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Online Health Information Seeking (OHIS) serves as an alternative form of social capital that can help older adults alleviate offline medical-related stress. This study collected and analyzed user interaction data from Patient-to-Doctor and Patient-to-Peer platforms and compared the roles of social support between them. Significant differences were identified in the dimensions of social support (information, emotional, and companion) on the Patient-to-Peer platforms compared with Patient-to-Doctor platforms (p < 0.05). The overall and core–core network density values for social support on Patient-to-Peer platforms were higher than those on Patient-to-Doctor platforms. Patient-to-Doctor interactions focused on information support, displaying a more centralized and efficient network with structural holes pertaining to treatment effects. By contrast, Patient-to-Peer interactions provided more emotional support, with a dispersed and redundant network containing structural holes related to individual information. Companion support was found to be weaker on both platforms. Additionally, digital literacy, surrogate seeking, and altruistic information significantly explained the variances between the two platforms (p < 0.01), with surrogate seeking playing a crucial role. These findings enhance our understanding of OHIS disparities among older adults and their surrogates, offering valuable insights for developing effective support systems and regulatory frameworks for health information platforms. [ABSTRACT FROM AUTHOR]

Aims To understand the compliance, influencing factors, and action path of family cardiac rehabilitation exercise prescriptions for children after congenital heart disease surgery. Methods and results A random sampling method was used to select 200 paediatric patients and their parents from a paediatric hospital in Shanghai. Among them, 57 cases (28.5%) of children's families followed the cardiac rehabilitation exercise prescription. Path analysis showed that peak oxygen uptake exerted a negative impact on the compliance of family cardiac-rehabilitation prescriptions for patients after congenital heart disease surgery through doctor–patient trust, with a standardized path coefficient of −0.246 (P = 0.001). Disease-related knowledge exerted a positive effect on the compliance of family cardiac-rehabilitation prescriptions for children after congenital heart surgery through doctor–patient trust, with a standardized path coefficient of 0.353 (P < 0.001). The dimension of friend support in social support had a direct positive effect on the compliance of family cardiac-rehabilitation prescriptions for children after cardiac surgery, with a standardized path coefficient of 0.641 (P = 0.006). Conclusion The compliance of cardiac rehabilitation exercise prescription in children with congenital heart disease is not good and is affected by many factors, and there is a complex path relationship between various factors; the kilogram oxygen consumption of the child, the disease-related knowledge of the caregiver, and social support all play important roles in the compliance of the child's family's health prescription. Registration ChiCTR2200062022 [ABSTRACT FROM AUTHOR]

The doctor-patient relationship in China has become increasingly tense, with patients lacking trust in doctors. Meanwhile, online healthcare flourished, accelerated by the COVID-19 pandemic. This study utilized the direct and indirect pathway model of clinician-patient communication to health outcomes and online trust theory to examine the associations between online patient-centered communication (OPCC), benevolence and ability trust in doctors, negative online health information seeking experiences, and willingness to recommend doctors. The findings revealed that benevolence and ability trust mediated the relationship between OPCC and willingness to recommend doctors. Additionally, when participants had a high level of negative online health information seeking experiences, OPCC had a stronger effect on ability trust; meanwhile, the mediation effect of ability trust between the relationship of OPCC and willingness to recommend was stronger. This study also discussed theoretical and practical implications. [ABSTRACT FROM AUTHOR]

Background and objective: Developing harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China's hierarchical medical system on doctor-patient relationships, thus contributing to China's medical and health system reform. Methods: With panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy. Results: Hierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger. Conclusion: While reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries. [ABSTRACT FROM AUTHOR]

Objectives: General practitioners are trained to care for patients with a high level of responsibility and professional competency. However, there are few reports on the physical and mental health status of general practitioners (GPs) in China, particularly regarding help seeking and self-treatment. The primary aims of this study were to explore GPs' expectations of their own family doctors and their reflection on role positioning, and to explore the objective factors that hinder the system of family doctors. Study design: Cross-sectional study. Methods: We conducted an online survey of Chinese GPs. Descriptive statistics were used to summarize the findings. Results: More than half of the participants (57.20%) reported that their health was normal over the past year. A total of 420 participants (23.35%) reported having chronic diseases. For sleep duration, 1205 participants (66.98%) reported sleeping 6–8 h per day; 473 participants (26.29%) reported chronic insomnia. Two hundred thirty-one participants (12.84%) had possible depression. A total of 595 (33.07%) participants reported that they had contracted a fixed family doctor. In terms of preventing themselves from contracting for a family doctor, the following factors were identified: lack of sufficient time (54.81%), could solve obstacles themselves (50.97%), and embarrassment (24.24%). The proportion of the contract group (12.44%) taking personal relationship as a consideration was higher than that of the non-contract group (7.64%) (χ2 = 10.934 P = 0.01). Most participants (79.90%) in the non-signed group reported never having seen a family doctor. In terms of obstacles, more than half of the signed group thought that they could solve obstacles themselves, while the non-signed group (39.20%) was less confident in the ability of family doctors than the signed group (29.75%) (χ2 = 15.436, P < 0.01). Conclusions: GPs work under great pressure and lack of self-care awareness, resulting in an increased prevalence of health conditions. Most GPs did not have a regular family doctor. Having a family doctor with a fixed contract is more conducive to the scientific management of their health and provides a reasonable solution to health problems. The main factors hindering GPs from choosing a family doctor were time consumption, abilities to solve obstacles themselves, and trust in the abilities of GPs. Therefore, simplifying the process of family doctor visits, Changing the GPs' medical cognition, and strengthening the policy of GP training would be conducive to promoting a family doctor system that enhances hierarchical diagnosis and treatment. International collaboration could integrate GP health support into global healthcare system. [ABSTRACT FROM AUTHOR]

Online health communities (OHCs) are encouraging doctors to engage in prosocial behaviors to promote sustainable development of OHCs and benefit the user base, which may further influence doctor-level performance. However, it is unclear how prosocial behavior and its intensity affect doctor-level performance, such as doctor-patient relationship, online reputation, and online demand. The purpose of this study is to test the effects of prosocial behavior and its intensity on doctor-patient relationship, online reputation, and online demand. We conducted a series of empirical analyses on 103,208 doctor-level samples from a leading OHC in China. Initially, we applied the propensity score matching (PSM) method to obtain a more balanced sample, then, we employed a negative binomial regression model to analyze the sample after PSM, and finally, we performed a robustness test using a zero-inflated negative binomial regression model and changing the time window. Our research findings indicate that prosocial behavior positively affects the doctor-patient relationship, doctors' online reputation, and online demand. The intensity of prosocial behavior has an inverted U-shaped relationship with the doctor-patient relationship, online reputation, and online demand. The doctor's clinical title negatively moderates the effect of prosocial behavior on the doctor-patient relationship and online demand. Therefore, OHC operators can draw on our findings to encourage more doctors to engage in prosocial behavior while suggesting they consider the role of the intensity of prosocial behavior and clinical title. [ABSTRACT FROM AUTHOR]

