Correlation between Perceived Organizational Support and Work Engagement among Traditional Chinese Medicine General Practitioners:Chain-mediating Role of Self-Efficacy and Public Service Motivation

Correlation between Perceived Organizational Support and Work Engagement among Traditional Chinese Medicine General Practitioners:Chain-mediating Role of Self-Efficacy and Public Service Motivation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlation between Perceived Organizational Support and Work Engagement among Traditional Chinese Medicine General Practitioners:Chain-mediating Role of Self-Efficacy and Public Service Motivation Jiayu Sun, Zhihong Lu, Xue Song, Dong Guo, Lijun Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6732491/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background TCM general practitioners, as the primary force in providing grassroots TCM services, play a significant role in the prevention of grassroots diseases and the control of major epidemic situations. This study aims toexplore the correlation between the perceived organizational support received by TCM general practitioners and their level of work engagement. Besides , it measures the potential mediating roles of self-efficacy and public service motivation in this correlation,aiming at providing a reference for the formulation of policies and incentive measures related to TCM general practitioners, thereby contributing to the construction of grassroots medical and health services and safeguarding the health of the people. Methods This study is based on a survey conducted during March-April 2024. Data were collected through a self-administered questionnaire from 528 TCM general practitioners (response rate, 99.8%) in Shandong province , China. Using the Perceived Organizational Support Scale (POSS), a 13-item scale was designed to measure perceived organizational support,while a 13-item scale was designed to assess work engagement using the Utrecht Work Engagement Scale (UWES).Moreover, a 13-item scale was designed to measure public service motivation service motivation using the Public Service Motivation Questionnaire (PSMQ),while a 13-item scale was designed to evaluate self-efficacy using the General Self-Efficacy Scale (GSES).Statistical analyses wereperformed using SPSS 26.0 for descriptive statistics and bivariate correlation analysis. Furthermore, a structural equation model was constructed using Amos 24.0 to assess the correlations among the variables and test the proposed hypotheses. Results The proposed model attained a good model fit. A significant positive correlation was suggested between work engagement and perceived organizational support ( r = 0.593, P < 0.01), self-efficacy ( r = 0.712, P < 0.01), and public service motivation ( r = 0.886, P < 0.01). Moreover, three mediating pathways were identified: mediating effect of self-efficacy ( b = 0.087, 95% confidence interval [CI]: [0.042, 0.154]), mediating effect of public service motivation ( b = 0.141, 95%CI: [0.073, 0.241]), and chain-mediating effect including both self-efficacy and public service motivation ( b = 0.130, 95%CI: [0.086, 0.183]), all of which were statistically significant. Conclusion This study demonstrates the substantial impact of perceived organizational support on work engagement and clarifies the mediating role mechanism of public service motivation and self-efficacy between perceived organizational support and work engagement. Hence, to encourage and improve the work engagement of TCM general practitioners, efforts should be directed toward three essential strategies: enhancing perceived organizational support, reinforcing self-efficacy, and intensifying public service motivation. primary care TCM general practitioners work engagement perceived organizational support self-efficacy public service motivation chain intermediary Figures Figure 1 Background The General Practitioner of Traditional Chinese Medicine (TCM general practitioner) is an officially recognized profession by “The General Code of Occupational Classification of the People’s Republic of China [ 1 ] ” in 2015. These are trained professionals proficient in applying TCM practices together with modern medical theories to offer assorted services like the diagnosis, treatment, rehabilitation, prevention, and health management of common and chronic diseases. With the combination of modern and traditional medical practices, TCM general practitioners play a distinguishing and essential role in protecting public health. Nevertheless, with the ongoing healthcare reform and the swing in medical service paradigms in China [ 2 ] , along with the bolstered health consciousness among people, primary general practice clinics have become a crucial gateway for hospitals in patient reception [ 3 ] . Moreover, a growing number of patients are now seeking care at these clinics [ 4 ] . However, the number of general practitioners specializing in TCM is notably low [ 5 ] , posing a significant challenge in fulfilling the snowballing demand. Meanwhile, a considerable discrepancy exists between the demand and supply for specialized roles in the field of TCM general practice. Moreover, these positions lack stability and attractiveness, often creating issues in recruitment and a high rate of staff turnover [ 6 ] . Consequently, the TCM general practitioner system and its workforce remain under constant strain, thereby necessitating a comprehensive investigation into strategies to address this challenge, ensuring the sustainability and efficacy of the TCM healthcare system. Work engagement plays a crucial role in primary healthcare [ 7 ] , where it functions as a quantifiable concept [ 8 ] broadly used in disciplines like health psychology and nursing science. Lately, it has become a foremost research focus within the realms of positive organizational behavior and human resource management [ 9 ] , steadily cementing itself in healthcare sector research [ 7 ] . Numerous factors have been reported to influence work engagement, which are broadly divided into two categories [ 10 ] : internal and external. While internal factors comprise aspects like self-efficacy [ 11 ] , service motivation [ 12 ] , performance feedback [ 13 ] , and job satisfaction [ 14 ] , external factors comprise organizational support [ 15 ] , job resources, and organizational commitment [ 16 ] . This study aims to assimilate perceived organizational support as an external influence and self-efficacy with public service motivation as internal influences to investigate their impact on the work engagement of TCM general practitioners and their operational mechanisms. Literature review and hypotheses Work engagement is defined as a positive work-related mental state [ 17 ] , manifested by vigor, dedication, and absorption [ 18 ] . The key role of work engagement [ 19 ] has been well-established among healthcare workers in augmenting their job performance [ 20 ] . However, limited studies are available on work engagement [ 21 ] in the healthcare sector [ 22 ] , particularly in primary healthcare, where empirical research is scant [ 23-25 ] . This gap warrants a focus on the work engagement of TCM general practitioners, examining the mechanisms underlying work engagement and the intrinsic motivations that reinforce the efficiency of these practitioners. American social psychologist R. Eisenberger introduced the concept of perceived organizational support as the support, help, and care offered by an organization to its employees, acknowledging and valuing their contributions [ 26 ] . Per the social exchange theory [28] , employees who perceive organizational support [ 25 ] tend to exert greater effort, improve their work engagement, and display enhanced loyalty to the organization. Besides, studies have suggested that perceived organizational support [ 27 ] , as a “soft area” in the work environment, is a vital factor in nurturing work engagement [ 7 ] . Accordingly [ 28 ] , the following hypothesis is proposed: Hypothesis 1: Perceived organizational support positively and directly correlates with work engagement. Self-efficacy denotes an individual’s belief in their ability [ 29 ] to adopt adaptive behaviors amid environmental challenges [ 30 ] . The self-efficacy [ 31 ] theory postulates that these beliefs are essential to behavior [ 32 ] . In addition, the “social cognitive behaviorism” theory emphasizes perceived organizational support as a vital external environmental factor in a system where the individual, environment, and behavior are mutually determined. A robust and positive sense of perceived organizational support augments [ 33 ] work behavior by affecting individual efficacy. Accordingly, the following hypothesis is proposed: Hypothesis 2: Self-efficacy mediates the correlation between perceived organizational support and work engagement. James Perry was the first to propose and elaborate on public service motivation, who defined four dimensions for its measurement, namely, attraction to public service, commitment to public values, compassion, and self-sacrifice [ 34 ] . As an intrinsic and participatory motivation, public service motivation influences their behavior. Reportedly, intrinsic motivation plays a mediating role between [ 35 ] job performance and perceived organizational support. Besides, participation motivation plays an indirect role between organizational citizenship behavior [ 12 ] and perceived organizational support. Accordingly, the following hypothesis is proposed: Hypothesis 3: Public service motivation mediates the correlation between perceived organizational support and work engagement. Per Bandura’s social cognitive theory, self-efficacy is a source and motivator of human actions. Without self-efficacy, individuals could struggle to engage in work or handle challenges [ 36 ] . Notably, self-efficacy is a foundational element of motivation [ 37 ] . Accordingly, the following hypothesis is proposed: Hypothesis 4: Public service motivation and self-efficacy play a chain-mediating role between perceived organizational support and work engagement. Methods Study participants Using stratified sampling, four cities in Shandong Province were selected based on their economic development level and geographical location: Jinan, Binzhou, Dongying, and Jining. A survey was conducted among grassroots TCM general practitioners in village clinics, township hospitals, and community healthcare centers in these cities. For each city, 4 counties (cities, districts) were sampled based on their economic development level. A questionnaire survey was conducted among the grassroots general practitioners working in medical institutions at the county (city, district) level. A total of 528 questionnaires were distributed. After excluding questionnaires with missing items, those with a response time of less than 10 minutes, a final total of 525 valid questionnaires were obtained, resulting in an effective response rate of 99.43%. Measurements Work engagement Work engagement was mceasured using the Utrecht Work Engagement Scale (UWES) [ 38 ] , which comprises three dimensions. In this study, we developed three subscales, comprising a total of nine items, to measure the following three key dimensions: vigor (3 items), dedication (3 items), and absorption (3 items) [ 39 ] . Vigor measures elements like enthusiasm, energy, and work sustainability; dedication defines the feelings of pride upon work completion and the sense