The Path to Compliance: Exploring the Roles of Trust, Positive Expectancy Violation, and eHealth Literacy in Online Patient-Centered Communication

The rapid growth of online healthcare in China is accompanied by challenges in physician-patient relationships and patient compliance. Drawing on the pathway model in physician-patient communication (PPC) and language expectancy theory (LET), we conceptualized a framework to explore the impact of online patient-centered communication (OPCC) on patient compliance, with positive expectancy violation (PEV) and patient trust as mediators and eHealth literacy as a moderator. Through a two-wave longitudinal survey in China (Wave 1: N = 1000; Wave 2: N = 498), we found that the direct relationship between OPCC and patient compliance was not significant. However, there was a significant serial mediation effect of OPCC on patient compliance through PEV and patient trust. Additionally, we tested the moderating effect of eHealth literacy. This study contributes to the theoretical extension of OPCC and offers practical implications for enhancing PEV, improving patient trust, and increasing online medical compliance in the Chinese context.