Situated generosity in clinical care: A mixed-methods study of STI services in China

BACKGROUND: Generosity is a critical yet understudied dimension of prosocial behavior in healthcare. Existing research has focused on individual traits or professional values, with limited attention to how generosity is shaped in everyday clinical contexts. This study examines how healthcare professionals in China understand and enact generosity in sexually transmitted infection (STI) services, and how it is shaped by relational and organizational conditions. METHODS: We conducted semi-structured interviews with 27 healthcare professionals and a focus group with four participants across five hospitals in Guangdong Province, China. Thematic analysis explored clinicians' understandings and experiences of generosity. Crisp-set Qualitative Comparative Analysis (csQCA) examined configurations of relational and organizational conditions associated with reported generous practices. Data were analyzed using NVivo 12 and csQCA 4.0. Given uniform outcome presence, findings are interpreted as descriptive configurational patterns rather than causal effects. RESULTS: Participants described generosity as discretionary practices beyond formal duties, including emotional support, flexible scheduling, and financial accommodations. These practices were associated with patient trust and collegial support, but also with emotional strain and boundary tensions in resource-constrained settings. Generosity was more often described in accounts involving clinicians' engagement with patients' broader social circumstances and experiences of supportive team environments. Overall, generosity appeared as a context-dependent practice shaped by interacting relational and organizational conditions. CONCLUSION: Generosity in STI care appears as a relationally embedded practice shaped by interactions among clinicians, patients, and organizational environments. It reflects the coupling of relational dynamics and institutional conditions that simultaneously enable and constrain discretionary care. Sustaining situated generosity therefore depends less on individual motivation than on organizational infrastructures that structure relational work in clinical settings.