JMIR Publications

ABSTRACT

Background:

The growing demand for home-based care, driven by rapid population aging, has accelerated the development of Internet-based Home Care. Despite its emerging status, a subset of loyal patients has consistently used Internet-based Home Care with high frequency, showing strong commitment and willingness to recommend it to others. Understanding their experiences with trust-building among loyal patients is essential to optimize and scale this service model. However, few studies have specifically explored the experience of trust-building among this patient group, leaving a significant gap in the literature.

Objective:

To explore the experiences of trust-building among loyal patients in Internet-based Home Care, guided by the Cognitive-Affective-Conative model.

Methods:

Design: A descriptive qualitative design was employed. Setting: Zhejiang Province, China. Participants: Fifteen Loyal Patients in Internet-based Home Care (mean age 65 years, range 30 to 92; mean number of care visits 168, range 101 to 359) participated in this study.

Methods:

A purposive sampling method was used to select loyal patients. Semi-structured interviews, informed by the Cognitive-Affective-Conative framework, were conducted between June and August 2025. Data were analyzed using directed content analysis with NVivo 12.0.

Results:

Three core themes emerged. The first theme, cognitive dimension—building the foundation of trust through rational appraisal, included channels of trusted information, recognition of professional competence, convenience of digital services, and concerns about safety and privacy. The second theme, affective dimension—deepening trust through emotional and cultural connection, involved professional interaction to “quasi-family” bonds, emotionally tailored support across patient groups, and filial piety culture as an emotional and trust catalyst. The third theme, conative dimension—translating trust into loyal behaviors within rational limits, underscored trust-driven advocacy and word-of-mouth, willingness to pay as a monetization of trust, engaged participation in services improvement, and rational boundaries of trust and loyalty.

Conclusions:

Patient trust in Internet-based Home Care is shaped by the interplay of cognitive appraisal, emotional connection, and behavioral intention. This study shows that loyalty first originates from a rational understanding of service quality, which generates trust. During the service process, emotional connections and cultural factors such as filial piety further enhance this trust, gradually leading to loyalty behaviors based on rational choice, such as frequent use and word-of-mouth promotion. This study demonstrates that loyalty is not only a rational choice based on service quality but also a commitment anchored in long-term emotional relationships, further reinforced by cultural factors like filial piety that embed the services within family values. The Cognitive-Affective-Conative model effectively captures this multifaceted experience. Consequently, moving beyond mere technical utility, future development must strategically integrate emotional support and cultural sensitivity to nurture deep, sustainable trust.