Sustained Engagement, Assurance and Cooperation in Healthcare Provider–Patient Relationships: A Mixed-Methods Study in Malaysia

Continuity of care has been widely associated with improved healthcare outcomes; however, limited research has examined the mechanisms through which continuity fosters assurance and cooperation within provider–patient relationships. This study investigates the relationship between continuity of care, assurance, and cooperation in Malaysian primary healthcare settings using probability theory as a theoretical framework. A mixed-methods design was employed, combining a cross-sectional survey of 279 patients with a secondary thematic analysis of 32 interview transcripts comprising 20 patient interviews and 12 healthcare provider interviews.
Quantitative findings revealed that interpersonal care, provider awareness of treatment adherence, and patients’ perceptions that providers acted in their best interests were significant predictors of assurance. Collectively, these variables explained 72% of the variance in assurance (Adjusted R² = .72, p < .001). Qualitative findings indicated that assurance developed progressively through ongoing provider–patient interactions, reducing uncertainty and encouraging greater cooperation, including active participation in healthcare discussions, information disclosure, and adherence to treatment recommendations.
Integrating both quantitative and qualitative findings, the study proposes a conceptual model demonstrating how continuity of care facilitates assurance through reduced uncertainty and positive expectations regarding future encounters, thereby promoting cooperative behaviour and improved healthcare outcomes. The findings highlight the importance of relationship continuity in primary healthcare and contribute to existing literature by applying probability theory to explain the behavioural mechanisms underlying assurance and cooperation in healthcare relationships.

continuity of care, assurance, cooperation, primary healthcare, provider–patient relationship, probability theory, healthcare communication.

1. Fan, V. S., Burman, M. B., McDonell, M. B., & Fihn, S. D. (2005). Continuity of care and other determinants of patient satisfaction with primary care. Journal of General Internal Medicine, 20(3), 226–233. https://doi.org/10.1111/j.1525-1497.2005.40135.x [Google Scholar] [Crossref]

2. Ng, J. H. Y., & Luk, B. H. K. (2019). Patient satisfaction: Concept analysis in the healthcare context. Patient Education and Counseling, 102(4), 790–796. https://doi.org/10.1016/j.pec.2018.11.013 [Google Scholar] [Crossref]

3. Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., & Amenta, P. (2017). Determinants of patient satisfaction: A systematic review. Perspectives in Public Health, 137(2), 89–101. https://doi.org/10.1177/1757913916634136 [Google Scholar] [Crossref]

4. Pansari, A., & Kumar, V. (2017). Customer engagement: The construct, antecedents, and consequences. Journal of the Academy of Marketing Science, 45(3), 294–311. https://doi.org/10.1007/s11747-016-0485-6 [Google Scholar] [Crossref]

5. Ayanian, J. Z., & Markel, H. (2016). Donabedian's lasting framework for health care quality. New England Journal of Medicine, 375(3), 205–207. https://doi.org/10.1056/NEJMp1605101 [Google Scholar] [Crossref]

6. Sofaer, S., & Firminger, K. (2005). Patient perceptions of the quality of health services. Annual Review of Public Health, 26, 513–559. https://doi.org/10.1146/annurev.publhealth.25.050503.153958 [Google Scholar] [Crossref]

7. Andaleeb, S. S. (2001). Service quality perceptions and patient satisfaction: A study of hospitals in a developing country. Social Science & Medicine, 52(9), 1359–1370. https://doi.org/10.1016/S0277-9536(00)00235-5 [Google Scholar] [Crossref]

8. Shilling, V., Jenkins, V., & Fallowfield, L. (2003). Factors affecting patient and clinician satisfaction with the clinical consultation: Can communication skills training for clinicians improve satisfaction? Psycho-Oncology, 12(6), 599–611. https://doi.org/10.1002/pon.731 [Google Scholar] [Crossref]

9. Cheng, S. H., Yang, M. C., & Chiang, T. L. (2003). Patient satisfaction with and recommendation of a hospital: Effects of interpersonal and technical aspects of hospital care. International Journal for Quality in Health Care, 15(4), 345–355. https://doi.org/10.1093/intqhc/mzg045 [Google Scholar] [Crossref]

10. Westaway, M. S., Rheeder, P., Van Zyl, D. G., & Seager, J. R. (2003). Interpersonal and organizational dimensions of patient satisfaction: The moderating effects of health status. International Journal for Quality in Health Care, 15(4), 337–344. https://doi.org/10.1093/intqhc/mzg038 [Google Scholar] [Crossref]

11. Pansari, A., & Kumar, V. (2017). Customer engagement: The construct, antecedents, and consequences. Journal of the Academy of Marketing Science, 45(3), 294–311. https://doi.org/10.1007/s11747-016-0485-6 [Google Scholar] [Crossref]

• Assessment of the Role of Artificial Intelligence in Repositioning TVET for Economic Development in Nigeria
• Teachers’ Use of Assure Model Instructional Design on Learners’ Problem Solving Efficacy in Secondary Schools in Bungoma County, Kenya
• “E-Booksan Ang Kaalaman”: Development, Validation, and Utilization of Electronic Book in Academic Performance of Grade 9 Students in Social Studies
• Analyzing EFL University Students’ Academic Speaking Skills Through Self-Recorded Video Presentation
• Major Findings of The Study on Total Quality Management in Teachers’ Education Institutions (TEIs) In Assam – An Evaluative Study