of attainment in facing challenges; absorption signifies engagement level and focus acumen. Each item in the three subscales was scored on the 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). The cumulative score for work engagement ranged between 9 and 45, with high scores signifying high degrees of work engagement. The Cronbach a values for vigor, dedication, and absorption were 0.96, 0.98, and 0.94, respectively. Public service motivation The established public service motivation measurement approach developed by Perry and Wise [ 34 ] was used to assess TCM general practitioners’ public service motivation. We rated 13 items using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). These items were subclassified into four distinct dimensions: attraction to public service (4 items), commitment to public values (3 items), compassion (3 items), and self-sacrifice (3 items). The cumulative scores for public service motivation ranged between 13 and 65, with a higher score signifying a higher degree of public service motivation. The Cronbach a values for the four subscales were 0.98, 0.96, 0.97, and 0.94, respectively. Self-efficacy We used the General Self-Efficacy Scale (GSES), developed by Schwarzer [ 40 ] , to assess TCM general practitioners’ self-efficacy. To accommodate the overall length of the questionnaire, the complete 10-item [ 41 ] scale was shortened to six items, for example, “When I encounter difficulties, I typically come up with strategies to cope.” Items 1 and 2 represented the clear objectives and the ability to perform long-term problem analysis; items 3 and 6 evaluated the competence and methods to manage sudden snags and difficulties; items 4 and 5 signified the affirmation of contributions to residents and society. Each item was scored on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Thus, the cumulative score of the six items ranged between 6 and 30, with higher scores denoting greater self-efficacy. The Cronbach a value for the scale was 0.95, which affirms a high degree of internal consistency. Perceived organizational support Perceived organizational support was evaluated using the Perceived Organizational Support Scale [ 42 ] (POSS), developed by Shen and Benson, which contains eight items, for example, “I believe my organization is concerned about my well-being.” Items 1 and 4 suggested the emphasis on members’ views and opinions; items 2 and 7 assessed the concern for members’ well-being; items 3 and 5 denoted the recognition of members’ efforts; items 6 and 8 signified the value of members’ job satisfaction. Each item was scored on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). The cumulative score of the eight items ranged between 8 and 40, with a higher score indicating stronger perceived organizational support. Furthermore, with a Cronbach a coefficient of 0.99, the POSS illustrated an excellent level of internal consistency. Statistical analysis First, we conducted Cronbach a reliability tests on each module scale using SPSS 27.0. Then, each research variable was subjected to descriptive statistics and normality tests. Using the Pearson correlation coefficient, the correlations between the research variables were assessed. Then, we performed the confirmatory factor analysis using AMOS 28.0 to assess the fit of the measurement model against the hypothesized model. The fit indices included chi-square ( χ 2 ), normalized chi-square statistic Tucker–Lewis index(TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) [ 43 ] . Finally, the significance of both direct and indirect effects proposed in the hypothesis model was tested using bootstrap resampling. Results Descriptive analysis The gender distribution of the study sample was reasonably equitable. The age range was primarily 31-50 years (76.0%), with a noteworthy representation from the departments of Traditional Chinese Medicine General Practice (48.5%) and General Practice (21.6%). The majority of participants held junior and intermediate professional titles and had undergraduate degrees (72.0%). Moreover, their work experience was homogeneously distributed across various levels (Table 1). Table 1 . General participant characteristics (N = 528) Variables Categories N % Gender Male 290 54.9 Female 238 45.1 Age ≤30 57 10.8 (years) ≥51 70 13.2 31-50 401 76.0 Department Pediatrics 7 1.3 Obstetrics and gynecology 7 1.3 Nursing department 9 1.7 Emergency department 4 0.7 Rehabilitation department 13 2.5 Internal medicine 37 7.0 Other 69 13.1 General practice 114 21.6 Surgery department 12 2.3 Traditional Chinese Medicine 256 48.5 Educational level Master’s degree or above 15 2.8 Undergraduate 380 72.0 Below undergraduate 133 25.2 Professional qualifications Senior title 85 16.1 Intermediate title 211 40.0 Primary title 179 33.9 Other 53 10.0 Years of experience (years) £5 174 33.0 6-10 Years 105 19.9 11-20 Years 113 21.4 ³21 136 25.7 Table 2 provides a detailed descriptive analysis of the measurement scales and variables used in this study.Among all the valid questionnaires collected, the absolute values of skewness for all measured variables did not surpass 1.97, and the absolute values of kurtosis were all <2.58, which corroborates the recommended standards for normal distribution [ 44 ] . Subsequently, we analyzed and validated the proposed hypotheses by examining the correlations among these variables. Table 2 . Descriptive statistics of measured variables ( N = 525) Scale and variables Quantity Range Average Item Score ( x̄ ±s) Skewness Kurtosis Work Engagement Scale 9 1-5 4.20 ± 0.70 −0.86 1.26 Vigor 3 1-5 4.22 ± 0.72 −0.87 1.32 Dedication 3 1-5 4.28 ± 0.70 −0.87 1.28 Absorption 3 1-5 4.11 ± 0.78 −0.70 0.63 Public Service Motivation Scale 13 1-5 4.40 ± 0.61 −0.75 0.99 Attraction to public service 4 1-5 4.41 ± 0.61 −0.87 1.26 Commitment to public values 3 1-5 4.39 ± 0.62 −0.87 1.23 Compassion 3 1-5 4.39 ± 0.65 −0.95 1.48 Self-sacrifice 3 1-5 1-5 1-5 4.40 ± 0.62 −0.84 1.06 Self-Efficacy Scale 6 4.29 ± 0.65 −0.54 0.43 Perceived Organizational Support Scale 8 3.91 ± 0.83 −0.95 2.22 Correlation analysis Using the Pearson correlation coefficient analysis, we investigated the correlations among various measured variables. Table 3 reveals that the level of work engagement positively correlates with participants’ public service motivation scores ( r = 0.886, P < 0.01), self-efficacy scores ( r = 0.712, P < 0.01), and perceived organizational support scores ( r = 0.593, P < 0.01). In addition, the perception of organizational support positively correlated with the public service motivation scores ( r = 0.539, P < 0.01) and self-efficacy scores ( r = 0.461, P < 0.01). Moreover, a positive correlation is noted between public service motivation and self-efficacy scores ( r = 0.670, P < 0.01). Furthermore, the significant correlations among all variables fulfilled the necessary conditions for proceeding with a serial mediation analysis [ 45 ] . Table 3 . Pearson’s correlations among each variable Variables M SD 1 2 3 4 1. Work engagement 4.25 0.66 1 2. Public service motivation 4.40 0.61 0.886** 1 3. Self-Efficacy 4.29 0.65 0.712** 0.670** 1 4. Perceived organizational support 3.91 0.83 0.593** 0.539** 0.461** 1 ** P < 0.01 Chain mediation model and effect analysis Figure 1 explains a chain mediation model including work engagement and perceived organizational support and demonstrates the model paths with standardized coefficients. Table 4 presents the total, direct, and indirect effects of model paths. Based on the four goodness-of-fit indices, the overall fit of the model was high: = 690.06, = 183, = 3.77, CFI = 0.97TLI = 0.97, RMSEA = 0.073 (95% confidence interval [CI]). Typically, the vast proportion of the model path effects were statistically significant. Precisely, both Table 4 and Fig. 1 present that the 95%CI for the impact of perceived organizational support on work engagement is [0.082, 0.181], with a path coefficient of b = 0.126 ( P < 0.001). As this interval does not include zero, the direct effect was statistically significant, thereby validating Hypothesis 1. Besides, the 95%CIs for the mediating effects of self-efficacy ([0.042, 0.154]; b = 0.087, P < 0.001) and public service motivation ([0.073, 0.241]; b = 0.141, P < 0.001) excluded zero, suggesting that both self-efficacy and public service motivation significantly mediate the correlation between perceived organizational support and work engagement. Hence, the results validated Hypotheses 2 and 3. In addition, the concurrent mediating effect of self-efficacy [ 46 ] and public service motivation in the chain mediation pathway between perceived organizational support and work engagement was significant, as demonstrated by the 95%CI [0.086, 0.183] for the combined effect ( b = 0.130, P < 0.001). Moreover, the specific chain mediation pathway’s 95%CI [0.043, 0.096] excluded zero, thereby validating Hypothesis 4 and illustrating the significance of the chain mediation effect. Table 4 . The 95% confidence interval (CI) of bootstrap for chain mediation effect decomposition and bias correction Hypothesis Intermediary Path Effect coefficient Two-tailed test CI Intermediary effect Lower bounds Upper bounds H1 POS-WE 0.126 0.000 0.082 0.181 Support H2 POS-SE-WE 0.087 0.001 0.042 0.154 Support H3 POS-PSM-WE 0.141 0.001 0.073 0.241 Support H4 POS-SE-PSM-WE 0.130 0.001 0.086 0.183 Support Discussion In recent years, with the constant growth of TCM, the support of national policies, and the enhancement of people’ s health awareness, the demand for primary healthcare and traditional Chinese medical services in China has been rising continuously. While TCM general practitioners serve as the key providers of these services, a certain gap exists between their training and distribution and the supply−demand relationship of the services offered. Therefore, identifying the correlations among variables is essential to enhance the work engagement level among TCM general practitioners, augmenting the quality and efficiency of work engagement, and markedly contributing to fulfilling the rising service demand. Besides, it supports the Chinese government [ 47 ] in executing effective plans to raise the overall quality of medical services offered by pertinent departments. Summary of key findings This study explored the correlations between the perceived organizational support and work engagement of TCM general practitioners, as well as the mediating effects of self-efficacy and public service motivation. The findings suggested that the average self-evaluation work engagement score for TCM general practitioners was 4.20 ± 0.70, which was higher than that of nurses (2.98 ± 0.98) [ 48 ] , other hospital staff (3.52 ± 0.54) [ 49 ] , nonpermanent staff in public hospitals (2.99 ± 1.58) [ 50 ] , teachers (3.82 ± 0.67) [ 51 ] , and community workers (3.75 ± 0.72) [ 52 ] . The abovementioned differences are attributable to inadequate sample size or participants’ characteristics [ 47 ] , such as income level, education level, years of work experience, and work environment, which contribute to a higher work engagement level among TCM general practitioners. In addition, the average score for the public service motivation scale items for TCM general practitioners was 4.40 ± 0.61, significantly higher than that of grassroots civil servants (3.50 ± 0.66) [ 53 ] , public officials (4.01 ± 0.73) [ 54 ] , community workers (3.99 ± 0.66) [ 52 ] , and medical students (4.13 ± 0.51) [ 