reaction and feel confident with them, as they are no wrong answer but your true feelings.

Confidentiality

All data obtained from participants will be kept confidential and will only be reported in an aggregate format (by reporting only combined results and never reporting individual ones). All questionnaires will be concealed, and no one other than then primary investigator and assistant researches listed below will have access to them. The data collected will be stored in the HIPPA-compliant, Qualtrics-secure database until it has been deleted by the primary investigator. Early, before the creation of Facebook and Twitter, my business partners, themselves health professionals and '' 2.0'' visionaries, created a virtual community where health professionals could discuss their daily practice. Working with them gave me early on extensive knowledge about virtual communities' day-to-day functioning and an interpretive willingness to conduct research in this field.

Besides these activities, I always valued teaching experiences and was lucky to be given these opportunities by prestigious institutions.

My corporate experience and education are summarized in tables 50, 51, 52. Convinced that the exchange within the academic world and that peers reviews would greatly be beneficial for my work, I very early on wished to present my work in progress in conferences. I had already participated in some of them as an entrepreneur and in the field of Health 2.0 and it is not uncommon in health industry meetings to mix genres between startups and academic research. I had the chance to present my work in five conferences, including three oral presentations (ICEMS2011, MedX2012 and ICIS2012) (See Table 53). Au cours des dernières années, les communautés virtuelles de patients se sont énormément développées sur l'Internet. Ces communautés permettent des échanges fréquents entre les patients, qui peuvent partager des informations liées à la santé dans un environnement interactif. Alors que beaucoup s'accordent sur l'opportunité représentée par ces communautés pour ses utilisateurs, les connaissances sur ce qui détermine l'action collective en ligne des patients ainsi que sur les fondamentaux de l'action collective en ligne dans ces espaces virtuels sont relativement peu développées. En conséquence, ce travail doctoral examine les raisons pour lesquelles les patients interagissent entre eux et comment ils procèdent. En nous appuyant sur le modèle du comportement orienté vers un but, la théorie de la valeur de l'attente, la théorie des forces du champ, les concepts de dons et les interviews menées, nous avons développé un modèle qui examine les interactions en ligne des patients dans un contexte d'action collective en ligne. Une approche multi-méthode, qualitative et quantitative, permet d'explorer les interactions des patients et de mesurer les déterminants de l'action collective en ligne sur ces espaces virtuels. L'analyse qualitative de 54 entretiens menés avec des patients, des proches de patients, des professionnels de la santé 2.0, des médecins et des soignants permet d'affiner le modèle de recherche, qui a ensuite été testé au travers d'une enquête quantitative auprès de 269 patients. Cette recherche contribue à la recherche en systèmes d'information en augmentant nos connaissances sur la dynamique individuelle et les interactions qui entourent les communautés de patients en ligne.

Over the last few years, virtual patients' communities have been developing tremendously over the Internet. These Web 2.0 communities allow frequent interactions among patients, who can share health-related information within an interactive environment. While many agree on the opportunity represented by those communities for its users, we know very little about what determines patients' online collective action, specifically on virtual communities as well as the fundamentals of online collective action in these virtual spaces. Accordingly, this doctoral work examines why patients interact with others and how they interact on topics related to their disease through these virtual communities. Drawing on the goal-directed behavior (MGB), the expectancy-value (EVT) theories, the field force theory, gift concepts and field interviews, we have developed a model for examining patients' online interactions and identified gift-giving behaviors in the context of online collective action. A multi-method, qualitative and quantitative approaches, enables us to explore patients' interactions and measures the determinants of online collective action on these virtual spaces. The qualitative analysis of 54 interviews conducted with patients, patient's relatives, Health 2.0 professionals, doctors and caregivers allows refining the research model, which has then been tested through a survey handled with 269 patients, members of patient's communities. This research contributes to IS research by increasing our knowledge regarding the individual dynamics and interactions that surround online patients' communities.

  5.1.1 Discussion on Research Question 1: What are the individual and social driving and restraining forces of patients' online collective action? .................... 252 5.1.2 Discussion on Research Question 2: What are the relevant expectancy values during the course of patients' interactions with virtual communities? ..... 252 5.1.3 Discussion on Research Question 3: Do these expectancy values predict patients' desires and intentions regarding virtual communities' usage, and subsequently their engagement with online collective action?.............................. 253 5.1.4 Discussion on Research Question 4: What are the characteristics of giftgiving behaviors in the context of online collective action in virtual communities? 253 5.1.5 Discussion on Research Question 5: How do patients perform gift-giving behaviors in the context of online collective action in patients' virtual communities? ........................................................................................................... 254 5.2 CONTRIBUTION .............................................................................. 254 5.3 CONCLUSION ..................................................................................255 6 ANNEXES ......................................................................................... 260 6.1 INTERVIEW GUIDES ........................................................................ 260 6.1.1 Conceptualizing and Predicting Online Collective Action in Patients' Virtual Communities ............................................................................................................ 260 6.1.2 System Usage and Social Behaviors in Web 2.0 Environments: the Contribution of Gift-Giving Concepts to Online Collective Action ......................... 261 6.2 COMMUNITIES' CHARACTERISTICS .................... ERREUR ! SIGNET NON DEFINI. 6.3 QUESTIONNAIRE............................................................................. 262

FIGURESFigure 1 .

 1 FIGURESFigure 1. Preliminary Research Model -Driving and Restraining Forces of Online Collective Action ................................................................................................................

Figure 2

 2 Figure 2 Emerging Model of Driving and Restraining Forces of Online Collective Action (before coding) ...................................................................................................................

Figure 3

 3 Figure 3 Model of Driving and Restraining Forces of Online Collective Action (after coding) ..............................................................................................................................

Figure 4 .

 4 Figure 4. Research Model .................................................................................................

Figure 5 .

 5 Figure 5. Parameter Estimates for the Structural Model .................................................

Figure 6

 6 Figure 6 Critical Realist Research Design .......................................................................

  0, des médecins et des soignants permet d'affiner le modèle de recherche, qui a ensuite été testé au travers d'une enquête quantitative auprès de 269 patients. Cette recherche contribue à la recherche en systèmes d'information en augmentant nos connaissances sur la dynamique individuelle et les interactions qui entourent les communautés de patients en ligne. The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Mots Clés Patients 2.0, Santé 2.0, Communautés Virtuelles, Action Collective en Ligne, Concepts de Dons, Théorie des Forces de Terrain, Théorie de la Valeur de l'Attente, Modèle de Comportement Orienté vers un But, Émotions, Systèmes d'Information en Santé, Adoption, Médias sociaux, Réalisme Critique Raphaëlle Laubie -December 21, 2017

1. 1

 1 Systèmes d'Information et le Contexte du Web 2.0 1.1.1 Théories et Modèles Existants Dans le domaine des Systèmes d'Information, des modèles antérieurs ont été utilisés pour examiner l'adoption de la technologie dans différents contextes, qu'il s'agisse du Raphaëlle Laubie -December 21, 2017

Raphaëlle Laubie -

 Laubie December 21, 2017 comportement d'utilisation du modèle recouvrent la notion même d'acceptation, et invitent les chercheurs à « fournir la preuve systématique que les mesures d'usage retenues, le cas échéant, sont de bons indicateurs des construits qu'elles sont censées mesurer et de déterminer quels autres construits, le cas échéant, seraient de bons indicateurs de l'usage de la technologie » (Burton-Jones and Straub 2006, p.241). Bokhari (2005) souligne en outre que la recherche ne propose pas de conclusions congruentes reliant l'utilisation du système et la satisfaction des utilisateurs. De même, en ce qui concerne le modèle de succès (ISM) (Delone and McLean 2003), Hofmann (2002) met en garde contre les conséquences de phénomènes collectifs ajoutant un caractère à plusieurs niveaux pour l'utilisation du système. 1.1.2 Lacunes Identifiées concernant le Web 2 .0 Certaines recherches se sont appuyées sur plusieurs des modèles tels que TAM ou ISM pour expliquer l'adoption des utilisateurs en termes de facilité d'utilisation et l'utilité dans le contexte du Web 2.0. Elles ont démontré que certaines variables pouvaient contribuer à motiver une masse critique d'utilisateurs s'agissant de l'adoption des

Raphaëlle Laubie -

 Laubie December 21, 2017 En outre et concernant la théorie unifiée d'acceptation et d'utilisation de la technologie (UTAUT) (Venkatesh et al. 2003), Burton-Jones et Gallivan (2007) soulignent l'absence de prise en compte de plusieurs niveaux, les construits étant conceptualisés au niveau individuel. En conséquence, et en dépit de la force conceptuelle de tous ces modèles pour comprendre l'utilisation des systèmes, nous croyons que, seuls, ils ne fournissent pas une base suffisante pour examiner l'action collective en ligne, qui est liée à l'utilisation des technologies de l'information et de la communication (TIC) dans un contexte Web 2.0. En somme, ces modèles ne parviennent pas à répondre à quatre principales lacunes. Tout d'abord, ils se concentrent sur l'utilisation des systèmes et restent silencieux sur la nature fondamentalement collective de l'utilisation et des avantages des technologies offertes par le Web 2.0. Contrairement au Web 1.0, l'utilisation du Web 2.0 sous-tend l'action collective. Pour cela, la conceptualisation de l'utilisation des systèmes dans un contexte Web 2.0 ne peut se faire par les conceptualisations classiques car ses principes et avantages résident dans l'usage collectif de la technologie (Burton-Jones and Gallivan

  ) were elaborated for conducting the interviews (McCracken 1988). They were constructed in compliance with DeMarrais (2004)'s guidelines suggesting to alternate short and clear questions, questions that would allow participants to recall specific event, and few openended questions. These questions were developed based on the literature review and the information gathered from the field. The interviews have been conducted taking into account the potential difficulties of qualitative interviews, namely: elite bias, Hawthorne effects (H. M. Parsons 1974) and construction of knowledge for our main concerns (M.D. Myers et Newman 2007).

.

  allow them to find the right resources in a flexible adaptation and virtuous cycle (B. L Fredrickson et Joiner 2002). Neuropsychological theories further show that cognitive performance is improved by the presence of positive emotions, indicating that positive affect is associated with an Raphaëlle Laubie -December 21, 2017

  antinaturalism or interpretivism on the other, thus, reinventing a new and more sophisticated version or realist ontology" (Zachariadis et al. 2010, p.4), interpretive reading appeared to offer the right posture for this research. It allowed us to unearth hidden characteristics and to highlight the actual meaning of data. Therefore, we accepted to be involved in constructing a version of what we "think the data mean or

  2.6.1 Research Question: Determinants of Online Collective Action 2.6.1.1 Driving forces for Online Collective Action 2.6.1.1.1 Utilitarian Value: Information Needs, Overcoming Isolation, Instrumental Needs

"

  Because they are human beings and intelligent ones and share the same experience as us. And I feel like this is my family. I feel like these girls are in my living room, and we are talking. And it is really because of this relational we share." (Breast cancer community patient) Besides, it reveals patients' need to gather online and to feel that they belong to the group of peers, while they often experience exclusion, sometimes within their own families, due to the effects of the disease and its physiological consequences. , This, only other patients can empathize with. "Well, during my disease, although I was well surrounded by my family, I needed something else. I needed to talk to people, women sharing the same disease." (Breast cancer community patient)

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 123 RaphaëlleLaubie -December 21, 2017

  immediately surrounded and supported by peers: "Like I say to my friends, overnight, I got 10 friends, and then one month later, I got 50 friends. Now we are 9000 patients connected…and I immediately found a community…" (Breast cancer community patient) "I realized that I had my first breast cancer in 1992 and now, in 2001, I'm still connected to this site… You see how strong it is…" (Breast cancer community patient) 2.6.2.1.2 Enlightened Patients Virtual communities offer patients the positive response to their need for information, so much so that with this wealth of knowledge they may become experts. Besides, one of the striking features of these enlightened patients is that they often know how to use understandable language for the newcomers: "Sometimes, patients are real experts and I can hardly follow the discussion." (Doctor) "Yes, because I find tips and ideas from other parents who have children with the same syndrome, especially when it is very rare… and parents are more expert than doctors." (Rare Disease Community patient family member) 2.6.2.1.3 Role in Healing What is the healing power of this general phenomenon? When patients are asked whether online exchanges have increased their chances of recovery, their responses are often enthusiastic and affirmative: "These forums can help you heal. I'm sure of that ... And I'm someone quite realistic ... I am sure that when you have positive thoughts and laughter despite all the things that happen to you, it helps you." (Breast cancer community patient) The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 126 Raphaëlle Laubie -December 21, 2017

  2.7.1 Coming back to the research question 2.7.1.1 Discussion on Research Question 2.7.1.1.1 Driving Forces of Patients' Online Activity and Emergent Categories Once the research field was defined, our concern was to determine the individual and social determinants of patients joining web-based patients' virtual communities, i.e.what would be the driving or restraining forces for patients to collaborate online.As the literature guided us through what was learned from studies performed on online communities and what were patients' online behaviors, we were however questioning the emergence of new categories to deliver ad hoc knowledge.

