Construction Of A Health-seeking Behavioral Intention Model Of Scheduled Inpatient Appointment

BackgroundInpatient appointments are an important measure to improve medical services,which can maximize the use of limited medical resources.However,wih the advancement of inpatient appointment services,the phenomenon of non-attendance has become increasingly prominent.Non-attendance not only caused economic loss and waste of medical resources,but also seriously affected the social integrity system.Throught strengthening the management of inpatient appointmet and predicting the in-patients’ health-seeking behavioral intention to take timely intervention measures can effectively reduce non-attendance.Previous research showed that TPB and CSM can scitntifically analyze health-seeking behavioral intentions.So we speculated that combining TPB and CSM to construct a predictive factor model for health-seeking behavioral intentions,it can effectively predict the inpatients’health-seeking dynamics and provide scientific basis for reducing non-attendance.ObjectivesBased on the theory of planned behavior to develop the inpatients’health-seeking behavioral intention scale,and combined the common-sense model of self-regulation to construct a predictive factor model for the inpatients’ health-seeking behavioral intention,which provide an interventional strategy for the management of inpatient apointment to reduce the non-attendance.Methods1.Semi-structured interview methodThe semi-structured interview was conducted to 25 patients who made inpatient appointments,in order to obtain the prominent beliefs of the health-seeking behavior to construct the item pool of the scale.2.Delphi methodA total of 16 experts were included,and the item pool was screened through two rounds of expert consultation.3.Questionnaire survey method390 patients waiting in line for inpatient appointment were investigated by convenient sampling,and analyzed reliability and validity of the scale by IBM SPSS22.00.Through the second round survey of 330 patients waiting in line to conduct empirical research on the hypothetical model.Results1.Delphi methodThe rate of two rounds questionnaire recovery of expert consultation was 66.67%and 93.75%respectively,and the authority coefficients were 0.79 and 0.81;The coefficient of variation was 0～0.60,0.07～0.53;Kendall’s concordance coefficient were 0.22 and 0.29.After the expert consultation,a tentative scale with 4 dimensions and 26 items was formed.2.The reliability and validity test of ScaleIn terms of reliability,the Cronbach’ s a of total scale was 0.84,with dimensions of 0.73-0.89;the half reliability of the total scale was 0.89,and the half reliability of each dimension was 0.73-0.79.In terms of validity,I-CVI was 0.88-1.00,and S-CVI was 0.93;Combining the results of parallel analysis and factor analysis,it retains the four factors,namely,attitude toward the behavior,subjective norms,perceived behavioral control,and behavioral intention,which could explain 72.25%of the variance;The correlation coefficient among each dimension was 0.37～0.56,and the correlation coefficient between each dimension and the total scale was 0.54～0.72.Finally,the application scale was determined,including 13 items and 4 dimensions,including attitude toward the behavior,subjective norms,perceived behavioral control,and behavioral intention.3.Hypothetical model empirical analysisSubjective norms had the greatest impact on the health-seeking behavioral intention,with the direct effect of 0.22 the indirect effect of 0.27 and the total effect of 0.49,which was consistent with the H2 hypothesis;The direct effect and indirect effect of disease cognition influence on behavioral intention was 0.30 and 0.13 respectively,and the total effect value was 0.43,which was consistent with H4 hypothesis;The total effect of behavioral attitude on health-seeking behavioral intention was 0.30,which was consistent with Hypothesis H1;The perceived behavioral control on the health-seeking behavioral intention was not significant,which was inconsistent with the H3 hypothesis.ConclusionsThe scale of the health-behavioral intention of patients who make inpatient appointments based on the TPB was simple and easy to operate.It has good reliability and validity.The model fitting effect of the structural equation model was good.The study verified that the application of the TPB and the CSM in the field of health-seeking behavior,namely,attitude toward the behavior,subjective norms and disease cognition had a positive effect on the health-seeking behavioral intention of patients who made inpatient appointments,while the effect of perceived behavioral control on the health-seeking behavioral intention of patients was not significant.