Objective: To explore the symptom experiences and influencing factors of gastrointestinal (GI) cancer patients on chemotherapy (CTX) in China. Methods: Semi-structured interviews were conducted with 13 GI cancer patients undergoing CTX. Following the Colaizzi 7-step analysis method, the interview data were read carefully, meaningful statements related to the research questions were extracted, coded, collected, and described in detail, and the authenticity of the theme was verified. Results: Nine themes were grouped into two main areas including the characteristics of symptom experiences and influences on symptom experiences. Conclusion: The symptom experiences of patients undergoing CTX for GI cancer is poor and influenced by multiple factors. Nurses need to pay attention to the assessment and monitoring of CTX-related symptoms, improve symptom recognition, enhance doctor-patient communication and social support, explore intelligent management methods, and increase the efficiency of healthcare services to improve patients' symptom experience. [ABSTRACT FROM AUTHOR]

This study aimed to assess the level of public trust in general practitioners (GPs) and its association with primary care contract services (PCCS) in China. Cross-sectional study. Between September and December 2021, 4158 residents across eastern, central, and western China completed a structured self-administered questionnaire. Trust was assessed using the Chinese version of Wake Forest Physician Trust Scale. Multivariable linear regression models were established to identify predictors of trust. The effect size of PCCS on trust was estimated by the average treatment effect for the treated (ATT) through propensity score matching. The study participants had a mean Wake Forest Physician Trust Scale score of 36.82 (standard deviation = 5.45). Enrollment with PCCS (β = 0.14, P < 0.01), Han ethnicity (β = 0.03, P < 0.05), lower educational attainment (β = −0.06, P < 0.01), higher individual monthly income (β = 0.03, P < 0.05), better self-rated health (β = 0.04, P < 0.05), chronic conditions (β = 0.07, P < 0.01), and higher familiarity with primary care services (β = 0.12, P < 0.01) and PCCS (β = 0.21, P < 0.01) were associated with higher trust in GPs. The ATT of PCCS exceeded 1 (P < 0.05). PCCS are associated with higher levels of trust in GPs. PCCS may become an effective tool to attract public trust in GPs, although the relationship between the two may be bi-directional. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression.SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services.Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. What the paper adds to existing knowledge?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression.MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression.The positive preferences for providing information and family involvement in treatment decision‐making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. What are the implications for practice?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision‐making actively.A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression.SDM‐related training should be encouraged for MHPs to promote widespread SDM. Introduction: Shared decision‐making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well‐documented. Aim: This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. Method: In this cross‐sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision‐Making Questionnaire—Physician Version (SDM‐Q‐Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. Results: The mean SDM‐Q‐Doc was 80.47 (±16.31). Within the six specific decision‐making situations, most MHPs selected non‐SDM (52.7%–71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision‐making, working in an outpatient clinic and receiving SDM training (F = 23.582; p =.000; R2 =.198; adjusted R2 =.189). Discussion: Although the MHPs' self‐rated score of SDM‐Q‐Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM‐related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer‐practitioner relationship. Implications for Practice: MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high‐quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families. [ABSTRACT FROM AUTHOR]

Introduction: In response to evolving patient‐centred care initiatives, this study investigates teasing in Chinese outpatient interactions. By exploring how teasing impacts knowledge exchange and decision‐making processes, the research underscores its utility in enhancing patient engagement and communication efficacy, aligning with China's healthcare reform objectives. Methods: Utilizing conversation analysis, the study meticulously examines a series of outpatient interactions, identifying and analyzing instances of teasing. Through a detailed investigation of the sequential organization, design features, and interactional tasks accomplished by teasing, the research unravels the complex mechanisms through which teasing operates within clinical settings. Results: Findings reveal that teasing is a sequential accomplishment that is intertwined with institutional contingencies and embedded in overarching sequential projects of clinics. Teases often arise from subtle cues that may lead to delicate moments and are crafted with a blend of playfulness and seriousness, serving to bridge the gap between patient experiences and medical expertise. This study highlights how teasing facilitates the exchange of knowledge and influences collaborative decision‐making, marking a departure from its more casual use in everyday interactions. Teasing acts as a catalyst for a more profound comprehension of medical facts, encouraging patients to actively participate in their care by expressing concerns and preferences, thus aligning medical decisions with patient autonomy. The responses to teases vary, reflecting the complexity of clinical communication and the need for a delicate balance between humour and professionalism. Conclusions: The study underscores the significance of teasing as a multifaceted communicative practice within outpatient clinical interactions. It highlights how teasing can contribute to a more nuanced and patient‐centred approach to healthcare, enhancing the collaborative exploration of medical advice and fostering a more engaging and empathetic clinical environment. Patient or Public Contribution: This study utilized real outpatient interactions, with participants' informed consent. The analysis focused on authentic teasing exchanges between clinicians and patients, ensuring the findings reflect genuine communication practices in healthcare settings. Participants, including both healthcare professionals and patients, were informed about the study's goals and their essential role in providing insights into clinician–patient communication, contributing to a deeper understanding of interaction dynamics in outpatient clinics. [ABSTRACT FROM AUTHOR]

Antibiotic overprescription in China has long been considered a problem on the supply side, linked to the financial incentives of physicians. Based on the conversation analysis of 187 video‐recorded naturally occurring medical consultations in Chinese paediatric primary care settings, this study finds that the driving force behind the problem of antibiotic overprescription in China has changed. Physicians use a low‐authority communication style to recommend treatment, displaying a low level of medical authority and a willingness to accommodate caregivers' preferences in antibiotic prescribing decisions. The problem is now attributed to physician–caregiver interaction, doctor–patient relationship and the antibiotic‐saturated prescribing culture. Practice implications involve deepening the understanding of the evolving nature of the antibiotic overprescription problem in China, building trust between physicians and patients/caregivers in order to facilitate the physicians' role as the gatekeeper of antibiotics and providing training programmes to help physicians develop effective communication skills. [ABSTRACT FROM AUTHOR]

Objectives: In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. Methods: Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction. Results: The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training. Conclusion: This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction. [ABSTRACT FROM AUTHOR]

Numerous women struggling with health issues dare not go to the hospital due to the stigmatization of obstetric and gynecological diseases in traditional Chinese culture. Social media provide a platform for women to access health information from experts easily. Guided by the doctor-patient communication model, attribution theory, and destigmatization framework, we sought to understand the topics/diseases covered by top OB/GYN influencers on Weibo and the prevalent functions, language style, responsibility attribution, and destigmatization cues used by them. We also examined how these communication strategies predicted followers' engagement behavior. The results showed that women's childbirth-related issues received the highest exposure in the leading OB/GYN influencers' Weibo posts. Influencers' emphasis on building psychological connectedness with their followers was exhibited in the following communication strategies: avoiding using complex medical terminology, drawing equivalences between the outgroup and ingroup, and providing health information. However, using everyday language, responding to emotions, and removing blame served as the three most influential predictors of followers' engagement. Theoretical and practical implications are also discussed. [ABSTRACT FROM AUTHOR]

This paper addresses doctor-patient communication about C-sections (CSs) in Shanghai, China. Specifically, we examine the information discrepancies between obstetricians' and patients' perceptions of CS and the important factors affecting shared decision-making. We conducted semi-structured individual interviews with 12 postnatal women who experienced CS and with 12 obstetricians. We identified barriers to patient-doctor communication and shared decision-making: obstetricians' lack of time in outpatient prenatal visits to explain the implications of CSs, family members' knowledge and opinions on CSs, and information from media and social networks. The lack of communication between the expectant women and the obstetricians was driving the women's distrust in the latter. The lack of obstetricians' time to communicate with the pregnant woman led to low trust in the medical staff and overutilization of CS, whereas a lack of financial resources led to underutilization of CS. The obstetricians suggested providing expectant women with more education programs and midwifery support. [ABSTRACT FROM AUTHOR]

