Antidepression social marketing (SM) campaigns are often accompanied by comprehensive websites to engage and help people with mental health problems; however, the use of theory is not always apparent. The transtheoretical model (TTM) involves five stages of change through which a person transitions to a healthier life. This paper combines TTM and the fundamental principles of SM, such as consumer orientation, targeting, and value creation and exchange through 4Ps (product, place, promotion, and price), and applies them to mental e-health. We create a set of detailed criteria to guide the development of antidepression websites. These criteria are further used to analyze the online content of five antidepression campaigns and to demonstrate the relevance of TTM and SM to online delivery of the information and self-help interventions in the context of depression.

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The clinical significance of nonspecific esophageal motility disorder (NEMD) is unclear. Our aim was to investigate the natural history of NEMD. All manometries performed at Meir Hospital from 1997 to 2004 and diagnosed as NEMD were reviewed. Manometric criteria for NEMD included either low-amplitude peristalsis, nonprogression of peristalsis, prolonged retrograde or triple-peaked waves, or incomplete relaxation of the lower sphincter. Patients determined to have NEMD were contacted and asked to complete a questionnaire and undergo a second manometry. NEMD had been diagnosed in 137 patients. Upon review of manometry results, 65 patients were eligible for the study (36 men and 29 women). The other 72 patients did not have NEMD when we reviewed their manometry tracing, applying strict criteria as specified in Table 1. The average age was 64 +/- 16 years (range 24-83 years). The average follow-up period was 7 +/- 2 years. All 65 patients were symptomatic at their initial prestudy visit. By the second visit, symptoms had resolved in 33 (51%) patients and improved in 13 (19%). Dysphagia, chest pain, and food regurgitation had improved, whereas heartburn and respiratory symptoms had not. Of 37 patients with triple-peaked waves, only 11 (30%) had improved clinically. Of the 65 study patients, 17 (26%) had a second manometry during the study, which was normal in 2 (12%), unchanged in 11 (69%), and revealed achalasia in 4 (23%), representing 6% of all study patients. NEMD is generally a benign disorder that improves clinically in most cases. Nevertheless, in about 6% of patients, NEMD may evolve into achalasia.

Purpose – The purpose of this paper is to extend understandings of the demand-side view of strategy and how organizations co-create value with stakeholders. Through an iterative process of theory development, data collection, data analysis and writing, the authors propose a value co-creation perspective that more fully takes into account stakeholder complexity. Design/methodology/approach – The empirical data derives from a wider exploratory study on value creation and competitive advantage in Christian churches in Canada. Here the authors explore one case study from that wider study and analyze interviews with church members and leaders. Findings – The authors discuss two mutually constitutive processes of value co-creation, building a culture of community and enacting relational and shared leadership. Research limitations/implications – The authors propose a stakeholder-complex understanding of value creation where stakeholders can enact multiple roles, often simultaneously, in co-creation and where products/services are consumed for their symbolic, rather than material value. Further, co-creation may involve ongoing interactions and value creation can occur in non-monetary transactions. Originality/value – The authors offer, through an empirical exploration of a religious organization, an illustrative account of how value co-creation might be tied to stakeholder complexity. This study stretches the boundaries of mainstream strategy research by challenging two fundamental assumptions: that stakeholder roles must be distinct and that “value” must be clearly defined and explicitly linked to exchange value.

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