  Another major restraining force of patients' online collective action is negative emotions, triggered by what can be stated on collaborative platforms. Those emotions constitute probably one of the main obstacles for joining these virtual spaces. This fear was very salient among the study participants and often elaborated with concrete examples of what can generate sorrow or anxiety among other negative emotions.

First, a significant

  amount of prior research dealing with technology adoption and success has focused on system usage(Benbasat and Barki 2007b) [START_REF] Burton-Jones | Reconceptualizing system usage: An approach and empirical test[END_REF] Usluel and Mazman 2009), creating, thus, a progressive coherence[START_REF] Locke | Constructing opportunities for contribution: Structuring intertextual coherence and "problematizing" in organizational studies[END_REF] among researchers focusing on the explanation of use by the technology features, the user himself/herself, the system or the task. The evolutions of the web in particular, makes it necessary to make evolve the approaches to the success of IS to better acknowledge online collective action phenomenon. The first generation of the World Wide Web or Web 1.0, allowed people to get varied and rich contents over the Internet on a top-down manner. In contrast, the second generation of the web, often labeled as Web 2.0 or social web[START_REF] Governor | Web 2.0 Architectures[END_REF][START_REF] Lai | Groups Formation and Operations in the Web 2.0 Environment and Social Networks[END_REF][START_REF] Oreilly | What Is Web 2.0: Design Patterns and Business Models for the Next Generation of Software[END_REF] The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach RaphaëlleLaubie -December 21, 2017

  and the model of goal directed behaviors -MGB[START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] theorizing, allow us to conceptualize a model that predicts intentional action and subsequent online collective action during individual interactions on patients' virtual communities. In order to test the model, we then apply a rich, sequential, mixed-method approach(Venkatesh et al. 2013;[START_REF] Creswell | Research Design: Qualitative, Quantitative, and Mixed Methods Approaches[END_REF]. First, in combination with the theoretical anchors of the research, we have conducted a qualitative inquiry in order to check the relevance and the completeness of the identified facets of the model variables. This process has also enabled us to ensure the content validity of the model constructs, namely expectancy values, emotions, desires, intentional collective action, post-adoptive behaviors, and online collective action. Second, we have completed a survey in order to measure the impacts of expectancy values and emotions on desires, intentional collective action, and ultimately on online collective action.RaphaëlleLaubie -December 21, 2017

  applied to examine how individuals use IT in different contexts with Web 1.0 and Web 2.0 technologies around the concept of system usage (Hofmann 2002; Bokhari 2005; Straub and Burton-Jones 2007; Burton-Jones and Gallivan 2007; Usluel and Mazman

  249 PRIVACY_CONCERN1 -0.141 -0.123 -0.217 -0.268 -0.348 0.029 0.271 -0.078 -0.215 0.817 PRIVACY_CONCERN2 -0.141 -0.138 -0.241 -0.367 -0.448 -0.034 0.322 -0.119 -0.226 0.892 PRIVACY_CONCERN3 -0.144 -0.175 -0.228 -0.361 -0.459 -0.030 0.366 -0.133 -0.272 0.902 PRIVACY_CONCERN4 -0.096 -0.269 -0.388 -0.502 -0.658 -0.049 0.313 -0.169 -0.421 0.836 Notes: ASI = Affective Social Identity, CSI = Cognitive Social Identity, D = Desires, ESI = Evaluative Social Identity, H = Habits, IMI = Inaccurate Medical Information, InfN = Information Needs, InsN = Instrumental Needs, IR = Isolation Rupture, PC = Privacy Concerns

  0.921 0.890 -0.146 -0.222 -0.333 -0.459 -0.589 0.370 -0.030 -0.153 -0.354 0.863 Notes: ASI = Affective Social Identity, CSI = Cognitive Social Identity, D = Desires, ESI = Evaluative Social Identity, H = Habits, IMI = Inaccurate Medical Information, InfN = Information Needs, InsN = Instrumental Needs, IR = Isolation Rupture, PC = Privacy Concerns, CR = Composite Reliability, CA = Cronbach's Alpha. Items on the diagonal (in boldface) are the square root of average variance extracted (AVE).

The

  Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 4 -SYSTEM USAGE AND SOCIAL BEHAVIORS IN WEB 2In the IS domain, several models have been developed to examine technology adoption and success around the concept of system usage (Hofmann 2002; Bokhari 2005; Straub and Burton-Jones 2007; Burton-Jones and Gallivan 2007; Usluel and Mazman 2009).

  For example, in the case of corporations: taking into account corporate culture, the support of top management, proper leadership, communication, motivation and training of end-users should be further studied, as explained in the case of web-based collective action (Trkman and Trkman 2009).

  4.2.1 Collective Usage and Collective Action among SocialActorsCollective actions theories have explained human behaviors in diverse environments such as corporate ones[START_REF] Alter | Donner et prendre[END_REF] or social movements (Tarrow 2011). With new information and communication technologies, the concept of collective action needs to be revisited as collective action in actual social contexts differs from online collective action[START_REF] Lupia | Which Public Goods Are Endangered?: How Evolving Communication Technologies Affect The Logic of Collective Action[END_REF].

Figure 6

 6 Figure 6 Critical Realist Research Design

  and need to help others. It makes me feel useful and it's rewarding to see the effect on others. It's a give and take. It takes back the pride and pleasure of giving." (Breast cancer community patient) Second, patients' feel the need to gather online with peers and develop social relationships and bonds, referring to the social value or bonding value of gift-giving behaviors. "At some point, I really needed to feel less isolated and the only option was to virtually connect. I couldn't leave my home and wanted to exchange with other that would encounter the same matters as I do. I needed to break with the loneliness that comes with the disease." (Breast cancer community patient) "When you're too weak to face the outside world you meet others online and you decide to meet sisters who share the same concerns." (Breast cancer community patient) "I don't know if feel so closed to others because I meet them online everyday or the other way around. But the bound is really strong" (Breast cancer community patient) Third, the strong ties between online patients highlight the patients' needs to be connected to their networks, in order to share experiences about the course of their illness and to want to give-help in a utilitarian manner. It refers to generalized reciprocity behaviors. As a result, patients in needs for information aren't left alone: "I didn't wait for an appointment with my doctor anymore to find the answer of any information I would need. I know that the community members are here to help me if I need it." (Breast cancer community patient) Patients' decision-making process can benefit from others' testimonies resulting in their enlightenment: "I've learned a lot from the discussions we had about what to do and the disease itself. I feel more equipped to fight my battle against cancer, and in return I can help others to be better informed." (Breast cancer community patient) 4.4.2 Research Question 2: How do Patients Perform Gift-Giving Behaviors in the Context of Online Collective Action in Patients' Virtual Communities? Drawing on the characteristics of gift-giving behaviors in the context of online collective action in virtual communities, we then investigated what specific designations of the three sub-categories of giving-help were relevant for connected patients, and how giftgiving was actually performed by connected patients.

5. 1 . 1

 11 Discussion on Research Question 1: What are the individual and social driving and restraining forces of patients' online collective action?Among the segmentation of the driving forces for online collective action (utilitarian value, social value and anticipated positive emotions), the information needs, the belongingness needs, the exclusive value and the positive emotions were the most quoted by the interviewees. On the other hand and concerning the restraining forces of patients' online collective action inaccurate medical information, privacy issues and negative emotions were frequently enunciated by the patients. All these variables were therefore tested in a subsequent quantitative analysis. 5.1.2 Discussion on Research Question 2: What are the relevant expectancy values during the course of patients' interactions with virtual communities?

  of community helping us to determine what type of other than IT incentives motivate patients to act and interact online; therefore answering to key questions in IS adoption research. 5.1.4 Discussion on Research Question 4: What are the characteristics of gift-giving behaviors in the context of online collective action in virtual communities?

5. 1 . 5

 15 Discussion on Research Question 5: How do patients perform gift-giving behaviors in the context of online collective action in patients' virtual communities?

  Patients 2.0, Santé 2.0, Communautés Virtuelles, Action Collective en Ligne, Concepts de Dons, Théorie des Forces de Terrain, Théorie de la Valeur de l'Attente, Modèle de Comportement Orienté vers un But, Émotions, Systèmes d'Information en Santé, Adoption, Médias sociaux, Réalisme Critique Patients 2.0, Health 2.0, Virtual Communities, Online Collective Action, Gift Concepts, Field Theory, Expectancy Value Theory, Model of Goal-Directed Behavior, Emotions, Health Information Systems, IT Adoption, Social Media, Critical Realist

Table 6 .

 6 The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 6.3.1 The Determinants of Online Collective Action in Patients' Virtual Communities: the Contribution of Social, Utilitarian and Emotional Influences in an Extended Model of Goal-Directed Behavior ...................................................... 6.3.1.1 Informed Consent Form Introduction .................................................. 6.3.1.2 Confidentiality ....................................................................................... 6.3.1.3 Questions about the Research ............................................................... 6.3.1.4 Questionnaire ........................................................................................ Interview Guide in Preliminary SDCI .................................................................

6.4 RESEARCHER PROFILE .................................... ERREUR ! SIGNET NON DEFINI. 6.4.1 Teaching Experience, Corporate Experience and Education ................. 6.4.2 Presentations and Publications in Conferences with Peers Reviews...... 7 BIBLIOGRAPHY ............................................................................... TABLES Table 1. Présentation des Etudes ....................................................................................... Table 2. Collective Action and Related Concepts .............................................................. Table 3. The Benefits of Health 2.0 ................................................................................... Table 4. The Risks of Health 2.0 ....................................................................................... Table 5. Interviews .............................................................................................................

Table 7 .

 7 Interview Guide in Patients and Patients' Relatives SDCI .................................. Table 9 The Driving Forces of Online Collective Action ...................................................Table 11.1 Open Codes for Driving Forces of Online Collective Action ........................... Table 11.2 Open Codes for Restraining Forces of Online Collective Action ....................

Table 12.1 Open Codes for Background Factors of Online Collective Action .................. The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 16 Raphaëlle Laubie -December 21,

Table 14 .

 14 Table 12.2 Open Codes for Benefits of Online Collective Action ..................................... Table 13.1 Open Codes for Driving Forces of Online Collective Action .......................... Table 13.2 Open Codes for Restraining Forces of Online Collective Action ................... Open Codes for Background Factors of Online Collective Action ...................

Table 15 .

 15 Open Codes for Benefits of Online Collective Action ......................................Table 16.1 Open Codes for Driving Forces of Online Collective Action .......................... Table 16.2 Open Codes for Restraining Forces of Online Collective Action ....................

Table 17 .

 17 Open Codes for Background Factors of Online Collective Action ....................

Table 18 .

 18 Open Codes for Benefits of Online Collective Action ......................................

Table 19 .

 19 Categorization of IT Artifacts and Role on Online Collective Action ............... Table 26 Categorization and Secondary Concepts -Benefits of Online Collective Action ...........................................................................................................................................Table 27 Categorization and Secondary Concepts -Background Factors .....................

Table 20.1 Categorization and Leading Concepts -Driving Forces .................................. Table 20.2 Categorization and Leading Concepts -Restraining Forces.......................... Table 21. Categorization and Secondary Concepts .......................................................... Table 22 Categorization and Leading Concepts -Utilitarian Value ............................... Table 23 Categorization and Leading Concepts -Social Value ...................................... Table 24 Categorization and Leading Concepts -Anticipated Positive Emotions ......... Table 25 Categorization and Leading Concepts -Cost Value .........................................

Table 28 .

 28 Collective Action and Related Concepts ...........................................................

Table 29 .

 29 Our Multimethod Research Approach .............................................................

Table 30 .

 30 Interviews .........................................................................................................

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21,

Table 38 .

 38 Table 31.1 Social values as the determinants of desires and online collective action ..... Table 31.2 Utilitarian values as the determinants of desires and online collective action........................................................................................................................................... Table 31.3 Anticipated Emotions values as the determinants of desires and online collective action ............................................................................................................... Table 31.4 Trust as the determinants of desires and online collective action ................. Table 31.5 Online Collective Action .................................................................................. Results of Hypotheses Tests .............................................................................Table 39.1 Gift Concepts as an Utilitarian Value ............................................................. Table 39.2 Gift Concepts as a Social Value ...................................................................... Table 40 Online Gift Concepts as Utilitarian, Social and Emotional Values .................

