| "Large hospitals are crowded and small hospitals are deserted" is a chronic disease in the field of medical and health care in China.The fundamental reason for this phenomenon is the unreasonable allocation of medical and health resources in China and the low efficiency of resources utilization,which is manifested in the waste of resources caused by highquality medical resources undertaking a large number of general outpatient services,while primary medical institutions are unable to play their role due to resource shortages.In addition,the neglect of non-disease health needs in daily life and the serious information asymmetry between doctors and patients in traditional offline health-seeking behavior,lead to people flocking to big cities and large hospitals when there is a need for diseases,which also aggravates this phenomenon.In order to solve this problem and form a scientific and orderly health-seeking pattern,the government puts forward the requirements of setting up a hierarchical medical system and rationally allocating medical resources.Hierarchical medical system is to take common diseases,frequently-occurring diseases and chronic diseases as a breakthrough,patients with these diseases are encouraged to have their first consultation with a general practitioner in a primary hospital when they have medical needs.For diseases beyond the service capacity of primary medical institutions,general practitioners provide referral services for patients,so as to realize the orderly diversion of patients.Combined with the current social development status and the popularity of the Internet,the Internet gives full play to its advantages in breaking through the limitations of time and space,and provides a pioneering solution for the establishment of hierarchical medical systemonline health consultation.Based on its huge daily consultation volume,online health consultation has achieved the goal of hierarchical medical system to a certain extent through the mobile Internet,which is of great significance for optimizing the allocation of medical resources and alleviating the pressure of offline medical resources.Moreover,online health consultation also has the advantages of anonymity,so as to facilitate the consultation of embarrassing and sensitive health problems.Especially during the epidemic,the advantage of online health consultation is more prominent and has attracted a lot of attention,because it can avoid cross infection caused by patients gathering in the hospital.Online health consultation has become an industry with great development potential.Therefore,how to improve the service experience of users on the online health consultation platform,attract more users to use the online health consultation service and recommend it to others,and further leverage the advantages of the online health consultation platform has become an important issue.This study comprehensively applies a variety of research methods,from establishing the trust model for patients’ choice and decision-making in online health consultation service,to analyzing the specific mechanism of cognitive trust and affective trust on patients’ choice and decisionmaking behavior,and then using cognitive neuroscience technology methods to record the whole process of information processing of patients’choice and decision-making behavior,and explore the specific neural mechanism of patients’ decision-making,thus completely and deeply revealing the influence mechanism and chain of patients’ choice and decision-making in online health consultation service.The main contents and conclusions of this study include the following three parts:First,construct the trust model for patients to choose doctors in online health consultation service.This study firstly uses the method of structural equation modeling,based on the related theories of online trust and cognitive trust and affective trust,clarifies that the rich doctor information provided on the online health consultation platform belongs to which antecedents of online trust:ability,integrity or benevolence,explores how patients’ perception of doctors’ ability,integrity and benevolence affect patients’ perception of patients’ cognitive trust and affective trust to doctors,and then affects patients’ willingness to choose doctors,so as to preliminarily construct the trust model for patients to choose doctors in online health consultation services.The results show that doctors’ professional knowledge,doctors’ rank,treatment effect and doctors’ image can affect patients’ perception of doctors’ ability,and then affect patients’ cognitive trust in doctors.Doctors’service commitment can affect patients’ perception of doctors’ integrity,so as to affect patients’ affective trust in doctors.Doctors’ service attitude and communication skills affect patients’ perception of doctors’ benevolence,which affects patients’ affective trust in doctors.And the impact of doctors’response speed is not significant,indicating that doctors who provide online health consultation services usually provide consultation services in their spare time,so patients have a certain tolerance to doctors’ response speed.Finally,patients’ cognitive trust and affective trust in doctors can significantly affect their willingness to choose doctors,which shows that on the online consultation platform,patients not only have rational cognitive judgment when choosing doctors,but also the influence of affection to patients’ choice and decision-making behavior is very important.This result has initially drawn the conclusion that both cognitive trust and affective trust will have an impact on patients’decision-making behavior,but the relationship between the two and the specific impact mechanism on patients’ decision-making behavior need to be further explored.Second,explore the specific mechanism of cognitive trust and affective trust on patients’ choice and decision-making behavior in online health consultation service.After initially getting the conclusion that both cognitive trust and affective trust will affect patients’ choice and decision-making behavior,this study based on the relevant theories of individual decision-making secondly introduced need for cognition and need for affect,two personality trait variables which have an important impact on individual decision-making behavior,and health involvement(disease type)variable,through 2(cognitive trust high/low)× 2(affective trust high/low)behavioral experiment,artificially manipulated the different level of cognitive trust and affective trust,so as to analyze the relationship between them and their specific mechanism and behavior performance on patients’ choice and decision-making behavior.The results show the different impact of cognitive trust and affective trust on patients with different personality traits in their choice and decision-making behavior.The reasons for this difference are:(1)According to the elaboration likelihood model,patients with high need for cognition take the central route to process information and comprehensively and carefully evaluate all the information they receive.Therefore,they are more sensitive to the improvement of either cognitive trust or affective trust,that is to say,the improvement of either of the two can significantly improve patients’ willingness to choose doctors(this study named this decision-making mode as decision-making mode one:cognitively sensitive and affectively sensitive);When the patient’s need for cognition are low,the