External Impetus And Internal Motivation:Study On The Influencing Mechanism Of Physicians’ Patient-Centered Behavior

ObjectivesThe external environment provides impetus for physicians’ patient-centered behavior,and individual internal resources is the basis of physicians’ initiative.The organic connection between the two factors forms an important motivation for patient-centered behavior.However,previous studies mostly examined the impact of a single factor on the implementation of patient-centered behavior of physicians,ignoring the complex linkage of internal and external factors of individuals.From two perspectives of external impetus(patient-oriented climate)and internal motivation(self-efficacy in patient-centeredness),this study explored the action mechanism of physicians’ patient-centered behavior,and analyzed the mediating and moderating effect of self-efficacy in patient-centeredness between patient-oriented climate and patient-centered behavior.Finally,the promotion strategy of patient-centered behavior is proposed.Methods1.Literature research method:Based on literature and theoretical review,the complex effects of internal and external motivations on physicians’ patient-centered behavior were clarified,and the relationship model between patient-oriented climate,self-efficacy in patient-centeredness and physician’s patient-centered behavior was established.2.Expert consultation method:Experts in relevant fields were invited to guide theoretical model construction,cross-cultural adjustment of scale,survey scheme design,etc.It focused on the sinicization of Self-Efficacy in Patient-Centeredness Questionnaire.After cross-cultural adjustment of the scale by experts,the Chinese version of Self-Efficacy in Patient-Centeredness Questionnaire is formed.3.Questionnaire survey method:The Patient-Oriented Climate Scale,Self-Efficacy in Patient-Centeredness Questionnaire,and Patient-Centered Behavior Scale were used to conduct a questionnaire survey among 1318 physicians from 26 grade ⅢA general hospitals in the Pearl River Delta,east,west and north of Guangdong by stratified proportional sampling.4.Statistical analysis method:Critical ration,correlation analysis,exploratory and confirmatory factor analysis,and reliability analysis were used to evaluate the psychometric characteristics of the scale.Through descriptive analysis,independent sample T-test,one-way ANOVA and multiple linear regression to analyze the status quo of patient-centered behavior and compare the differences.Correlation analysis,hierarchical regression and the SPSS macro PROCESS program were used to explore the mediating and moderating effects of self-efficacy in patient-centeredness.Results1.The average score of patient-centered behavior of physicians was(83.784±17.995).Multiple linear regression analysis showed that hospital category,professional title and average working hours per day had significant effects on the scores of physicians’ patient-centered behavior(P<0.05).2.The patient-oriented climate had a positive impact on physicians’patient-centered behavior(β=0.499,P<0.001);however,it(β=0.058,P<0.001)was a weaker predictor than self-efficacy in patient-centeredness(β=0.853,P<0.001)when both of them were included in the same regression analysis.3.Self-efficacy in patient-centeredness played a partially mediating role between patient-oriented climate and patient-centered behavior(β=0.441,95%CI:[0.371,0.507]),and the mediating effect value was 0.441,accounting for 88.38%of the total effect.4.Self-efficacy in patient-centeredness negatively moderated the relationship between patient-oriented climate and physicians’ patient-centered behavior(β=-0.048,P<0.001).The positive association between patient-oriented climate and physicians’patient-centered behavior was significant only among physicians with low self-efficacy in patient-centeredness(β=0.110,P<0.001).Conclusion1.The patient-centered behavior of physicians is at a high level and is affected by various factors such as different hospital categories,professional titles and average working hours per day.2.Physicians’ patient-centered behavior is effectively driven by internal and external factors.Patient-oriented climate and self-efficacy in patient-centeredness are the external and internal driving forces of physicians’ patient-centered behavior.3.Self-efficacy in patient-centeredness not only partially mediates the relationship between patient-oriented climate and patient-centered behavior,but also negatively moderates the relationship.It is suggested that from the perspective of strengthening individual external motivation and stimulating internal motivation,comprehensive measures should be taken at the hospital level,such as hospital culture remodeling,human resource management,medical ethics construction,and working environment optimization,and at the individual level,such as professional concept transformation and professional quality training,to effectively interfere with patient-centered diagnosis and treatment behavior of doctors.