How Adult Children’s Filial Piety Shapes Older Patients’ Medical Responsible Behavior: Psychological Safety and Trust as Sequential Mediators

Filial piety shapes intergenerational care in China, yet its role in older patients’ clinical behavior is unclear. Survey data from 478 older patients across three hospitals in two provinces were analyzed using partial least squares structural equation modeling. Pragmatic obligations were associated with all endogenous constructs; compassionate reverence was associated with relationship comfort, trust, and medical responsible behavior, but not belonging atmosphere. Global trust in doctors mediated all four paths, whereas belonging atmosphere mediated only the pragmatic obligations path and relationship comfort operated solely through trust. The two filial piety dimensions engage structurally distinct pathways, suggesting differentiated family engagement strategies.