Communication and relationships: how patients’ perceived informational and interactional justice can improve patient-centered care

Communication and relationships: how patients’ perceived informational and interactional justice can improve patient-centered care | 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 Communication and relationships: how patients’ perceived informational and interactional justice can improve patient-centered care Diana Pérez-Arechaederra, Elena Briones, Luis García-Ortiz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3801299/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Mar, 2025 Read the published version in BMC Health Services Research → Version 1 posted 4 You are reading this latest preprint version Abstract Background: After analyzing the three tenants of patient-centered care (i.e., communication, relationships and health promotion), we tested the role of patients’ perceived interactional and informational organizational justice in health service performance with respect to patients’ behaviors of adhering to professional advice and loyalty to the service. Literature shows that organizational variables as perceived organizational justice can influence patients’ behaviors. We have the ultimate goal of better understanding patients’ experiences with health care organizations, so health care service management can adjust to provide a better-quality patient-centered care considering patients’ inputs. Methods : We conducted a cross-sectional study using two data samples from Spain and the U.S. The sample comprised 473 (male 59.2%) health care users from Spain and 450 (male 52.0%) from the U.S. over 18 years old. We measured the interactional and informational dimensions of perceived organizational justice, participants’ trust in the health care provider, their satisfaction with health care services, their adherence to professional advice and their loyalty to the service through a self-administered survey. Results: Significant correlations were found in both samples for each justice dimension with both behaviors: adherence to advise (interactional, r =.15/.18, p <.01; informational, r =.19/.19, p<.01) and loyalty to the service (interactional, r =.45/.79, p <.01; informational, r =.45/.70, p <.01). When we tested the model that included mediating patients' attitudes of trust and satisfaction, we found that the direct relationship between informational justice and adherence still held (standardized trajectory coefficient =.13, p <.01) showing their consolidated relationship. For interactional fairness, trust and satisfaction significantly mediated the relationship with adherence. On the other hand, the relationships between both justices and patient loyalty to the service were always partially mediated by patient trust and satisfaction (model fit for interactional justice perceptions RMSEA=.101, CFI=.959, GFI=.959; model fit for informational justice perceptions RMSEA=.136, CFI=.937, GFI=.946). Conclusions: Patients’ perceptions of interactional and informational justice play an essential role in their adherence to professional advice, their loyalty to the service, and their ability to foster trust and satisfaction in health services. When discussing communication and relationships in patient-centered care, we should also consider fostering patients’ perceptions of fairness to improve health services results. Policies, programmes and procedures for patient-centered care should consider these patients’ perceptions. Article classification: Empirical research paper patient-centered care fairness perceptions health care quality care management informational justice interactional justice communication relationships Figures Figure 1 Figure 2 Highlights 1.- Patients perceive how fairly treated they are by policies and practitioners when using health care services, and these perceptions influence their health behaviors. 2.- Patients’ perceptions of organizational justice in relation to information handling (perceived as sufficient, accurate, suitable, clear, thorough, or timely) directly relate to adherence to professional advice (e.g., changes in diet, exercise habits, or drug prescriptions). 3.- Patients’ interactional and informational perceived organizational justice relates to service loyalty through the mediation of patient trust and satisfaction with the service. Introduction Worldwide, the major causes of death by 2030 are expected to be HIV/AIDS, depressive disorders, and heart disease; as chronic diseases, their trajectory may be influenced by the application of effective health behavior interventions, as individual behaviors increase the risk of morbidity and mortality [ 1 ]. In this context, health care service management should improve connections with patients to enhance their performance and strengthen efforts toward accomplishing general public health [ 2 ]. This patient-centered care approach is recognized as an essential dimension of healthcare systems' missions worldwide and an important condition for ensuring the quality of care [ 3 – 6 ]. Thus, health policy makers have advocated for patient-centered care, shared decision-making, and the engaged patient as a more accurate conceptualization of this new patient role [ 7 , 8 ]. There is evidence that a better connection with patients and good patient-centered care imply the consideration of multiple streams, from an individual one focusing on preferences or characteristics of the patient in the health care process [ 9 ] to