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Examining the service engagement process in value co-creation in healthcare service delivery: A multi-level perspectiveThis study furthers our understanding of value co-creation, which has received little attention in the doctor-patient encounter relationship. We employed a quantitative survey method to shed light on factors driving this fundamental service aspect, followed up with a multilevel data analysis. These factors (assurance, social skills, doctor-patient orientation) from the doctor significantly strengthen the effects of the patient-level factors (trust, perceptual beliefs, interactions) on the service engagement and outcomes of the focal doctorpatient dyad. We establish the cross-level interactive effects at the group level of the focal dyad on service engagement. The findings suggest service engagement at the group level had no significant effect on patients’ perceived value. We provide new empirical insights to understand and operationalize these fundamental influencing factors of the value co-creation concept in a healthcare setting, and contribute to the value co-creation literature.