Background: The emergence of proprotein convertase subtilisin/kexin type 9 inhibitors offered dyslipidemia patients an alternative to statins for lipid‐lowering treatment. Understanding patient and physician preferences for lipid‐lowering drugs may promote shared decision‐making and improve treatment outcomes. Methods: This study utilized an online discrete choice experiment (DCE) to assess the relative importance (RI) of six attributes related to lipid‐lowering drugs, including frequency of administration, mode of administration, reduction of low‐density lipoprotein cholesterol (LDL‐C) level, risk of myopathy, risk of liver damage, and out‐of‐pocket monthly cost. Respondents were recruited from dyslipidemia patients and cardiovascular physicians in China. A mixed logit model and latent class analysis were employed to estimate the preference coefficient, marginal willingness to pay (mWTP), and RI of attributes. Ethical approval has been obtained for this study. Results: A total of 708 patients and 507 physicians participated in the survey. Patients prioritized the 'risk of liver damage' (RI = 23.6%) with 'mode of administration' (RI = 19.2%) and 'frequency of administration' (RI = 18.8%) following closely. Contrarily, physicians prioritized the 'reduction of LDL‐C level' (RI = 33.5%), followed by 'risk of liver damage' (RI = 26.0%) and 'risk of myopathy' (RI = 16.1%). Patients placed a higher value on 'frequency of administration' (p <.001) and 'mode of administration' (p <.001) compared to physicians, while physicians valued 'reduction of LDL‐C level' (p <.001) and 'risk of myopathy' (p =.012) more than patients. Physicians exhibited higher mWTP than patients for all attributes except frequency and mode of administration. The LCA revealed three distinct patient classes: focus on oral administration, focus on hepatic safety and frequency and focus on hepatic safety and cost. Likewise, three physician classes were identified: frequency‐insensitive, efficacy‐focused and safety‐focused. Conclusions: The preferences for lipid‐lowering drug therapy differed between patients and physicians in China. Physicians should take into account patients' preferences and provide personalized treatment when they formulate lipid‐lowering treatment plans. Patient or Public Contribution: Patients participated in the questionnaire design process. They engaged in a focus group discussion to determine attributes and levels and also participated in a pilot survey to assess the comprehensibility of the questionnaires. Additionally, patients were involved in the DCE survey to express their preferences. The findings of patient preference for lipid‐lowering drug therapy will promote shared decision‐making and optimize the treatment regimen. [ABSTRACT FROM AUTHOR]

Objective of this study is to elucidate the current status of outpatient trust in physicians in China and its influencing factors, providing empirical evidence to enhance doctor-patient trust and improve doctor-patient relationships. Methods: Between December 2017 and January 2018, 28,760 patients seeking care at the outpatient departments of 136 tertiary hospitals were interviewed, where they were asked to rate their trust in physicians. We applied a multilevel logistic regression model to explore the association between patients trust and characteristics of hospitals, physicians and patient characteristics. We conducted a series of sensitivity analysis to check the robustness of our findings. Results: Among 28,760 participants included in this study, 91.54% expressed trust in their physicians, while 7.52% showed moderate trust. Only 0.94% expressly distrusted or strongly distrusted their physicians. Outpatients of hospitals with convenient payment, volunteer guidance and enough seats available in the rest and waiting area showed higher levels of trust. Physicians who had a senior title, showed patience and protection of the patient's privacy were more likely to be trusted by their patients in the outpatient setting. Compared to their female counterparts, male outpatients showed a higher degree of trust. Conclusion: While this study highlights an overall high level of Trust in physicians (TIP) among patients in China's tertiary hospitals, it is found to vary with patient demographic factors as well as provider's attributes. Hospitals with a more keen sense of protecting patients privacy and better meeting patients' need for efficient and caring service provision process appeared to yield a higher level of trust. [ABSTRACT FROM AUTHOR]

The authors explore the barriers and facilitators to early mobilisation and weight-bearing as tolerated following hip fracture surgery among older adults in China and other countries, like India and Saudi Arabia. Topics discussed include the factors in determining weight-bearing prescriptions, the importance of multidisciplinary co-management and patient education, and the use of a gradual transition approach to expand early mobilisation.

Trust-related issues have attracted much attention from researchers recently. In the studies on trust, little attention has been paid to its interrelations with cooperativity and reliability. This paper sheds light on the relationship among trust, cooperation, and reliability in a medical context. Through a discourse analysis of the conversations between doctors and patients (including the patients' relatives) in China, this paper finds that: (i) cooperativity will not directly lead to trust in a medical context; (ii) being cooperative or using strategies to disclaim responsibility will lead to high reliability and will indirectly construct trust; (iii) reliability is a premise for trust in the medical context, and it can be repaired through rapport management strategies, such as empathy discourse if that reliability has been broken down. The research findings in this paper possess both theoretical and practical signifi- cance because they will refresh our understanding of the interrelationship among trust, cooperation, and reliability and contribute to the maintenance or enhancement of trust relations between doctors and patients. [ABSTRACT FROM AUTHOR]

Background: Patient satisfaction is an important outcome domain of patient-centered care. Medical humanization follows the patient-centered principle and provides a more holistic view to treat patients. The COVID-19 pandemic posed significant barriers to maintaining medical humanization. However, empirical study on the relationship between medical humanization and patient satisfaction is clearly absent. Objectives: We examined the mediation effects of communication on the relationship between medical humanization and patient satisfaction when faced with a huge public health crisis like the COVID-19 pandemic, and the moderation effect of medical institutional trust on the mediation models. Methods: A cross-sectional survey study was performed. A final sample size of 1445 patients was surveyed on medical humanization, communication, patient satisfaction and medical institutional trust. Results: All correlations were significantly positive across the main variables (r = 0.35–0.67, p < 0.001 for all) except for medical institutional trust, which was negatively correlated with the medical humanization (r=-0.14, p < 0.001). Moderated mediation analysis showed that the indirect effect of medical humanization on patient satisfaction through communication was significant (b = 0.22, 95% CI: 0.18 ~ 0.25). Medical institutional trust significantly moderated the effect of medical humanization on patient satisfaction (b=-0.09, p < 0.001) and the effect of medical humanization on communication (b= -0.14, p < 0.001). Conclusion: Medical humanization positively influence patient satisfaction, communication mediated the association between medical humanization and patient satisfaction, and medical institutional trust negatively moderated the effects of medical humanization on patient satisfaction and communication. These findings suggest that humanistic communication contributes to patient satisfaction in the face of a huge public health crisis, and patients' evaluation of satisfaction is also regulated by rational cognition. [ABSTRACT FROM AUTHOR]