a dyadic stream centered on interactions and communications [ 10 ] and even an organizational approach including structural levers (design, technology, spaces, organizational models); procedural levers (e.g., care pathways); cultural levers (organizational climate, professional cultures such as the interprofessional collaboration level [ 11 ]; and professional and job training to convey relational skills [ 12 ]. Additionally, patients' levels of information preference and perceived autonomy support are important for their trust, satisfaction, and mental health-related quality of life [ 13 ]. However, there is a lack of research on patients’ psychological variables that can help in enhancing the effectiveness of patient-centered care. Theories of social cognition guide investigations aimed at identifying the determinants of health behaviors and, importantly, the processes by which these determinants relate to each other and to behavior [ 14 , 15 ]. To better understand health-related behaviors and patients’ experiences with health care, we consider patients’ perceptions of interactional and informational organizational justice, as well as some of their attitudes and emotions, for the first time in this field of research following the theory of reasoned action (TRA) [ 16 ], a widely used theory of social cognition. Perceived interactional justice refers to patients’ subjective perception of the quality of the interactions between health care providers and users. This dimension measures the extent to which users felt listened to and treated with respect and dignity [ 17 ]. Perceived informational justice refers to users’ perceptions of information as sufficient, accurate, suitable, clear, thorough, and timely in their exchanges with health care services [ 17 ]. These two dimensions of organizational justice will add detail and accuracy to understanding the patient-centered care tenants of communication and relationship principles of patient-centered care provision [ 6 , 18 ]. In response to the calls in recent research to explore nonconscious and automatic processes to explain engagement in health behaviors [ 14 ], our study also considered satisfaction and trust. Satisfaction has been linked to treatment adherence [ 17 ] and loyalty to service [ 19 ]. In addition, user satisfaction is related to perceived organizational justice in health care [ 20 , 21 ]. Patient‒physician trust promotes medical adherence and is a mediator between health consciousness and medical adherence [ 22 ] and between patient-centered communication and patients’ perceptions of healthcare quality [ 23 ]. Therefore, the main objective of this study was to test the role of patients’ perceived interactional and informational organizational justice in health service performance with respect to their adherence to professional advice and loyalty to the service as indicators of health-related behaviors. Furthermore, we studied the mediating effect of patient satisfaction with health services and trust in health providers in two different health care systems and countries. These are graphically represented in Fig. 1 . Methods We conducted a cross-sectional study using two data samples from Spain and the U.S. The data were collected with the help of a self-administered survey at one point in time in each country. All methods were carried out in accordance with relevant guidelines and regulations. Sample recruitment Patients included in the study were aged 18 years or older and had visited a health care center in the last 6 months. The study was approved by the Ethics Committee of the Health Area of the Hospital of Salamanca (Spain) in accordance with international standards and the Institutional Review Board for the Protection of Human Subjects of Duke University (NC, The U.S.) in accordance with current law. Informed consent was obtained from all subjects. Description of Spanish sample recruitment The sample comprised 473 participants who visited two health care services in a medium-sized city in Spain located in two distinct neighborhoods of the urban area. Considering the list of physicians currently working at the health care service, we randomly selected one of them and made appointments with the patients for the next day, inviting them to arrive early to participate in our study. Subsequently, two new doctors and their patients were selected every day. Informed consent was provided to the patients, who read and signed the form. The general purpose of the study was explained, and anonymity was guaranteed. The survey was then conducted with the help of a research assistant who provided the required instructions to the patients. Description of the US sample recruitment A sample of 450 participants was selected using a national paid panel of adult respondents on a web platform following previous studies [ 24 ]. The survey design included quality control procedures for the data. The information provided by participants who completed the survey in less than 10 minutes was excluded from the analyses because of unreliable information. First, participants were invited to participate in the survey. Second, they read an informed consent statement with details regarding the characteristics of the survey and guarantee anonymity. After providing their consent, we proceeded with the survey. Measures The demographics and characteristics of health care customers and the Perceived Organizational Justice in Care Services scale (PJustCS) were used to measure the interactional and informational dimensions of justice [ 20 ]. The interactional justice measure included seven items. An example of these is “In terms of how people treated you personally during this health care experience, to what extent were they really concerned with you as a person?”