反驳文本对患方信任和道德判断的影响与机制 *

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吕小康¹, 付春野²(

), 汪新建¹

1 南开大学周恩来政府管理学院社会心理学系, 天津 300350
2 天津师范大学心理与行为研究院, 天津 300074

收稿日期:2019-03-29出版日期:2019-11-25发布日期:2019-08-19
通讯作者:付春野E-mail:chunyefu1919@163.com

基金资助:* 教育部哲学社会科学重大攻关项目(15JZD030);教育部人文社科基金青年项目(19YJC840030);中央高校基本科研业务费专项资金资助(63192204)

Effect and underlying mechanism of refutation texts on the trust and moral judgment of patients

LYU Xiaokang¹, FU Chunye²(

), WANG Xinjian¹

1 Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin 300350, China
2 Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300074, China

Received:2019-03-29Online:2019-11-25Published:2019-08-19
Contact:FU Chunye E-mail:chunyefu1919@163.com

摘要/Abstract

摘要： 采用反驳文本范式对患方进行知识修正, 提升患方对医方的信任和道德判断。预实验编制反驳文本并验证其有效性, 实验1验证反驳文本可以显著提高患方的对医信任和道德判断, 并发现医疗结果是影响患方信任和对医道德判断的重要因素。实验2和实验3探究了反驳文本有效性的作用机制及适用普遍性, 发现不确定性容忍度和宽容度在反驳文本和患方信任及道德判断之间呈链式中介作用, 且反驳文本可脱离医学情境提升普遍患方信任。

图/表 10

表1预实验错答情况和干预有效性自评

类别	条件	n	%
错答情况	全部正确	6	5.8
	错1题	16	15.5
	错2题	20	19.4
	错3题	25	24.3
	错4题	30	28.6
	全部错误	6	5.8
干预有效性自评	非常不同意	2	1.9
	不同意	4	3.9
	一般	16	15.5
	同意	48	46.6
	非常同意	33	32.0

表1预实验错答情况和干预有效性自评

类别	条件	n	%
错答情况	全部正确	6	5.8
	错1题	16	15.5
	错2题	20	19.4
	错3题	25	24.3
	错4题	30	28.6
	全部错误	6	5.8
干预有效性自评	非常不同意	2	1.9
	不同意	4	3.9
	一般	16	15.5
	同意	48	46.6
	非常同意	33	32.0

图1医患对白情境

图1医患对白情境

表2反驳文本干预、行为方式及检查结果条件下道德判断和患方信任得分

反驳文本	遵医嘱行为	检查结果	n	道德判断(后测)	患方信任
反驳文本	遵医嘱行为	检查结果	n	M ± SD	M ± SD
实验组	做检查	普通发烧	40	7.63 ± 1.72	44.85 ± 8.01
	做检查	淋巴细胞白血病	41	8.39 ± 1.26	49.10 ± 5.83
	不做检查	普通发烧	36	6.92 ± 1.61	43.17 ± 9.48
	不做检查	淋巴细胞白血病	38	8.82 ± 1.14	47.18 ± 8.06
控制组	做检查	普通发烧	42	5.95 ± 2.32	35.40 ± 10.97
	做检查	淋巴细胞白血病	38	7.13 ± 1.61	41.05 ± 9.41
	不做检查	普通发烧	38	5.21 ± 2.04	34.39 ± 8.31
	不做检查	淋巴细胞白血病	36	7.78 ± 1.40	45.64 ± 8.22

表2反驳文本干预、行为方式及检查结果条件下道德判断和患方信任得分

反驳文本	遵医嘱行为	检查结果	n	道德判断(后测)	患方信任
反驳文本	遵医嘱行为	检查结果	n	M ± SD	M ± SD
实验组	做检查	普通发烧	40	7.63 ± 1.72	44.85 ± 8.01
	做检查	淋巴细胞白血病	41	8.39 ± 1.26	49.10 ± 5.83
	不做检查	普通发烧	36	6.92 ± 1.61	43.17 ± 9.48
	不做检查	淋巴细胞白血病	38	8.82 ± 1.14	47.18 ± 8.06
控制组	做检查	普通发烧	42	5.95 ± 2.32	35.40 ± 10.97
	做检查	淋巴细胞白血病	38	7.13 ± 1.61	41.05 ± 9.41
	不做检查	普通发烧	38	5.21 ± 2.04	34.39 ± 8.31
	不做检查	淋巴细胞白血病	36	7.78 ± 1.40	45.64 ± 8.22

图2不同检查结果条件下遵医嘱行为对道德判断的影响

图3不同检查结果条件下反驳文本对患方信任的影响

图3不同检查结果条件下反驳文本对患方信任的影响

表3反驳文本干预和不同检查结果条件下道德判断和信任得分

反驳文本	检查结果	n	道德判断得分	患方信任
反驳文本	检查结果	n	M ± SD	M ± SD
实验组	普通发烧	44	7.20 ± 1.49	41.57 ± 8.72
实验组	淋巴细胞白血病	39	8.44 ± 0.88	45.25 ± 7.58
控制组	普通发烧	42	6.62 ± 1.67	40.71 ± 7.26
控制组	淋巴细胞白血病	40	7.76 ± 1.25	45.17 ± 8.41