55 ] . These differences are attributable to the sample selection, as our sample was drawn from Shandong province, China, which might have regional biases. This can be clarified culturally, as Shandong province is the origin of Confucian culture, where virtues like dedication, sacrifice, and altruism are predominant. Under such a cultural atmosphere, the values, behaviors, and cognitions of TCM general practitioners in this region could be influenced, placing their public service motivation at a comparatively higher level than other groups. Besides, the average score for the self-efficacy scale items for TCM general practitioners was 4.29 ± 0.65, which is above the medium level and higher than comparable studies, such as the study on the self-efficacy of medical students in the training and education process in China at 71.50% [ 56 ] . Meanwhile, the perceived organizational support score of TCM general practitioners eligible for scoring accounted for 62.10%, with an average score of scale items at 3.91 ± 0.83, suggesting that the overall proportion and score was not high, although it is still higher than that of doctors in public hospitals in China (3.580 ± 1.13) [ 57 ] , rural doctors (3.30 ± 0.534) [ 46 ] , nurses in tertiary hospitals (3.11 ± 0.57) [ 58 ] , nonpermanent staff in public hospitals (2.80 ± 1.05) [ 50 ] , and grassroots public officials (3.99 ± 0.80) [ 54 ] . These differences are attributable to the present national policies and specific provincial policies and measures that stimulate TCM general practitioners, yielding a higher sense of organizational support than other groups. Perceived organizational support exerts a direct positive impact on work engagement Our findings demonstrated that perceived organizational support exerted a direct positive impact on work engagement, corroborating the corresponding research [ 59 – 62 ] . Per the “China Health Statistics Yearbook” for 2021−2023, as of 2023, the planned completion rate for TCM general practitioners in China reached 66.76%. Meanwhile, the nurturing of TCM general practitioners is reflected by an extended training period. Based on China’s prevailing medical training model, it is anticipated that the training of TCM general practitioners takes 10−12 years, including undergraduate and master’s education, along with standardized training for specialist physicians. Moreover, the assessment and certification are stringent, with high requirements on a comprehensive knowledge structure, thereby demanding the mastery of various systems of knowledge, including both TCM and Western medicine, further intensifying the challenges. Thus, an even greater need exists for organizational support from the nation, localities, and units, including respect support (whether the organization values employees’ contributions), welfare support (whether the organization cares about employees’ welfare), and instrumental support (e.g., information, resources, tools, equipment, and training). Prior research revealed that the organization dynamically creates a promising work environment, recognizes the contributions and values of individuals, offers them ample support, and by improving employees’ perception of organizational support, they tend to focus more on pursuing organizational goals [ 63 ] and strengthen work engagement. Our study further validates the findings and offers insights for articulating solution strategies to improve the work engagement of TCM general practitioners. Actions like increasing salary and benefits, offering supplementary opportunities for professional growth, enhancing the work environment, and focusing on physical and mental health are needed to raise the sense of organizational support for TCM general practitioners, thereby augmenting their work engagement. Self-efficacy plays a mediating role between perceived organizational support and work engagement This study corroborates prior studies [ 64 , 65 ] by demonstrating that self-efficacy plays a mediating role between perceived organizational support and work engagement. Many studies on the self-efficacy theory have demonstrated self-efficacy as a vital factor influencing behavior [ 40 ] . When employees receive effective support from the organization, it can nurture positive and adaptive behaviors and beliefs, leading the employees to respond more proactively to environmental deviations and stressors, thereby augmenting work engagement and efficiency. Consequently, based on this principle, when TCM general practitioners feel valued and supported by their organization and receive acknowledgment for their contributions, it can translate into robust intrinsic motivation, resulting in higher work engagement and enhanced efficiency. Public service motivation plays a mediating role between perceived organizational support and work engagement This study demonstrated that public service motivation markedly mediates the correlation between work engagement and perceived organizational support, which is further supported by an exhaustive literature review, including prior research on participation motivation, member behavior, performance, and more [ 12 ] . In a study examining the moderating effect of volunteer participation motivation on perceived organizational support and organizational citizenship behavior, Hui et al. observed that, besides improving perceived organizational support, organizations can increase employee organizational citizenship behavior by enhancing their motivation to volunteer. Likewise, our findings suggest that public service motivation plays a mediating role in the correlation between perceived organizational support and work engagement, thereby positively influencing this pathway. Thus, under the influence of organizational environment and culture, the self-worth and social value of TCM general practitioners are affirmed continually, translating their sense of perceived organizational support into a basis for intrinsic and extrinsic motivations, which kindles their service-oriented motivation from both social orientation and personal growth needs, thereby successfully raising their work engagement levels. Self-efficacy and public service motivation play a chain-mediating role between perceived organizational support and work engagement This study demonstrates that self-efficacy and public service motivation play a chain mediation [ 66 ] effect in the correlation between work engagement and perceived organizational support. Owing to the intricate nature of creating the work engagement impact mechanism among TCM general practitioners, several survey studies share similar structures to our study; while they do not directly validate our findings, they provide a basis for linking these with previous studies, thereby offering exploratory insights [ 67 ] . In the exploration process, we first examined the potential correlation between self-efficacy and public service motivation, demonstrating a noteworthy positive relationship. For example, Klassen and Klassen reported that self-efficacy is the basis for the motivation of research subjects [ 37 ] . Accordingly, we further established and explored the chain mediation [ 66 ] effect of public service motivation and self-efficacy between work engagement and perceived organizational support. In this model path, when TCM general practitioners perceive adequate organizational support, it affects their self-efficacy level, which, in turn, affects their beliefs and motivations, as reflected in public service motivation through personal value and social value needs. Eventually, this affects work engagement owing to a combination of internal self-interest and external altruism, and our study further establishes this positive impact. Limitations and future research directions First,regarding research methodology, the cross-sectional design of this correlational study fundamentally limits the ability to construct causal relationships.Thus, subsequent studies should adopt longitudinal or experimental methodologies to strengthen and elucidate the causal relationships suggested by our study. Second,regarding the research sample, this study focused on TCM general practitioners in Shandong province, China. The sample might not be fully representative because of regional cultural differences, differences in educational backgrounds, and other demographic factors.Thus, it will be better to increase the number of participants and incorporate a wide array of individuals in the study. Finally, future research should investigate the potential moderating roles of incentive mechanisms, occupational burnout, and other pertinent factors within the pathway mechanism,as this would support a more comprehensive theoretical model by assessing the impact of these variables on the correlations among the variables. Conclusions This study sampled TCM general practitioners from several cities in Shandong Province. By exploring the correlation between four variables, it was found that there is a direct effect between work engagement and perceived organizational support, as well as an indirect effect between work engagement and public service motivation and self-efficacy. Additionally, there is a chain mediating effect among the four variables.Therefore,our findings suggest actionable strategies and a conceptual framework for improving the work engagement of TCM general practitioners by focusing on perceived organizational support. To increase the work engagement of TCM general practitioners, the following three approaches are recommended: 1. Augmenting Perceived Organizational Support: Organizations should foster an environment where TCM practitioners feel valued and that contributes to their improved work engagement. 2. Reinforcing Self-Efficacy: Initiatives aimed at boosting the confidence and capability of TCM general practitioners can support their belief in their skills to successfully execute their roles, thereby improving their work engagement. 3.Underpinning Public Service Motivation: Inspiring and fostering a sense of public service motivation among TCM general practitioners can reinforce their commitment to their profession and the communities they serve, which closely correlates with higher levels of work engagement. By applying the strategies mentioned above, not only can the work engagement of TCM general practitioners be enhanced but also the overall quality of healthcare services provided. Abbreviations TCM Traditional Chinese Medicine GP general practitioners Declarations Acknowledgements Special thanks to the Office of Natural Science Foundation of Shandong Province for funding. The authors would like to thank all the researchers who contributed to this study. Authors’ contributions ZHL conceptualized the article and its design; DG and XS conducted data collection; JYS drafted the manuscript; LJW was responsible for the overall article, guidance, improvement, supervision and management. All authors read and approved the final manuscript. Funding This project was supported by The Research on Incentive Policy Optimization of Grassroots TCM General Practitioners Based on Public Service Motivation Theory (ZR2022MG039). Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This study has obtained ethical approval from the Ethics Committee of Shandong University of Traditional Chinese Medicine Affiliated Hospital. The approval number is: [2025] Ethics Review No. (007) - QT. All procedures were in accordance with the ethical standards of the Helsinki Declaration.All participants have provided informed consent. Dual publication The results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration by another publisher. