Abstract: Background　Primary medical first consultation plays an important role in the rational utilization of medical services and alleviating the contradiction between supply and demand of medical resources. However, the rate of primary medical first consultation in China is lower than the policy expectations, and it is very important to guide patients to primary care. Therefore, it is of great significance to conduct an in-depth exploration of the driving mechanism of patients' willingness for primary medical first consultation. Objective　Based on the family doctor contract service scenario, a theoretical model of "expectation confirmation-patient trust-sustained willingness to first visit at the grassroots level" was constructed based on the expectationconfirmation theory. Through empirical research, this paper verifies the social psychological mechanism of patients' willingness to continue grassroots first diagnosis, reveals the path of patient trust, and provides theoretical basis and practical enlightenment for improving patients' willingness to continue grassroots first diagnosis. Methods　Taking a community health service center in Chengdu as the research site, a questionnaire survey was conducted on the patients served by the center in March 2024,including four parts: general information questionnaire, expectation confirmation, patient trust, and medical seeking willingness at the grassroots level. Independent sample t-test and one-way analysis of variance were used to study the differences in patients' trust between groups.and the structural equation model was used to verify the theoretical hypothesis and mediating effect. Results　A total of 318 questionnaires were collected for the survey, of which 288 were valid (90.6%).The average expection confirmation score for patients was (3.99±0.74) points, with 208 cases (72.2%) exhibiting high expected confirmation. The average patient trust score was (4.13±0.61) points, with the three dimensions of technical trust, service trust, and emotional trust averaging (4.18±0.65), (3.60±1.02), and (4.35±0.64) points respectively. Patients who are adults, aged 60 years or older, have hypertension/diabetes, have signed up with a family doctor, and have high expectations demonstrate higher trust in primary care (P<0.05). Patients who do not have a designated doctor show lower trust in primary care (P<0.05). Patient trust has a complete mediating effect between expectation confirmation and the willingness to seek initial treatment at primary care facilities. Conclusion　Patient trust has a significant full mediating effect between expectation confirmation and willingness to continue primary care. It is the starting point to cultivate patients' trust by providing patients with super-expected experience through targeted demand satisfaction, so as to improve patients' expectation confirmation. Taking public health services as an opportunity to establish emotional trust, relying on the improvement of diagnosis and treatment ability and the optimization of referral services to establish technical trust and service trust may be the key path to enhance the first diagnosis of patients' willingness at the grassroots level.

Key words: Basic initial diagnosis, Patient trust, Expectation confirmation, Medical seeking willingness, Structural equation model

摘要： 背景　基层首诊对合理利用医疗服务、缓解医疗资源供需矛盾具有重要作用。当前我国基层首诊率尚未达到政策预期，引导患者基层就诊具有现实必要性，深入探究患者基层首诊意愿的驱动机制具有重要意义。目的　基于家庭医生签约服务场景，依循期望确认理论构建“期望确认—患者信任—持续基层首诊意愿”理论模型，通过实证研究验证患者持续基层首诊意愿的社会心理机制，揭示患者信任的作用路径。方法　以成都某社区卫生服务中心为研究场所，于2024年3月对该中心服务的患者进行问卷调查，内容包括一般资料调查表、期望确认、患者信任、持续基层首诊意愿4个部分。采用独立样本t检验、单因素方差分析研究患者信任的组间差异，运用结构方程模型验证理论假设和中介效应。结果　调查共回收问卷318份，其中有效问卷288份（90.6%）。患者的平均期望确认得分为（3.99±0.74）分，其中高期望确认208例（72.2%）；平均患者信任得分为（4.13±0.61）分，其中技术信任、服务信任、情感信任3个维度的平均得分分别为（4.18±0.65）、（3.60±1.02）、（4.35±0.64）分。成年、≥60岁、患高血压/糖尿病、已签约家庭医生、高期望确认的患者对基层医疗的信任度较高（P<0.05），不固定医生就诊的患者对基层医疗的信任度较低（P<0.05）。患者信任在期望确认与患者持续基层首诊意愿之间起完全中介作用（P<0.05）。结论　患者信任在期望确认和持续基层首诊意愿之间存在显著的完全中介效应。通过针对性需求满足，为患者提供超预期体验，从而提升患者期望确认度，是培育患者信任的起点；以公共卫生服务为契机建立情感信任，依托诊疗能力提升与转诊服务优化建立技术信任和服务信任，可能是增强患者基层首诊意愿的关键路径。

关键词: 基层首诊, 患者信任, 期望确认, 就诊意愿, 结构方程模型