Background: China is implementing the family doctor (FD) system to reform the primary healthcare (PHC). The family doctor contract service (FDCS) policy plays a crucial role in this system implementation, aiming to transform the doctor-patient relationship and enhance PHC quality. This study aims to investigate the impact of FDCS on the doctor-patient relationship in PHCs using field research methodology. Method: The field research methodology was employed to address the research questions. Quantitative methods were utilized for data collection and analysis. A structure questionnaire was used to collect data based on the research questions. Our investigation encompassed twenty-five village clinics across three counties in China. A total of 574 subjects helped us to finish this investigation in the study. The collected data was analyzed using statistical analysis including ordinary least squares (OLS) model and propensity scores matching model (PSM) to estimate the relationship. Result: The findings from ordinary least squares (OLS) regression revealed that FDCS had a positive influence on patient trust in doctors within PHCs, with patients who participated the FDCS exhibiting higher levels of trust compared to those who did not participate. Propensity score matching (PSM) analysis further confirmed these results by accounting for selection bias. Conclusions: The implementation of family doctor contract service has brought about significant transformation in the doctor-patient relationship within rural Chinese PHCs. In essence, it has revolutionized the service model of doctor in PHC, playing a pivotal role in improving primary health quality and enhance the service capability of doctors in PHC. This transformative process has been crucial for carrying out hierarchical diagnosis and treatment policy, which aims to adjust the medical service structure and optimizing the health service system. Therefore, it is imperative for government authorities and health administration departments to ensure continuous support for this essential service through appropriate formulation. [ABSTRACT FROM AUTHOR]

Background: Retention of doctors is a global challenge and doctors working in different departments may face different problems. The study aimed to explore the turnover behavior and intention and correlated factors among Chinese dentists and medical doctors in other clinical fields. Methods: A cross-sectional study was conducted online in 5 regions of China from March 12th to April 12th, 2020. The questionnaire included 3 parts, socio-demographic characteristics, turnover behavior and intention, and concerns about work-related factors. Chi-square test and/or Wilcoxon Mann-Whitney test were applied for comparison, and binary logistic regression was used for finding the factors. Results: A total of 2428 eligible questionnaire were received, comprising 1954 responses from dentists and 474 from medical doctors. Rates of turnover behavior among dentists and medical doctors were 2.87% and 6.96%, respectively. Similarly, rates of turnover intention were 51.79% among dentists and 71.20% among medical doctors. Educational level was negatively correlated with turnover behavior of both medical doctors and dentists, and concern about salary was a unique negatively correlated factor for dentists. Age was negatively correlated with turnover intention in both medical doctors and dentists. Conversely, concerns about workload and doctor-patient relationship were positively correlated with turnover intention in both groups. Concern about salary was the distinct correlated factor of medical doctors' turnover intention, while gender and annual household income were correlated with turnover intention among dentists. Conclusions: Low turnover rate but high turnover intention rate was the current status of Chinese doctors' employment. Turnover behavior and intention were more optimistic among dentists than medical doctors. Factors related to turnover behavior and turnover intention were not identical among dentists and medical doctors. Therefore, personalized retention measures were necessary for dentists and medical doctors. [ABSTRACT FROM AUTHOR]

Despite patients' cultural background influencing their satisfaction with medical care the majority of studies draw on assumptions and models from the Western world. We move attention to the East Asian world by investigating the attributes of Chinese patients' satisfaction with their hospital in-patient care. Our research design is an exploratory qualitative study of 577 incidents of Chinese hospital in-patients' complaints and compliments. The data were drawn from a sample of reports of patients' satisfaction with their care in a district general hospital over a five-year period. Analysis focused on satisfactory and dissatisfactory events to derive attributes involved. We find patients in Chinese culture evaluate satisfaction with their care using eight attributes: professionalism, efficiency, chīn-chièh, respect, patience, responsibility, value and ethics. We explore how Chinese patients' values and beliefs toward medicine and care-giving construct distinct meanings around these attributes. By synthesizing our findings with those in the literature we propose generic attributes which can form the basis of measures of Chinese patient satisfaction and inform training in cultural competence. [ABSTRACT FROM AUTHOR]

The rapid advancement of digital technology has transformed the media landscape, with platforms e.g., WeChat, Weibo, TikTok, and online platforms are gaining popularity for healthcare services and information dissemination platform in China. Traditional media e.g., newspapers, television, and radio, once dominant, now face challenges and transitions, leading to insufficient healthcare communication. As one of the major alternatives, WeChat offers official accounts for hospitals to enhance their healthcare quality and promote their medical services. Hospitals now must rely on diverse and content-rich digital media to enhance their reputation. Addressing privacy concerns and user preferences will enhance the adoption and utilization of digital healthcare services, meet users' ever evolving needs, and promote the sustainable development of healthcare quality. User interactions and social engagement are crucial in shaping brand trust within the scope of doctor-patient relationships. Building trust and addressing privacy concerns are essential for successful adoption of digital healthcare services. Perceived ease of use and usefulness are among critical factors in technology adoption by the respective society. Future research should explore the adoption of digital branding platforms in different healthcare settings and cultures to provide a more comprehensive digital branding strategies for healthcare providers. The adoption of hospital WeChat Official Accounts as digital branding platforms is influenced by user interactions, trust, ease of use, and perceived usefulness. Addressing privacy concerns and focusing on usability and relevance are key for successful implementation. [ABSTRACT FROM AUTHOR]

Background: Based on the principle of informed consent, doctors are required to fully inform patients and respect their medical decisions. In China, however, family members usually play a special role in the patient's informed consent, which creates a unique "doctor-family-patient" model of the physician-patient relationship. Our study targets young doctors to investigate the ethical dilemmas they may encounter in such a model, as well as their attitudes to the family roles in informed consent. Methods: A questionnaire was developed including general demographic characteristics, the fulfillment of the obligation to fully inform, who will be informed, and the ethical dilemmas in decision-making. We recruited a total of 421 doctors to complete this questionnaire, of which 368 met the age requirements for this study. Cross tabulation and Pearson's chi-squared test were used to analyze the differences between types of patients for categorical variables, and a p-value < 0.05 was considered statistically significant. Results: Our data shows that only 20 doctors (5.40%) stated "informing the patient alone is sufficient" when it comes to informing patients of their serious conditions. The rest of the participants would ensure that the family was informed. When facing elderly patients with decision-making capacity, the data was statistically different (3.8%; P < 0.001) The primary reason for ensuring that family members be informed differs among the participants. In addition, when family members asked doctors to conceal the patient's medical condition for the best interests of patients, 270 doctors (73.4%) would agree and cooperate with the family. A similar proportion (79.6%) would do so when it comes to elderly patients. Conclusions: (1) Chinese doctors pay extra attention to informing the patient's family, which may not be in the patient's best interests. (2) Chinese doctors treat adult (but not elderly) patients and elderly patients differently when it comes to informing family members. (3) When family members request that doctors withhold information from patients "in the best interest of the patient," the majority choose to comply with the request, although this may cause them distress. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this study was to examine the association among doctor-patient communication, trust, and patients' negative stereotypes for healthcare professionals during COVID-19. Background. Patients' negative stereotypes for healthcare professionals have been considered a major cause of violence against healthcare professionals. During COVID-19, since the fear for illness could exacerbate patients' negative stereotypes for healthcare professionals, therefore, how to inhibit patients' negative stereotypes for healthcare professionals has become a top priority. Methods. From January 2020 to April 2020, a cross-sectional survey study was performed in which a total of 2000 patients were convenience-sampled from different regions of China. The survey measured doctor-patient communication, institutional trust, interpersonal trust, and patients' negative stereotypes for healthcare professionals, respectively. After standardizing the total data scores, the association between doctor-patient communication, trust and patients' negative stereotypes for healthcare professionals using the bootstrap method was built. Results. There was a moderate to the high correlation between doctor-patient communication, patients' negative stereotypes for healthcare professionals, interpersonal trust, and institution trust (r = 0.36–0.68, p < 0.01). Mediation analysis showed that patients' interpersonal trust (β = −0.25, 95% CI: −0.312–−0.209) than patients' institution trust (β = −0.02, 95% CI: −0.042–−0.007) played a greater role in suppressing negative stereotypes through doctor-patient communication. Conclusions. Through communication, healthcare professionals and patients increase their familiarity and identification, thereby reducing patients' negative stereotypes. Moreover, because interpersonal trust connotes emotional and cognitive trust, it was more beneficial than institution trust in reducing negative stereotypes. Implications for Nursing Management. The results of this study can tell governments, healthcare organizations, communities, and healthcare professionals that reducing violent behaviors based on negative stereotypes requires attention to institutional trust building, interpersonal trust development, and communication improvement. [ABSTRACT FROM AUTHOR]

