Parental anxiety and intention to receiving health care again in pediatric dental anesthesia: The mediating role of trust and commitment to the dentist
Keywords:
Trust in Physician, Physician Commitment, Anxiety, Repurchase Intention to ServiceAbstract
This study aims to assess the anxiety levels of these parents and examine the relationship between their anxiety and their trust in the physician, commitment to the physician, and intention to use the services again. The study population consisted of 300 parents residing in Sakarya. The sample consisted of 150 parents who agreed to participate in the research. Data were collected using a questionnaire containing, statements on participants' socio-demographic characteristics and four scales. The data were analyzed using descriptive statistics, correlation analysis, and structural equation modeling. All analyses were conducted with 95% confidence (p = 0.05). The findings of the study indicate a negative relationship between parents’ anxiety levels and trust in the physician and commitment to the physician. However, no direct relationship was found between anxiety levels and repurchase intention to health care. Physician loyalty has a mediating effect on the relationship between anxiety and trust in the physician. Similarly, trust in the physician and loyalty to the physician jointly mediated the relationship between anxiety and repurchase intention to health care. The study's results suggest that commitment to the physician and trust in the physician are two critical determinants of parents repurchase intention to health care, whose children undergo treatment under general anesthesia. Moreover, trust in the physicians and commitment to physicians may help alleviate parental anxiety and support the continuity of treatment.
References
Alkan, A., & Özyıldız, K. H. (2022). Hastaların hekim bağlılığı üzerine nitel bir araştırma. Electronic Turkish Studies, 17(1), 1–23.
American Academy of Pediatric Dentistry [AAPD]. (2015). Guideline on behavior guidance for the pediatric dental patient. Clinical Practice Guidelines. Reference Manual, 38(6/16–17), 185–198.
American Academy of Pediatric Dentistry [AAPD]. (2019). Behavior guidance for the pediatric dental patient. Pediatric Dentistry, 41(6), 254–267.
Anderson, L. A., & Dedrick, R. F. (1990). Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychological Reports, 67(3_suppl), 1091–1100.
Bakkal, M. (2018). Çocuklarda genel anestezi altında yapılan dental tedavilerin değerlendirilmesi. Bezmialem Science, 6(4), 248–252.
Balmer, R., O’Sullivan, E. A., & Toumba, K. J. (2004). Anxiety related to dental general anaesthesia: Changes in anxiety in children and their parents. European Journal of Paediatric Dentistry, 5(1), 9–14.
Buchbinder, S. B., Wilson, M., Melick, C. F., & Powe, N. R. (2001). Primary care patient satisfaction and loyalty: A review of the literature. Family Practice, 18(1), 45–54.
Chen, Y. P., Hsieh, C. Y., Hsu, W. T., Wu, F. Y., & Shih, W. Y. (2017). A 10-year trend of dental treatments under general anesthesia of children in Taipei Veterans General Hospital. Journal of the Chinese Medical Association, 80(4), 262–268.
Cohen, L. A., Bonito, A. J., Eicheldinger, C., Manski, R. J., Macek, M. D., Edwards, R. R., & Khanna, N. (2006). Parental anxiety associated with children undergoing dental treatment. Journal of the American Dental Association, 137(1), 42–50.
Çakır, Ç. (2019). Dağıtılmış liderlik ile örgütsel vatandaşlık davranışı arasındaki ilişkide örgütsel kimliğin rolü. Turkish Studies Educational Sciences, 14(4), 1189–1209.
Davidson, A. J., & Sun, L. S. (2018). Clinical evidence for any effect of anesthesia on the developing brain. Anesthesiology, 128(4), 840–853.
Deniz, S., & Çimen, M. (2021). Hekimlere güven düzeyinin belirlenmesine yönelik bir araştırma. Manisa Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 8(1), 10–16.
Dugan, E., Trachtenberg, F., & Hall, M. A. (2005). Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Services Research, 5(64). https://doi.org/10.1186/1472-6963-5-64
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50.
Franck, L. S., & Spencer, C. (2005). Informing parents about anaesthesia for children's surgery: A critical literature review. Patient Education and Counseling, 59(2), 117–125.