表3反驳文本干预和不同检查结果条件下道德判断和信任得分

反驳文本	检查结果	n	道德判断得分	患方信任
反驳文本	检查结果	n	M ± SD	M ± SD
实验组	普通发烧	44	7.20 ± 1.49	41.57 ± 8.72
实验组	淋巴细胞白血病	39	8.44 ± 0.88	45.25 ± 7.58
控制组	普通发烧	42	6.62 ± 1.67	40.71 ± 7.26
控制组	淋巴细胞白血病	40	7.76 ± 1.25	45.17 ± 8.41

表4反驳文本影响道德判断的链式多重中介效应检验

变量	不确定性容忍度 (M₁)			对医宽容度 (M₂)			道德判断 (Y₁)
变量	回归系数	SE	p	回归系数	SE	p	回归系数	SE	p
反驳文本(X)	0.76	0.15	< 0.001	0.09	0.15	0.583	0.26	0.17	0.113
不确定性容忍度(M₁)	—	—	—	0.37	0.08	< 0.001	0.37	0.09	0.676
对医宽容度(M₂)	—	—	—	—	—	—	0.20	0.08	0.018
常量	1.27	0.26	< 0.001	0.10	0.27	0.712	0.35	0.28	0.221
	R2 = 0.143			R2 = 0.199			R2 = 0.089
	F(2, 162) = 13.50 p < 0.001			F(3, 161) = 13.34 p < 0.001			F(4, 160) = 3.93 p = 0.005

表4反驳文本影响道德判断的链式多重中介效应检验

变量	不确定性容忍度 (M₁)			对医宽容度 (M₂)			道德判断 (Y₁)
变量	回归系数	SE	p	回归系数	SE	p	回归系数	SE	p
反驳文本(X)	0.76	0.15	< 0.001	0.09	0.15	0.583	0.26	0.17	0.113
不确定性容忍度(M₁)	—	—	—	0.37	0.08	< 0.001	0.37	0.09	0.676
对医宽容度(M₂)	—	—	—	—	—	—	0.20	0.08	0.018
常量	1.27	0.26	< 0.001	0.10	0.27	0.712	0.35	0.28	0.221
	R2 = 0.143			R2 = 0.199			R2 = 0.089
	F(2, 162) = 13.50 p < 0.001			F(3, 161) = 13.34 p < 0.001			F(4, 160) = 3.93 p = 0.005

图4反驳文本影响道德判断的中介效应检验路径系数图注：*p < 0.05; ***p < 0.001

图4反驳文本影响道德判断的中介效应检验路径系数图注：*p < 0.05; ***p < 0.001

表5反驳文本影响患方信任的链式多重中介效应检验

变量	不确定性容忍度 (M₁)			对医宽容度 (M₂)			患方信任 (Y₂)
变量	回归系数	SE	p	回归系数	SE	p	回归系数	SE	p
反驳文本(X)	0.68	0.23	0.004	0.56	0.20	0.583	0.41	0.21	0.056
不确定性容忍度(M₁)	—	—	—	0.41	0.09	< 0.001	0.01	0.10	0.918
对医宽容度(M₂)	—	—	—	—	—	—	0.55	0.11	< 0.001
常量	0.09	0.56	0.876	0.37	0.47	0.712	0.61	0.47	0.201
	R2 = 0.133			R2 = 0.410			R2 = 0.420
	F(2, 80) = 6.15 p = 0.003			F(3, 79) = 18.30 p < 0.001			F(4, 78) = 14.09 p < 0.001

表5反驳文本影响患方信任的链式多重中介效应检验

变量	不确定性容忍度 (M₁)			对医宽容度 (M₂)			患方信任 (Y₂)
变量	回归系数	SE	p	回归系数	SE	p	回归系数	SE	p
反驳文本(X)	0.68	0.23	0.004	0.56	0.20	0.583	0.41	0.21	0.056
不确定性容忍度(M₁)	—	—	—	0.41	0.09	< 0.001	0.01	0.10	0.918
对医宽容度(M₂)	—	—	—	—	—	—	0.55	0.11	< 0.001
常量	0.09	0.56	0.876	0.37	0.47	0.712	0.61	0.47	0.201
	R2 = 0.133			R2 = 0.410			R2 = 0.420
	F(2, 80) = 6.15 p = 0.003			F(3, 79) = 18.30 p < 0.001			F(4, 78) = 14.09 p < 0.001

图5反驳文本影响患方信任的中介效应检验路径系数图注：**p < 0.01; ***p < 0.001

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