Consumers experiencing vulnerability are prevalent in healthcare contexts across the globe, so it is surprising that such groups do not typically feature in the extant literature on service separation. Telehealth as a spatially separated service offering requires a combined perspective that captures the experiences of both users’ experiencing vulnerability and providers’ delivering the separated service. The inclusion of these actor perspectives with health-related vulnerabilities is essential to fully understand the impacts, dynamics, and effects of a spatially separated service. We address this need by conducting a twelve-month longitudinal qualitative study of an online mental health service in Brazil, drawing on qualitative data from patients experiencing vulnerability and psychologists. Phenomenographic interviews (n = 67) reveal the consequences of spatial separation on service encounter actors, how spatial separation impacts relational dynamics and roles between users experiencing vulnerability and providers over time, and how these service actors overcome challenges from spatial separation for value creation.
AgarwalRituDugasMichelleGaoGuodongKannanP. K.2020. “Emerging Technologies and Analytics for a New Era of Value-Centered Marketing in Healthcare.” Journal of the Academy of Marketing Science48: 9–23.
2.
AlhathalFaisal T.SharmaPiyushKingshottRussel PJ. 2019. “Moderating Effects of Service Separation on Customer Relationships with Service Firms: A Social-Exchange Perspective.” Journal of Service Theory and Practice29, no. (1): 71–92.
3.
AndrewsJ.Scot BurtonCraigGundlachGregory T.HillRonald PaulKeesJeremyNetemeyerRichard G.WalkerKristen L.2022. “What Exactly is Marketing and Public Policy? Insights for JPPM Researchers.” Journal of Public Policy & Marketing. 41, no. (1): 10–33.
4.
BaertPatrick. 1991. “Unintended Consequences: A Typology and Examples.” International Sociology6, no. (2): 201–10.
5.
BairdAaronRaghuT. S.NorthFrederickEdwardsFrederick. 2014. “When Traditionally Inseparable Services are Separated by technology: The Case of Patient Portal Features Offered by Primary Care Providers.” Health Systems3, no. (2): 143–58.
6.
BakerStacey MenzelGentryJames W.RittenburgTerri L.2005. “Building Understanding of the Domain of Consumer Vulnerability.” Journal of Macromarketing. 25, no. (2): 128–139
7.
BasuRituparnaKumarAnilKumarSatish. 2023. “Twenty-Five Years of Consumer Vulnerability Research: Critical Insights and Future Directions.” Journal of Consumer Affairs57, no. (1): 673–95.
8.
BerryLeonard L.BendapudiNeeli. 2007. “Healthcare: A Fertile Field for Service Research.” Journal of Service Research10, no. (2): 111–22.
9.
BerryLeonard L.AttaiDeanna J.ScammonDebra L.Adawi AwdishRana Lee. 2022. “When the Aims and the Ends of Health Care Misalign.” Journal of Service Research25, no. (1): 160–84.
10.
BetancourtRogerGautschiDavid. 2001. “Product Innovation in Services: A Framework for Analysis.” Advertising and Differentiated Products10, no. (4): 155.
11.
BlockerChristopher P.DavisBrennanAndersonLaurel. 2022. “Unintended Consequences in Transformative Service Research: Helping Without Harming.” Journal of Service Research25, no. (1): 3–8.
12.
BoenigkSilkeKreimerAaron A.BeckerAnnikaAlkireLindaFiskRaymond P.KabadayiSertan. 2021. “Transformative Service Initiatives: Enabling Access and Overcoming Barriers for People Experiencing Vulnerability.” Journal of Service Research24, no. (4): 542–62.
13.
CaiShaohanWangXiaoyanZhouXinyueYang.Zhilin2025. “How Do Institutional Forces Promote Social Actions in Life-Threatening Events?” Journal of Service Research. 29, no. (2): 298–312.
14.
CenophatSadracEisendMartinBayónTomásHaasAlexander. 2024. “The Role of Customer Relationship Vulnerability in Service Recovery.” Journal of Service Research. 27, no. (2): 283–301.
15.
CheungLilliemayMcColl-KennedyJanet R.2019. “Addressing Vulnerability: What Role Does Marketing Play?”Journal of Services Marketing33, no. (6): 660–70.
16.
CollisJillHusseyRoger. 2014. Business Research: A Practical Guide for Undergraduate and Postgraduate Students. 4th ed.Macmillan International Higher Education.
17.
CorriganPatrick. 2004. “How Stigma Interferes with Mental Health Care.” American Psychologist59, no. (7): 614–25.
18.