Table 32.1 Constructs and measures for social value .......................................................183 Table 32.2 Constructs and measures for utilitarian value .............................................. Table 32.3 Constructs and measures for anticipated emotions...................................... Table 32.

4 Constructs and measures for trust ................................................................. Table 32.5 Constructs and measures for desires, intentional collective action, habits, online collective action ..................................................................................................... Table 33. Communities' characteristics .......................................................................... Table 34. Cross Loadings ................................................................................................. Table 35. Discriminant Validity and Reliability ............................................................... Table 36. Transformation Matrix Components ............................................................... Table 37. Path Coefficients ...............................................................................................

Table 41 .

 41 The Research Approach ...................................................................................

Raphaëlle Laubie -December 21,

Table 42 .

 42 Interviews ........................................................................................................

Table 43 .

 43 Interview Guide in Preliminary SDCI .............................................................

Table 44 .

 44 Interview Guide in Patients and Patients' Relatives SDCI ............................. Table 45 Open Codes for Gift-giving Behaviors in the Context of Online Collective Action ...........................................................................................................................................

Table 46 .

 46 Open Codes for Gift-giving Behaviors in the Context of Online Collective Action ...............................................................................................................................

Table 47 .

 47 Categorization of Gift-giving Behaviors in the Context of Online Collective

Action ...............................................................................................................................

Table 48. Research Issues ............................................................................................... Table 49. Multimethod Research Approach .

.................................................................. Table 50. Contributions for Theory and Practice ............................................................ Theory .............................................................................................................................. Table 51. Researcher Profile -Teaching Experience ...................................................... Table 52. Researcher Profile -Corporate Experience ..................................................... Table 53. Researcher Profile -Education ........................................................................ Table 54. Researcher Profile -Presentations and Publications in Conferences with Peers Reviews ............................................................................................................................

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Dans cette recherche quantitative, les questions de recherche posées sont donc les Durant toutes ces étapes de notre recherche, nous avons estimé que les cadres théoriques existants devaient être adaptés à notre champ d'enquête. Par conséquent, une approche exploratoire a été appliquée. Avec les apports émergents du terrain et des théories telles que MGB, nous développons un modèle visant la compréhension de l'action collective en ligne des patients qui inclut spécifiquement les concepts d'émotions et de dons. De plus, nous ne sommes pas convaincus que la façon dont les concepts et les catégories sont couplés pour les Raphaëlle Laubie -December 21, 2017 permettre de rendre compte de façon suffisante de l'action collective en ligne dans des contextes en rapport avec la santé. Ce faisant, cette approche nous permet de bénéficier d'idées nouvelles provenant du terrain, tout en contribuant à la connaissance d'une manière cumulative. Les besoins et les interactions des patients sur plateformes Web 2.0 ont été examinées attentivement dès le début de la recherche. En cela, les entrevues ont été menées afin de contextualiser la recherche et d'intégrer le contexte des patients dans les analyses. Notre approche vise à aller au-delà d'une approche «purement» positiviste,

	distances avec cette vue principalement utilitaire mettant en avant les valeurs du lien,
	suivantes : des relations humaines altruistes et des émotions véhiculées (Chakrabarti and Berthon
	1. Quelles sont les valeurs relatives à l'espérance dans le cadre des interactions des 2012). terrain ont été comparés à la littérature dans une quête exploratoire de réponses
	patients avec les communautés virtuelles? Pour les patients connectés, les liens tissés reposent principalement sur les échanges qui (Mingers 2000; Mingers 2004).
	2. Ces valeurs de l'espérance permettent-elles de prédire les désirs et les intentions ont lieu dans les communautés virtuelles, même si les individus sont plus difficiles à Tout d'abord, des entretiens préliminaires nous ont permis de comprendre à quel point
	concernant l'usage des communautés virtuelles de patients, et par la suite leur identifier du fait des conditions particulières dans lesquelles les échanges ont lieu l'étude de l'environnement était importante pour notre recherche. Deuxièmement, les
	engagement dans l'action collective en ligne? (anonymat, échanges partagés entre de multiples entités…). La notion d'équilibre chère à premiers échanges avec les patients nous ont guidés pour la réalisation d'une étude
	La première approche considère le don comme le signal d'échange à partir duquel la
	réciprocité ne peut qu'opérer et est ainsi instrumentalisée ; la seconde prend ses

Suite à cette seconde étude, une troisième étude dont l'objet est la détermination des comportements des patients connectés nous a semblé intéressante. Elle se concentre sur les différentes facettes de l'action collective en ligne sur notre terrain d'étude, celui des patients touchés pas des maladies chroniques ou rares. Cette étude est décrite dans le paragraphe suivant.

1.2.3 Etude 3 : Détermination des Caractéristiques de

Comportements Relatifs au Don dans les

Communautés Virtuelles

La littérature sur le don suggère fréquemment deux notions complémentaires et difficilement divisibles, celle de l'approche utilitaire

[START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF][START_REF] Malinowski | Argonauts of the Western Pacific; an Account of Native Enterprise and Adventure in the Archipelagoes of Melanesian New Guinea[END_REF][START_REF] Gregory | Gifts and Commodities[END_REF][START_REF] Bataille | La part maudite[END_REF][START_REF] Godbout | L'esprit du don[END_REF][START_REF] Alter | Donner et prendre[END_REF][START_REF] Camerer | Gifts as economic signals and social symbols[END_REF]

) et l'approche sociale

[START_REF] Hyde | The Gift: How the Creative Spirit Transforms the World[END_REF][START_REF] Bollier | The cornucopia of the commons[END_REF] Skageby 2010)

.

[START_REF] Mauss | The Gift: The Form and Reason for Exhange in Archaic Societies[END_REF]

est donc plus difficile à percevoir et les fondamentaux de ces dons sont quelques peu bouleversés quand ils ont lieux dans ces espaces virtuels (Smith and

[START_REF] Kollock | The economies ol online cooperation[END_REF]

. Dans ces systèmes complexes, nous reprendrons les trois caractéristiques des dons le plus fréquemment cités dans la littérature et combinant ces approches utilitaires et sociales dans des espaces virtuels (Skageby 2010), ie : i) l'orientation vers autrui, ii) la valeur du lien, iii) la réciprocité généralisée. Partant de ces concepts et des informations reçues du terrain, cette seconde approche qualitative et troisième étude menée pose les questions suivantes :

1. Quelles sont les caractéristiques de comportements relatifs au concept de don dans le cadre de l'action collective en ligne dans les communautés virtuelles ? 2. Quels sont les comportements des patients relatifs au concept de don dans le cadre de l'action collective en ligne dans les communautés virtuelles de patients ?

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017 utilisateurs 'standards'

[START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]

soit pertinente pour les patients, compte tenu de la possible difficulté de leur situation en fonction de leur état de santé et d'un potentiel état mental fragilisé. Nous avons étudié le rôle du don, du travail initial de Mauss (2002) -également mis en évidence dans les communautés open source, afin d'expliquer les succès de ces entités de collaboration -ainsi que les travaux et résultats de (Bergquist and Ljungberg 2001). Ce travail exploratoire vise à fournir des connaissances supplémentaires sur les déterminants de l'action collective en ligne de patients. Les émotions positives, concept de base qui déclenche le désir d'agir dans MGB (Perugini and Bagozzi 2001), est également étudié dans ce contexte de participation et d'aide envers l'autre entre les patients souffrant des mêmes troubles. Cependant, tous ces concepts ont été adaptés considérant les aspects particuliers des usages et des besoins des patients. Une approche fondée tant sur le terrain que sur la théorie a été appliquée afin d'approfondir l'action collective en ligne dans les contextes Web 2.0. En effet, bien que nous croyions que les théories existantes fournissent des indications pertinentes pour examiner cette question, nous pensons cependant qu'elles sont insuffisantes pour parfois représentée comme un réalisme naïf "dans lequel la réalité est compréhensible et la connaissance peut être facilement capturée et généralisée sous une forme sans contexte" (Zachariadis et al. 2010, p.5), ou une approche «purement» interprétativiste qui exclut l'explication causale "au début des débats sur la philosophie des sciences sociales et concernant la compréhension par rapport à l'explication ou les raisons face aux causes" (Sayer 2000, p.96). En effet, en définissant précisément la portée du réalisme critique Zachariadis et al. écrit : "Au lieu de chercher des lois sociales, nous devrions chercher des mécanismes de causalité et comment ils fonctionnent. Selon les réalistes critiques, les régularités cohérentes ne sont susceptibles de se produire que dans des circonstances particulières dans des systèmes fermés" (2010, p.5). En conséquence, notre posture suit les principes du réalisme critique qui répond aux défauts ontologiques et épistémologiques du positivisme Zachariadis et al. (2010) et est conforme à la façon dont nous envisageons la construction de la connaissance. Dans la pratique, les allers-retours constants entre les témoignages des patients recueillis au cours des entretiens et les préceptes apportés par la littérature, ont façonné notre conception de la recherche conforme à notre approche réaliste critique. Cette approche nous a permis de renforcer la pertinence de ce travail, où les concepts provenant du approfondie de la littérature. Ces premiers contacts avec le terrain nous ont permis de déterminer les théories qui permettent de mieux prendre en compte la réalité de cet environnement et d'élaborer un premier projet de modèle en conséquence. Tant l'étude de la littérature que la compréhension de l'environnement en conformité avec les théories existantes ont contribué à l'élaboration de ce modèle. Les premiers facteurs du modèle ont donc été adaptés et tout en revisitant la littérature. Nous avons procédé à une approche inductive qui nous a aidés dans la construction de l'ensemble du cadre conceptuel. En prenant en compte les implications de la communication médiatisée par ordinateur (Sproull and Kiesler

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach RaphaëlleLaubie -December 21, 2017 Enfin, aidés par notre cadre théorique, une exploration plus en profondeur nous a permis de recouper la connaissance de la littérature ainsi que des connaissances transitives. Tous ces concepts et dimensions ont été associés à la structure du modèle.

	En conséquence, la connaissance transitive est un élément essentiel qui décrit
	l'environnement choisi et comble les lacunes de la recherche. Les concepts ont été
	constamment comparés à la connaissance de la littérature à laquelle ils se référaient et
	vers laquelle ils convergeaient. Ceci a contribué à l'ajout de nouveaux construits qui s'est

traduit par la création d'un modèle original, initié par la littérature et la rationalisation du champ à travers l'ensemble du processus de recherche.

Table 1

 1

			. Présentation des Etudes
		1ère Etude	2nde Etude	3ème Etude
		x La Théorie des
		Valeurs de
		l'Espérance -EVT
		(J. S. Eccles et al.
		1983), le Modèle
		du Comportement
	Théories	Orienté vers un
		But -MGB
		(Perugini and
		Bagozzi 2001) et
		le Champs des
		Forces de Lewin

  Nous démontrons la pertinence de la combinaison de MGB et EVT pour développer ce modèle pour les patients de communautés virtuelles afin de mieux examiner les déterminants de l'action collective en ligne. Nous avons enrichi le cadre sous-jacent de MBG -établi par Perugini et Suite à cela, nous présentons les matériaux, les méthodes et conceptions pour cette recherche et toutes les procédures connexes. Faisant suite à l'étude de la littérature et aux informations provenant du terrain, un modèle a été développé selon une première approche qualitative et testé dans une seconde approche quantitative. Une seconde approche qualitative explicite l'action collective en ligne présentée à la lumière des concepts du don. Ensuite, ces résultats sont discutés et les contributions sont décrites.Nous concluons chacune des trois études avec les limites de notre recherche et les opportunités ainsi offertes pour de nouvelles explorations, ainsi que les perspectives pour les patients et l'environnement relatif à la Santé 2.0.

	don. The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 2 CONCEPTUALIZING AND PREDICTING ONLINE COLLECTIVE
	ACTION IN PATIENTS' VIRTUAL COMMUNITIES
	Bagozzi (2001) et adapté aux communautés virtuelles par Dholakia et al. (2004) -en
	présentant une compréhension holistique des déterminants du désir de participer à
	l'action collective en ligne avec ses valeurs EVT (Eccles et al. 1983). L'approche
	qualitative nous a permis de fournir une compréhension profonde du contexte de notre 2 -CONCEPTUALIZING AND
	recherche ; l'approche quantitative nous a permis de construire un modèle qui peut, sous PREDICTING ONLINE
	COLLECTIVE ACTION IN
	PATIENTS' VIRTUAL
	COMMUNITIES 1
	Notre travail est structuré comme suit. Dans chacune des trois études présentées dans
	cette thèse, nous décrivons nos motivations concernant l'acquisition de nouvelles
	connaissances sur les déterminants de la participation des patients dans les
	communautés virtuelles et les composantes de l'action collective en ligne relatives au

Tout d'abord, pour répondre à nos questions de recherche, ce travail dresse un modèle d'action collective en ligne afin de mieux reconnaître le processus d'engagement chez un certain type de patients. Deuxièmement, elle illustre et contextualise, dans la cadre des patients connectés, l'action collective en ligne relative aux concepts du don. L'approche multiméthodes (Venkatesh et al. 2013), et notre posture réaliste critique contribuent à la pertinence de l'étude (avec une approche qualitative qui enrichit le modèle de recherche avec un aperçu de l'expérience des patients et la nature de leurs actions en ligne) et à la rigueur (avec une étude quantitative subséquente pour mesurer les impacts des déterminants de l'action collective en ligne). sa forme générique, être mobilisé dans d'autres domaines d'enquête. Les résultats du terrain mettent en exergue le désir en tant que facteur déterminant de l'action collective intentionnelle, elle-même facteur déterminant de l'action collective en ligne. Les résultats suggèrent que l'action collective en ligne est fonction de la fréquence d'utilisation, le désir fonction des valeurs sociales, valeurs utilitaires, des émotions positives anticipées, en ligne avec la dernière constatation sur les communautés virtuelles (Tsai and Bagozzi 2014). Le modèle construit peut permettre d'aider les concepteurs de communautés virtuelles à comprendre ce qui serait souhaitable en ce qui concerne la formulation des besoins des patients. Enfin, cette recherche met en lumière la notion de don et son implication dans différentes catégories de l'action collective en ligne, elle contextualise les facettes de l'action collective en ligne concernant les communautés virtuelles de patients.