Background: The mental health workforce sustainability in China suffers high rates of attrition and the intention to leave. Among current professionals, the intention to choose the same career is an interesting way to gauge their job satisfaction and other factors, and it may affect the career choices of younger generations. We aimed to survey the intention of psychiatrists and psychiatry residents to choose the same career if they could start over and to identify associated factors. Methods: We conducted an anonymous survey of psychiatrists in 41 tertiary psychiatric hospitals in China. We collected demographic data, work-related information, the sense of professional identity, job satisfaction, and burnout (Maslach Burnout Inventory), and we specifically asked each participant whether they would choose to be a psychiatrist again if they could. Results: Among 3,783 psychiatrists we surveyed, one-quarter responded that they would not choose to be a psychiatrist again if they had a choice, with less than half (47.2%) saying they would. Those who would not choose psychiatry again were more likely to have a negative (relative to positive) professional identity (OR = 7.47, P＜0.001, 95%CI: 4.587–12.164); experience job burnout (OR = 2.945, P＜0.001, 95%CI: 2.356–3.681); be dissatisfied with their job (OR = 2.739, P＜0.001, 95%CI: 2.102–3.569) and excessive regulation (OR = 1.819, P＜0.001, 95%CI: 1.487–2.226); have a heavy workload (OR = 1.749, P＜0.001, 95%CI: 1.423–2.149) or a lower income (OR = 1.748, P＜0.001, 95%CI: 1.415–2.161); be married (relative to single) (OR = 1.604, P = 0.004, 95%CI: 1.165–2.208); be dissatisfied with strained doctor-patient relationship (OR = 1.333, P = 0.005, 95%CI: 1.089–1.632); have more night shifts per month (OR = 1.055, P = 0.021, 95%CI: 1.008–1.104) or work longer hours per week (OR = 1.016, P = 0.001, 95%CI: 1.006–1.025). Conclusion: Among psychiatrists in tertiary hospitals in China, those with a heavier workload, poor sense of professional identity, job dissatisfaction, and burnout were less likely to choose psychiatry again. Policymakers and hospital administrators need to take effective measures to improve psychiatrists' sense of professional identity and increase their intention to stay. [ABSTRACT FROM AUTHOR]

Objective: The doctor-patient relationship (DPR) plays a crucial role in the Chinese healthcare system, functioning to improve medical quality and reduce medical costs. This study examined the psychometric properties of the Chinese version of the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) among general hospital inpatients in China. Methods: The research recruited 38 resident doctors responsible for 120 participants, and factor analyses were used to assess the construct validity of the scale. Convergent validity was evaluated by examining the correlation between DDPRQ-10 and depressive symptoms, burnout, and self-efficacy, using the Patient Health Questionnaire Depression Scale-9 item (PHQ-9), and the Maslach Burnout Inventory (MBI). Both multidimensional item response theory (MIRT) and unidimensional item response theory (IRT) frameworks were used to estimate the parameters of each item. Results: The Chinese version of DDPRQ-10 showed satisfactory internal consistency (Cronbach's alpha = 0.931), and fitted in a modified two-factor model of positive feelings and negative feelings (χ2/df = 1.494, GFI = 0.925, RMSEA = 0.071, SRMR = 0.008, CFI = 0.985, NFI = 0.958, NNFI = 0.980, TLI = 0.980, IFI = 0.986). Significant correlations with PHQ-9 with DDPRQ-10 and both subscales were revealed (r = 0.293 ~ 0.333, p <.001), while DDPRQ-10 score also significantly correlated with doctors' MBI score (r = -0.467, p <.001). The MIRT model of full scale and IRT models of both subscales showed high discrimination of all items (a = 2.30 ~ 10.18), and the test information within the range of low-quality relationship was relatively high. Conclusion: The Chinese version of DDPRQ-10 displayed satisfactory reliability and validity and thus was appropriate for measuring the DPR in Chinese medical settings. [ABSTRACT FROM AUTHOR]

Medical social work is gradually developing in China, and children's hospitals greatly need medical social workers. However, different groups have different perceptions of medical social workers' roles. The role of nascent Chinese medical social workers in children's hospitals is unclear, which hinders the growth of this profession. Therefore, this study aimed to resolve role ambiguity by comprehensively exploring the specific roles of Chinese medical social workers in a children's hospital. A descriptive qualitative research design was adopted. Twenty-six participants, including medical social workers (n = 8), primary caregivers of children (n = 6), and medical staff (n = 12, including 6 doctors and 6 nurses), were recruited by purposive sampling at a tertiary-level children's hospital in China between October and November 2022. Face-to-face semi-structured interviews were conducted to collect data. Three major themes with eleven roles were extracted through Colaizzi's 7-step method of phenomenological data analysis: (1) the role identified by all three groups: psychological supporter, resource linker, and consultant; (2) the role identified by healthcare professionals: coordinator, planner, assessor, advocate, organizer, promoter, and educator; and (3) the role identified by medical social workers themselves: manager. This qualitative study was the first to comprehensively describe the eleven roles assumed by Chinese pediatric medical social workers in the hospital and role ambiguity among different groups. The lack of medical background and practitioners, as well as lower social status, led to medical social workers' role ambiguity problems. Recommendations to strengthen policy support, cultivate a new medical social work culture, and increase the social understanding and recognition of medical social work to resolve role ambiguity are provided. [ABSTRACT FROM AUTHOR]

Introduction/Objective Advance Care Planning (ACP) discussions are infrequently conducted with physicians, even fewer among minorities. We explored physicians' experiences in engaging Chinese (CH) and South Asian (SA) patients in ACP conversations to understand initiation and participation patterns, topics covered, and barriers and facilitating factors. Method Twenty-two physicians with 15%+ SA patients aged 55+ and 19 with 15%+ CH patients aged 55+ were interviewed. Results SA- and CH-serving physicians described similar initiation patterns, cultural context, and need for standardized ACP routines. However, the SA-serving physicians described greater involvement of family members, while CH-serving physicians described more communication barriers and family members' desire to hide the diagnosis from patients. Conclusion Cultural taboos surrounding discussion around death and dying appear to influence CH older adults and families strongly. Lack of familiarity with ACP amongst the SA population accounts more for their limited engagement in ACP discussions. [ABSTRACT FROM AUTHOR]