CrossSamantha NNEkpoAkon E.2024. “When Marketplaces Fail: How Market Challenged Consumers Navigate the Marketplace.” Journal of the Academy of Marketing. 53, no. (2): 513–532.
19.
CummingsCamillaRajaPushpaGabrielianSonyaDoranNeal. 2024. “The Impact of Telehealth Adoption on the Quality of Care for Individuals with Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data.” JMIR Mental Health11, no. (1): e56886.
20.
DanaherTracey S.GallanAndrew S.2016. “Service Research in Health Care: Positively Impacting Lives.” Journal of Service Research19, no. (4): 433–37.
21.
DanaherTracey S.BerryLeonard L.HowardChuckMooreSarah G.AttaiDeanna J.2023. “Improving How Clinicians Communicate with Patients: An Integrative Review and Framework.” Journal of Service Research26, no. (4): 493–510.
22.
DavisFred D.1989. “Technology Acceptance Model: TAM.” Al-Suqri, MN, Al-Aufi, AS: Information Seeking Behavior and Technology Adoption205, no. (219): 5.
23.
DoddsSarahBulmerSandyMurphyAndrew. 2018. “Incorporating Visual Methods in Longitudinal Transformative Service Research.” Journal of Service Theory and Practice. 28, no. (4): 434–457.
24.
EcheverriPerSalomonsonNicklas. 2019. “Consumer Vulnerability During Mobility Service Interactions: Causes, Forms and Coping.” Journal of Marketing Management35, no. (3–4): 364–89.
25.
EisenhardtKathleen M.1989. “Building Theory from the Case Study Research.” Academy of Management Review14, no. (4): 532–50.
26.
EppAmber M.OtnesCele C.2021. “High-quality Qualitative Research: Getting into Gear.” Journal of Service Research24, no. (2): 163–7.
27.
FiskRaymond P.DeanAlison M.AlkireLinda, et al. 2018. “Design for Service Inclusion: Creating Inclusive Service Systems by 2050.” Journal of Service Management29, no. (5): 834–58.
28.
FiskRaymond P.GallanAndrew S.JoubertAlison M.BeekhuyzenJenineCheungLilliemayRussell-BennettRebekah. 2023. “Healing the Digital Divide with Digital Inclusion: Enabling Human Capabilities.” Journal of Service Research26, no. (4): 542–59.
29.
FletcherTerri L.HoganJulianna B.KeeganFallon, et al. 2018. “Recent Advances in Delivering Mental Health Treatment via Video to Home.” Current Psychiatry Reports20: 1–9.
30.
MichelleFunkSaracenoBenedettoDrewNatalieFaydiEdwige. 2008. “Integrating Mental Health into Primary Healthcare.” Mental Health in Family Medicine5, no. (1): 5.
31.
GleimMarkMcCulloughHeathFerrellO. C.GablerColin. 2024. “Metaverse: Shifting the Reality of Services.” Journal of Services Marketing38, no. (1): 13–27.
32.
GoodeSigi. 2021. “A Cognitive Social Capital Explanation of Service Separation Distress.” Journal of Services Marketing35, no. (4): 487–504.
33.
GreenTeeganHartleyNicoleGillespieNicole. 2016. “Service Provider’s Experiences of Service Separation: The Case of Telehealth.” Journal of Service Research19, no. (4): 477.
34.
GuoLinLotzSherry L.TangChuanyiGruenThomas W.2016. “The Role of Perceived Control in Customer Value Cocreation and Service Recovery Evaluation.” Journal of Service Research19, no. (1): 39–56.
35.
HartleyNicoleGreenTeegan. 2017. “Consumer Construal of Separation in Virtual Services.” Journal of Service Theory and Practice27, no. (2): 358–83.
KeatingByron W.AlahakoonThiliniMortimerGaryMathmannFrank. 2025. “Advocating for Consumers Experiencing Vulnerability: A Typology and Research Agenda.” Journal of Services Marketing. 39, no. (6): 596–613.
38.
KehHean TatPangJun. 2010. “Customer Reactions to Service Separation.” Journal of Marketing74, no. (2): 55–70.
39.
KehHean TatHartleyNicoleWangDi. 2019. “The Differential Effects of Separated Vs. Unseparated Services: The Roles of Performance Risk and Regulatory Focus.” Journal of Service Theory and Practice29, no. (1): 93–118.
40.
LarsonLindsay R. L.BockDora E.2016. “Consumer Search and Satisfaction with Mental Health Services.” Journal of Services Marketing30, no. (7): 736–48.
41.
