Abstract: Background　The implementation of the contracted family doctor services has a late start in China. Moreover，the implementation status of this kind of services differs significantly across regions，and the factors associated with residents' signing a contract with the family doctor are diverse. Objective　To construct a conceptual model for exploring the factors associated with signing a health service contract with the family doctor in community-dwelling residents. Methods　Totals of 956 community-dwelling residents were recruited from Hangzhou by convenience sampling during March to May 2018. Data about residents' intention and performance concerning signing a health service contract with the family doctor were collected through a survey with a questionnaire developed by our research group based on the Theory of Planned Behavior （TPB） and information-motivation-behavioral skills（IMB） model. On the basis of the survey results，a structural equation model （SEM） was constructed to explore the factors associated with residents' contract signing. Altogether，910 participants returned responsive questionnaires，achieving a response rate of 95.2%. Results　The Cronbach' s α of the questionnaire was 0.934，the KMO value was 0.924，and the Bartlett's spherical test was significant （P<0.01），indicating that the questionnaire was appropriate for factor analysis，and the factors extracted by factor analysis explained 76.776% of the total variance. Analysis with the SEM model found that，residents' signing a health service contract with the family doctor was influenced directly by information （0.529），intention of signing the contract （0.195），and perceived behavior control （0.184），and it was influenced indirectly by acting according to the intention （0.085），positive attitude （0.045） and normative beliefs （0.039），the coefficient of determination for the model was 0.522 （P<0.01）．Conclusion　The factors associated with residents' behaviors of signing a contract with the family doctor can be explained well by our model constructed on the basis of the TPB and IMB model. The most important factor is information，followed by intention of signing a contract，then perceived behavior control.

Key words: Contracted family doctors services, Contract-signing behavior, Root cause analysis, Structural equation model, The theory of planned behavior, The information-motivation-behavioral skills model

摘要： 背景　我国家庭医生签约服务起步较晚，各地实施情况不一，影响居民签约家庭医生的因素繁杂。目的　构建社区居民签约家庭医生行为的影响因素模型。方法　于2018年3—5月方便抽取杭州市社区居民956名，利用计划行为理论和信息-动机-行为技巧模型自制量表，调查居民对签约家庭医生的签约意向和签约行为，构建结构方程模型分析影响签约行为的因素。共发放问卷956份，回收有效问卷910份，有效回收率95.2%。结果　问卷总体Cronbach' s α系数为0.934，KMO值为0.924，Bartlett's球形检验P<0.01，总体方差解释率为76.776%。结构方程模型分析结果显示，对居民签约家庭医生行为有直接效应的是信息（0.529）、签约意向（0.195）及知觉行为控制（0.184），有间接效应的是遵从意愿（0.085）、正向态度（0.045）及规范信念（0.039），签约行为的决定系数（R2）为0.522（P<0.01）。结论　利用计划行为理论和信息-动机-行为技巧模型构建的模型可以较好地解释社区居民签约家庭医生行为，对签约行为影响最大的是信息、其次是签约意向与知觉行为控制。

关键词: 家庭医生签约服务, 签约行为, 影响因素分析, 结构方程模型, 计划行为理论, 信息-动机-行为技巧模型