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Internet to learn about health related topics, 34% read comments from other Internet users, and 18% of the persons studied research carried out by persons sharing similar pathologies (Pew Internet). In France, over the same period, 64% of patients were seeking information on health (Ipsos polling Institute 2010).In order to address those research gaps, this study investigates the individual and social factors that drive patients to participate in online collective action. This article addresses the following research question: What are the individual and social driving and restraining forces of patients' online collective action?

Table 2

 2

			. Collective Action and Related Concepts
	Area	Concept	Definition	Author
			"A commitment of an individual to
			participate in joint action and involves an
		We-Intentions	implicit or explicit agreement between the participants to engage in that joint action."	(Tuomela 1995)
			(Tuomela 1995, p.2), (Tuomela and Miller
			1988)
	Philosophy

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

		Matthews 1978)
		Action is directed by individuals' motives.
		Therefore, actions need to offer tangible
	Social Action	significance and outcomes to each actor in	(T. Parsons 1949)
		the actor-situation system, even they act
		collectively. (T. Parsons 1949)
		Collective action put the organizations'
		interests before individuals' ones which can
		foster free-riding of individuals on the effort
	Collective Action	of others. In order to avoid this phenomenon,	(Olson 1965)
		organizations have to motivate participants
		in collective action efforts and coordinate
		their efforts.
		Collective action is studied within
		organizations where individuals are players
	Collective Action	and not passive agents who perform instructions. Individuals develop strategies	(Crozier and Friedberg 1977)
		based on personal goals that sometimes
		disregard the organization's interests.
		Collective action suggests that dynamics
		implying a "startling homogeneity of
		organizational forms and practices"
	Collective Action	(DiMaggio and Powell 1983) and therefore rules and requirements in compliance with	(DiMaggio and Powell 1983)
		institutional and impersonal customs of
		interaction that don't leave room for out-of-
		the-box thinking skills.

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

Table 3

 3

		. The Benefits of Health 2.0
	Benefits	Description
		Overcoming isolation allowed by asynchronous communication
	Overcoming Isolation	accessible 24/7/365 on demand respecting a patient's time required to
		respond, as well as erasing geographical barriers
		Anonymity, allowing patients to discuss sensitive issues as well as
	Anonymity	sidestepping the disclosure of socio demographic factors such as age, gender, racial or ethnic identity, income, social status or disabilities.
		Nonverbal cues are eliminated for the sake of enhanced privacy
		Wisdom of crowds, due to the "unlimited" number of participants,
	Wisdom of Crowds	allows group members to draw from a wide variety of perspectives,
		experiences, disabilities and points of view
	Political Power	Increased influence in advocacy capacity and a means of organizing and networking politically for a particular cause or disease

Table 4

 4

		. The Risks of Health 2.0
	Risks	Description
		Digital divide effect, that eliminates from participation poor
	Digital Divide Effect	populations or those without a rudimentary knowledge of how to use a
		keyboard and computer
	Time Consuming	Time-consuming effect, while browsing through the extensive amount of information
	Misinterpretation	Misinterpretation, an inconvenience of the absence of nonverbal cues
		Anonymity can be a concern, due to the relative impersonal nature of
	Lack of Anonymity	the medium as well as deceiving behavior that can occur under the
		cloak of anonymity
	Inaccurate Medical Information	Inaccurate medical information, that can happen when medical advice is given by people without medical training or expertise
	Addiction	Addiction, with online relationships replacing gradually real-life social interactions

Table 8

 8

	below, summarizes the objectives of the interviews that have been conducted
	with a number of different actors in the domain of Health 2.0 and of patients.

Table 8

 8

		. The Research Approach
	Approach	Objectives	Procedures
		-Identify the specificities of patients that
		join virtual communities.
		-Contextualizing the variables chosen for
		the research model and survey instrument;
		ensuring content validity.
	Qualitative	-Identifying in practice the emerging
	Approach	individual and social determinants of
		patients joining web-based patients' virtual
		communities.
		-Examining the role played by the IT
		artifacts versus information and emotional
		needs in patient's commitment.

Table 6

 6

	. Interview Guide in Preliminary SDCI
	Questions	Objectives
	Is there an existing patient typology for a
	focus group whether they gather online or
	offline?

Table 7 .

 7 Interview Guide in Patients and Patients' Relatives SDCI

		Questions		Value's Dimension Addressed
	Do you feel the need to be informed on your disease?	Information Needs
	Where do you go to find medical
	information? Do you think online medical information	Inaccurate Medical Information
	is relevant?
	What (other than information) would you seek on an online medical portal?	Instrumental Belongingness Overcoming Isolation Needs, Needs,	Positive Exclusive	Emotions, Value,
	Would you say special relations are
	developed	with	other	patients	Belongingness Needs, Group Norms
	participating?

Table 10 .

 10 IT Artifacts as Utilitarian Value and Anticipated Positive Emotions

	Dimension Relevant Facet	Definition	Author	Implication for Online Collective Action
	Utilitarian	Navigational		(Vance et al.	The model including
	Value	Structure		2008)	system quality constructs
					of navigational structure
					and visual appeal
			''Visual appeal is defined as the tangible		influences positively the
			aspect of the online environment that reflects		intention to use an online
	Anticipated Positive Emotions	Visual Appeal	the 'look and feel' or perceived attractiveness of a Website. Visual appeal connotes the attractiveness of the Web site, including	(Vance et al. 2008)	platform and possibly to contribute to online collective action
			graphics, colors, and fonts.'' (Vance et al.
			2008, p.79)

''Navigational structure is defined as the organization and hierarchical layout of the content and pages in a Website and involves the relative effort required for a user to traverse an IT artifact user interface''

(Vance et al. 2008

, p.79) Raphaëlle Laubie -December 21, 2017 2.4.1.4.2 IT Artifacts from Patients' Perspective

  [START_REF] Ajzen | The theory of planned behavior[END_REF] did not subscribe to the view of past behaviors as being meaningful for predicting present ones. For researchers such as Bamberg et al. who stated that: "if social behavior is reasoned, then-it is argued-frequency of prior behavior should have

	(Anticipated Positive Emotions of Online Collective Action's Driving Forces)
	2.4.1.5 Habits
	2.4.1.5.1 On Habits
	In TPB,
	Raphaëlle Laubie -December 21, 2017

-in order to help us understand the functioning of Health 2.0 communities. Proposition 8: Navigational Structure is positively related to online action regarding virtual patients' communities. (Utilitarian Value of Online Collective Action's Driving Forces) Proposition 9: Visual Appeal is positively related to online action regarding virtual patients' communities.

only an indirect link to later behavior; its effect should be mediated by intention and perceived behavioral control"

(2003, p.176)

, or others such as Sommer (2011): habits

  argued that statistical research designs are irrelevant to social sciences as closure of systems can't possibly be achieved in society, but he moderated his adamant statement positing that open systems demi-regularities can encode social mechanisms' patterns.On demi-regularities and Lawson research process guidance, Bache also states that: "Lawson admits a role for demi-regularities at two stages in a realist research project. First, demi-regularities have a role in the context of discovery. Demi-

	Driving Forces	Restraining
	Forces
	Belongingness Needs
	Group Norms
	Exclusive Value
	Information Needs
	Overcoming Isolation
	Instrumental Needs
	Navigational Structure
	Negative emotions
	Privacy Protection
	Positive Emotions	Inaccurate Medical
	Information
	Visual Appeal
	Figure 2 Emerging Model of Driving and Restraining Forces of Online Collective Action (before
	coding)

regularities help direct the research process and contribute to the generation of hypotheses about causal mechanisms. Second, demi-regularities could have a role in the assessment of causal explanations"

(2003, p.14)

.

Therefore, critical realism allows us, given the specification of our ontological domain, to explain the widest possible range or phenomena and thus enlightens black boxes and reveals emergent dimension

[START_REF] Pratschke | Realistic models? Critical realism and statistical models in the social sciences[END_REF]

.

Table 11

 11

	.1);

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 101 Raphaëlle

Laubie -December 21, 2017

  Table 11.1 Open Codes for Driving Forces of Online Collective Action 2 categories for the restraining forces of online collective action (See Table 11.2);

	Broad Nodes	Sub-Nodes
		UV*	Information Needs
		SV**	Belongingness Needs (Social Identity)
		HV***	Positive Emotions
	Driving Forces for Online Collective Action	SV**	Group Norms
		UV*	Instrumental Needs
		UV*	Navigational Structure
		HV***	Visual Appeal
	*Utilitarian Value **Social Value ***Hedonic Value
	Table 11.2 Open Codes for Restraining Forces of Online Collective Action
	Broad Nodes		Sub-Nodes
	Restraining Forces for		Negative Emotions
	Online Collective Action		Privacy Protection

x

Table 12 .

 12 1 Open Codes for Background Factors of Online Collective Action

	Broad Nodes	Sub-Nodes
	Background Factors	Habits

  Table 13.1 Open Codes for Driving Forces of Online Collective Action

	Broad Nodes	Sub-Nodes	Key Terms and Phrases	Number references
				"I had a question", "asked a question", "I got the
		UV* Information Needs	answer", "girls explain", "share information", "looking	101
				for information in order to know"
		SV**	Belongingness Needs (Social Identity)	"bound by the same diseases", women sharing the same disease" "share the same experience as us", "I feel like this is my family", " this relational we share", " I needed to talk to	94
		SV**	Exclusive Value	"sharp people in the field, in the pathology and it is very reassuring", "we know that this person is concerned"	61
				"positive emotions", "successful experience", "an
		HV*** Positive Emotions	operation that succeeded", "when you feel that parents	61
	Driving Forces for Online Collective Action	UV* SV** UV*	Overcoming Isolation Group Norms Instrumental Needs	are pleased", "people's emotions" "the disease is a social handicap", "I am a bit lonely", "come out of my isolation", "we share the same vision", "same thoughts", "people who share my problems, my opinions, my values" "when girls explain", "I can find no answer" "they give you the information you need',", "give tips"	44 31 30
		UV*	Navigational Structure	"website is fluid", "it meets my needs", "user-friendly interface"	26
		HV***	Visual Appeal	"the appearance of the website", "website page is catchy"	12
		UV*	Preference over Medical Process	"more easily than taking an appointment with a doctor", "administrative medical system"	5
		HV***	Doctors Positive Perception	"my doctor recommended me the website", "my doctor indicated me the community"	4
		HV***	Boredom Avoidance	"need to do something", ''I have more time"	3

*Utilitarian Value **Social Value ***Hedonic Value Codes Added from the Field The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

Table 14 .