. Informational justice was measured using six questions. An example of these: “In terms of the information you received during your visit to the health care service, to what extent were your questions answered clearly?” We used the Satisfaction With Health Care Services Scale [ 25 ] to measure satisfaction with different aspects of health services, including practitioner staff, support staff, center facilities, and center accessibility and procedures, by utilizing 11 items. An example of these is “To what extent were you satisfied with the time spent with your health care provider (nurse/physician)?” Trust in the health provider was assessed using two items: “Were you willing to rely on the health care professional’s judgment on important matters?”, and “Did you trust the health care provider you dealt with?” [ 26 ]. To measure adherence, participants were required to respond to the following item about how far they followed the advice provided on their visit [ 17 , 27 ]: “To what extent did you follow the advice or take the prescription provided by the health care worker?”. The user loyalty to the service measure included two items: 1) the intention to give a positive word of mouth, which was inferred from “Would you recommend this service to your friends and family?”, and 2) the intention to return to the service, which was inferred from “Would you willingly visit this health care center again if you needed health care?”[ 28 , 29 ]. All the items were answered on a five-point Likert scale ranging from 1 “not at all” to 5 “totally.” The Cronbach’s alpha of each measure can be found in the Results section. Data analysis The results are expressed as the means and standard deviations for quantitative variables and as frequency distributions (n and %) for qualitative variables. Student’s t test (2-tailed) and the chi-square test were used to determine differences in baseline characteristics between the two samples (Spanish and American). Pearson correlations were used to analyze the relationship between quantitative variables in each sample. The internal consistency and reliability of each scale were assessed using Cronbach’s alpha. We performed multigroup path analysis using Amos software to test the hypothesized, best-fitting models and multigroup analysis. The hypotheses established an alpha of.05. The data were analyzed using SPSS version 23.0 (IBM Corp, Armonk, NY, USA) and AMOS version 16. Results Sample characteristics Table 1 shows the demographic characteristics of the participants. In the Spanish sample, the proportion of women is slightly greater. In addition, visits to health care services are more recent in Spain than in the US. The number of people with private health insurance is greater in the U.S. than in Spain. Table 1 Demographic characteristics of the data samples Spain United States Level of significance N 473 406 Women (%) 59.20% 52% < 0.05 Age ( M ± SD ) 55.75 ± 16.77 52.24 ± 14.06 < 0.01 Years of schooling ( M ± SD ) 10.67 ± 3.70 13.23 ± 2.21 < 0.01 Recent health service visits (in the last month) (%) 65.80% 57.10% < 0.05 Contact professional: doctor (%) 81% 72.2% < 0.01 Private insurance (%) 14.20% 70% < 0.01 Note. N: number of observations, %: percentage, M: mean, SD: standard deviation. Descriptive results The mean values of the variables analyzed in the model by country of sample origin and the differences between them are shown in Table 2 . In the U.S. sample, informational justice, satisfaction and loyalty scores were higher, and in the Spanish sample, adherence was greater. Table 2 Correlations and descriptive data of each variable for both samples of health care users (below Spain/ above U.S) 1 2 3 4 5 6 1. Informational Justice (.96/.95) .79 ** .70 ** .75 ** .70 ** .19 ** 2. Interactional Justice .66** (.91/.94) .76 ** .81 ** .79 ** .18 ** 3. Trust .61** .56** (.89/.93) .75 ** .76 ** .18 ** 4. Satisfaction .57** .50** .50** (.89/.96) .82 ** .18 ** 5. Loyalty .45** .45** .46** .59** (.87/.88) .16 ** 6. Adherence .19** .15** .17** .09 .15** n.a. Mean ± SD (Spain) 4.24 ± 1.02 4.40 ± 0.79 4.52 ± 0.87 3.87 ± 0.67 3.91 ± 0.59 4.75 ± 0.68 Mean ± SD (U.S.) 4.47 ± 0.81 4.48 ± 0.80 4.51 ± 0.82 4.32 ± 0.86 4.46 ± 0.97 4.64 ± 0.73 Note . Cronbach’s alpha for each scale in each sample are given in the diagonal between brackets (Spain/U.S.) where n.a.: not available; SD: standard deviation, significance level: * p < .05, ** p < .01. The correlation coefficients and reliability of the scales for each sample are also presented in Table 2 . All reliabilities are shown on the diagonal for the Spanish/U.S. samples, indicating a good level of reliability in all the cases (all above .87). Significant Pearson’s correlations are found in both samples for each justice dimension. Additionally, patients’ attitudes, such as trust in the clinician and satisfaction with the service, are strongly related (significant Pearson’s correlations in all cases, except between patients’ satisfaction and adherence for the Spanish sample). Model tests We present two models computed with the whole sample (n = 923), the hypothesized (Fig. 1 , I & III) and the best-fitting models (Fig. 1 , II & IV), for interactional justice perception and for informational justice