LeiteHigorHodgkinsonIan R.2023. “Examining Resilience Across a Service Ecosystem Under Crisis.” Public Management Review25, no. (4): 690–709.
42.
LeiteHigorHodgkinsonIan R.JoubertAlison M.2026. “A Separated Service: Examining Virtual Reality Experiences of Actor Groups in a Rehabilitative Healthcare Setting.” Journal of Business Research204: 115858.
LovelockChristopherGummessonEvert. 2004. “Whither Services Marketing? In Search of a New Paradigm and Fresh Perspectives.” Journal of Service Research7, no. (1): 20–41.
45.
MartiniukAlexandraToepferAmyLane-BrownAmanda. 2024. “A Review of Risks, Adverse Effects and Mitigation Strategies when Delivering Mental Health Services Using Telehealth.” Journal of Mental Health33, no. (3): 415–438.
46.
MedaliaAliceLynchDavid A.HerlandsTiffany. 2020. “Telehealth Conversion of Serious Mental Illness Recovery Services During the COVID-19 Crisis.” Psychiatric Services71, no. (8): 872.
47.
MendeMartinBradfordTonya WilliamsRoggeveenAnne L.ScottMaura L.ZavalaMariella. 2024. “Consumer Vulnerability Dynamics and Marketing: Conceptual Foundations and Future Research Opportunities.” Journal of Academy of Marketing Science52, no. (5): 1301–22.
48.
MirabitoAnn M.FarrellJustine RappMachinJane E.CrosbyElizabethAdkinsNatalie Ross. 2025. “Hijacked, Blindfolded, and Handcuffed: Navigating the Turbulent Consumer Journey for Mental Illness Treatment Services.” Journal of the Academy of Marketing Science53, no. (6): 1644–69.
49.
MiuAdriana A.VoHoa T.PalkaJayme M.GlowackiChristopher R.RobinsonReed J.2023. “Teletherapy with Serious Mental Illness Populations During COVID-19: Telehealth Conversion and Engagement.” In Miu, Adriana S., Hoa T. Vo, Jayme M. Palka, Christopher R. Glowacki, and Reed J. Robinson (eds) How the COVID-19 Pandemic Transformed the Mental Health Landscape. Routledge. pp. 63–80.
50.
O’LoughlinDeirdreGummerusJohannaKelleherCarol. 2024. “It Never Ends: Vulnerable Consumers’ Experiences of Persistent Liminality and Resource (MIS) Integration.” Journal of Service Research27, no. (3): 327–45.
51.
OstromAmy L.ParasuramanAnanthanarayananBowenDavid E.PatrícioLiaVossChristopher A.2015. “Service Research Priorities in a Rapidly Changing Context.” Journal of Service Research18, no. (2): 127–59.
52.
OstromAmy L.FieldJoy M.FotheringhamDarima, et al. 2021. “Service Research Priorities: Managing and Delivering Service in Turbulent Times.” Journal of Service Research24, no. (3): 329–53.
53.
PaluchStefanieBlutMarkus. 2013. “Service Separation and Customer Satisfaction: Assessing the Service Separation/Customer Integration Paradox.” Journal of Service Research16, no. (3): 415–27.
54.
ParkinsonJoyL.Lisa SchusterMulcahyRoy. 2022. “Online Third Places: Supporting Well-Being Through Identifying and Managing Unintended Consequences.” Journal of Service Research25, no. (1): 108–25.
55.
ParkinsonJoySchusterLisaMulcahyRoryTaiminenHeini M.2017. “Online Support for Vulnerable Consumers: A Safe Place?” Journal of Services Marketing31, no. (4-5): 412–422.
56.
PettigrewAndrew M, 1990. “Longitudinal Field Research on Change: Theory and Practice.” Organization Science1, no. (3): 213–337.
57.
RacitiMaria M.Russell-BennettRebekhaLetherenKate. 2022. “A Strengths-Based Approach to Eliciting Deep Insights from Social Marketing Customers Experiencing Vulnerability.” Journal of Marketing Management28, no. (11–12): 1137–77.
58.
RhoadsMeredith A.BennettAronté MarieAzzariCourtney NationsBakerStacey Menzel. 2025. “Service Design for Humanitarian Value.” Journal of Service Research 0(0).
59.
RiedelAmyMessengerDanaFleischmanDavidMulcahyRory. 2022. “Consumers Experiencing Vulnerability: A State of Play in the Literature.” Journal of Services Marketing36, no. (2): 119–28.
60.