 14 Table 13.2 Open Codes for Restraining Forces of Online Collective Action Open Codes for Background Factors of Online Collective Action

	Broad Nodes	Sub-Nodes	Key Terms and Phrases	Number of references
			"negative diagnosis", "punch in your stomach",
			"your fear is coming back and spreading",
		Negative Emotions	"negative emotions", "anxiety", "more afraid",	46
			"announce their bad news", "diagnosis of
	Restraining		metastases"
	Forces for		"it exposes you", "confidential information",
	Online	Privacy Protection	"control", "confidentiality of data", "the Internet is	33
	Collective		risky", "sense of security"
	Action	Inaccurate Medical Information	"they aren't necessarily enlightened patients", "not dangerous" been validated", "invalidated information", " can be	30
		Complexity of Information	"difficult to understand"	2
	Codes Added from the Field
	Broad Nodes	Sub-Nodes	Key Terms and Phrases	Number of References
	Background
	Factors

Table 15 .

 15 Open Codes for Benefits of Online Collective Action

	26

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 104 Raphaëlle

Laubie -December 21, 2017

  1 category was dropped for the restraining forces of online collective action, leaving 3 categories (See Table16.2);

		Table 16.2 Open Codes for Restraining Forces of Online Collective Action
	Broad Nodes	Sub-Nodes	Key Terms and Phrases	Number of references
				"negative diagnosis", "punch in your stomach",
				"your fear is coming back and spreading",
	Negative Emotions Table 16.1 Open Codes for Driving Forces of Online Collective Action "negative emotions", "anxiety", "more afraid", Sub-Nodes Key Terms and Phrases "announce their bad news", "diagnosis of UV* Broad Nodes Information Needs Restraining metastases" "I had a question", "asked a question", "I got the answer", "girls explain", "share information", "looking Forces for "it exposes you", "confidential information", Online Privacy Protection "control", "confidentiality of data", "the Internet is for information in order to know" SV** Belongingness Needs (Social Identity) Collective risky", "sense of security" "bound by the same diseases", "share the same experience as us", "I feel like this is my family", " this relational we share" SV** Exclusive Value Action "they aren't necessarily enlightened patients", "not Inaccurate Medical been validated", "invalidated information", " can be Information dangerous" "sharp people in the field, in the pathology and it is very reassuring", "we know that this person is concerned" HV*** Positive Emotions Complexity of "difficult to understand" Information "positive emotions", "successful experience", "an operation that succeeded", "when you feel that parents are pleased", "people's emotions" Codes Added from the Field Codes Dropped by the Researcher Interpretive approach	46 References 101 33 94 30 61 2 61
	Driving Forces for Online Collective Action	UV* SV** Group Norms Overcoming Isolation UV* Instrumental Needs	"the disease is a social handicap", "I am a bit lonely", "come out of my isolation" "we share the same vision", "same thoughts", "people who share my problems, my opinions" "when girls explain", "I can find no answer" "they give problem", "give tips" you the information you need', "solve practical	44 31 30
		UV*	Navigational Structure	"website is fluid", "it meets my needs", "user-friendly interface"	26
		HV*** Visual Appeal	"the appearance of the website", "website page is catchy"	12
		UV*	Preference over Medical Process	"more easily than taking an appointment with a doctor", "administrative medical system"	5
		HV***	Doctors Positive Perception	"my doctor recommended me the website", "my doctor indicated me the community"	4
		HV***	Boredom Avoidance	"need to do something", ''I have more time"	3
	*Utilitarian Value **Social Value ***Hedonic Value
	Codes Added from the Field Codes Dropped by the Researcher Interpretive approach

x x 1 category was dropped for the background factors of online collective action (See Table 17);

Table 17 .

 17 Open Codes for Background Factors of Online Collective Action

	Broad Nodes	Sub-Nodes	Key Terms and Phrases	Number of References
	Background
	Factors

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 106

			26
	Information Control	"This self-moderates", "moderation is required", "safeguards."	18
	Online Clinical	"there should scientific profiles", "from medical
	Advices	sector to speak on the subject", "to provide	12
	Requirement	expertise"
	Open Virtual Space	"it to be open", "open is normal"	7
	Codes Added from the Field
	Codes Dropped by the Researcher Interpretive approach
		Raphaëlle Laubie -December 21, 2017

Table 18 .

 18 Open Codes for Benefits of Online Collective Action

	Broad Nodes	Sub-Nodes	Key Terms and Phrases	Number of References
	Benefits of	Belongingness Speed and Strength	"Immediately", "taken under the wing of the other patients", "I immediately felt the supported"	18
	Online Collective	Enlightened Patients	"sometimes, patients are true experts", "they are more experts than doctors"	13
	Action	Role in Healing	"I am convinced that sharing positive emotions helps heal", "we feel better, more quickly"	12
	Codes Added from the Field
	Codes Dropped by the Researcher Interpretive approach

Table 19 .

 19 Categorization of IT Artifacts and Role on Online Collective Action

	Broad Nodes	Role on Online Collective Action	Illustration	Number of References
		Positive Role	"Yes, the website is fluid and it meets my needs."*	26
	Navigational Structure	Neutral Role	"It is not that the site is particularly well thought out, but just I easily get what I'm searching for. Besides I have my habits. Through conversations I	23
			easily find what I need."*
		Positive Role
	Visual Appeal

"The appearance of the website brings to it seriousness and the trust that I will give it. Yes it is important."* 12 Neutral Role "The appearance of the website has little importance compared to the heat or human comfort that I can find through conversations."* 27 * Quotes from interviews with breast cancer community patients Indeed, during the course of the interviews, we were particularly interested in comments of patients with a long experience of attending patients' virtual communities -who happened to frequent them for more than 5 years -highlighting the minor relevance of sites' visual appeal:

''It is of little importance to me. You know the struggle of the disease will not be relieved by beautiful colors, there is something else in these spaces.'' (Breast cancer community patient)

The design is of little importance in the end we are left with the warmth, the emotion conveyed.'' (Breast cancer community patient)

Given the low rate of occurrences reached in the interviews, we won't keep the navigational structure and visual appeal concepts as driving forces of online collective action, considering them secondary. However, and following this qualitative approach, we recommend and will conduct in a future research study the consolidation of this study by testing these observations and therefore the two aforementioned dimensions in a quantitative analysis.

2.5.3.1.2 Preference over Medical Process, Doctors Positive Perception and

Boredom Avoidance

Preference over Medical Process could be illustrated by: "This could easily become an automatic behavior compared to making an appointment with a doctor who is not necessarily available before 2-3 months.

When you see him, well, you took one hour to go to the hospital. In consultation, you've waited 1 more hour and on the top of all that… he does not necessarily have action. Some patients mentioned these aspects and that's why we highlighted them as emergent categories from the field, but out of the 54 codings, few interviews were neither relating nor confirming these statements. Therefore we decided to drop these values.

2.5.3.2 Dropped Variables for Restraining Forces for Online Collective Action

2.5.3.2.1 Complexity of Information

Complexity of Information could be illustrated by: "But I thought it was complex, patients sometimes become too expert, one can't understand them anymore." (Breast cancer community patient)

Here again, although it was an interesting testimony, the occurrences were far too few, only rising to 2, to keep this value in our model. We, thus, left this factor aside. children's disease. That is the reason why the Facebook group remained closed to public access On the other hand, it may seem surprising that women facing the hardship of breast cancer are willing to open their platform to strangers -whether they express themselves anonymously or not. Furthermore, when they are asked about such behavior, this question resonates as something that never came to their minds: "I think it's normal. It is a question I have never thought of. No, for me it is something entirely normal." (Breast cancer community patient)

Due to the few mentions about this factor, the lack and sometimes absence of reflection about it when questioned, and the ethical matters this issue can raise, we decided to drop this category from the results of this research.

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

  ).

			Table 20.2 Categorization and Leading Concepts -Restraining Forces
	Broad Nodes	Sub-Nodes	Definition
				"Negative (anticipated) emotions refer to failures in achieving a
			Negative	goal"
			Emotions
	Restraining Forces for
	Online	Collective
	Action
				"With asynchronous communication, participants in online groups
		UV*	Overcoming Isolation	have access 24 h a day, 7 days a week, at times most convenient to them" (White and Dorman 2001, p.694).The concept of overcoming isolation refers to the possibility for patients to get an in-demand
				response for interpersonal relationships.
				Group norms is the concept of people sharing norms concerning
		SV**	Group Norms	matters of common interest and participate in a system of interlocking roles, influencing each other, and pursuing common
				goals. (Tajfel 1982)
				"When social interactions in online communities help participants to
		UV*	Instrumental Needs	accomplish specific tasks, such as solving problems, validating a decision already reached or buying a product" (Grabner-Kräuter
				2010, p.509).
	*Utilitarian Value **Social Value ***Anticipated Positive Emotions

Table 21 .

 21 Categorization and Secondary Concepts

	Broad Nodes	Sub-Nodes	Definition
	Benefits Online Collective Action	of	Belongingness Speed and Strength Enlightened Patients Role in Healing	Patients, upon entering this virtual world, will feel immediately surrounded and supported Virtual communities offer patients valuable knowledge, so much so that they become experts Patients claim a positive role on their healing
			Habits	Virtual communities are addictive and affect a population who is imprisoned in idleness and pain.
	Background Factors		Females Disinhibition Information Control Patients wish the information gathered online to be moderated More than men, females have the tendency to confide in virtual communities
			Online Clinical Help	Patients wish the information gathered online to be moderated by
			Requirement	healthcare professionals

"

  Very few friends stay nearby when you are sick. And you do not want to bother them with your problems … So, yes, it's much easier to speak with someone who will understand and hear what you say because she experiences the same thing." (Breast cancer community patient) Finally, instrumental needs reflect the fact that, together, with the help of other patients' testimonies, a patient can get support for solving some issues s/he faces and make better decisions. Table 22 below illustrates the utilitarian values:

"When girls explain what happened to them even in the reconstruction process, they really know what they're talking about, almost as well as doctors and other medical professionals." (Breast cancer community's patient)

Table 22

 22 Categorization and Leading Concepts -Utilitarian Value This can be explained by the social environment surrounding collective action, even when performed online. Besides, this contributes to the very differentiation of virtual communities compared to social networks, proven not to be that socializing[START_REF] Ellison | Social network sites: Definition, history, and scholarship[END_REF] Grabner-Kräuter 2009).Belongingness needs conveys a very important motive for online collective action with the second highest number of references. This concept includes the search for similar experience and feedback among the community members due to the sharing of the same pathology's concerns: "We feel that people support each other. People are willing to help each other, even if we don't know each other well. All of this because we are bound by the same diseases." (Rare Disease Community patient' family member)

	Broad Nodes	Sub-Nodes	Illustration	Number of References
			"I was looking like so many other people who seek
		Information Needs	information to know whether what we had was survival, whether I was going to die within 5 years or serious or not serious, to know what was my 5-year	101
			not."*
			"The disease is a social handicap, I am a bit lonely…I
	Utilitarian		really think social networks are perfect. I express
	Value	Overcoming Isolation	there this "me-digital" which is different from "physical self". So you can keep the image you want	44
			on the net, either by being someone different or by
			being yourself."*
		Instrumental Needs	"And then we could ask them a question, no problem. to them and they often give me the answer."** If I have a problem where I can find no answer, I go	30
	* Quotes from interviews with breast cancer community patients

** Quotes from interviews with parents of autistic children To conclude, utilitarian value is an important driver for online collective action with information needs taking the lead over any other social or anticipated positive emotions. However, social value appeared to bring high incentives for collaborative action according to patients. 2.6.1.1.2 Social Value: Belongingness Needs, Group Norms and Exclusive Value Social values are also salient driving forces for online collective action among the research participants (see Table

16

.1).

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 120 All these concepts are recalled in table 23 and demonstrate the importance of social values and their identified sub-facets as motives for online action.