Gordon, H. S., Pugach, O., Berbaum, M. L., & Ford, M. E. (2014). Examining patients’ trust in physicians and the VA healthcare system in a prospective cohort followed for six months after an exacerbation of heart failure. Patient Education and Counseling, 97(2), 173–179.
Guffey, T., & Yang, P. Q. (2012). Trust in doctors: Are African Americans less likely to trust their doctors than White Americans? SAGE Open, 2(4), 1–8.
Günay, O., Sevinç, N., & Aslantaş, E. (2017). Hastanede yatan çocukların annelerinde durumluk ve sürekli anksiyete düzeyi ve ilişkili faktörler. Turk J Public Health, 15(3), 176–186.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2014). Multivariate data analysis (7th ed.). Pearson Education.
Hellier, P. K., Geursen, G. M., Carr, R. A., & Rickard, J. A. (2003). Customer repurchase intention: A general structural equation model. European Journal of Marketing, 37(11/12), 1762–1800.
Hennig-Thurau, T., Gwinner, K. P., & Gremler, D. D. (2002). Understanding relationship marketing outcomes: An integration of relational benefits and relationship quality. Journal of Service Research, 4(3), 230–247.
Henseler, J., Ringle, C. M., & Sinkovics, S. R. (2009). The use of partial least squares path modeling in international marketing. New Challenges to International Marketing, 20, 277–319.
Karsavuran, S., Kaya, S., & Akturan, S. (2011). Hasta-hekim iletişiminde güven: Bir genel cerrahi polikliniği örneği. Hacettepe Sağlık İdaresi Dergisi, 14(2), 185–212.
Kavuncubaşı, Ş., & Yıldırım, S. (2018). Hastane ve sağlık kurumları yönetimi. Siyasal Kitabevi.
Khodadadi, E., Nazeran, F., & Gholinia-Ahangar, H. (2016). Awareness and attitude of parents toward pediatric dental treatment under general anesthesia. Journal of Oral Health & Oral Epidemiology, 5(1), 17–23.
Krikken, J. B., van Wijk, A. J., ten Cate, J. M., & Veerkamp, J. S. (2013). Measuring dental fear using the CFSS-DS: Do children and parents agree? International Journal of Paediatric Dentistry, 23(2), 94–100.
Lee, C. Y., Chang, Y. Y., & Huang, S. T. (2007). Prevalence of dental anxiety among 5- to 8-year-old Taiwanese children. Journal of Public Health Dentistry, 67(1), 36–41.
Li, L., Zhang, Q., Zhu, L., Zeng, G., Huang, H., Chen, Z., ... & Lu, Z. (2025). Patients’ loyalty to primary care institutions and associated factors in China: A cross-sectional study. BMC Health Services Research, 25, 162. https://doi.org/10.1186/s12913-025-12244-4
Miller, K. M., Wysocki, T., & Cassady, J. F. (1999). Validation of measures of parents’ preoperative anxiety and anesthesia knowledge. Anesthesia & Analgesia, 88(2), 251–257.
Myles, P. S., Leslie, K., Chan, M. T. V., Forbes, A., Paech, M. J., Peyton, P., ... & Sessler, D. I. (2016). The safety of anesthesia in children: A review. The Open Public Health Journal, 17, e18749445328813.
Öztürk, H., & Başarangil, İ. (2019). Kamp deneyiminin ziyaretçi memnuniyeti ve yeniden ziyaret niyeti üzerine etkisi. Journal of International Social Research, 12(65), 1189–1201.
Özvurmaz, S., & Büyükçoban, S. (2018). Kırsal bir bölgede halkın anesteziyoloji uygulamaları hakkındaki bilgi ve korkuları ile ilişkili faktörlerin değerlendirilmesi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 5(3), 99–106.
Parlak, S. (2024). Bütünleşik pazarlama iletişiminin hizmet sonrası davranışlara etkisinde algılanan değer ve hasta memnuniyetinin aracı rolü [Yayımlanmamış yüksek lisans tezi, Sakarya Üniversitesi İşletme Enstitüsü, Sağlık Yönetimi Anabilim Dalı].