discussion needs to be divided into two situations:(2)The first situation is when the patient’s need for affect are high,according to previous studies about the impact of need for affect on individual decision-making behavior,patients should be more sensitive to emotional stimuli.Therefore,the initial hypothesis of this study is that patients respond more significantly to doctor information that can stimulate their affective trust,but the results contradict this hypothesis.The data shows that when the affective trust is improved,the participants with high need for affect have no significant improvement in their willingness to choose,but when the cognitive trust is improved,their willingness to choose doctors have increased significantly(this study named this decision-making mode as decision-making mode two:cognitively sensitive and affectively insensitive);(3)The second situation is when the patient’s need for affect are also low,patients take peripheral route to process information,and because the need for affect is low,the separate improvement of cognitive trust or affective trust does not have a significant impact on patients’ willingness to choose,only when both the two are improved can significantly improve their willingness to choose doctors(this study named this decision-making mode as decision-making mode three:cognitively insensitive and affectively insensitive).Additionally,this study not only classifies the participants through personality traits,but also classifies them through health involvement,that is,different disease priorities,to analyze the actual performance of patients’choice and decision-making behavior in different disease types.The results showed that patients with mild and chronic diseases were consistent with the participants with high need for cognitiom.The decision-making mode was mode one(cognitively sensitive and affectively sensitive).Patients with severe diseases were consistent with the participants with low need for cognitiom and high need for affect.The decision-making mode was mode two(cognitively sensitive and affectively insensitive).And patients with acute diseases were consistent with the participants with low need for cognition and low need for affect.The decision-making mode was mode three(cognitively insensitive and affectively insensitive).This result indicates that the impact of health involvement on patients’ information processing mode is consistent with the impact of need for cognition and need for affect.When the health involvement is low,that is,the disease is mild,patients choose the central route to process information,and when the health involvement is high,patients choose the peripheral route to process information.There are two inconsistencies between the above results and previous research conclusions related to decision-making.The first is that participants with high need for affect are more sensitive to cognitive stimulus information.The improvement of cognitive trust can improve their willingness to choose doctors.The second is the influence of involvement on the individual decision-making behavior in the field of online health-seeking and the field of consumption decision-making is opposite.In the field of consumption decision-making,users with higher involvement prefer to use the central route to process information,while users with low involvement prefer to use the peripheral route.But this study found that in the field of online healthseeking,patients with high health involvement choose the peripheral route to process information,and patients with low health involvement choose the central route.Third,explore the neural/physiological mechanism of patients’choice and decision-making in online health consultation service.In order to deeply explore the information processing and the real reaction mechanism of cognitive trust and affective trust when patients choose doctors online,and reveal the "black box" of patients’ decision-making behavior,this study based on previous studies on the neural/physiological mechanisms of individual decision-making finally uses fMRI experiment to record the brain reaction process when patients choose doctors,to explore the patients’ information processing mode and whether different types of doctor information(cognitive stimulation information and affecive stimulation information)influence patients’ decision-making behavior through cognitive judgment or emotional response.The results show that:(1)Both cognitive stimulation information and affecive stimulation information activate the brain regions related to emotional processing,but this does not mean that online health-seeking behavior is a complete emotional "hot" decision-making,without any element of rational cognition.Actually,the cognitive response of the patients does not come from the cognition related "cold" stimulus information such as the doctor’s title,hospital level,etc.,only when there is a decision-making dilemma such as conflicting information,the individual’s higher cognitive processing functions are invoked to make decisions.Therefore,on the whole,online health-seeking behavior still conforms to the dual-processing theory of decision-making,which includes both the cognitive reasoning process and the emotional perceptual process;(2)According to the comparative analysis of the activation differences of brain regions under different disease types,it is found that patients with low health involvement invest more cognitive resources in the decision-making process,because the fMRI data analysis showed that the brain regions were more activated in this situation,and the brain regions related to subjective value are also significantly activated,which indicates that when-evaluating different types of doctor information,patients can convert them to the same value dimension for comprehensive evaluation.Therefore,at this time,patients use the central route to process information.In contrast,patients with high health involvement have low brain activation and invest less cognitive resources.They use peripheral route to process information;(3)Through ROI analysis of brain regions related to conflict information,it is found that in the case of low health involvement,the reduction of affective trust can create greater conflict for patients’ decisionmaking,and in the case of high health involvement,the reduction of cognitive trust can create greater conflict for patients,indicating that the milder the disease,the more important the impact of affecive trust on patients,and the more critical the disease,the more important the impact of cognitive trust on patients.This study conducted an in-depth study on the influencing mechanism and chain of patients’ choice and decision-making behavior on the online health consultation platform.The conclusions have certain contributions to user behavior,individual decision-making related theories,and cognitive neuroscience research.In practice,this study can provide decision-making basis and scientific suggestions for patients to choose doctors,doctors,platforms and relevant practitioners,improve the service experience of patients on the online health consultation platform,attract more users to use the online health consultation service and recommend it to others,and further enhance the advantages of the online health consultation platform,such as optimizing the allocation of medical resources and alleviating the pressure of offline medical resources. |
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