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Shandong University of Traditional Chinese Medicine, 4655 University Road, Jinan, Shandong 250355, China References Occupational Classification Code of the People's Republic of China. China Human Resources and Social Security , 8 (2015). F.X.L, et al. Cultivate general practitioners of traditional Chinese medicine to improve the function of community health services. China Higher Medical Education 10 , 124-125 (2009). Ye, W, et al . Current Situation and Strategies for the Special Post Program for General Practitioners in Traditional Chinese Medicine. 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Research on the Relationship betweenPublic Service Motivation and WorkEngagement of Community Workers Master thesis, Central China Normal University, (2023). Nan, Z. et al. An Empirical Study on the Impact of Public Service Motivation on Job Happiness of Grassroots Civil Servants in China. Chinese Public Administration , 83-87 (2017). https://doi.org:10.3782/j.issn.1006-0863.2017.03.15 Jiahui, J. Effect of Organizational Support and Public Service Motivation on Job Performance of Grass-roots Civil Servants ——An Empirical Study Based on 622 Samples doctor thesis, Zhengzhou University, (2022). Meiling, C. et al . Status quo of volunteer service motivation of medical student volunteers participating in community volunteer service and its influencing factors. CHINESE NURSING RESEARCH 35 , 3065-3070 (2021). https://doi.org:10. 12102/j. issn. 1009-6493. 2021. 17. 010 Dezhi, L. et al . Effect of a medical education environment on medical students’ learning engagement：the mediating effect of academic self-efficacy. Journal of China Medical University 49 (2020). http://kns.cnki.net/kcms/detail/21.1227.r.20200415.1412.030.html Jinghan, Z. et al . The Influence of Organizational Support on Doctors’Career Satisfaction in Public Hospitals：An Analysis of Mediating Effects Based on Role Stress. Chinese Hospital Management 44（3） (2024). Liu, W. et al. Workplace violence, job satisfaction, burnout, perceived organisational support and their effects on turnover intention among Chinese nurses in tertiary hospitals: a cross-sectional study. BMJ Open 8 , e019525 (2018). https://doi.org:10.1136/bmjopen-2017-019525 Şanliöz, E., Sağbaş, M. & Sürücü, L. The Mediating Role of Perceived Organizational Support in the Impact of Work Engagement on Job Performance. Hosp Top 101 , 305-318 (2023). https://doi.org:10.1080/00185868.2022.2049024 Xu, D., Zhang, N., Bu, X. & He, J. The effect of perceived organizational support on the work engagement of Chinese nurses during the COVID-19: the mediating role of psychological safety. Psychol Health Med 27 , 481-487 (2022). https://doi.org:10.1080/13548506.2021.1946107 Ni, Y. X., Wu, D., Bao, Y., Li, J. P. & You, G. Y. The mediating role of psychological needs on the relationship between perceived organizational support and work engagement. Int Nurs Rev 70 , 204-210 (2023). https://doi.org:10.1111/inr.12797 Yang, S. et al. Psychological Capital Mediates the Association Between Perceived Organizational Support and Work Engagement Among Chinese Doctors. Front Public Health 8 , 149 (2020). https://doi.org:10.3389/fpubh.2020.00149 H., L. Reciprocation: the relationship between man and organization. Adm Sci Q 9(4):370–390 (1965). https://doi.org:10.2307/2391032 Al-Hamdan, Z. & Bani Issa, H. The role of organizational support and self-efficacy on work engagement among registered nurses in Jordan: A descriptive study. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6732491","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488290535,"identity":"a25ffc0c-452e-48bc-82c1-f7bc6ff132ab","order_by":0,"name":"Jiayu Sun","email":"","orcid":"","institution":"Shandong University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jiayu","middleName":"","lastName":"Sun","suffix":""},{"id":488290536,"identity":"6a23ef82-6deb-4db6-bfff-e54e2ab1879d","order_by":1,"name":"Zhihong Lu","email":"","orcid":"","institution":"Shandong University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhihong","middleName":"","lastName":"Lu","suffix":""},{"id":488290539,"identity":"fa777656-a452-47e0-9942-a4209dfa7a4e","order_by":2,"name":"Xue Song","email":"","orcid":"","institution":"Shandong University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Song","suffix":""},{"id":488290541,"identity":"d1277fa5-2121-481a-8846-e0eb8d83516a","order_by":3,"name":"Dong Guo","email":"","orcid":"","institution":"Shandong University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"","lastName":"Guo","suffix":""},{"id":488290542,"identity":"f7b9e559-c95b-45a1-b0d9-87f675f14e31","order_by":4,"name":"Lijun Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACgwNA4oEBGwMDe/OBAxIVEnL8RGlJAGnhOZb4wOKMhbFkA1FaQCyJHGWDyraKxA0EtRw/e/hFQgFf4naGHDaJm/MkGDcwMD98dAOPFrMzeWkWQIcl7mw4e0xy5jYJZnMGNmPjHHxaDuSYGYC0bDjYlyYtuU2CzbKBh00ar5bzb6BaDvOYSf+dI8FjcICAFvsbOcYPwFqO8RgbSDZISBDUYnnjjRkokI03nGFLfCBxTMJAspmAXwzO5xh/+PDnmOyG+4+BUVlTV9/P3vzwMT4tQMAmwcBwDInPjF85WMkHBoYawspGwSgYBaNg5AIAfNpTZPOdj5gAAAAASUVORK5CYII=","orcid":"","institution":"Shandong University of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Lijun","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-05-23 11:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6732491/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6732491/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87403005,"identity":"5c0402ee-9839-4204-b516-ee9594ce1795","added_by":"auto","created_at":"2025-07-23 12:14:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":204254,"visible":true,"origin":"","legend":"\u003cp\u003eChain mediation model.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6732491/v1/169e0ca45922d989ba430304.png"},{"id":87404412,"identity":"b20762ac-1b65-401e-b2db-e72d66b4a6a7","added_by":"auto","created_at":"2025-07-23 12:38:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1493193,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6732491/v1/0aa64baf-45d6-4292-b7f5-e62dc320a809.pdf"},{"id":87403964,"identity":"26ceca6d-5d0f-4bcf-806f-84890ce5a5b3","added_by":"auto","created_at":"2025-07-23 12:30:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":42119,"visible":true,"origin":"","legend":"","description":"","filename":"file.docx","url":"https://assets-eu.researchsquare.com/files/rs-6732491/v1/0a6e30dcc5788f5727a27474.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation between Perceived Organizational Support and Work Engagement among Traditional Chinese Medicine General Practitioners:Chain-mediating Role of Self-Efficacy and Public Service Motivation","fulltext":[{"header":"Background","content":"\u003cp\u003eThe General Practitioner of Traditional Chinese Medicine (TCM general practitioner) is an officially recognized profession by \u0026ldquo;The General Code of Occupational Classification of the People\u0026rsquo;s Republic of China\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e\u0026rdquo; in 2015. These are trained professionals proficient in applying TCM practices together with modern medical theories to offer assorted services like the diagnosis, treatment, rehabilitation, prevention, and health management of common and chronic diseases. With the combination of modern and traditional medical practices, TCM general practitioners play a distinguishing and essential role in protecting public health.\u003c/p\u003e\u003cp\u003eNevertheless, with the ongoing healthcare reform and the swing in medical service paradigms in China\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, along with the bolstered health consciousness among people, primary general practice clinics have become a crucial gateway for hospitals in patient reception\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Moreover, a growing number of patients are now seeking care at these clinics\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. However, the number of general practitioners specializing in TCM is notably low\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, posing a significant challenge in fulfilling the snowballing demand. Meanwhile, a considerable discrepancy exists between the demand and supply for specialized roles in the field of TCM general practice. Moreover, these positions lack stability and attractiveness, often creating issues in recruitment and a high rate of staff turnover\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Consequently, the TCM general practitioner system and its workforce remain under constant strain, thereby necessitating a comprehensive investigation into strategies to address this challenge, ensuring the sustainability and efficacy of the TCM healthcare system.\u003c/p\u003e\u003cp\u003eWork engagement plays a crucial role in primary healthcare\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, where it functions as a quantifiable concept\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e broadly used in disciplines like health psychology and nursing science. Lately, it has become a foremost research focus within the realms of positive organizational behavior and human resource management\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, steadily cementing itself in healthcare sector research\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Numerous factors have been reported to influence work engagement, which are broadly divided into two categories\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e: internal and external. While internal factors comprise aspects like self-efficacy\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, service motivation\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, performance feedback\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, and job satisfaction\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, external factors comprise organizational support\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, job resources, and organizational commitment\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. This study aims to assimilate perceived organizational support as an external influence and self-efficacy with public service motivation as internal influences to investigate their impact on the work engagement of TCM general practitioners and their operational mechanisms.\u003c/p\u003e"},{"header":"Literature review and hypotheses","content":"\u003cp\u003eWork engagement is defined as a positive\u0026nbsp;work-related mental state\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e17\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, manifested by vigor, dedication, and absorption\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e18\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The\u0026nbsp;key role of work engagement\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e19\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e has been well-established among healthcare workers in augmenting their job performance\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e20\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u0026nbsp;However, limited studies are available on work engagement\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e21\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e in the healthcare sector\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e22\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e,\u0026nbsp;particularly in primary healthcare, where empirical research is scant\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e23-25\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u0026nbsp;This gap warrants a focus on the work engagement of TCM general practitioners, examining the mechanisms underlying work engagement and the intrinsic motivations that reinforce the efficiency of these practitioners.