perception (see Fig. 1 ). The fit indices can be found in Table 3 . Afterwards, a multigroup analysis was computed using the country-of-origin data separately for each justice perception to test the model in both the U.S. and Spain. Interactional justice perception path analyses The fit indices were acceptable in the case of the hypothesized model (see Table 3 ), but they could be improved. The best-fitting model showed that the effect of satisfaction on adherence (g) was not maintained in the case of interactional justice [Δχ 2 = 0.1, df = 1, p = 1.00]. The best-fitting model (see Fig. 1 , II) excluded the direct effect of interactional justice on adherence and the effect of satisfaction on adherence, showing a satisfactory better fit with respect to the hypothesized model [Δχ 2 = 2.3, df = 2, p = .86]. Table 3 Path analysis data of the nested interactional and informational justice models to test trust and satisfaction mediation hypotheses Models for Interactional J. χ2 df Δ χ2 Δdf RMSEA IFI CFI GFI Hypothesized Model 236.7 17 - - .131 .958 .958 .960 Model 1 Without b 238.3 18 2.4 1 .113 .959 .959 .959 Model 2 Without c 293.1 18 56.4 1 .145 .932 .931 .933 Model 3 Without g 236.8 18 0.1 1 .112 .959 .959 .960 Model 4 Without b and g 239.0 19 2.3 2 .101 .959 .959 .959 Models for Informational J. χ 2 df Δ χ 2 Δ df RMSEA IFI CFI GFI Hypothesized Model 281.7 17 - - .155 .938 .938 .948 Model 1 without b 293.4 18 11.7 1 .140 .933 .933 .942 Model 2 without c 296.5 18 14.8 1 .143 .931 .930 .939 Model 3 without g 283.9 18 2.2 1 .136 .937 .937 .946 Note. Model 1 excludes the relationship between justice and adherence (b). Model 2 excludes the relationship between justice and loyalty (c). Model 3 excludes the relationship between satisfaction and adherence (g). Model 4 excludes the relationship between justice and adherence as well as satisfaction and adherence (b & g). RMSA = root mean square error of approximation; IFI = incremental fit index; CFI = comparative fit index; GFI = goodness of fit index. According to our multigroup analysis, the CFI was close to the critical recommended value of 0.01 (χ2 = 95.18, df = 6, p < .001; CFI = 0.042). Testing the final model for each of the samples yielded a good fit for Spain [ χ 2 (4) = 34.0, p < .001; CFI = .961, RMSEA = .126, TLI = .902] and the US [ χ 2 (4) = 51.7, p < .001; CFI = .965, RMSEA = .172, TLI = .914]. Nevertheless, significant differences appeared in specific relationships, between interactional justice and trust (z = 2.94, p < .05), interactional justice and satisfaction ( z = 9.04, p < .05), and satisfaction and loyalty ( z = -2.50, p < .05), with loadings in the same direction but significantly greater in the U.S. sample. The model that did not include these three relationship parameters was invariant between samples (χ2 = 8.19, df = 3, p = .04; CFI = 0.003), indicating a proper fit [χ 2 (13) = 106.8, p < .001; CFI = .956, RMSEA = .091, TLI = .933]. Informational justice perception path analyses In this case, the direct effect of informational justice on adherence must be maintained (see Fig. 2 , III & IV, and fit indices in Table 3 ). Otherwise, the model worsened significantly when it was eliminated [Δχ 2 = 11.7, df = 1, p < .001]. Additionally, we found that satisfaction had no influence on adherence, in contrast to what was hypothesized [Δχ 2 = 2.2, df = 1, p = .14]. The modification indices with respect to this model indicated that if covariance was added between the measurement errors of trust and satisfaction, the model fit improved substantially [χ 2 (17) = 174.2, p < .001; CFI = .996, RMSEA = .040, TLI = .986]. When we performed the multigroup analysis, the group fit of the final model for each sample did not work invariably for the two samples (χ2 = 95.54, df = 7, p < .001; CFI = 0.04), although its fit was good in both Spain [χ 2 (2) = 5.4, p < .001; CFI = .996, RMSEA = .060, TLI = .979] and the US [χ 2 (2) = 0.05, p < .001; CFI = 1.00, RMSEA = .00 (.00-.00), TLI = 1.008]. Specifically, differences in the characteristics of the countries appeared in the relationship between informational justice and trust (z = 3.97, p < .05), informational justice and satisfaction (z = 9.59, p < .05), and trust with patient loyalty (z = 2.58, p < .05), with higher loadings in the U.S. sample. Discussion This paper answers how patients’ perceived organizational justice matters and how it should be considered when delivering patient-centered care and providing better health care results (i.e., adherence to clinical advise and loyalty to the service) and health care policies. In this sense, we showed that patients' perception of informational justice directly influenced adherence to professional advice, whereas their perceptions of interactional or informational justice fostered their satisfaction with health services, trust in health providers, and loyalty to services. In addition, trust in health providers acted as a mediator of the influence of interactional justice on adherence. These findings have major implications for the management of healthcare services and policies and, ultimately, for contributing to the quality of healthcare and patient-centered care. We will offer guidelines of the implications of each finding next. 1. Perceived organizational justice and adherence to clinical advice and loyalty to the service Perceptions of interactional and informational justice were related to adherence to professional advice, which is in line with the findings of previous studies