	Raphaëlle Laubie -December 21, 2017

Table 23

 23 Categorization and Leading Concepts -Social Value When it is more general, you can really get on very distant people concerning the disease. It is a little open to everyone. As a result, the information loses quality. While there, we know that we will inevitably fall on sharp people in the field, in the pathology, and it is very reassuring. So, we spend less time and we know that someone will answer us. We know that this person is concerned, is mostly concerned herself."**

	Broad Nodes	Sub-Nodes	Illustration	Number of References
				"Because it is reassuring. Because we can meet
		Belongingness	with other moms going through the same thing.
		Needs	(Social	Because you can ask questions that you would not	94
		Identity)		ask to your companion or to your doctor or even to
				your family, or even to your best friend."**
	Social Value	Exclusive Value	"61
		Group Norms	"I needed people who share my problems, my opinions, my values."**	31

* Quotes from interviews with breast cancer community patients ** Quotes from interviews with parents of autistic children 2.6.1.1.3 Anticipated Positive Emotions: Positive Emotions

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

121

Raphaëlle

Laubie -December 21, 2017

  When you see a successful experience, an operation that succeeded, where everything went well, when you feel that parents are pleased that the child did well. Either they post videos, photos or short phrases. Immediately you can feel it. It is palpable. It breathes. This communicates very quickly ... It's fabulous! This is extraordinary. It is magical to live, thousands of kilometers apart, people's emotions and power, at a given instant to be able to feel what they feel and how they share these emotions. I find it very powerful, really, very powerful."*

		Table 24 Categorization and Leading Concepts -Anticipated Positive
			Emotions
	Broad Nodes	Sub-Nodes Illustration	Number of References
	Anticipated Positive Emotions	Positive Emotions	"Positive emotions! 61
	* Quotes from interviews with breast cancer community patients
	2.6.1.2 Restraining forces for Online Collective Action
	The auspicious picture of patients' virtual communities may end with the many negative
	aspects unearthed by further testimonies highlighting restraining forces for online
	collective action.
	2.6.1.2.1 Cost Value: Negative Emotions, Inaccurate Medical Information,
	Privacy Protection

Table 25

 25 Categorization and Leading Concepts -Cost Value

	Broad Nodes	Sub-Nodes	Illustration	Number of References
		Negative Emotions		46
			"I think the problem with these social networks
			is… this sense of security among quotes, but that
	Cost Value	Privacy Protection	is not real. And so, people drop out, confide very they reveal a little too much I'd say. Especially, easily without really measuring the risks. Yes,	33
			that information can be kept, operated, tested,
			sorted and segmented. So..."**
			"And so it is extremely dangerous, I see when
			girls exchange information. They found, for
			example, a new reconstruction technique etc..,
			And when I got interested in information I
		Inaccurate	realized that the reconstruction technique has not
		Medical	been validated, or works in the U.S. but not in	30
		Information	France ... but the other girls will say that there is a
			super reconstruction technique and that it is
			imperative for them to find the doctor for that,
			etc.. You see? So I think this kind of invalidated
			information can be dangerous, yes of course..."**
	* Quotes from interviews with breast cancer community patients
	** Quotes from interviews with parents of autistic children

"Ah, negative emotions... It's about anxiety when you compare yourself to people who are in a worse position than you, who are even more afraid than you and who announce their bad news. I mean the person who will have a check-up and comes with a diagnosis of metastases. You take it in the chin because it is your fear that comes back too ... So yes, I've already had those damn negative emotions, yes."*

Table 26

 26 Categorization and Secondary Concepts -Benefits of Online Collective Action Immediately, when you approach it, you are taken under the wing of the other patients. And me, I was especially pleased ... I'm not very good, I'm not someone who goes on Facebook and all that. So I like things easy, I'm a little disinterested in the technology…So my first reaction has been to say: oops, it works and it works very quickly… And the fact that they replied very quickly, it was also very nice and I immediately felt the support."*

	Broad Nodes	Sub-Nodes	Illustration	Number of References
		Belongingness Speed and Strength	"18
	Benefits of
	Online
	Collective Action		"Yes because like us, she has a disability, she has a rare disease. Practitioners frequently tell me that,
		Enlightened Patients	sincerely, they do not know enough about this	13
			disease. And they also say that they do not have all
			the knowledge parents show themselves…"**
			"I am convinced that sharing positive emotions
		Role in Healing	helps heal ... Here, there is not a direct exchange …I	12
			think it really helps with the healing."*
	* Quotes from interviews with breast cancer community patients
	** Quotes from interviews with parents of autistic children
	2.6.2.2 Background Factors
	Following the benefits found in patients' collaborative work, they expressed background
	factors that should be taken into account while using virtual spaces. Among them,
	addiction or automatic behavior driving to patients' online connection -see the
	aforementioned concept of habits -was the most cited of online collective action

"In difficult times, I think I was in auto mode connection. The first thing I did in the morning, on waking, was to log on to the forum, and after I took my breakfast and I accompanied my children to school ... In the evening, I spent another 2 or 3 hours ... Yes, it was an automatic reflex." (Breast cancer community patient) 2.6.2.2.2 Females Disinhibition

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 129 All these background factors, open virtual space excluded as explained above, are summarized in table 27.

	Raphaëlle Laubie -December 21, 2017

Table 27

 27 Categorization and Secondary Concepts -Background Factors

	Broad Nodes	Sub-Nodes	Illustration	Number of References
				"There is a risk of addiction, yes indeed. There is a
		Habits		risk of addiction to the extent that it is true that I do	29
				not spend a day without connecting there."*
				"There are women really there talking about their
				womb, their breasts. There are plenty of breasts,
		Females Disinhibition		there are many wombs. And also printed somewhere was that she found her femininity, you	26
	Background			know? These are beautiful exchanges. This is
	Factors			because they are women, mainly."**
				"This self-moderates, although moderation is
		Information Control	required on these sites, it is unthinkable to leave	18
				women without safeguards."**
		Online	Clinical
		Advice Requirement

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 130

	Raphaëlle Laubie -December 21, 2017

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 131

	Raphaëlle Laubie -December 21, 2017

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 134

	Raphaëlle Laubie -December 21, 2017

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

	Task Values
						Past
	Trust	H7-			Behavior
	H4+				H1+
	Social Values		H3+	Intentional	H2+	Online
		Desires	Collective	Collective
	H5+			Action		Action
	Utilitarian
	Values
		H6+	H6-
	Anticipated	Anticipated
	Positive Emotions	Negative Emotions	Anticipated Emotions
	Expectancy Values
			Figure 4. Research Model

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

	Raphaëlle Laubie -December 21, 2017

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

	Raphaëlle Laubie -December 21, 2017

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

	influence the beliefs people hold, such as: age, gender, ethnicity, socio-economic status,
	education, nationality, religious affiliation, personality, mood, emotion, general attitudes
	and values, intelligence, group membership, past experiences, exposure to information,
	social support, coping skills, and so forth" (Ajzen 2005, p.134) influence individual
	beliefs. In particular, he has distinguished personal, social and informational factors.
	Raphaëlle Laubie -December 21, 2017

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

	Raphaëlle Laubie -December 21, 2017

  Table 31.1 Social values as the determinants of desires and online collective action

	Relevant Facet	Definition	Illustration*	Author
			"Sharing a common
			vision is often verified at
		Group norms is the concept of	the very
		people sharing norms concerning	beginning. When we
		matters of common interest and	browse on a
	Group Norms	participate in a system of interlocking roles, influencing	forum, we quickly realize that we share the	(Tajfel 1982)
		each other, and pursuing	same vision. You decide
		common goals. (Tajfel 1982)	to leave because of
			conflicts about
			the purpose of
			the forum."
		"The belongingness hypothesis is	"Well, during my
		that human beings have a	disease, although I was
		pervasive drive to form and	well surrounded by my
		maintain at least a minimum	family, I needed
		quantity of lasting, positive, and	something else. I needed
		significant interpersonal	to talk to people, women	(Baumeister
		relationships." (Baumeister and	sharing the same	and Leary
	Affective	Leary 1995, p.497)	disease."	1995;
	Social	"In an emotional sense, social		Dholakia et al.
	Identity	identity implies a sense of		2004;Massimo
	Social Value	emotional involvement with the characterized as attachment or group, which researchers have		Bergami and Bagozzi 2000)
		affective commitment."
		(Dholakia et al. 2004,
		p.245;(Massimo Bergami and
		Bagozzi 2000)

  .

	Table 31.4 Trust as the determinants of desires and online collective action
	Relevant Facet	Definition	Illustration*	Author
		"On the Internet, individuals may
		trust others to provide honest and
		accurate information"
	Inaccurate
	Medical
	Information
	Trust
			"Emotions are present,	(Perugini
			regularly. In fact, when	and
			I'm in low spirits, I'm	Bagozzi
			going on the network and	2001;
			it goes away."	(Dholakia
				et al. 2004;
				Bagozzi et
				al. 1998;
				Tsai and
				Bagozzi
				2014)
	Negative Anticipated Emotions	"Negative (anticipated) emotions refer to failures in achieving a goal" (Perugini and Bagozzi 2001, p.83). In online communities' contextual background, it can refer to stress and anxiety through interacting with other patients.	"When a person does his check-up and returns with a negative diagnosis, then you get a punch in your stomach because your fear is coming back and spreading…"	(Perugini and Bagozzi 2001; Bagozzi et al. 1998; Tsai and Bagozzi 2014)
	* Quotes from interviews with Breast Cancer Community's patients

Table 31

 31

		.5 Online Collective Action
	Relevant Facet	Definition	Illustration*	Author

Table 35

 35

					. Discriminant Validity and Reliability
	Variables CR CA	1	2	3	4	5	6	7	8	9	10
	(1) ASI	0.908 0.797 0.911
	(2) CSI	0.910 0.804 0.639 0.914
	(3) D	0.961 0.939 0.463 0.453 0.944
	(4) ESI	0.947 0.888 0.462 0.413 0.670 0.948
	(5) H	0.937 0.899 0.365 0.452 0.626 0.704 0.912
	(6) IMI	0.944 0.886 -0.198 -0.242 -0.295 -0.293 -0.407 0.946
	(7) InfN	1	1 0.315 0.317 0.264 0.148 0.228 -0.212	1
	(8) InsN	0.925 0.837 0.399 0.445 0.410 0.304 0.328 -0.305 0.709 0.927
	(9) IR	0.905 0.792 0.410 0.511	0.68 0.599 0.587 -0.286 0.422 0.563 0.909
	(10) PC

Table 36

 36

				. Transformation Matrix Components
	Component	1	2	3	4	5	6	7	8	9	10
	1	.500	-.301	.360	.396	-.240	.340	.288	.246	.189	.144
	2	.108	.723	.468	-.166	.222	-.032	.223	.268	.117	-.184
	3	.452	.320	-.586	.263	.408	.317	-.093	-.035	-.027	.051
	4	-.186	-.342	-.245	-.122	.385	-.027	.439	.620	-.147	-.162
	5	-.007	-.327	.379	-.026	.744	.021	-.188	-.266	.261	.144
	6	-.561	.213	.012	.631	.085	.016	.363	-.159	.001	.276
	7	-.224	.014	.275	.173	.045	.474	-.481	.249	-.553	-.137
	8	.285	-.073	.110	.469	.106	-.645	-.065	-.043	-.330	-.374
	9	-.228	-.012	-.127	.281	-.072	.021	-.348	.257	.664	-.469
	10	-.028	-.093	.020	-.059	.003	.376	.378	-.507	-.069	-.664
	Extraction Method: Principal component analysis.
	Rotation Method: Varimax with Kaiser Normalization

Table 37 .

 37 Path Coefficients

	Link	Hypothesis (Validation)	Original Sample	Sample Mean	Standard Deviation	Standard Error	t-Statistics
	Affective Social Identity ->
	Desires	H4a (No)	0.083	0.083	0.067	0.067	1.249
	Age -> Online Collective
	Action	-	0.117	0.094	0.068	0.068	1.736
	Cognitive Social Identity ->			-
	Desires	H4b (No)	-0.031	0.036	0.078	0.078	0.391
	Desires -> Intentional
	Collective Action	H3 (Yes)	0.632*	0.577	0.282	0.282	2.246
	Education -> Online Collective			-
	Action	-	-0.034	0.029	0.035	0.035	0.962
	Evaluative Social Identity ->
	Desires	H4c (Yes)	0.245*** 0.232	0.072	0.072	3.382
	Gender -> Online Collective			-
	Action	-	0.000	0.000	0.024	0.024	0.002
	Group Norms -> Desires	H4d (Yes)	0.194** 0.201	0.074	0.074	2.634
	Habits -> Online Collective
	Action	H1a (No)	0.028	0.010	0.059	0.059	0.476
	IT Experience -> Online			-
	Collective Action	-	-0.047	0.040	0.052	0.052	0.910
	Inaccurate Medical Information			-
	-> Desires	H7a (No)	-0.022	0.017	0.050	0.050	0.445
	Information Needs -> Desires	H5b(No)	-0.040	-0.039	0.075	0.075	0.540
	Instrumental Needs -> Desires	H5c (No)	0.024	0.025	0.098	0.098	0.240
	Intentional Collective Action ->
	Online Collective Action	H2 (Yes)	0.717*** 0.710	0.071	0.071	10.085
	Isolation Rupture -> Desires	H5a (Yes)	0.333** 0.319	0.083	0.08	4.014
	Anticipated Negative Emotions
	-> Desires	H6b (No)	0.055	0.075	0.050	0.050	1.087
	Anticipated Positive Emotion -
	> Desires	H6a (Yes)	0.122*	0.139	0.061	0.061	1.992
	Privacy Concerns -> Desires	H7b (No)	0.013	0.008	0.053	0.05	0.238
	Use Frequency -> Online
	Collective Action	H1b (Yes)	0.168*	0.200	0.077	0.077	2.182

