Value creation and destruction in telehealth services: the role of technology affordances

Purpose This study examines the role of customer-focused technology affordances in value creation and destruction throughout the patient journey in telehealth services. Using the DART-E framework and affordance theory, the research identifies key technology affordances, including connectivity, personalization, exploration, visibility and evaluative affordances and investigates their impact on service co-creation. By analyzing user-generated content, this study provides insights into how these affordances shape the customer experience in telehealth, contributing to a more patient-centric healthcare approach and addressing gaps in existing service research by considering both value creation and value destruction simultaneously. Design/methodology/approach The study employs sentiment analysis on customer reviews and tweets from X (formerly Twitter), Trustpilot, Whitecoat and RateMDs. A total of 11,757 tweets and 10,922 online reviews were collected, categorized and analyzed to assess sentiment polarity as a proxy for value creation and destruction. The study applies an ensemble sentiment analysis method using TextBlob, Vader and BERT Sentiment to enhance classification accuracy. Qualitative content was further analyzed using template analysis, identifying key technology affordances and their influence on service co-creation across pre-consultation, in-consultation and post-consultation stages. Findings The results indicate that technology affordances shape value co-creation and destruction at different stages of the patient journey. Connectivity, personalization and exploration affordances significantly impact the pre-consultation phase, while visibility and personalization affordances enhance the in-consultation experience. Evaluative affordance plays a key role in the post-consultation phase. Sentiment analysis shows that positive interactions improve emotional well-being (value creation), whereas technical issues, lack of transparency and poor execution contribute to negative experiences (value destruction). The study highlights spill-over effects, where experiences in one phase influence the next, emphasizing the need for seamless digital service integration. Originality/value This research contributes to service co-creation theory by integrating affordance theory and the DART-E framework to examine both value creation and destruction in telehealth services. Unlike prior studies that focus on firm-oriented affordances, this study adopts a customer-centric perspective, emphasizing the role of patient technology affordances in shaping healthcare experiences. The triangulation of sentiment analysis and template analysis offers a novel methodological approach to understanding user-generated content in healthcare. Findings provide practical guidance for healthcare providers to enhance patient engagement, optimize digital service design and improve telehealth implementation strategies for better service outcomes.