RiehleRamonaWieserVerena E.HemetsbergerAndrea. 2024. ““We Truly Love What We Do”: The Tribal Consumer Inside Passionate Service Employees.” Journal of Service Research27, no. (4): 559–78.
61.
RosenbaumMark S.WaltersGabbyEdwardsKaren L.Gonzalez-ArcosClaudia. 2022. “Commentary: The Unintended Consequences of Digital Service Technologies.” Journal of Services Marketing36, no. (2): 97–109.
62.
RosenbaumMark S.Seger-GuttmannTaliGiraldoMario. 2017. “Commentary: Vulnerable Consumers in Service Settings.” Journal of Services Marketing31, no. (4/5): 309–12.
SandbergJörgen. 1997. ‘‘Are Phenomenographic Results Reliable?’’Higher Education Research and Development16, no. (2): 203–12.
66.
SandbergJörgen. 2000. “Understanding Human Competence at Work: An Interpretative Approach.” Academy of Management Journal43, no. (1): 9–25.
67.
SchafferCalvin T.NakraniPreetiPirragliaPaul A.2020. “Telemental Health Care: A Review of Efficacy and Interventions.” Telehealth and Medicine Today5, no. (4): 1–13.
68.
SembadaAgungTsarenkoYelenaTojibDewi. 2016. “The positive effects of customers’ power on their behavioral responses after service failure.”Journal of Service Research 19, no. (3): 337–351.
69.
SharmaAmaleshBorahSourav BikashMosesAditya Christopher. 2023. “Achieving Social and Economic Sustainability Through Innovations in Transformative Services: A Case of Healthcare Organizations in an Emerging Market.” Journal of the Academy of Marketing Science 52, no. (5): 1–25.
70.
SharmaShikhaConduitJodie. 2016. “Cocreation Culture in Health Care Organizations.” Journal of Service Research19, no. (4): 438–57.
71.
SharmaShikhaConduitJodieHillSally Rao. 2017. “Hedonic and Eudaimonic Well-being Outcomes from Co-creation Roles: A Study of Vulnerable Customers.” Journal of Services Marketing31, no. (4/5): 397–411.
72.
ShachakAvivKuziemskyCraigPetersenCarolyn. 2019. “Beyond TAM and ATAUT: Future Directions for HIT Implementation Research.” Journal of Biomedical Informatics100: 103315.
73.
SpiegelbergH.1971. “Franz Brentano (1838–1917): Forerunner of the Phenomenological Movement.” In The Phenomenological Movement: A Historical Introduction. Dordrecht: Springer. pp. 27–52
74.
SvistovaJulianaHarrisChristopherFogartyBarbeKulpChristinaLeeAhyoung. 2022. “Use of Telehealth Amid the COVID-19 Pandemic: Experiences of Mental health Providers Serving Rural Youth and Elderly in Pennsylvania.” Administration and Policy in Mental Health and Mental Health Services Research49, no. (9): 530–8.
75.
Van ManenM. 2017. “But is it Phenomenology?”Qualitative Health Research 27, no. (6): 775–9.
76.
VarmanRohitVijayDeviSkålénPer. 2022. “The Conflicting Conventions of Care: Transformative Service as Justice and Agape.” Journal of Service Research25, no. (1): 86–107.
77.
VenkateshViswanathMorrisMichael G.DavisGordon B.DavisFred D.2003. “User Acceptance of Information Technology: Toward a Unified Theory.” MIS Quarterly. 27, no. (3): 425–478.
78.
VieiraAlessandro DiogoLeiteHigorLachowski VolochtchukAna Vitória. 2022. “The Impact of Voice Assistant Home Devices on People with Disabilities: A Longitudinal Study.” Technological Forecasting and Social Change184: 121961.
79.
VoorheesClay M.FombellePaul W.GregoireYany, et al. 2017. “Service Encounters, Experiences and the Customer Journey: Defining the Field and a Call to Expand Our Lens.” Journal of Business Research79: 269–80.
80.
WalshGianfrancoSchaarschmidtMarioIvensStefan. 2018. “Assessing the Effects of Multichannel Service Provider Corporate Reputation on Customer New Product Adoption and RFM Value.” Journal of Service Management29, no. (4): 680–702.
WünderlichNancy V.WangenheimFlorian V.BitnerMary Jo. 2013. “High Tech and High Touch: A Framework for Understanding User Attitudes and Behaviors Related to Smart Interactive Services.” Journal of Service Research16, no. (1): 3–20.
83.
YinRobert K.2014. Case Study Research. Design and Methods. 5th ed.Sage.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