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

	Trust	Past Behavior
	Social Values
		Individual
		Differences
	Utilitarian Values	Anticipated Emotions
	Figure 5. Parameter Estimates for the Structural Model

  are probably not the most relevant for investigating online collective action in the context of health-related virtual communities. In fact, being meaningful for other virtual communities actors is sometimes more important than any economic reward. The

	Affective Social Identity		Inaccurate Information Medical	Concerns Privacy		Habits	Age
	Cognitive	0.083	-0.022		0.013			0.028
	Social						Use
	Identity						Frequency	Gender
								0.117
		-0.031
	Evaluative Social Identity						0.168	0.000	Education
		0.245
	Norms Group			Desires	0.632	Action Intentional Collective	0.717	Action Online Collective	-0.034
		0.194						Internet
								-0.047	Experience
		0.333	-0.040	0.024	0.122		0.055
	Isolation Rupture	Information Needs	Instrumental Needs	Anticipated Positive Emotions	Anticipated Negative Emotions

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	Raphaëlle Laubie -December 21, 2017

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	208	Raphaëlle Laubie -December 21,
	2017

Table 39

 39

			.1 Gift Concepts as an Utilitarian Value
	Dimension	Area	Definition	Author
			"If one gives things and returns them, it is because one is
			giving and returning 'respects'-we still say 'courtesies'.
		Sociology	Yet it is also because by giving one is giving oneself, and if	(Mauss 1922)
			one gives oneself, it is because one 'owes' oneself-one's
			person and one's goods-to others. " (Mauss 1922, p.59)
			Malinowski (2010) emphasized the reciprocity of
		Anthropology	exchanges as the demonstration of gratitude between individuals. Gratitude ensures the duration and stability of the trade and its repetition secures the implication of both	(Malinowski 2010)
			parts.
			"Gift exchange is an exchange of inalienable objects
		Sociology	between people who are in a state of reciprocal dependence that establishes a qualitative relationship between the transactors"	(Gregory 1982)
			(Gregory 1982, p.16)
	Utilitarian		In Bataille's theory of consumption, the accursed share is
	Value	Anthropology	that excessive and non-recoverable part of the economy which highlights the willingness to create a link, to	(Bataille 1967)
			sacrifice something to manifest the desire to create this
			link.
		Sociology	Free gift doesn't exist and altruistic behavior in gift-giving is a missing characteristic. Reciprocal behavior is a core incentive of the gift-giving experience.	(Godbout and Caillé 1992)
			The gift is nothing but a strategic means to achieve goals in
		Sociology	the corporate environment. Altruistic behaviors or free gifts don't exist; however, they can be reduced to strict	(Alter 2010)
			market logic.

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

	222	Raphaëlle Laubie -December 21, 2017

Table 42

 42

			. Interviews
	Interviewees	#	Purpose
	Doctors and caregivers	5	To increase our understanding of the feelings and concerns of the patient population from a medical standpoint.
			To increase our understanding of the patient population's
	Health 2.0 experts	13	activities when joining Health 2.0 IT from a medical and
			technological standpoint.
			To increase our understanding of an individual's activity
	Web 2.0 experts	7	when joining online communities. To establish contrasts between health communities and more traditional
			communities.
	Patients	21	To contextualize the individual and social activities when joining virtual communities from a patient standpoint.
	Patients' relatives	8	To find the individual and social activities when joining virtual communities from the standpoint of patients' relatives.
	Total	54

Table 44 .

 44 Interview Guide in Patients and Patients' Relatives SDCI

	Questions	Value's Dimension Addressed
	Do you feel the need to be informed or
	inform others on your disease?
	What (other than information) would you	Giving-Help (Other-Orientation/Bonding
	seek or give on an online medical portal?	Value/Generalized Reciprocity) and specificities
	Would you say special relations are	of those dimensions
	developed with other patients
	participating?

Table 47 .

 47 Categorization of Gift-giving Behaviors in the Context of Online Collective Action

	Broad Nodes	Broad Nodes	Illustration	Number of

Table 46 ,

 46 47).

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 245 Raphaëlle Laubie -December 21, 2017

Table 50 .

 50 Contributions for Theory and Practice Theory x The study helps to create a richer social media adoption model for health purposes that can also be tested in its generic form to other shared interests' communities. x We demonstrate the relevance of combining MGB and EVT for developing this model for patients' communities in order to better examine the determinants of patients' online collective action. x The qualitative approach allowed us to provide a deep understanding of the context of our research and the quantitative approach enabled us to build theories that can be confronted in other fields of inquiry. x We confirm the field's findings about desires being a determinant of intentional collective action, itself a determinant of online collective action.

  The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 256 Raphaëlle Laubie -December 21, 2017

Table 43 .

 43 Interview Guide in Preliminary SDCI Questions Objectives Is there an existing patient typology for a focus group whether they gather online or offline?

Table 44 .

 44 Interview Guide in Patients and Patients' Relatives SDCI Questions Value's Dimension Addressed Do you feel the need to be informed or inform others on your disease? Giving-Help (Other-Orientation/Bonding Value/Generalized Reciprocity) and specificities of those dimensions What (other than information) would you seek or give on an online medical portal? Would you say special relations are developed with other patients participating? Do you feel the need to be connected to other online patients? How do you feel when you're connected to people living the same pathologies? Do you feel pleasure while connected to these participants? Do you think you're helping people or being helped while connected? 6.2 Questionnaire The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach 263 Raphaëlle Laubie -December 21, 2017 6.2.1 The Determinants of Online Collective Action in Patients' Virtual Communities: the Contribution of Social, Utilitarian and Emotional Influences in an Extended Model of Goal-Directed Behavior 6.2.1.1 Informed Consent Form Introduction Thank you for answering the questions on this questionnaire. Please do not sign this

  6.2.1.3 Questions about the ResearchIf you have questions regarding this study, you may contact Raphaëlle Laubie, at rlaubiester@gmail.com 6.2.1.4 QuestionnaireThe Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Q 4.1 How often do you use your online group for satisfying the following needs? Please answer the following questions about yourself. Please rate the degree to which each statement is characteristic or true of you. How many times in the past two weeks did you interact together on the Internet with the group? Q 17.2 How many hours do you spend on average when you interact together on the Internet with the group? Q 17.3 How many times did you interact together on the Internet with the group you identified above in a typical two week period over the past 6 months?

	Never (1) Neither (4) (2) (3) Neither (4) Q 15.1 Strongly to get information (Information Needs) (1) to gain insight into myself (Information Needs) (2) to learn how to do things (Instrumental Needs) (3) to solve problems (Instrumental Needs) (4) to provide others with information (Giving Help) (5) to contribute to a pool of information (Giving-Help) (6) to get to know others (Isolation Rupture) (7) to feel less lonely (Isolation Rupture) (8) Extremely unlikely (1) (2) (3) (1) Extremely harmful (1) (2) (3) (1) disagree (1) (2) (3) I like helping people by providing them with information about medicine (1) My friends think of me as a good source of information when it comes to medicine (2) I like helping people by providing them with information about how I live my disease, my treatment, its side effects (3) Q 15.2 Extremely uncharacteristic (1) (2) (3) It takes me time to overcome my shyness in new situations (1) I have trouble working when someone is watching me (2) I get embarrassed very easily (3) I don't find it hard to talk to strangers (4) I feel anxious when I speak in front of a group (5) Large groups make me nervous (6) Q 16 Do you know your tumor grade? If, so, please, could you indicate it : Sometimes (4) (5) (5) (6) (5) (6) Neither (4) (5) (6) confidential (5) Neither (4) (5) (6) (1) Q 17.1 Q 18 Please indicate your age: Q 19 Please indicate your gender: Male (1) Female (2) Q 20 Please indicate your nationality: Q 21 Please indicate your level of education: Self-educated (1) CAP (2) BEP (3) BAC (4) BAC+1 (5) BAC+2 (6) BAC+3 (7) BAC+4 (8) BAC+5 (6) Always (7) Extremely likely (7) Extremely beneficial (7) Strongly agree (7) concerned (6) Extremely characteristic (7) (9) More than BAC+5 (10) 6.3.1 Teaching Experience, Corporate Experience and Education (1) 6.3 Researcher Profile I am fortunate to work in the health sector since 2006.
	1 (1)	2 (2)	3 (3)	Unknown (4)	keep it	not

Table 51 .

 51 Researcher Profile -Teaching Experience

	Institutions	Period	Position Held	Expertise
	La Sorbonne University	Since 2015	Corporate Lecturer	Entrepreneurship
	Dauphine University	Since 2012	Corporate Lecturer	Web 2.0, Open Innovation, Social Media
	EM Lyon	Since 2011	Corporate Lecturer	Web 2.0, Open Innovation, Social Media
	ESCP Europe	Since 2011 2009 -2011	Affiliate Professor Corporate Lecturer	Web 2.0, Open Innovation, Social Media, Health 2.0 Web 2.0, Open Innovation, Social Media

Table 54 .

 54 Researcher Profile -Presentations and Publications in Conferences with Peers Reviews

	Institutions	Period
	Conferences -Journal

RaphaëlleLaubie -December 21, 2017

Raphaëlle Laubie -December 21,

RaphaëlleLaubie -December 21, 2017 The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

Laubie, R., Elie-Dit-Cosaque, C. (2016). Conceptualizing and Predicting Online Collective Action in Patients' Virtual Communities: the Influences of Utilitarian Values, Social Values and Anticipated Emotions" (AIM

2016), IESEG, Lille, France, May 15,

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

Laubie, R., Elie-Dit-Cosaque, C. (2012). Exploring and Predicting Online Collective Action on Patients' Virtual Communities: a Multi-method Investigation in France. Research (ICIS 2012), Orlando, Florida, USA, December16-19, 2012.

[START_REF] Laubie | Conceptualizing and Predicting Online Collective Action in Patients' Virtual Communities: the Influences of Utilitarian Values, Social Values and Anticipated Emotions[END_REF]. Expectancy Values and Gift-Giving Influences on Patients' Online Collective Action.(OCIS 2015), Vancouver for McGill University, Canada, August 7, 2015.

Raphaëlle Laubie -December 21, 2017

Acknowledgements ''There is no unique picture of reality.'' -Stephen Hawking J'espère pouvoir inspirer par ce travail autant que les personnes rencontrées durant ces années de thèse m'ont inspirée. Ces années de recherche ont certainement beaucoup modifié ma façon de penser et d'appréhender la nature des choses. Des amitiés sincères sont nées, des liens forts ont été noués. J'aimerais remercier tout particulièrement : 1 -INTRODUCTION The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

Data analyses were performed via a Partial Least Squares Structural Equation Modeling (PLS-SEM) software, SmartPLS [START_REF] Ringle | Smart PLS 2.0 M3[END_REF] Ringle et al. 2012). The PLS algorithm is particularly appropriate for our model as it involves both reflective and

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach

Raphaëlle Laubie -December 21, 2017 Table 9 The Driving Forces of Online Collective Action

Broad Nodes

Sub-Nodes References Driving Forces for Online Collective Action UV Information Needs [START_REF] Flanagin | Internet use in the contemporary media environment[END_REF] SV Belongingness Needs (Social Identity) [START_REF] Baumeister | The need to belong: Desire for interpersonal attachments as a fundamental human motivation[END_REF] SV Exclusive Value [START_REF] Baumeister | The need to belong: Desire for interpersonal attachments as a fundamental human motivation[END_REF] HV Positive Emotions [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF][START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] UV Overcoming Isolation (White & Dorman, 2001) SV Group Norms . (Tajfel, 1982) UV Instrumental Needs (Grabner-Kräuter, 2010)

Restraining Forces for Online Collective Action

Negative Emotions [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF] Privacy Protection [START_REF] Green | Trust and social interaction on the Internet[END_REF][START_REF] Goldberg | Privacy-enhancing technologies for the Internet[END_REF][START_REF] Graber | Reading level of privacy policies on Internet health Web sites[END_REF]) Inaccurate Medical Information [START_REF] Green | Trust and social interaction on the Internet[END_REF]Williams et al., 2003) UV = Utilitarian Value, SV = Social Value, HV = Anticipated Positive Emotions

Model Formulation and Propositions

Following Lewin (1947) and [START_REF] Eccles | Expectancies values and academic behaviors[END_REF] theories, we have built on a first draft model of driving and restraining forces of online collective action (See Figure 1), influenced by the [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF] work in an online context, itself inspired by MGB [START_REF] Perugini | The role of desires and anticipated emotions in goaldirected behaviours: broadening and deepening the theory of planned behaviour[END_REF]. Although this model does not respond to the complete understanding of online collective action phenomenon in Health 2.0 environments, it values a synthetic framework of this construct and its field forces. Indeed, none of these models thoroughly covered all aspects of what would drive patients to join online virtual communities and participate in communal work. In order to ensure a more comprehensive perspective of the patients' online collective action phenomenon, this research seeks clarification and further information from both literature and field.