\u003c/p\u003e\n\u003cp\u003eAmerican social psychologist R. Eisenberger introduced\u0026nbsp;the concept of perceived organizational support\u0026nbsp;as the support, help, and care offered by an organization to its employees, acknowledging and valuing their contributions\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e26\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Per the social exchange theory\u003csup\u003e[28]\u003c/sup\u003e, employees who perceive organizational support\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e25\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e tend to exert greater effort, improve their work engagement, and display enhanced loyalty to the organization.\u0026nbsp;Besides, studies have suggested that perceived organizational support\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e27\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, as a \u0026ldquo;soft area\u0026rdquo; in the work environment, is a vital factor in nurturing work engagement\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Accordingly\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e28\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, the following hypothesis is proposed: \u003cstrong\u003eHypothesis 1:\u0026nbsp;\u003c/strong\u003ePerceived\u0026nbsp;organizational support positively and directly\u0026nbsp;correlates with\u0026nbsp;work engagement.\u003c/p\u003e\n\u003cp\u003eSelf-efficacy\u0026nbsp;denotes an individual\u0026rsquo;s\u0026nbsp;belief in their ability\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e29\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e to adopt adaptive behaviors amid environmental challenges\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e30\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The\u0026nbsp;self-efficacy\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e31\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e theory postulates that these beliefs are essential to behavior\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e32\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. In addition, the \u0026ldquo;social cognitive behaviorism\u0026rdquo; theory\u0026nbsp;emphasizes perceived organizational support as a\u0026nbsp;vital external environmental factor in a system where the individual, environment, and behavior are mutually determined. A robust and positive sense of perceived organizational support augments\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e33\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e work behavior by affecting individual efficacy. Accordingly, the following hypothesis is proposed:\u003cstrong\u003eHypothesis 2:\u0026nbsp;\u003c/strong\u003eSelf-efficacy mediates the\u0026nbsp;correlation\u0026nbsp;between perceived organizational support and work engagement.\u003c/p\u003e\n\u003cp\u003eJames Perry was the first to propose and elaborate on public service motivation, who defined four dimensions for its measurement, namely, attraction to public service, commitment to public values, compassion, and self-sacrifice\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e34\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. As an\u0026nbsp;intrinsic and participatory motivation,\u0026nbsp;public service motivation influences their behavior. Reportedly, intrinsic motivation plays a mediating role between\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e35\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e job performance and perceived organizational support. Besides, participation motivation plays an indirect role between organizational citizenship behavior\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e12\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e and perceived organizational support. Accordingly, the following hypothesis is proposed: \u003cstrong\u003eHypothesis 3:\u0026nbsp;\u003c/strong\u003ePublic service motivation mediates the\u0026nbsp;correlation\u0026nbsp;between perceived organizational support and work engagement.\u003c/p\u003e\n\u003cp\u003ePer Bandura\u0026rsquo;s social cognitive theory, self-efficacy is a source and motivator of human actions. Without self-efficacy,\u0026nbsp;individuals\u0026nbsp;could struggle to engage in work or handle challenges\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e36\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Notably,\u0026nbsp;self-efficacy is a foundational element of motivation\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e37\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u0026nbsp;Accordingly, the\u0026nbsp;following\u0026nbsp;hypothesis is\u0026nbsp;proposed:\u0026nbsp;\u003cstrong\u003eHypothesis 4:\u0026nbsp;\u003c/strong\u003ePublic service motivation and self-efficacy play a chain-mediating role between perceived organizational support and work engagement.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing stratified sampling, four cities in Shandong Province were selected based on their economic development level and geographical location: Jinan, Binzhou, Dongying, and Jining. A survey was conducted among grassroots TCM general practitioners in\u0026nbsp;village clinics, township hospitals, and community healthcare centers in these cities. For each city, 4 counties (cities, districts) were sampled based on their economic development level. A questionnaire survey was conducted among the grassroots general practitioners working in medical institutions at the county (city, district) level. A total of 528 questionnaires were distributed. After excluding questionnaires with missing items, those with a response time of less than 10 minutes, a final total of\u0026nbsp;525\u0026nbsp;valid questionnaires were obtained, resulting in an effective response rate of\u0026nbsp;99.43%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWork engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWork engagement was mceasured using the Utrecht Work Engagement Scale (UWES)\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e38\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, which comprises three dimensions. In this study, we developed three subscales, comprising a total of nine items, to measure the following three key dimensions: vigor (3 items), dedication (3 items), and absorption (3 items)\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e39\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Vigor measures elements like enthusiasm, energy, and work sustainability; dedication defines the feelings of pride upon work completion and the sense of attainment in facing challenges; absorption signifies engagement level and focus acumen. Each item in the three subscales was scored on the 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). The cumulative score for work engagement ranged between 9 and 45, with high scores signifying high degrees of work engagement. The Cronbach\u0026nbsp;\u003cem\u003ea\u003c/em\u003e values for vigor, dedication, and absorption were 0.96, 0.98, and 0.94, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublic service motivation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe established public service motivation measurement approach developed by Perry and Wise\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e34\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e was used to assess TCM\u0026nbsp;general practitioners\u0026rsquo;\u0026nbsp;public service motivation. We rated 13 items using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). These items were subclassified into four distinct dimensions: attraction to public service (4 items), commitment to public values (3 items), compassion (3 items), and self-sacrifice (3 items). The cumulative scores for public service motivation ranged between 13 and 65, with a higher score signifying a higher degree of public service motivation. The Cronbach\u0026nbsp;\u003cem\u003ea\u003c/em\u003e values for the four subscales were 0.98, 0.96, 0.97, and 0.94, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-efficacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used the General Self-Efficacy Scale (GSES), developed by Schwarzer\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e40\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, to assess TCM\u0026nbsp;general practitioners\u0026rsquo;\u0026nbsp;self-efficacy. To accommodate the overall length of the questionnaire, the complete 10-item\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e41\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e scale was shortened to six items, for example,\u0026nbsp;\u0026ldquo;When I encounter difficulties, I typically come up with strategies to cope.\u0026rdquo; Items 1 and 2 represented the clear objectives and the ability to perform long-term problem analysis; items 3 and 6 evaluated the competence and methods to manage sudden snags and difficulties; items 4 and 5 signified the affirmation of contributions to residents and society. Each item was scored on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Thus, the cumulative score of the six items ranged between 6 and 30, with higher scores denoting greater self-efficacy. The Cronbach\u0026nbsp;\u003cem\u003ea\u003c/em\u003e value for the scale was 0.95, which affirms a high degree of internal consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived organizational support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerceived organizational support was evaluated using the Perceived Organizational Support Scale\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e42\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e (POSS), developed by Shen and Benson, which contains eight items, for example, \u0026ldquo;I believe my organization is concerned about my well-being.\u0026rdquo; Items 1 and 4 suggested the emphasis on members\u0026rsquo; views and opinions; items 2 and 7 assessed the concern for members\u0026rsquo; well-being; items 3 and 5 denoted the recognition of members\u0026rsquo; efforts; items 6 and 8 signified the value of members\u0026rsquo; job satisfaction. Each item was scored on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). The cumulative score of the eight items ranged between 8 and 40, with a higher score indicating stronger perceived organizational support. Furthermore, with a Cronbach\u0026nbsp;\u003cem\u003ea\u003c/em\u003e coefficient of 0.99, the POSS illustrated an excellent level of internal consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, we conducted Cronbach \u003cem\u003ea\u003c/em\u003e reliability tests on each module scale using SPSS 27.0. Then, each research variable was subjected to descriptive statistics and normality tests. Using the Pearson correlation coefficient, the correlations between the research variables were assessed. Then, we performed the confirmatory factor analysis using AMOS 28.0 to assess the fit of the measurement model against the hypothesized model. The fit indices included chi-square (\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e), normalized chi-square statistic \u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1753272785.png\" width=\"55\" height=\"58\"\u003e Tucker\u0026ndash;Lewis index(TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA)\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e43\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Finally, the significance of both direct and indirect effects proposed in the hypothesis model was tested using bootstrap resampling.