| Author: | Lu, Wenze |
| Title: | Examining the effects of empathy and dialogic risk communication in physicians' text-based messages on patient satisfaction and compliance in Chinese online medical consultations |
| Advisors: | Ngai, Sing Bik Cindy (CBS) Li, Chor Shing David (CBS) |
| Degree: | Ph.D. |
| Year: | 2024 |
| Subject: | Medical personnel and patient -- Language Communication in medicine Medical personnel -- Language Hong Kong Polytechnic University -- Dissertations |
| Department: | Department of Chinese and Bilingual Studies |
| Pages: | xvi, 286 pages : illustrations |
| Language: | English |
| Abstract: | The advancement of Internet healthcare technologies, along with the rise in the aging population, the increasing of intractable diseases, and the global outbreak of COVID-19, has facilitated the worldwide growth of online medical consultations (OMCs). The growing popularity of OMCs has attracted significant attention from researchers worldwide, leading to a substantial increase in the number of published OMC studies in recent years. Compared with face-to-face (F2F) medical consultations, OMC can overcome geographic limitations to visit a physician, reduce logistical delays for follow-up treatments, and provide user-friendly interfaces due to its easy-to-follow guidelines and various communication modes, thereby facilitating medical resource management while enhancing the accessibility, quality, efficiency, and cost- effectiveness of healthcare and medical education delivered to patients. Furthermore, the publicly accessible nature of OMC platforms allows for more transparent patient feedback. Patients utilizing OMCs are empowered to switch physicians easily if they are dissatisfied, thereby challenging the traditional power dynamics between physicians and patients in F2F settings. Physician communication is crucial in providing patient care, ensuring positive patient outcomes, and establishing a strong patient-physician relationship. Given the importance of physician communication in diverse F2F healthcare and medical settings, it is reasonable to anticipate similar impacts in the realm of OMCs. Therefore, it is of utmost essence to identify variations in physician communication within OMCs and understand how these variations affect patients differently. Underpinned by theories, models, and empirical evidence drawn from communication, psychology, and healthcare disciplines, the thesis developed a hypothesized model to examine the effects of Physician Empathy (PE) and Physician Dialogic Risk Communication (PDRC) on Patient Satisfaction (PS) and Patient Compliance with Physician Recommendations (PCPR) through Patient Cognitive Engagement towards Understanding (PCEU) and Patient Emotional Engagement (PEE) in Chinese cancer-related OMCs. Phase I of the thesis consists of a pre-experimental study that constructed PE and PDRC through the identification of content words, style words, linguistic features, and representative sentences from 102 real online users with experience in Chinese cancer-related OMCs. On the basis of Phase I's results, a pilot study in Phase II was conducted using a 2x2 between-subjects design involving 140 participants to ensure the successful manipulation of the experimental design and to explore potential associations between the variables as proposed in the model. Meticulous determination was given to the measurement items of instrument scales assessing PE, PDRC, PEE, PCEU, PS and PCPR. These items were either adapted, developed, or employed based on relevant literature and measuring scales to ensure accuracy and appropriateness when examining the relationships between variables within the context of Chinese text-based and cancer-related OMCs. The PDRC instrument scale was newly developed using the Delphi method, with the support of an expert panel, followed by a rigorous English-Chinese translation, a pilot test and a validation study on 250 target participants. Based on the results from the pilot study, additional revisions were made to Phase II’s main experiment on 280 target participants. The participants were randomly and evenly assigned to four experimental scenarios, each featuring different levels of PE and PDRC presentation. Associations between potential confounding variables and participants’ responses were examined to minimize interference from extraneous factors. The internal consistency and construct validity of each instrument scale were investigated to ensure that each variable could be accurately and consistently represented by relevant measurement items. Multicollinearity was assessed to identify the association between PE and PDRC and to determine if such an association might influence the final pathways in the model. Manipulation checks of PE and PDRC were performed to validate the effectiveness of the four combined stimuli designs. Confirmatory factor analysis was employed to evaluate the data fit for the model and to determine if the measured variables could potentially present the proposed pathways. Structural Equation Modeling (SEM) analysis was employed to examine the hypotheses proposed in the thesis. Significant direct and indirect associations were identified by SEM. Specifically, PDRC positively leads to PCEU while PE positively affects PEE. PDRC has a positive association with PS via PCEU. PS was noted with a positive effect on PCPR. The direct positive associations were also found between PDRC and PEE, between PE and PCEU as well as between PE and PS. The indirect association between PE and PS was mediated by PCEU. Neither PE nor PDRC directly impacted PCPR. Both PE and PDRC must lead to PS at first, either directly or indirectly, to subsequently influence PCPR. The potential reasons underlying each significant pathway were elucidated. The thesis enriches the existing literature in health communication by examining the impact of physicians' text-based communication on patient outcomes within the context of Chinese cancer-related OMCs. It also serves as a robust groundwork for integrating healthcare, psychology, and communication theories into the context of online physician-patient communication. It offers valuable insights and inspirations to researchers from diverse disciplines to pursue interdisciplinary studies in the future. From a practical standpoint, this thesis provides physicians with valuable training in implementing message framing strategies for future healthcare practices. Considering the growing prevalence of OMCs, this thesis holds the potential to contribute to the provision of high-quality online health information and the efficiency of online medical services. Ultimately, these contributions will positively influence public health services, improve the well-being of individuals, and foster the sustainable development of the online healthcare ecosystem. The continuous evolution of Artificial Intelligence and 5G technology encourages the adoption of innovative medical services for health interventions. Further research endeavors can delve into exploring innovative medical services, such as medical chatbots and hospital navigation robots, and compare communication patterns between healthcare providers and patients across traditional F2F medical consultations, OMCs, and AI-related medical consultations. These comparisons would provide valuable insights into developing optimized medical services tailored to patient needs, leading to improved health outcomes and satisfying patient experience. |
| Rights: | All rights reserved |
| Access: | open access |
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