Research On The Patient-physician Trust And Its Dynamic Evolution Under The Environment Of Internet Medical

[Objective]The emergence of Internet medical provides a new model for the development of medical services,which is conducive to the optimal allocation of medical resources and improves the efficiency of medical services.However,the current relationship between physicians and patients is tense in our country,there are frequent medical disputes and conflicts.This kind of distrust between physicians and patients has become a serious social problem,but also hindered the further development of online medical.Improving the trust between physicians and patients under the Internet environment is of great significance.Current researches on physican-patient trust are focused on the traditional offline part,rarely paid attention to the online medical context.Also,considering that the development of trust is an uninterrupted and dynamic process,physician-patient trust at different stages is also different.Based on the background of online medical and the whole process of online medical usage,this study aims to explore the evolution,antecedents and consequences of physician-patient trust in different stages,to help the sustainable development of online medical and promote the construction of a good physician-patient relationship.[Methods]In this study,the trust building is divided into three stages according to different status of patient online medical usage.Based on the literature analysis and relevant researches on theory of reasoned action,expectation confirmation theory,trust transfer theory and signaling theory,three models are built respectively under the online medical environment,namely the initial trust model of patients,the continuous trust model of patients and the online-to-offline trust transfer model of patients.The data is obtained by questionnaire survey and web data crawling,and the models are verified by structural equation model and econometric analysis.[Results]First,this study built an initial trust model of patients under the environment of online medical.The results indicated that 46.2% of the patient initial trust could be explained by the initial trust model.Patient trust propensity(?=0.121,p<0.01)and platform credibility(?=0.382,p<0.001)had significant positive effects on patient's initial trust,among which the effect of platform credibility was greater.Perceived risk had a significant negative effect on patients' initial trust(?=-0.153,p<0.01),but not on the behavioral intention of patients(?=-0.134,p>0.05).Perceived benefit had a significant positive effect on patients' initial trust(?=0.518,p<0.001)and behavioral intention(?=0.203,p<0.05).Patients' initial trust had a significant positive effect on patients' behavioral intention(?=0.331,p<0.01).Second,this study investigated the patient continuous trust under the enviroment of online medical.The results indicated that 48.9% of the patient continuous trust could be explained by the research model.Patient satisfaction had a significant positive effect on patients' continuous trust(?=0.237,p<0.01),and patients' continuous trust had a significant positive effect on their intention to continuous use(? = 0.328,p<0.001).The perceived effectiveness of E-health institutional mechanisms positively moderated the relationship between patients' satisfaction and patient continuous trust(?=0.131,p<0.05),but indicated no significant effect on the relationship between patients' continuous trust and intention of continuous use(?=-0.124,p>0.05).Health self-efficacy negatively moderated the relationship between continuous trust and intention of continuous use(?=-0.153,p<0.01).Third,this study explored the patient trust transfer from online to offline.The results indicated that online patient trust(?=0.626,p<0.001)and online physician reputation(?=0.128,p<0.001)had a significant positive effect on offline patient trust,among which the effect of online trust was greater.There was no significant effect of patient group convergence on the offline patient trust(?=-0.025,p>0.05).The positive effect of physician self-representation on the offline patient trust was not confirmed(?=-0.106,p<0.001).Patient group convergence(?=0.185,p<0.001),physican self-representation(?=0.047,p<0.001)and physician online reputation(?=0.128,p<0.001)all had significant positive effects on online patient trust,of which patient group convergence had the greatest effect.Physican online reputation positively moderated the relationship between online and offline patient trust(?=0.014,p<0.05).[Conclusions]The development of trust is dynamic,and physician-patient trust shows different characteristics under different stages of online medical use.In the initial stage,patient trust is influenced by patients' propensity to trust and various perception factors;in the continuous trust stage,patients have already had experience with online medical services,and their continuous trust is mainly affected by satisfaction;in the online-to-offline trust transfer stage,patient trust will be influenced from both the patient and the physician side.Similarly,patient trust in different stages will lead to different consequences,patient initial trust will affect the intention of patients to use online medical services;patients continuous trust will affect the intention of patients to continue using online medical services.The consequence of trust in the trust transfer stage needs further exploration,the offline trust may affect patients' intention to seek medical services offline.Online medical service providers should not only pay attention to the trust of patients,but also understand the characteristics of patients in different stages of online medical services use.Using these effective features to enhance the trust of patients at different stages can not only create a harmonious physician-patient relationship,but also promote the development of online medical services.[Innovation and Deficiency]This study is innovative in three aspects:First,this paper explores the physician-patient trust under the context of online medical and builds three trust models in different stages.The online medical have been developed for many years in China,howerver,no major breakthrough has been made.Online environment usually involves high risks and uncertainties,physician-patient trust is critical for the success of online medical services under these circumstances.Although physician-patient trust plays an important role in the domain of online medical,researches on physician-patient trust still focused on the offline part.The researches on the online medical trust were less,mostly on the trust toward health information and website.Based on the stages of internet medical usage,this study builds three patient trust models,explores the antecedents of patient trust.The mechanism of antecedents is also analyzed.This research extends the research of physician-patient trust to online environment.Second,this paper investigates the evolution of trust,constructs patient continuous trust and trust transfer model respectively.Patient trust is a dynamic process that evolves with time and space,and there are few empirical studies on the dynamic process of trust.In this study,we build a continuous trust model of patients,explore the development of trust from the perspective of time evolution level,the different antecedents in two stages(initial and continuous)are also analyzed.Then we build a online-to-offline turst transfer model of patients from the perspective of spatial evolution,and analyze the influence of online trust on offline trust.The exploration of continuous trust and trust transfer is a supplement to the current study of trust evolution.Third,this paper researches the trust transfer from online to offline.The patient trust transfer model from online to offline is built.Trust transfer has been attached great importance in the field of e-commerce.Rresearch on trust transfer focuses on the analysis of online-to-online and online-to-mobile environments,and few studies focus on online-to-offline trust transfer.Since the first diagnosis can not be provided by online medical services,patients finally have to go to offline for medical services,which provides a real situation for the research of trust transfer from online to offline.This study builds a patient trust transfer model from online to offline,analyzes the possibility of trust transfer from online to offline,the moderate effect of online reputation is also investgated.The main deficiencies of this study are as follows:First,the analysis of trust in each stage of this study is mainly based on cross-sectional data,and only two periods of data were collected to verify the model of trust transfer.This kind of phased research lacks continuity in data,so it is necessary to deepen the research by longitudinal data collection in the follow-up.Second,the theme of this study is physician-patient trust.Considering that physician is the passive party in the physician-patient trust relationship,and the physician's trust to the patient will be greatly influenced by the patient trust.Based on the classfication of different use stage,this study mainly explores the physician-patient trust from the perspective of patients.In the follow-up studies,we also need to pay attention to the characteristics and views of physicians.