Background: This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. Methods: We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. Results: In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV‐focused care, and 14 reporting non‐HIV‐focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9–43%, I2 = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12–74%, I2 = 90%) refused hospitalization when needed in the previous year. Barriers to HIV‐focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician–patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non‐HIV‐focused care were financial constraints and the perceived need for medical services at individual‐level factors; and discrimination from physicians, and medical distrust at the community/social level. Conclusion: This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity. [ABSTRACT FROM AUTHOR]

Aim: To explore the job demands of healthcare workers (HCWs) working in mobile cabin hospitals in Shanghai and identify the influencing factors. Design: The study had a cross‐sectional design. Methods: Using the convenience sampling method, we selected 1223 HCWs (medical team members) working in these mobile cabin hospitals during April–May 2022. The findings of the general information questionnaire and the hierarchy scale of job demands of HCWs working in mobile cabin hospitals were used for the investigation. Results: The total score of job demands of the included HCWs was 132.26 ± 9.53; the average score of the items was 4.73 ± 0.34. Multivariate linear regression analyses showed that the following HCWs had significantly higher job demands: female HCWs and HCWs who received psychological training or intervention during the COVID‐19 pandemic, were satisfied with the doctor/nurse–patient relationship, received support from family members/friends/colleagues, believed that the risk of working in mobile cabin hospitals was high, had adapted to the working environment of mobile cabin hospitals and had college/undergraduate level of education. They would benefit from increased social support and better training in terms of psychological coping mechanisms(both theoretical knowledge and applicable skills) and COVID‐19 prevention,control and treatment abilities. [ABSTRACT FROM AUTHOR]

Research based on recordings made across numerous specialties and geographical locations has characterized doctors' solicitations of patients' reasons for the visit as normative. However, in our dataset of 132 audio-recordings of consultations in Chinese primary and secondary care, it was as common for patients to self-initiate giving the reason for their visit as it was for doctors to solicit these (n = 65 vs. n = 67 respectively). Based on a conversation analytic examination of our dataset, we show that doctors do not treat patient-initiated problem presentations as deviant. Whilst there are some contextual contingencies (related, for example, to the queuing-system) that might account for this novel finding, these are only partly explanatory. Instead, we argue that, relative to Western contexts, the participants in our data treat the medical consultation as akin to a service-encounter in which patients are entitled to ask for what they want. Implications for understanding medical openings and health outcomes are discussed. [ABSTRACT FROM AUTHOR]

Based on the theory of planned behavior (TPB), this study investigated how media presentations, intra-family communication, and doctor-patient communication influence compliance with social distancing orders during the initial COVID-19 outbreak. Results from an online survey in China suggested that media risk communication, intra-family communication, and doctor-patient communication enhanced respondents' intention for social distancing via the mediations of positive attitudes, subjective norms, and perceived behavioral control. Additionally, trust in government, information verification, and active media engagement can improve the outcome of risk communication. This study underscores the value of TPB framework in fostering health promotion. By analyzing the interplay between psychological constructs and communication channels, this research contributes to a nuanced understanding of compliance behavior amid pandemics, facilitating informed policy-making and promoting public cooperation. Ultimately, these insights illuminate pathways to cultivate informed decision-making and responsible actions during health crises. [ABSTRACT FROM AUTHOR]

Background: Patients with schizophrenia in rural areas of China face severe delays in getting appropriate treatment due to poverty, transportation, and limited availability of mental healthcare services. However, the experiences of care-seeking among patients with delayed diagnosis and treatment in rural areas remain poorly understood, and it remains unclear how these experiences influence patients' medical mistrust or expectations of care. This study aims to fill that void. Methods: We applied a qualitative phenomenological method. Patients were recruited through purposive sampling at a psychiatric hospital in Harbin, China. Semi-structured, one-to-one interviews were conducted, guided by an interview outline. Thematic analysis was performed using Colaizzi's seven-step method. Results: Data saturation was achieved after interviewing 13 participants aged 21 to 53 years. Three themes with eight subthemes were identified: (i) Barriers to seeking care, (ii) Feelings for psychiatric treatment, and (iii) Demand for mental healthcare. Several factors that may impede the timely diagnosis and treatment were identified, including patients, physicians, and institutions. The participants described their feelings of adverse treatment experiences, as well as expectations arising from this process. It predominantly covers awareness of the disease, supportive access to care, and geographic accessibility of services. Conclusion: Patients with delayed diagnosis and treatment in rural areas often have negative experiences and various needs for mental health services in the pursuit of effective treatments. Policymakers and health planners should seriously consider the current challenges in rural mental healthcare to develop comprehensive strategies for improving prehospital delays and medical experience for this group of patients. [ABSTRACT FROM AUTHOR]

What were the impacts of the Covid‐19 pandemic on trust in public health information, and what can be done to rebuild trust in public health authorities? This essay synthesizes insights from science and technology studies, information studies, and bioethics to explore sociotechnical factors that may have contributed to the breakdown of trust in public health information during the Covid‐19 pandemic. The field of science and technology studies lays out the dynamic nature of facts, helping to explain rapid shifts in public health messaging during Covid‐19 and reasons they produced a lack of trust in public health authorities. The information field looks at how facts are sociotechnically constructed through systems of classification, illustrating how extrascientific factors influence public health authorities. Putting these perspectives alongside bioethics principles raises additional factors to consider. The goal of this essay is to learn from past failures to point toward a brighter future where trust in public health authorities can be rebuilt, not on faith, but rather through striving for calibrated trust within which, through a virtuous circle, trust is validated. [ABSTRACT FROM AUTHOR]

The online mode of medical consultation has been gaining increasing popularity. Online medical consultation (OMC) in China is largely mediated through e-healthcare websites which are featured with an online evaluation system for patients and caregivers to assess OMC doctors' service. The evaluation system facilitates an e-commercialised way for delivering healthcare services. It is of interest to study how doctors make efforts to promote themselves in the e-commercialised OMC practice, in particular how language is used to elicit positive comments and evaluations in doctors' self-promotion. However, this, to my best knowledge, has not been studied. The present study thus examines discursive strategies for eliciting feedback by doctors who contribute to OMCs on a widely used e-healthcare website in China. By the approach of mediated discourse analysis, five strategies have been identified. These discursive strategies are discussed in relation to the disruption of stereotypical roles of doctor and patient and the influence of non-stereotypical positions on power relations between doctors and patients. This study provides a new perspective on doctor-patient relationship and serves as a starting point for further studying neoliberal medical discourse. [ABSTRACT FROM AUTHOR]

Background: The poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships. Methods: A cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of "usual care" as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions. Discussion: Fostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate. Trial registration: AsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW [ABSTRACT FROM AUTHOR]

