Abstract
BackgroundThere is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examined the influence among constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. In addition, the moderating effect of hospital facility levels is examined.MethodsA conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. Structural equation modeling was used to analyze the data in two steps that involved a measurement model and a structural model. The former was applied to estimate the Cronbach’s alphas, intercorrelations of factors, and descriptive statistics; the latter was used to test the hypothesized relationships of the constructs.ResultsThe results identified three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influenced cognitive efficacy (β = 0.16, p < 0.001), and cognitive efficacy influenced physician-patient communication (β = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (β = 0.38, p < 0.001). The healthcare structure influenced healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center has greater influences by the structure and physician-patient communication than it was treated in the regional hospitals.ConclusionsThis study revealed a complex pattern in relationships among process constructs for healthcare services. The findings of this study acknowledge the important potential interrelationships among the healthcare service constructs to improve the quality of healthcare outcomes.Trial registrationCRREC104107. Date: 22/01/2016. Prospectively Registered.
Highlights
There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services
The framework of this study focused on assessing the healthcare process, including physicianpatient communication, cognitive efficacy, and adherence behavior
We found a bidirectional relationship between physician-patient communication and patient cognitive efficacy, which influenced patient adherence behavior
Summary
There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concen‐ trated on the direct effect of physician-patient communication on service outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structureprocess-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. The patients’ willingness to comply the physician’s orders is enhanced when patients and physicians exchange sufficient information [1, 7, 8]. These findings emphasize effective interactive processes are essential to ensure patients’ perceptions of healthcare service quality [6] and reduce the possibility of medical disputes [4]
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