Table 2.
Commitment constructs and illustrative quotes
| BASIS OF COMMITMENT | DEFINITION ADAPTED (BY RESEARCHERS) TO THE HEALTH CARE CONTEXT | ILLUSTRATIVE QUOTE |
|---|---|---|
| Affective3,4 | Commitment characterized by an emotional attachment to, and identification with, the health care provider. Health care provider has a great deal of personal meaning for the patient. Patient stays with the provider because he or she truly wants to | “[I would] break out into sweats if she told me she was going to retire or if she was moving …. It would be a terrible, a terrible day for me.” “She just seems like a family member.” “I am at home now … and I don’t plan to, like, move … and I’m not going to go back into that dark, cold, negative space.” |
| Continuance3,4 | Commitment characterized by an acknowledgment of the perceived cost associated with discontinuing the health care relationship (eg, care would be interrupted if the patient left the health care provider; there are few other options available in terms of health care providers). Patient stays because he or she has to | “There’s not a lot of available doctors … I just … stick with her.” “If I had to find another doctor, I couldn’t do it again … it would just be so exhausting.” “I don’t really want to change right now … there’s so much history there … whether it’s good or bad, it’s there.” |
| Normative | ||
| • To doctor3,4 | Commitment characterized by a belief that it is one's moral obligation to remain with the health care provider. Patient would feel guilty if he or she left the health care provider; patient thinks that he or she owes the health care provider his or her loyalty. Patient stays because he or she ought to | “I have thought about, uh, how, you know, what’s she going to think if I all of a sudden just leave … I would feel bad even though we don’t really have … that good of a relationship.” |
| • To family members who see the same provider | Commitment based on concerns about disruption in family members’ care if the patient left. Patients believe they have an obligation to their family members, so they remain with the providers | “She’s my daughter’s doctor as well and I don’t want … I just hate to think about breaking that.” “I come with a family package … with my mum … [she] is in her 80s now … there are doctors that won’t take anyone over a certain age … I don’t want to have more than one family doctor involved … ” |