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDescriptive analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe gender distribution of the study sample was reasonably equitable. The age range was primarily 31-50 years (76.0%), with a noteworthy representation from the departments of Traditional Chinese Medicine General Practice (48.5%) and General Practice (21.6%). The majority of participants held junior and intermediate professional titles and had undergraduate degrees (72.0%). Moreover, their work experience was homogeneously distributed across various levels (Table 1).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e General participant characteristics (N = 528)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026le;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ge;51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePediatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eObstetrics and gynecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNursing department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmergency department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRehabilitation department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInternal medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGeneral practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSurgery department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTraditional Chinese Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBelow undergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProfessional qualifications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSenior title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntermediate title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrimary title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYears of experience (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026pound;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6-10 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11-20 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026sup3;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 provides a detailed descriptive analysis of the measurement scales and variables used in this study.Among all the valid questionnaires collected, the absolute values of skewness for all measured variables did not surpass 1.97, and the absolute values of kurtosis were all \u0026lt;2.58, which corroborates the recommended standards for normal distribution\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e44\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Subsequently, we analyzed and validated the proposed hypotheses by examining the correlations among these variables.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"677\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 457px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Descriptive statistics of measured variables (\u003cem\u003eN\u003c/em\u003e = 525)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eScale and variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003eQuantity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003eAverage Item Score ( x̄ \u0026plusmn;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eSkewness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eKurtosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eWork Engagement Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.20\u0026nbsp;\u0026plusmn;\u0026nbsp;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eVigor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.22\u0026nbsp;\u0026plusmn;\u0026nbsp;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eDedication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.28\u0026nbsp;\u0026plusmn;\u0026nbsp;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eAbsorption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.11\u0026nbsp;\u0026plusmn;\u0026nbsp;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003ePublic Service Motivation Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.40\u0026nbsp;\u0026plusmn;\u0026nbsp;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eAttraction to public service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.41\u0026nbsp;\u0026plusmn;\u0026nbsp;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eCommitment to public values\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.39\u0026nbsp;\u0026plusmn;\u0026nbsp;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eCompassion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.39\u0026nbsp;\u0026plusmn;\u0026nbsp;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eSelf-sacrifice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.40\u0026nbsp;\u0026plusmn;\u0026nbsp;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eSelf-Efficacy Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e4.29\u0026nbsp;\u0026plusmn;\u0026nbsp;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003ePerceived Organizational Support Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e3.91\u0026nbsp;\u0026plusmn;\u0026nbsp;0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026minus;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eCorrelation analysis\u003c/h3\u003e\n\u003cp\u003eUsing the Pearson correlation coefficient analysis, we investigated the correlations among various measured variables. Table 3 reveals that the level of work engagement positively correlates with participants\u0026rsquo; public service motivation scores (\u003cem\u003er\u003c/em\u003e = 0.886, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), self-efficacy scores (\u003cem\u003er\u003c/em\u003e = 0.712, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), and perceived organizational support scores (\u003cem\u003er\u003c/em\u003e = 0.593, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). In addition, the perception of organizational support positively correlated with the public service motivation scores (\u003cem\u003er\u003c/em\u003e = 0.539, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01) and self-efficacy scores (\u003cem\u003er\u003c/em\u003e = 0.461, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). Moreover, a positive correlation is noted between public service motivation and self-efficacy scores (\u003cem\u003er\u003c/em\u003e = 0.670, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). Furthermore, the significant correlations among all variables fulfilled the necessary conditions for proceeding with a serial mediation analysis\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e45\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"566\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 566px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Pearson\u0026rsquo;s correlations among each variable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e1.\u0026nbsp;Work engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e2.\u0026nbsp;Public service motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.886**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e3.\u0026nbsp;Self-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.712**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.670**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e4.\u0026nbsp;Perceived organizational support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e3.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.593**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.539**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.461**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e**\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eChain mediation model and effect analysis\u003c/h3\u003e\n\u003cp\u003eFigure 1 explains a chain mediation model including work engagement and perceived organizational support and demonstrates the model paths with standardized coefficients. Table 4 presents the total, direct, and indirect effects of model paths. Based on the four goodness-of-fit indices, the overall fit of the model was high: \u003cimg width=\"22\" height=\"25\" src=\"data:image/wmf;base64,R0lGODlhFgAZAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIABAARABIAhQAAAAAAAB0AAAAAHQAdMgAcSAAzWh1GbDMAADIAHTMzWzNbgEgcAFozHVozAFszM0YzRltIHVtISEZdXUZGbl1dbl1/f0huf2xGHW5bNW5GRm5bSH9/XX9uSGaIiIBbM4iIZgECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwY4QIBwSBwiAsVkMqFsOp2Kp/SJaQoKQwHAEeg+GdOhIyyMkAGMAbkjWJDBZyQZS1Zrwtr3MAOYOIMAOw==\" alt=\"image\"\u003e= 690.06, \u003cimg width=\"22\" height=\"22\" src=\"data:image/wmf;base64,R0lGODlhFgAWAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAMAAwASABAAhQAAAAAAAB0AAAAAHR0AHQAdHQAAMwAcSAAzWh0zWh1IWx1GbDMAADIdADQdNDMzSDNGbjNbgEgcAFozHVozAFtIHUZGM11dRkhbbkhuf11/f1luf1lubmxGHW5bNX9/XX9uSH9uWWaIiIBbM4iIZgECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwZhQIBwCJAEDsSJYEBsAhZDyRDqBDCGHUOVONICQILIthFQABDWgLrKFAaw27ZQLkE3r0SkEN/0CgVEcnlDFgQZQ3pEWUIPAH5SVWQJAB0FGEKGW1uJmkSQnUIOABWgTYJOQQA7\" alt=\"image\"\u003e= 183, \u003cimg width=\"26\" height=\"46\" src=\"data:image/wmf;base64,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\" alt=\"image\"\u003e=\u0026nbsp;3.77, CFI = 0.97TLI = 0.97, RMSEA = 0.073\u0026nbsp;(95% confidence interval [CI]).\u003c/p\u003e\n\u003cp\u003eTypically, the vast proportion of the model path effects were statistically significant. Precisely, both Table 4 and Fig. 1 present that the 95%CI for the impact of perceived organizational support on work engagement is [0.082, 0.181], with a path coefficient of \u003cem\u003eb\u003c/em\u003e = 0.126 (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). As this interval does not include zero, the direct effect was statistically significant, thereby validating Hypothesis 1.\u003c/p\u003e\n\u003cp\u003eBesides, the 95%CIs for the mediating effects of self-efficacy ([0.042, 0.154]; \u003cem\u003eb\u003c/em\u003e = 0.087, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) and public service motivation ([0.073, 0.241]; \u003cem\u003eb\u003c/em\u003e = 0.141, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) excluded zero, suggesting that both self-efficacy and public service motivation significantly mediate the correlation between perceived organizational support and work engagement. Hence, the results validated Hypotheses 2 and 3.\u003c/p\u003e\n\u003cp\u003eIn addition, the concurrent mediating effect of self-efficacy\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e46\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e and public service motivation in the chain mediation pathway between perceived organizational support and work engagement was significant, as demonstrated by the 95%CI [0.086, 0.183] for the combined effect (\u003cem\u003eb\u003c/em\u003e = 0.130, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Moreover, the specific chain mediation pathway\u0026rsquo;s 95%CI [0.043, 0.096] excluded zero, thereby validating Hypothesis 4 and illustrating the significance of the chain mediation effect.