Patients' continued willingness to seek initial treatment at primary care facilities: A study of trust-based driving mechanisms

Initial treatment at primary care facilities can promote rational use of healthcare services and alleviate imbalance between healthcare supply and demand. However, the proportion of Chinese patients seeking medical services primarily at primary healthcare institutions is very low, far below policy expectations. This phenomenon suggests that we need to explore strategies and methods to encourage patients to firstly contact with primary care when they seek medical help. Therefore, it is of great significant to explore the driving mechanisms of patients' willingness to seek initial treatment at primary care facilities. To verify the social and psychological mechanisms of patients' continued willingness to seek initial treatment at primary care facilities by empirical research. This study constructed a theoretical model of "Expectation Confirmation–Patient Trust–Continued Willingness to Seek Initial Treatment at Primary Care Facilities" in the context of family doctor contracted services. A questionnaire survey was conducted among patients at a community health centre in Chengdu. Independent sample t -tests and one-way ANOVA were used to examine the differences in patient trust across various groups; structural equation modeling was employed to verify the theoretical hypotheses and mediation effects. Patients expect a higher level of confirmation. The patients' trust is generally high, among which the emotional trust is the highest and the service trust is the lowest. Patients who were adults, aged 60 and above, suffered hypertension or diabetes, had signed a family doctor, chose a fixed doctor, and had higher expectation confirmation showed higher trust in primary care. Expectation confirmation did not significantly affect the willingness to seek initial treatment at primary care facilities, but patient trust served as a complete intermediary. Patient trust has a complete mediating effect between expectation confirmation and the willingness to seek initial treatment at primary care facilities. Meeting patients' targeted needs and providing experiences that exceed their expectations are the starting points for patient trust. Patients' willingness to seek initial treatment at primary care facilities can be enhanced by emotional trust based on public health services, technical and service trust by improved diagnostic capabilities and referral services.