Background: Workplace violence against medical staff in China is a widespread problem that has negative impacts on medical service delivery. The study aimed to contribute to the prevention of workplace violence against medical staff in China by identifying patterns of workplace violence, key risk factors, and the interplay of risk factors that result in workplace violence. Methods: Ninety-seven publicly reported Chinese healthcare violent incidents from late 2013 to 2017 were retrospectively collected from the internet and analysed using content analysis. A modified socio-ecological model guided analysis of the violent incidents focusing on risk. Results: Physical violence, yinao, or a combination of physical and verbal violence were the typical forms of violence reported. The findings identified risk at all levels. Individual level risk factors included service users' unreasonable expectations, limited health literacy, mistrust towards medical staff, and inadequacy of medical staff's communication during the medical encounter. Organisational level risk factors under the purview of hospital management included problems with job design and service provision system, inadequacies with environmental design, security measures, and violence response mechanisms within hospitals. Societal level risk factors included lack of established medical dispute-handling mechanisms, problems in legislation, lack of trust and basic health literacy among service users. Situational level risks were contingent on risk factors on the other levels: individual, organisational, and societal. Conclusions: Interventions at individual, situational, organisational, and societal levels are needed to systematically address workplace violence against medical staff in China. Specifically, improving health literacy can empower patients, increase trust in medical staff and lead to more positive user experiences. Organizational-level interventions include improving human resource management and service delivery systems, as well as providing training on de-escalation and violence response for medical staff. Addressing risks at the societal level through legislative changes and health reforms is also necessary to ensure medical staff safety and improve medical care in China. [ABSTRACT FROM AUTHOR]

The biomedical approach to medical knowledge is widely accepted around the world. This article considers whether the incorporated aspects of physician‐patient interaction have become similarly common across the globe by comparing the gestures that physicians use in their interactions with patients. Up to this point, there has been little research on physicians' use of gestures in health‐care settings. We explore how—in four university hospitals in Turkey, the People's Republic of China, The Netherlands and Germany—physicians use gesture in their discussions with simulated patients about the condition of heart failure. Our analysis confirms the importance of gestures for organising both the personal interaction and the knowledge transfer between physician and patient. From the perspective of global comparison, it is notable that physicians in all four hospitals used similar gestures. This demonstrates the globality of biomedical knowledge in an embodied mode. Physicians used gestures for a range of purposes, including to convey the idea of an 'anatomical map' and for constructing visual models of (patho‐)physiological processes. Since biomedical language is rife with metaphor, it was not surprising that we also identified an accompanying metaphorical gesture which has a similar form in the various locations that were part of the study. [ABSTRACT FROM AUTHOR]

How did the Communist Party of China (CPC) redefine the social and political roles of medicine and doctors as it developed from an illegitimate or minority party to the ruling political power? From the 1930s to the 1960s, decades replete with ideological shifts, political upheavals and wars, the formula CPC developed for its anti-imperial movements and state-building enterprise changed not only the political and economic fundaments of China's statehood, but also people's perception of physician-state-patient relationship. The article will start with a medical dispute that signifies a nostalgic idealization of doctors' social roles in the 21st century. Following an overview of the major shifts in medical regulations that define doctors' roles in the early ROC and the CPC regimes, the discussion then highlights three interrelated elements in CPC's wartime medical experiences: an extremely high standard of morality for medical practitioners; de-commodification of medical services; and mobilization of medical practitioners to support the CPC's political agenda. The CPC's wartime medical experiences at the regulative, normative and cultural-cognitive levels are essential to our understanding of the institutionalization of medicine in the early PRC and the changing physician-state-patient relationship in contemporary China. [ABSTRACT FROM AUTHOR]

Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories. Research on narrative medicine training suggests that it conveys benefits such as improved communication skills and personal and professional growth to physicians, medical students, and other health care providers. Narrative medicine can promote empathy and trust between patients and physicians and foster self-care. In 2014, the author and a colleague started an ongoing inter-disciplinary narrative medicine program in the Children's Center of the Johns Hopkins Hospital called AfterWards. The program, which meets monthly, is open to all on a volunteer basis. Through literature, art, and writing, AfterWards nurtures empathy, encourages reflective practice, and builds community among a diverse group of health care providers. Through a series of lectures and workshops at Johns Hopkins Medicine, Peking Union Medical College, and Fudan Hospital in Shanghai, the author has introduced AfterWards to Chinese medical educators and clinicians. Working with Dr. Marta Hanson, she created an AfterWards Facilitator's Guide for the use of Chinese practitioners. A recent White Paper on Chinese health care indicates that an infusion of humanities-based education, of which narrative medicine forms a part, can help rebuild patient-physician trust. Recently, there has been an increase in interest in narrative medicine in the United States and China. However, more research is needed to demonstrate the impact of programs like AfterWards. Challenges to the implementation of narrative medicine programs remain, most significantly in terms of expertise, resources, and time. [ABSTRACT FROM AUTHOR]

Online reviews are increasingly being used and researched by people worldwide. Compared with previous studies on traditional products or services, research focused on online health communities (OHCs) is still insufficient. Thus, based on cue diagnosticity theory, this research concentrates on combining two mainstream studies by incorporating the patient-generated review with the unique characteristics of online medical services–the doctor-patient relationship–to study the information processing issues in choosing consultations. We clawed the dataset, including 2865 doctors related to 152,864 patient-generated reviews and information, from the GoodDoctor website. We then employed a negative binomial regression to test our hypotheses. Interestingly, we found that the effects of review length and review volume on doctors' consultations can be negatively moderated by the doctor-patient relationship. Our findings can serve patients, doctors, platform managers, and others to optimize the application of patients' information processing when choosing consultations. [ABSTRACT FROM AUTHOR]

Health education is one of the most effective and efficient ways to achieve the goal of universal health coverage and the sustainable development goals. The equity of access to health services (especially services from community healthcare centers) for internal migrants is an important issue of global concern. However, due to the registration system, long-term residence plan, education level, and other determinants, it is more difficult for internal migrants to enjoy equitable health education compared with local residents. At present, there is no research on signing up with family doctors mainly from community healthcare centers among internal migrants and their impact on access to health education services. In this nationwide cross-sectional study, we used the migrant population dynamic monitoring survey (MDMS) in 2018 to assess the disparities in signing up with a family doctor and its association with health education among internal migrants in China. Among the 151,892 participants, a total of 11.26% migrants had signed up with a family doctor and 81.37% internal migrants had received health education. There was a significant association between signing up with a family doctor and health education in the univariate model (aOR = 1.113; 95% CI: 1.095, 1.132) and the multivariate model (aOR = 1.107, 95% CI: 1.089, 1.126). Meanwhile, age (aORinteraction = 0.996, 95% CI: 0.994, 0.997), migration time (aORinteraction = 0.927, 95% CI: 0.907, 0.948), and migration range (aORinteraction = 0.994, 95% CI: 0.992, 0.997) also had an impact on the relationship between signing up with family doctors and health education. Due to the health education inequalities among internal migrants in China, we need to improve health education access and utilization of internal migrants. As signed up with family doctors was significantly associated with health education among migrants in China, we recommended that the government and healthcare facilities promote health education through family doctors. The number and professional ability of family doctors should also be improved especially in areas with weak healthcare service resources in the future. [ABSTRACT FROM AUTHOR]

China has long been suffering from the problem of having health care that is expensive and difficult to access. Online patient–provider communication (OPPC) can offer a viable channel to increase access to care. However, through what underlying mechanisms OPPC can be associated with better health outcome is under-researched. To fill this research gap, this study investigated OPPC usage in China and identified psychological processes linking OPPC to emotional well-being. With two-wave panel surveys conducted in China, we found that mobile health app, social media, and health information service website were three common platforms for OPPC, followed by patient portal, whereas e-mail was used least frequently. Overall, OPPC did not have any direct effect on emotional well-being. Instead, OPPC first increased users' perceived social presence of providers in OPPC, which in turn triggered sense of patient empowerment, which finally enhanced emotional well-being. [ABSTRACT FROM AUTHOR]