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 631px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e The 95% confidence interval (CI) of bootstrap for chain mediation effect decomposition and bias correction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eHypothesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eIntermediary Path\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eEffect coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eTwo-tailed test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eIntermediary effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eLower bounds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eUpper bounds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eH1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003ePOS-WE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eH2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003ePOS-SE-WE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eH3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003ePOS-PSM-WE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eH4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003ePOS-SE-PSM-WE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years, with the constant growth of TCM, the support of national policies, and the enhancement of people\u0026rsquo; s health awareness, the demand for primary healthcare and traditional Chinese medical services in China has been rising continuously. While TCM general practitioners serve as the key providers of these services, a certain gap exists between their training and distribution and the supply\u0026minus;demand relationship of the services offered. Therefore, identifying the correlations among variables is essential to enhance the work engagement level among TCM general practitioners, augmenting the quality and efficiency of work engagement, and markedly contributing to fulfilling the rising service demand. Besides, it supports the Chinese government\u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e in executing effective plans to raise the overall quality of medical services offered by pertinent departments.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSummary of key findings\u003c/h2\u003e\u003cp\u003eThis study explored the correlations between the perceived organizational support and work engagement of TCM general practitioners, as well as the mediating effects of self-efficacy and public service motivation. The findings suggested that the average self-evaluation work engagement score for TCM general practitioners was 4.20 \u0026plusmn; 0.70, which was higher than that of nurses (2.98 \u0026plusmn; 0.98)\u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e, other hospital staff (3.52 \u0026plusmn; 0.54)\u003csup\u003e[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e, nonpermanent staff in public hospitals (2.99 \u0026plusmn; 1.58)\u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e, teachers (3.82 \u0026plusmn; 0.67)\u003csup\u003e[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e, and community workers (3.75 \u0026plusmn; 0.72)\u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e. The abovementioned differences are attributable to inadequate sample size or participants\u0026rsquo; characteristics\u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e, such as income level, education level, years of work experience, and work environment, which contribute to a higher work engagement level among TCM general practitioners. In addition, the average score for the public service motivation scale items for TCM general practitioners was 4.40 \u0026plusmn; 0.61, significantly higher than that of grassroots civil servants (3.50 \u0026plusmn; 0.66)\u003csup\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e, public officials (4.01 \u0026plusmn; 0.73)\u003csup\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e, community workers (3.99 \u0026plusmn; 0.66)\u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e, and medical students (4.13 \u0026plusmn; 0.51)\u003csup\u003e[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e. These differences are attributable to the sample selection, as our sample was drawn from Shandong province, China, which might have regional biases. This can be clarified culturally, as Shandong province is the origin of Confucian culture, where virtues like dedication, sacrifice, and altruism are predominant. Under such a cultural atmosphere, the values, behaviors, and cognitions of TCM general practitioners in this region could be influenced, placing their public service motivation at a comparatively higher level than other groups. Besides, the average score for the self-efficacy scale items for TCM general practitioners was 4.29 \u0026plusmn; 0.65, which is above the medium level and higher than comparable studies, such as the study on the self-efficacy of medical students in the training and education process in China at 71.50%\u003csup\u003e[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/sup\u003e. Meanwhile, the perceived organizational support score of TCM general practitioners eligible for scoring accounted for 62.10%, with an average score of scale items at 3.91 \u0026plusmn; 0.83, suggesting that the overall proportion and score was not high, although it is still higher than that of doctors in public hospitals in China (3.580 \u0026plusmn; 1.13)\u003csup\u003e[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e, rural doctors (3.30 \u0026plusmn; 0.534)\u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e, nurses in tertiary hospitals (3.11 \u0026plusmn; 0.57)\u003csup\u003e[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]\u003c/sup\u003e, nonpermanent staff in public hospitals (2.80 \u0026plusmn; 1.05)\u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e, and grassroots public officials (3.99 \u0026plusmn; 0.80)\u003csup\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e. These differences are attributable to the present national policies and specific provincial policies and measures that stimulate TCM general practitioners, yielding a higher sense of organizational support than other groups.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003ePerceived organizational support exerts a direct positive impact on work engagement\u003c/h2\u003e\u003cp\u003eOur findings demonstrated that perceived organizational support exerted a direct positive impact on work engagement, corroborating the corresponding research\u003csup\u003e[\u003cspan additionalcitationids=\"CR60 CR61\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]\u003c/sup\u003e. Per the \u0026ldquo;China Health Statistics Yearbook\u0026rdquo; for 2021\u0026minus;2023, as of 2023, the planned completion rate for TCM general practitioners in China reached 66.76%. Meanwhile, the nurturing of TCM general practitioners is reflected by an extended training period. Based on China\u0026rsquo;s prevailing medical training model, it is anticipated that the training of TCM general practitioners takes 10\u0026minus;12 years, including undergraduate and master\u0026rsquo;s education, along with standardized training for specialist physicians. Moreover, the assessment and certification are stringent, with high requirements on a comprehensive knowledge structure, thereby demanding the mastery of various systems of knowledge, including both TCM and Western medicine, further intensifying the challenges. Thus, an even greater need exists for organizational support from the nation, localities, and units, including respect support (whether the organization values employees\u0026rsquo; contributions), welfare support (whether the organization cares about employees\u0026rsquo; welfare), and instrumental support (e.g., information, resources, tools, equipment, and training). Prior research revealed that the organization dynamically creates a promising work environment, recognizes the contributions and values of individuals, offers them ample support, and by improving employees\u0026rsquo; perception of organizational support, they tend to focus more on pursuing organizational goals\u003csup\u003e[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/sup\u003e and strengthen work engagement. Our study further validates the findings and offers insights for articulating solution strategies to improve the work engagement of TCM general practitioners. Actions like increasing salary and benefits, offering supplementary opportunities for professional growth, enhancing the work environment, and focusing on physical and mental health are needed to raise the sense of organizational support for TCM general practitioners, thereby augmenting their work engagement.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eSelf-efficacy plays a mediating role between perceived organizational support and work engagement\u003c/h2\u003e\u003cp\u003eThis study corroborates prior studies\u003csup\u003e[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/sup\u003e by demonstrating that self-efficacy plays a mediating role between perceived organizational support and work engagement. Many studies on the self-efficacy theory have demonstrated self-efficacy as a vital factor influencing behavior\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. When employees receive effective support from the organization, it can nurture positive and adaptive behaviors and beliefs, leading the employees to respond more proactively to environmental deviations and stressors, thereby augmenting work engagement and efficiency. Consequently, based on this principle, when TCM general practitioners feel valued and supported by their organization and receive acknowledgment for their contributions, it can translate into robust intrinsic motivation, resulting in higher work engagement and enhanced efficiency.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePublic service motivation plays a mediating role between perceived organizational support and work engagement\u003c/h2\u003e\u003cp\u003eThis study demonstrated that public service motivation markedly mediates the correlation between work engagement and perceived organizational support, which is further supported by an exhaustive literature review, including prior research on participation motivation, member behavior, performance, and more\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. In a study examining the moderating effect of volunteer participation motivation on perceived organizational support and organizational citizenship behavior, Hui et al. observed that, besides improving perceived organizational support, organizations can increase employee organizational citizenship behavior by enhancing their motivation to volunteer. Likewise, our findings suggest that public service motivation plays a mediating role in the correlation between perceived organizational support and work engagement, thereby positively influencing this pathway. Thus, under the influence of organizational environment and culture, the self-worth and social value of TCM general practitioners are affirmed continually, translating their sense of perceived organizational support into a basis for intrinsic and extrinsic motivations, which kindles their service-oriented motivation from both social orientation and personal growth needs, thereby successfully raising their work engagement levels.