Structural modeling of smart governance of telehealth services marketing in the context of digital public services

Abstract

Digital transformation has turned telemedicine into a fundamental pillar of healthcare systems. The success of these services depends not only on technological infrastructure but also on governance models and marketing strategies compatible with the logic of digital public services. This study aimed to provide a conceptual model of smart governance for telemedicine marketing with a digital public service approach. This research was conducted using a mixed-methods approach with a priority on the qualitative section. In the first stage, qualitative data were collected through semi-structured interviews with 19 experts in digital health, healthcare management, public policy, and digital marketing, and were evaluated using thematic analysis. Consequently, 44 basic themes were identified within 9 overarching themes. In the second stage, Interpretive Structural Modeling (ISM) was utilized to explain the relationships among these themes. The results showed that technological infrastructure and innovation, along with regulation and policymaking, are located at the foundational layers of the model and possess the highest driving power over other components. The middle levels included inclusion and equitable access, continuous evaluation and improvement, participation and value co-creation, user interaction and experience, and digital marketing strategies, which play a mediating role. Ultimately, digital trust and legitimacy were placed at the apex of the model as the final outcome. The driving-dependence analysis proved that the smart marketing governance structure starts from infrastructure layers and culminates in the formation of public trust. This model provides an efficient framework for policymakers and managers to enhance efficiency and transparency in services.