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017 pairing a goal and an action (Verplanken and Orbell 2003). Habits have been defined as " the tendency to repeat past behavior in a stable context" (Ajzen 2002, p. 108;[START_REF] Ouellette | Habit and intention in everyday life: The multiple processes by which past behavior predicts[END_REF]. Thus, even when dealing with IT use, habits refer to habitual behaviors rather than to behaviors guided by intentions [START_REF] Limayem | Force of Habit and Information Systems Usage: Theory and Initial Validation[END_REF]Kim and Malhotra 2005). Some researchers found that habits have a significant effect on IT use that is "triggered by environmental cues" (Ortiz de Guinea and Markus 2009, p.440). Aarts and Djiksterhuis (2000) have further asserted that habits can be considered as links between goals and actions, activated by the environment; it contributes to the reaching of these goals through automatic behavior. Therefore, the more often the activation of a goal leads to the same behavior, the stronger the unconscious processes (Aaarts and Dijksterhuis 2000; [START_REF] Heckhausen | Intentional Action and Action Slips[END_REF][START_REF] Reason | Human Error[END_REF]).

Hypothesis 1a: Habits are positively related to online collective action regarding virtual patients' communities.

In this research, we are interested in IT-directed behavior [START_REF] Ahuja | Moving beyong intentions and toward the theory of trying: effects of work environment and genderon post-adoption information technology use[END_REF] as automatic goal-directed responses to specific cues. These responses result from a mental representation of the instrumental goal-action link in reaching the goal (Verplanken and Orbell 2003). Concerning virtual communities, in addition to habits, we expect that the repeated connection of the patient -namely, use frequency -will lead to a certain level of Internet addiction with the Internet usage performed in a social way by active users [START_REF] Emmanouilides | Internet usage: Predictors of active users and frequency of use[END_REF], implying an extensive level of virtual communities' interaction [START_REF] Beard | Modification in the proposed diagnostic criteria for Internet addiction[END_REF]Young 2004), and thereby of online collective action because of one's customary way of behaving. Therefore:

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach Raphaëlle Laubie -December 21, 2017 characterized by the evaluation of self-worth as a member of the group [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF]).

Hypothesis 4a: Affective social identity is positively related to desires regarding the participation in virtual patients' communities.

Hypothesis 4b: Cognitive social identity is positively related to desires regarding the participation in virtual patients' communities.

Hypothesis 4c: Evaluative social identity is positively related to desires regarding the participation in virtual patients' communities.

3.2.1.5.2 Utilitarian Values [START_REF] Deci | Intrinsic motivation and self-determination in human behavior[END_REF], highlighted the extrinsic motivation concept, which refers to doing something because it leads to a separable outcome and where extrinsic motivation is similar to the utilitarian benefit that leads to utilitarian value [START_REF] Chiu | Understanding customers' repeat purchase intentions in B2C e-commerce: the roles of utilitarian value, hedonic value and perceived risk[END_REF].

Indeed, utilitarian values are "determined by how well a task relates to current and future goal" (Eccles and Wigfield 2002, p.120). In the context of virtual communities, utilitarian values are likely to foster desires regarding online patients' communities use. Indeed, the individual sees such websites as a means through which he/she can reach his/her social goal. These values have been referred to as thinking dimensions (Sweeney and Soutar 2001) or confirmed as utilitarian values (Grabner-Kräuter 2010). These utilitarian values -purposive, namely instrumental and informational needs values were also studied by [START_REF] Dholakia | A social influence model of consumer participation in network-and small-group-based virtual communities[END_REF], have been adapted from the MGB, and help to create the link between the MGB and EVT. Following this, utilitarian values are likely to foster desires. Indeed, patients will use websites because they view them as providing

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach the interviews themselves. Specifically, we identified and coded, for the most frequent occurrences in the interviews, isolation rupture (White and Dorman 2001), inaccurate medical information [START_REF] Green | Trust and social interaction on the Internet[END_REF]Williams et al. 2003;[START_REF] Diaz | Patients' use of the Internet for medical information[END_REF][START_REF] Dickerson | Therapeutic connection: help seeking on the Internet for persons with implantable cardioverter defibrillators[END_REF], and privacy concerns [START_REF] Green | Trust and social interaction on the Internet[END_REF][START_REF] Goldberg | Privacy-enhancing technologies for the Internet[END_REF][START_REF] Graber | Reading level of privacy policies on Internet health Web sites[END_REF]. This process was repeated three times in order to reach theoretical saturation and ensure the nodes' relevance. Recurrent interactions between the two authors of the paper also ensured the accuracy of the coding process. Tables 31.1 , 31.2, 31.3, 31.4 and 31.5 below detail the different facets of the constructs that we have identified according to both this process and the literature.

Relationships between trust and desires

Unexpectedly, the links inaccurate medical information AE desires (β = -0.022, n.s.), privacy concerns AE desires (β = 0.013, n.s.) were not significant, which invalidated H7a and H7b. These results are summarized in Table 38 andFigure 5. Besides these behaviors, one should be cautious opposing the anti-utilitarian viewshighlighting the rationales of personal relations and altruistic behavior for gift-givingand the utilitarian views -highlight the rationales of the market, i.e. profit, trade, and exchange for gift giving - [START_REF] Chakrabarti | Gift giving and social emotions: experience as content[END_REF], that sometimes refer to pure gift or free gift [START_REF] Laidlaw | A free gift makes no friends[END_REF] and that embed implicit conditions that can rarely be explained or met.

Therefore and regarding the virtual context, specifically in health-related communities, studies examining the role of gift in order to understand the functioning of virtual communities, ought to dedicate a close attention to the social dimension of gift-giving behaviors in which "gift giving on the internet gets its social meaning" (Bergquist and Ljungberg 2001, p. 314).

Patients' Online Gift-Giving Experiences' Framework

The most cited and core values as applied to online patients are emotional [START_REF] Ruffle | Gift giving with emotions[END_REF][START_REF] Komter | Gifts and social relations: The Mechanisms of Reciprocity[END_REF], social [START_REF] Berking | Sociology of Giving[END_REF]) and utilitarian ones (Gérard-Varet and Kolm;

(Skageby 2010). Besides, the three main characteristics of the gift concepts highlighted in the literature, i.e.: i) other-orientation, i.e. helping others in order to enhance their well-being without hidden agenda, ii) bonding value, i.e. developing social relationships, and iii) generalized reciprocity, when the exchange of goods or services create mutual (Skageby 2010). We can therefore associate what has been observed in the field and demonstrated in the literature. To do so, we can link : i) emotional value with otherorientation concept, ii) social value with bonding value and iii) utilitarian value with generalized reciprocity concept (See Table 40).

Research Design and Methods

This research is focused on two objectives, so better understanding : i) the characteristics of gift-giving behaviors in the context of online collective action in virtual communities and ii) the patients' gift-giving behaviors in the context of online collective action in patients' virtual communities.

In order to reach our research objectives and to identify the most relevant characteristics of gift-giving behaviors in patients' virtual communities, an ethnographic, qualitative In order to get a more holistic view about how and why patients interact on online communities, we investigated the values as well as these online gift-giving behaviors' specificities among patients gathered on virtual communities.

Data Coding and Analysis

The thematic coding and data mapping [START_REF] Bazeley | Qualitative data analysis with NVivo[END_REF] was performed with the qualitative data analysis software NVIVO (software version 9 and 10). Using software for coding interviews indeed allows avoiding some of the limitations of manual techniques as:

"proponents of CAQDAS argue that it serves to facilitate an accurate and transparent data analysis process whilst also providing a quick and simple way of The NVIVO software helped us for the thematic coding and data mapping, allowing us to add new categories emerging from the field and the literature during the whole process which was repeated three times before reaching semantic saturation.

Based on the literature inputs (See Overall, we adopted an incremental approach to data gathering, consistent with the critical realist paradigm (Zachariadis et al. 2010;[START_REF] Mingers | The contribution of critical realism as an underpinning philosophy for OR/MS and systems[END_REF]. In an iterative back and forth process between the research field and literature, we were attentive to any new categories that could emerge from interviewees' testimonies. We expected to add any

The Determinants of Online Collective Action in Patients' Virtual Communities: a Multimethod Approach new themes and concepts emerging from the field as well as specific designations of these themes and concepts. This process resulted in a second version of the dictionary of themes. After the entire coding process and through interview analysis [START_REF] Bhaskar | The Possibilities of Naturalism[END_REF]) the 3 categories for giftgiving behaviors in the context of online collective action were left unchanged. Indeed, SDCI interviews didn't lead to emergent categories with an acceptable occurrence rate to create new ones.

This new dictionary was obtained after we added only the contextual designation for the 3 categories for gift-giving behaviors in the context of online collective action (See Table 46 below). It therefore comprises 3 specific themes -namely: i) emotional support as specificity of generic theme giving-help (other-orientation/emotional value), ii) giving help about practical advices for coping with day-to-day health situation as specificity of generic theme giving-help (bonding value/social value), iii) giving-help about general information (medical or miscellaneous/utilitarian value) as specificity of generic theme giving-help (generalized reciprocity). Emotional Support "so much support", "seeking consolation", feelings", "state of fragility", "find keen listeners", ' I gave consolation", "you become the one who helps" 49

Giving-Help (Bonding Value)

About practical advices for coping with day-to-day health situations "being in a community of patients sharing the same disease", "share", "help to better live it", "good advices", "communicate on specific information"

35

Giving-Help (Generalized

About General Information

"We asked each other's about health topics", general information", "we talk about everything", The testimonies also confirmed that these three dimensions refer to the emotional value (other-orientation), social value (bonding value) and utilitarian value (generalized reciprocity) of online gift-giving behaviors.

First, the community members of patients' virtual communities are inclined to support each other through the ups and downs of disease's hardship. It refers to the otherorientation behavior highlighting emotional value to these gift-giving behaviors.

The community members know they will be able to find the support they need online: "Although my family is there for me, when I'm down, when I seek support, the only suitable option is to reach the girls online. It's so powerful to lighten the burden of my doubts and heal my pains" (Breast cancer community patient) They know they will be understood by other community members sharing the same concerns: To identify a patient panel to address for the study Are there patients' networks that are more suitable for some patients than other To identify a patient's panel that would not be relevant for the study What would be the patients' motives for online engagement?

To compare the feedback of experts about determinants for patients' online engagement against the literature What would be some hindrances to engagement?

To compare the feedback of experts about hindrances to patients' online engagement against the literature What about privacy and data protection?

To compare the feedback of experts about hindrances for patients' online engagement against the literature Do you think these portals help patients during the healing process?

To compare the feedback of experts about positive psychology and patients' online engagement against the literature Imagine that you are logging on to the Internet to engage in the group interaction.

Visualize the average participants of your online group. Then write your first name (or pseudo) and a description of each participant that you think of in the table below. You may include up to, but not necessarily, five participants that come to mind.

Names or pseudos

My name or pseudo:_______________________________ Participant 1's name or pseudo:_______________________ Participant 2's name or pseudo: _______________________ Participant 3's name or pseudo: _______________________ Participant 4's name or pseudo: _______________________ Participant 5's name or pseudo: _______________________ Several of the following questions will refer to this group above described.

1.1.1. How strong would you say the explicit or implicit agreement is among each of the following to interact with on the internet as a group:

to learn about myself and others (9)

to play (10) to generate ideas (11) to impress people ( 12)

to be entertained (13) to relax ( 14)

to make decisions (15)

to pass the time away when bored ( 16)

to feel important (17)

Q 5.1 "The patients' virtual communities web site is attractive"

(2) (3) Moderately (4)

(5) (6) Very much (7)

(1) Relief ( 1)

Contentment

(2)

Happy ( 5) Glad ( 6) Satisfied ( 7)

Q 8.1 "Patients' virtual communities web site provides inaccurate medical information"

Not at all (1)

(2) (3) Moderately (4)

(5) (6) Very much (7)

(1) Q 8.2 "There are many errors in the medical information I obtain from the patients' virtualcommunities web site"

(5) (6) Very much (7)

(1) Q 9 9. Angry ( 1) Frustrated ( 2)

Ashamed ( 4) Sad ( 5) Disappointed ( 6) Depressed ( 7)

Worried ( 8)

Uncomfortable ( 9) Anxious ( 10) Agitated ( 11)

Nervous ( 12)