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSelf-efficacy and public service motivation play a chain-mediating role between perceived organizational support and work engagement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study demonstrates that self-efficacy and public service motivation play a chain mediation\u003csup\u003e[\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/sup\u003e effect in the correlation between work engagement and perceived organizational support. Owing to the intricate nature of creating the work engagement impact mechanism among TCM general practitioners, several survey studies share similar structures to our study; while they do not directly validate our findings, they provide a basis for linking these with previous studies, thereby offering exploratory insights\u003csup\u003e[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/sup\u003e. In the exploration process, we first examined the potential correlation between self-efficacy and public service motivation, demonstrating a noteworthy positive relationship. For example, Klassen and Klassen reported that self-efficacy is the basis for the motivation of research subjects\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. Accordingly, we further established and explored the chain mediation\u003csup\u003e[\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/sup\u003e effect of public service motivation and self-efficacy between work engagement and perceived organizational support. In this model path, when TCM general practitioners perceive adequate organizational support, it affects their self-efficacy level, which, in turn, affects their beliefs and motivations, as reflected in public service motivation through personal value and social value needs. Eventually, this affects work engagement owing to a combination of internal self-interest and external altruism, and our study further establishes this positive impact.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and future research directions\u003c/h2\u003e\u003cp\u003eFirst,regarding research methodology, the cross-sectional design of this correlational study fundamentally limits the ability to construct causal relationships.Thus, subsequent studies should adopt longitudinal or experimental methodologies to strengthen and elucidate the causal relationships suggested by our study.\u003c/p\u003e\u003cp\u003eSecond,regarding the research sample, this study focused on TCM general practitioners in Shandong province, China. The sample might not be fully representative because of regional cultural differences, differences in educational backgrounds, and other demographic factors.Thus, it will be better to increase the number of participants and incorporate a wide array of individuals in the study.\u003c/p\u003e\u003cp\u003eFinally, future research should investigate the potential moderating roles of incentive mechanisms, occupational burnout, and other pertinent factors within the pathway mechanism,as this would support a more comprehensive theoretical model by assessing the impact of these variables on the correlations among the variables.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study sampled TCM general practitioners from several cities in Shandong Province. By exploring the correlation between four variables, it was found that there is a direct effect between work engagement and perceived organizational support, as well as an indirect effect between work engagement and public service motivation and self-efficacy. Additionally, there is a chain mediating effect among the four variables.Therefore,our findings suggest actionable strategies and a conceptual framework for improving the work engagement of TCM general practitioners by focusing on perceived organizational support. To increase the work engagement of TCM general practitioners, the following three approaches are recommended:\u003c/p\u003e\n\u003cp\u003e1. Augmenting Perceived Organizational Support: Organizations should foster an environment where TCM practitioners feel valued and that contributes to their improved work engagement.\u003c/p\u003e\n\u003cp\u003e2. Reinforcing Self-Efficacy: Initiatives aimed at boosting the confidence and capability of TCM general practitioners can support their belief in their skills to successfully execute their roles, thereby improving their work engagement.\u003c/p\u003e\n\u003cp\u003e3.Underpinning Public Service Motivation: Inspiring and fostering \u0026nbsp;a sense of public service motivation among TCM general practitioners can reinforce their commitment to their profession and the communities they serve, which closely correlates with higher levels of work engagement.\u003c/p\u003e\n\u003cp\u003eBy applying the strategies mentioned above, not only can the work engagement of TCM general practitioners be enhanced but also the overall quality of healthcare services provided.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTCM Traditional Chinese Medicine\u003c/p\u003e\n\u003cp\u003eGP general practitioners\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpecial thanks to the Office of Natural Science Foundation of Shandong Province for funding. The authors would like to thank all the researchers who contributed to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZHL conceptualized the article and its design; DG and XS conducted data collection; JYS drafted the manuscript; LJW was responsible for the overall article, guidance, improvement, supervision and management. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was supported by The Research on Incentive Policy Optimization of Grassroots TCM General Practitioners Based on Public Service Motivation Theory (ZR2022MG039).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study has obtained ethical approval from the Ethics Committee of Shandong University of Traditional Chinese Medicine Affiliated Hospital. The approval number is: [2025] Ethics Review No. (007) - QT. All procedures were in accordance with the ethical standards of the Helsinki Declaration.All participants have provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDual publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration by another publisher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Shandong University of Traditional Chinese Medicine, 4655 University Road, Jinan, Shandong 250355, China\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOccupational Classification Code of the People\u0026apos;s Republic of China. \u003cem\u003eChina Human Resources and Social Security\u003c/em\u003e, 8 (2015). \u003c/li\u003e\n\u003cli\u003eF.X.L,\u003cem\u003eet al.\u003c/em\u003eCultivate general practitioners of traditional Chinese medicine to improve the function of community health services. \u003cem\u003eChina Higher Medical Education\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 124-125 (2009).\u003c/li\u003e\n\u003cli\u003eYe, W,\u003cem\u003eet al\u003c/em\u003e. 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This study aims toexplore the correlation between the perceived organizational support received by TCM general practitioners and their level of work engagement. Besides , it measures the potential mediating roles of self-efficacy and public service motivation in this correlation,aiming at providing a reference for the formulation of policies and incentive measures related to TCM general practitioners, thereby contributing to the construction of grassroots medical and health services and safeguarding the health of the people.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is based on a survey conducted during March-April 2024. Data were collected through a self-administered questionnaire from 528 TCM general practitioners (response rate, 99.8%) in Shandong province , China. Using the Perceived Organizational Support Scale (POSS), a 13-item scale was designed to measure perceived organizational support,while a 13-item scale was designed to assess work engagement using the Utrecht Work Engagement Scale (UWES).Moreover, a 13-item scale was designed to measure public service motivation service motivation using the Public Service Motivation Questionnaire (PSMQ),while a 13-item scale was designed to evaluate self-efficacy using the General Self-Efficacy Scale (GSES).Statistical analyses wereperformed using SPSS 26.0 for descriptive statistics and bivariate correlation analysis. Furthermore, a structural equation model was constructed using Amos 24.0 to assess the correlations among the variables and test the proposed hypotheses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proposed model attained a good model fit. A significant positive correlation was suggested between work engagement and perceived organizational support (\u003cem\u003er\u003c/em\u003e = 0.593, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), self-efficacy (\u003cem\u003er\u003c/em\u003e = 0.712, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), and public service motivation (\u003cem\u003er\u003c/em\u003e = 0.886, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). Moreover, three mediating pathways were identified: mediating effect of self-efficacy (\u003cem\u003eb\u003c/em\u003e = 0.087, 95% confidence interval [CI]: [0.042, 0.154]), mediating effect of public service motivation (\u003cem\u003eb\u003c/em\u003e = 0.141, 95%CI: [0.073, 0.241]), and chain-mediating effect including both self-efficacy and public service motivation (\u003cem\u003eb\u003c/em\u003e = 0.130, 95%CI: [0.086, 0.183]), all of which were statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study demonstrates the substantial impact of perceived organizational support on work engagement and clarifies the mediating role mechanism of public service motivation and self-efficacy between perceived organizational support and work engagement. Hence, to encourage and improve the work engagement of TCM general practitioners, efforts should be directed toward three essential strategies: enhancing perceived organizational support, reinforcing self-efficacy, and intensifying public service motivation.\u003c/p\u003e","manuscriptTitle":"Correlation between Perceived Organizational Support and Work Engagement among Traditional Chinese Medicine General Practitioners:Chain-mediating Role of Self-Efficacy and Public Service Motivation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 12:14:18","doi":"10.21203/rs.3.rs-6732491/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-08-08T15:31:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164497428471981103018701314207161780618","date":"2025-07-27T23:27:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-20T18:04:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-26T04:28:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-23T03:04:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-20T08:03:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-06-20T07:59:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"167b0f83-f72c-44b4-8482-d1aa109ad5fe","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-23T12:14:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 12:14:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6732491","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6732491","identity":"rs-6732491","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}