Exploring the association between social support and reward satisfaction: the mediating role of multi-dimensional psychological capital

Severe workforce shortages persist in China’s primary-care facilities, threatening healthcare-system sustainability and population health. Although multiple reward policies have been introduced since the 2009 healthcare reform, most primary healthcare providers remain dissatisfied with organizational incentives. Existing studies have separately examined associations between social support or psychological capital and reward satisfaction. However, most scholars treat psychological capital as a single composite indicator, overlooking distinct pathways of its four sub-dimensions. Furthermore, few studies have explored differential mechanisms underlying the association between social support and reward satisfaction through distinct psychological-capital dimensions within primary healthcare contexts. To address these gaps, this study explores the social support—reward satisfaction linkage, and identifies the mediating mechanisms of multidimensional psychological capital, to provide evidence for primary healthcare administrators to improve flexible incentive systems. A cross-sectional questionnaire survey was conducted, collecting 1154 valid samples from five types of primary healthcare institutions in Anhui Province. Correlation and mediation analyses were performed using Amos 22.0, SPSS 21.0 and the PROCESS macro tool. There was a significant positive correlation between social support and reward satisfaction (Model 5 β = 0.257, p < 0.001; Model 6 β = 0.178, p < 0.001). The sub-dimensions of psychological capital displayed divergent indirect effects. Hope exerted a positive partial mediating effect (indirect effect = 0.077, 95% confidence interval = [0.042, 0.115], excluding 0), whereas self-efficacy generated a masking effect (indirect effect = -0.033, 95% confidence interval = [-0.057, -0.009], excluding 0). Nevertheless, this masking negative indirect effect is observed only in the parallel mediation model, as it may also reflect a statistical suppression associated with high correlations among psychological-capital dimensions. Optimism (indirect effect = 0.019, 95% confidence interval = [-0.014, 0.051], including 0) and resilience (indirect effect = -0.009, 95% confidence interval = [-0.040, 0.021], including 0) showed non-significant mediating effects. Social support is positively correlated with reward satisfaction. This study examines four potential indirect pathways via psychological capital sub-dimensions, among which only hope and self-efficacy show statistically significant indirect effects. The findings differ from prior results and provide a basis for formulating a feasible incentive system in primary medical institutions.