Price, L. L., & Arnould, E. J. (1999). Commercial friendships: Service provider-client relationships in context. Journal of Marketing, 63(4), 38–56.
Rashewsky, S., Parameswaran, A., Sloane, C., Ferguson, F., & Epstein, R. (2012). Time and cost analysis: Pediatric dental rehabilitation with general anesthesia in the office and the hospital settings. Anesthesia Progress, 59(4), 147–153.
Ringle, C. M., da Silva, D., & de Souza Bido, D. (2014). Structural equation modeling with the SMARTPLS. Brazilian Journal of Marketing, 13(2), 56–73.
Rowe, R., & Calnan, M. (2006). Trust relations in healthcare—the new agenda. The European Journal of Public Health, 16(1), 4–6.
Rust, R. T., & Zahorik, A. J. (1993). Customer satisfaction, customer retention, and market share. Journal of Retailing, 69(2), 193–215.
Savanheimo, N., Vehkalahti, M., Pihakari, A., & Numminen, M. (2005). Reasons for and parental satisfaction with children’s dental care under general anaesthesia. International Journal of Paediatric Dentistry, 15(6), 448–454.
Schneider, M., Holzer, S., & Knapp, R. (2020). Pediatric dental surgery under general anesthesia: Uncooperative behavior and treatment outcomes. Anesthesia Progress, 67(1), 12–18.
Shan, L., Li, Y., Ding, D., Wu, Q., Liu, C., Jiao, M., ... & Ren, J. (2016). Patient satisfaction with hospital inpatient care: Effects of trust, medical insurance and perceived quality of care. PLOS ONE, 11(10), e0164366.
Shirley, P. J., Thompson, N., Kenward, M., & Johnston, G. (1998). Parental anxiety before elective surgery in children: A British perspective. Anaesthesia, 53(10), 956–960.
Stewart, M. A., Brown, J. B., Weston, W. W., McWhinney, I. R., McWilliam, C. L., & Freeman, T. R. (2003). Patient-centered medicine: Transforming the clinical method (2nd ed.). Radcliffe Medical Press.
Thom, D. H., Hall, M. A., & Pawlson, L. G. (2004). Measuring patients’ trust in physicians when assessing quality of care. Health Affairs, 23(4), 124–132.
Thompson, N., Irwin, M. G., Gunawardene, M. S., & Chan, L. (1996). Pre-operative parental anxiety. Anaesthesia, 51(11), 1008–1012.
Unpapar, A. A. (2021). The moderating role of electronic word of mouth (eWOM) in the influence of perceived value on repurchase intention. Indonesian Journal of Business Analytics, 1(1), 71–79.
Uzkurt, C. (2015). Müşteri değeri ve tatmininin satın alım sonrası gelecek eğilimlere etkisi üzerine ampirik bir çalışma. Dumlupınar Üniversitesi Sosyal Bilimler Dergisi, 17, 25–43.
Ünal, O., Akbolat, M., & Amarat, M. (2018). The influence of patient-physician communication on physician loyalty and hospital loyalty of the patient. Pakistan Journal of Medical Sciences, 34(4), 999–1003.
Versloot, J., Veerkamp, J., & Hoogstraten, J. (2008). Dental anxiety and psychological functioning in children: Its relationship with behaviour during treatment. European Archives of Paediatric Dentistry, 9(1), 36–40.
Wang, H., Huang, J., & Howng, S. (2011). The effect on patient loyalty of service quality, patient visit experience and perceived switching costs: Lessons from one Taiwan university hospital. Health Services Management Research, 24(1), 29–36.
Watson, A. T., & Visram, A. (2003). Children’s preoperative anxiety and postoperative behaviour. Paediatric Anaesthesia, 13(3), 188–204.
Wray, J. (2010). Parental anxiety and stress during children's hospitalisation. Journal of Child Health Care, 14(3), 256–267.
Zolnierek, K. B. H., & DiMatteo, M. R. (2009). Physician communication and patient adherence to treatment: A meta-analysis. Medical Care, 47(8), 826–834.
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Accepted 2025-06-19
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