The lack of medical humanistic care has led to the tension between doctors and patients and frequent incidences of violence against doctors. In the past few years, doctors reported feeling insecure due to the frequent occurrence of killing or maiming doctors. Conditions in medicine are not conducive to China's medical development and progress. This manuscript suggests that the violence against doctors caused by the tension between doctors and patients mainly stems from the lack of medical humanistic care, the overemphasis on technical rationality, and the lack of knowledge on humanistic care for patients. Therefore, the improvement of medical humanistic care is an effective way to reduce the occurrence of violence against doctors. The manuscript describes the steps to improve medical humanistic care and establish a harmonious relationship between doctors and patients to further reduce violence against doctors, improve the quality of humanistic care of medical staff, re-introduce the medical humanistic spirit by ending the dominance of technical rationality, optimize medical treatment processes, and establish the idea of humanistic care for patients. [ABSTRACT FROM AUTHOR]

Background: Physician trust is a critical determinant of the physician–patient relationship and is necessary for an effective health system. Few studies have investigated the association between acculturation and physician trust. Thus, this study analyzed the association between acculturation and physician trust among internal migrants in China by using a cross-sectional research design. Methods: Of the 2000 adult migrants selected using systematic sampling, 1330 participants were eligible. Among the eligible participants, 45.71% were female, and the mean age was 28.50 years old (standard deviation = 9.03). Multiple logistic regression was employed. Results: Our findings indicated that acculturation was significantly associated with physician trust among migrants. The length of stay (LOS), the ability of speaking Shanghainese, and the integration into daily life were identified as contributing factors for physician trust when controlling for all the covariates in the model. Conclusion: We suggest that specific LOS-based targeted policies and culturally sensitive interventions can promote acculturation among Shanghai's migrants and improve their physician trust. [ABSTRACT FROM AUTHOR]

The question of how patient-provider communication affects health outcomes has been a longstanding concern for health communication scholarship and practice. As patient-provider communication becomes increasingly mediated by digital technologies, much research has sought to compare online patient-provider communication (OPPC) with that conducted in-person, weighing its relative merits against its costs and barriers. This line of inquiry has mostly focused on the comparative benefits of OPPC for service delivery with little attempt to link these benefits to the wider health implications of OPPC. Consequently, the mechanisms that explain the impacts of OPPC on patients' overall wellbeing have been underexamined. Through a survey of 681 participants in China, this study examined the direct and indirect pathways between OPPC and quality of life (i.e., sleep, exercise, social activities, and psychological wellbeing). Our results demonstrate statistically significant direct relationships between OPPC and the four quality-of-life constructs examined as well as the mediation effects of patient-centered care and health competence in these relationships. The findings call for greater attention to the longer-term contributions of OPPC in empowering patients, especially those who are underserved by the healthcare system. [ABSTRACT FROM AUTHOR]

Objective: The patient-doctor relationship has been considered as a crucial concept in primary healthcare, while the medical reform launched by the Chinese government in 2009 has brought significant changes to the healthcare system, which made it urgent to introduce reliable measurement instruments for assessing today's doctor-patient relationship in China. This study examined the psychometric properties of the Chinese version of the Patient-Doctor-Relationship Questionnaire-9 item (PDRQ-9) scale among general hospital inpatients in China. Materials and methods: A total of 203 participants responded to the survey, of which 39 completed retest after 7 days. Factor analyses were used to test the construct validity of the scale. Convergent validity was evaluated by the correlation between PDRQ-9 and depressive symptoms measured using PHQ-9 (Patient Health Questionnaire Depression Scale-9 item). Both multidimensional item response theory (MIRT) and unidimensional item response theory (IRT) framework were used to estimate the parameters of each item. Results: The two-factor model of relationship quality and treatment quality was supported ($2/df = 1.494, GFI = 0.925, RMSEA = 0.071, RMR = 0.008, CFI = 0.985, NFI = 0.958, NNFI = 0.980, TLI = 0.980, IFI = 0.986). The PDRQ-9 and both subscales showed significant correlation with PHQ-9 (r = -0.196x-0.309) and good internal consistency (Cronbach's alpha = 0.865x0.933). ANCOVA analysis adjusted with age revealed significant difference in PDRQ-9 ratings between patients with or without significant depressive symptoms (P = 0.019). The 7-day test-retest reliability of the scale was 0.730. The MIRT model of full scale and IRT models of both subscales showed high discrimination of all items (a = 2.46x38.46), and the test information within the range of low-quality relationship was relatively high. Conclusion: The Chinese version of PDRQ-9 is a valid and reliable rating scale, which can measure the doctor-patient relationship among Chinese patients. [ABSTRACT FROM AUTHOR]

Participation by patients with chronic diseases under primary health care requires more attention to achieve effective disease management and better health outcomes. In 2016, China proposed accelerating the establishment of a system of family doctors (FDs) and strengthening doctor-patient communication to better meet residents' health service needs. This study aimed to describe perceived participation in primary health care among patients with chronic diseases in northeastern China and explore the impact of FD contract services and patient's trust on patients' perceived participation. A cross-sectional survey of 847 patients with chronic diseases in 16 primary healthcare institutions was conducted in Jilin Province, China. Among all participants, 453 patients reported signing up for FD contract services (62.93%). The perceived participation of patients with chronic diseases was at a low level (mean = 6.71 and SD = 3.35). After controlling for sociodemographic variables and health-related variables, FD contract services directly and indirectly influenced patients' perceived participation. The patient's trust was a mediator in the relationship between FD contract services and perceived participation. This study confirmed the valuation of family doctor contract services and provided a theoretical basis for the formulation of primary health service policies. Health organizations should continue to enhance the capacity of primary health services and attract more chronic disease patients to contract with FD teams, thereby enhancing doctor-patient trust and increasing patient's participation in primary health care. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, the performance of Chinese doctors may have led to improved doctor–patient relationships (DPRs). However, it is unclear how doctors and patients perceived the impact of doctors' communication and empathy skills on DPRs during the COVID-19 pandemic. Objective: To examine the perceptions of doctors and patients on how doctors' communication skills and empathy skills influence DPRs during COVID-19. Main Measures: Doctors' and patients' perceptions of doctors' communication skills were measured using the Chinese version of the SEGUE Framework. To measure empathy skills and DPRs, the Jefferson Scale of Empathy and Difficult Doctor-Patient Relationship Questionnaire were administered to doctors, and the Consultation and Relational Empathy Measure and Patient-Doctor Relationship Questionnaire were administered to patients. Results: A total of 902 doctors and 1432 patients in China were recruited during the pandemic via online or offline surveys (overall response rate of 69.8%). Both doctors and patients rated doctors' empathy skills as more impactful on DPRs than communication skills. Doctors believed that only their empathy skills influenced DPRs. But patients believed that there was a significant bi-directional relationship between doctors' communication and empathy skills and these two skills interacted to directly and indirectly influence DPRs, and doctors' empathy had a greater mediating effect than their communication. Conclusions: During COVID-19, there were both similarities and differences between Chinese doctors' and patients' views on how doctors' communication and empathy skills influenced DPRs. The greater effect of doctors' empathy skills suggests that both doctors and patients attach more importance to doctors' empathy in doctor–patient interactions. The bi-directional effect on patient outcomes suggests that both doctors' communication and empathy skills are important to patients' perceptions of DPRs. [ABSTRACT FROM AUTHOR]