Measuring behavioural incentive mechanisms for trust diffusion on Macau medical tourism digital platforms

Macau is rapidly developing into a regional hub for medical tourism, positioning itself as an intermediary point between Greater Bay Area residents and Southeast Asian travellers seeking advanced cross-border healthcare. However, trust deficits on digital service platforms continue to hinder conversion from browsing to booking. This study develops and empirically validates a behavioural-incentive framework grounded in trust diffusion theory. Using a mixed-methods design, we deployed a gamified prototype platform to 312 international participants from Mainland China, Hong Kong, and Indonesia. Data were collected through a 2 2 2 factorial experiment incorporating reputation badges, social proof nudges, and tiered loyalty rewards. Structural equation modelling (SEM) was applied to evaluate incentive-trust linkages, supported by log data analysis including dwell time, path length, and network centrality measures. Results demonstrate that cognitive trust increased significantly ( = 0.43, p < 0.001) when clinician credential badges were visible, while affective trust rose through social proof interventions. Purchase intention showed a 19% improvement relative to control groups, mediated through dual trust pathways. Network simulation revealed that trust propagated across participants peer networks with clustering coefficients above 0.62, indicating robust diffusion effects. The study advances theoretical understanding of trust spill-overs in health-tourism contexts and offers policy guidance for balancing incentive salience with ethical safeguards. Implications extend to platform operators, regulators, and regional policymakers tasked with strengthening Macaus competitiveness in digital health tourism