A Research Of The Relationship Among Patient Participation, Doctor-Patient Psychological Contract Violation And Patients' Trust

The doctor-patient relationship is an important problem directly face in the revolution of Chinese medical and health service, while the core of doctor-patient relationship is the reciprocal trust between doctors and patients. It is pitiful that there is not sufficient trust between doctors and patients, especially patient do not trust doctor. The high touch of medical service determine that the process of medical service acting not only need doctors'endeavor, but also need patients'participation. Insufficient and irrational participation is a important reason results in patients don't trust doctors. On the basis of social exchange theory, trust theory, psychological contract theory, customer participation theory and field research, this dissertation tries to find the mechanism of patients participation promoting the development of patients'trust. After recognizing the existence of doctor-patient psychological contract, this dissertation establishes the relationship model among patients' participation, doctor-patient psychological contract violation and patients'trust, and collects 155 effective samples, and then, tests hypotheses using SPSS 15.0, Empirical tests indicate:1. Patients'participation has significantly positive effect on patients'trust. The more of patients' responsible behavior, the more of calculus based trust and competence based trust of patients; the more of patients'information searching behavior, the more of competence based trust and benevolence based trust of patients; the more of patients'interpersonal interaction behavior, the more of calculus based trust, competence based trust and benevolence based trust of patients.2. Doctor-patient psychological contract violation mediates the relationship between patients'participation and patients'trust. Transactional psychological contract violation mediates the relationship between responsible behavior and calculus based trust, competence based trust; Transactional psychological contract violation mediates the relationship between patients'information searching behavior and competence based trust, benevolence based trust; Transactional psychological contract violation mediates the relationship between patients' interpersonal interaction behavior and calculus based trust, competence based trust, benevolence based trust. Relational psychological contract violation mediates the relationship between responsible behavior and calculus based trust, competence based trust; Relational psychological contract violation mediates the relationship between patients' information searching behavior and competence based trust, benevolence based trust; Relational psychological contract violation mediates the relationship between patients' interpersonal interaction behavior and calculus based trust, competence based trust, benevolence based trust.This dissertation has some theoretical contributions:Firstly, this dissertation advances social exchange theory and introduces this theory to studies the relationship of patient-doctor. This dissertation puts forward when doctors and patients develops economic exchange relationship, they develop social exchange relationship, thus, they'll develop psychological contract. Because the psychological contract violation, patients lost the trust to doctors. Secondly, through deeply interview, semi-open questionarire, initial evaluation, forecast, scale revise, this dissertation develops the scale of doctor-patient psychological contract. Thirdly, this dissertation has found the relationship between patients' participation and patients'trust. Patients'participation has directly development action to patients'trust, and patients'participation can improve psychological contract violation so that has indirectly development action to patients'trust and push the healthy development of Chinese medical and health service。This dissertation brings some important enlightment to Chinese medical and health service and trust relationship between patients and doctors:(1)to innovate hospitals' allocation mechanism, encourage doctors pay attention and excute doctor-patient psychological contract;(2) to encourage patients'participation and help them improve the competence of participation;(3)to strength guide and communication, prevent the misunstandant of doctor-patient psychological contract;(4)to strength the commonweal of medical and health policies, advocate medical ethics.