Investigating the Relationships Between Public Health Literacy and Public Trust in Physicians in China's Control of COVID-19: A Cross-Sectional Study

Doctors' Personal Preference and Adoption of Mobile Apps to Communicate with Patients in China: Qualitative Study

BACKGROUND

Different kinds of mobile apps are used to promote communications between patients and doctors. Studies have investigated patients' mobile app adoption behavior; however, they offer limited insights into doctors' personal preferences among a variety of choices of mobile apps.

OBJECTIVE

This study aimed to investigate the nuanced adoption behaviors among doctors in China, which has a robust adoption of mobile apps in health care, and to explore the constraints influencing their selection of specific mobile apps. This paper addressed 3 research questions: (1) Which doctors opt to adopt mobile apps to communicate with patients? (2) What types of mobile apps do they choose? (3) To what degree do they exercise personal choice in adopting specific mobile apps?

METHODS

We used thematic content analysis of qualitative data gathered from semistructured interviews with 11 doctors in Hangzhou, which has been recognized for its advanced adoption of mobile technology in social services, including health care services. The selection of participants was purposive, encompassing diverse departments and hospitals.

RESULTS

In total, 5 themes emerged from the data analysis. First, the interviewees had a variety of options for communicating with patients via mobile apps, with the predominant ones being social networking apps (eg, WeChat) and medical platforms (eg, Haodf). Second, all interviewees used WeChat to facilitate communication with patients, although their willingness to share personal accounts varied (they are more likely to share with trusty intermediaries). Third, fewer than half of the doctors adopted medical platforms, and they were all from tertiary hospitals. Fourth, the preferences for in-person, WeChat, or medical platform communication reflected the interviewees' perceptions of different patient cohorts. Lastly, the selection of a particular kind of mobile app was significantly influenced by the doctors' affiliation with hospitals, driven by their professional obligations to fulfill multiple tasks assigned by the hospitals or the necessity of maintaining social connections with their colleagues.

CONCLUSIONS

Our findings contribute to a nuanced understanding of doctors' adoption behavior regarding specific types of mobile apps for patient communication, instead of addressing such adoption behavior of a wide range of mobile apps as equal. Their choices of a particular kind of app were positioned within a social context where health care policies (eg, limited funding for public hospitals, dominance of public health care institutions, and absence of robust referral systems) and traditional culture (eg, trust based on social connections) largely shape their behavioral patterns.

How does patient-centered communication influence patient trust?: The roles of patient participation and patient preference

OBJECTIVE

The aim of this study was to examine the effects of patient-centered communication, patient participation, and patient preference on patient trust in the context of China.

METHODS

A cross-sectional survey was conducted involving 217 cancer patients in China. Mediation and moderation analyses were performed to examine the relationships among the study variables.

RESULTS

First, patient-centered communication increased patient participation in decision-making, which, in turn, enhanced patient trust. Second, patient-centered communication did not have a direct effect on patient trust. Third, patient preference for a passive role in decision-making weakened the relationship between patient participation and patient trust.

CONCLUSION

The results underscore the significant effect of facilitating patient participation in linking patient-centered communication to patient trust. However, medical communication should also respond to patients' preferred roles in the decision-making process.

PRACTICE IMPLICATIONS

Doctors should provide patients with opportunities to ask questions and express their concerns. In addition, they should evaluate patients' preferred degree of involvement before inviting them to contribute so as to respect their preferences and values.

Two cities, two stages in transforming society-a mixed methods study comparing doctors' adoption of mobile apps for communication with patients in Hangzhou and Yancheng, China

Objectives

Mobile apps have become commonplace in doctor-patient communication over the last 20 years. Doctors mainly use two kinds of app, social networking apps (i.e., WeChat) and medical platform apps (i.e., Haodf). The purpose of this study was to investigate whether the attributes of social interaction in local society impact doctors' choice of mobile apps to communicate with patients. This article addresses two research questions: (a) To what degree do doctors' adoption patterns in different societies differ? (b) Why do doctors choose certain mobile apps to communicate with patients?

Methods

This study employed a mixed methods research design to analyze doctor's adoption behavior patterns in two cities, Hangzhou (HZ) and Yancheng (YC), which represent two stages in transforming society. Various patterns, measured as the percentage of doctors who utilize the medical platform app of Haodf among all doctors and the average service counts per doctor, were compared in three groups of tertiary hospitals: the top ones in HZ, the average ones in HZ, and the average ones in YC. We also conducted thematic content analysis of qualitative data from semi-structured interviews with 20 purposely selected doctors in the two cities.

Results

The percentages of doctors who have adopted the app of Haodf from the three groups of tertiary hospitals were 49.97%, 41.00%, and 32.03%, with an average service counts per doctor of 261, 182 and 39, respectively. According to the interviewees, doctors from YC are more likely to use social networking apps to communicate with patients than their HZ counterparts to maintain social connections with their relatives, friends, colleagues, and others.

Conclusion

This study demonstrates that doctors' choices of mobile apps are dependent upon social context. In traditional society, where people have close ties, the logic of using social networking apps lies in doctors' need to maximize the utility of their knowledge by maintaining social connections with others. In modern society, where the close ties between people have gradually weakened, the logic of using medical platform apps lies in doctors' needs for reputation marketing, either for themselves or for institutions, their affiliated departments or hospitals.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives

Objective

The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians.

Methods

The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child).

Results

IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (β = -0.419, p < 0.01) and mothers' (β = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (β = -0.353, p < 0.01) and fathers' (β = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores.

Conclusion

The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

Public trust of physicians in China improved since the COVID-19 pandemic Began

RATIONALE

Public trust in physicians had declined in China for decades before the COVID-19 pandemic. During the COVID-19 pandemic, frontline physicians have experienced high work volume despite a high risk of COVID-19 infection. The willingness of physicians to treat COVID patients with a high risk of exposure to the infection may have improved public trust in physicians.

OBJECTIVE

This study analyzes how public trust in physicians has changed since the pandemic started using a nationally representative survey.

METHODS

We used the China Family Panel Studies (CFPS), with 179,123 respondents 10 years or older who were eligible to answer the question on public trust in physicians from 2012 to 2020. Public trust has been measured by an 11-point Likert scale. A quasi pre-post study design using a segmented regression impact model was used to evaluate the impact of the COVID-19 pandemic on public trust in physicians.

RESULTS

At the start of the observation period, the average public trust score was 6.86 out of 10.00. The immediate unadjusted change of mean score for public trust during COVID-19 was significantly higher (Coef. = 0.361; 95% CI = 0.359, 0.364). Moreover, a significant increase in the unadjusted trend during the COVID-19 pandemic was observed in the mean score for public trust (Coef. = 0.005; 95% CI = 0.004, 0.006). The results were similar to the estimates obtained when we adjusted for demographic characteristics and health status.

CONCLUSIONS

The mean score for public trust increased during the COVID-19 pandemic. This study provides a new perspective on restoring public trust in physicians, a significant concern of the Chinese healthcare system. During the COVID-19 pandemic, social and mainstream media helped to establish the "good doctor" image, which may have improved patients' trust in physicians. Improving health literacy through effective communication and education may help increase public trust in physicians.