highlighting the importance of the communication process with health care users [ 30 , 31 ] but here we add the necessary characteristics of patients’ perceived justice to foster adherence and then, to generate good patient-centered care results [ 32 ]. The direct effects of perceived justice on loyalty to the service are also aligned with previous research involving workers and users of other services. This finding demonstrates the importance of the perception of interactional justice in variables related to loyalty, such as the intention to leave an organization [ 26 ], behaviors related to reusing the same service [ 33 ], or providing positive references [ 34 ]. Therefore, the connection between health service management and users can be improved by fostering interactional and informational justice perceptions related to creating spaces and procedures that allow interactional exchanges, sufficient time to interact and an adequate exchange of information [ 20 ]. 2. Adherence to professional advice 2.1. Perceived interactional justice In the context of best-fitting models, the results of the present study indicate that trust in the health provider acts as a mediator in the influence of interactional justice on adherence to professional advice. Thus, the perception that interactions with professionals show respect and dignity seems to foster the trust that generates adherence to advice, which is consistent with the findings of previous research [ 22 , 35 ]. The quality of interaction with health personnel is essential in building trust [ 35 ], especially in contexts in which building trust is particularly challenging, such as those imposed by the COVID-19 pandemic and the use of masks [ 36 ]. In our study, we verified that the interactional dimension of organizational justice perception supports these assertions. Thus, perceiving interactions characterized by showing interest in the patient, willingness to listen, respect for their dignity, or treating the patient with respect and politeness are characteristics of interactional justice perception that foster the patient's trust in the health provider. This trust leads to better treatment adherence, service performance, and service-user connection as an important condition for ensuring the quality of care [ 37 ]. 2.2. Perceived informational justice However, informational justice has such a powerful relationship with treatment adherence that the effect of total mediation of trust in the health provider can be neglected. This finding also adds to the trend regarding the importance of the quality of the information provided for treatment, which is essential in patient-centered care [ 38 , 39 ]. Patients’ positive perceptions of the information provided and clarity regarding the effects, dosage, and characteristics of treatments increase the probability of adherence to the professional’s recommendations. Additionally, we know that when patients are ready for future procedures or outcomes through informational interventions, uncertainty levels decrease, and clinical outcomes improve [ 2 ]. Therefore, service design should try to provide well-tailored information to patients because if they do not perceive it as sufficient, accurate, suitable, clear, thorough, and timely (i.e., fair), the likelihood of adherence decreases. 2.3. Patients’ satisfaction Several contradictions have been found in previous research on the relationship between patient satisfaction and adherence. While certain studies [ 40 ] have found evidence of the existence of such a relationship, others have contradicted it [ 41 ]. In our study, satisfaction was not related to adherence in any of the models that we computed. This could be related to differences in satisfaction and adherence in terms of time, with satisfaction being an immediate and ephemeral reaction, while adherence is a behavior requiring long-term motivation. As both variables were at different levels, the relationship was ambiguous. These results suggest that satisfaction could have limited explanatory power for users’ long-term behavior. 3. Loyalty to the service Regarding patient loyalty, the current study showed that both dimensions of organizational justice have such a strong influence on this behavior that the loyalty of patients to health services is linked directly to their perceptions of justice and through their trust and satisfaction with the service. This result corroborates previous findings on the promotion of loyalty through patient satisfaction and trust [ 42 – 46 ]. Consequently, this research supports the importance of implementing a health service design that promotes the perception of organizational interactional and informational justice in health services, as these factors are directly and indirectly associated with patients returning to health services and their tendency to provide positive references. This would lead not only to better service performance, cost savings in resources, and an improved image of the services [ 44 ] but also to better patient-centered care. 4. Country comparison Testing the relational models with each country’s sample separately confirmed their robustness since the relationships were maintained in the health care systems of both countries. Differences were found only in terms of the strength of certain relationships but not in the direction of the proposed links. There may be various reasons why the perception of justice is more closely linked to trust and satisfaction among users in the U.S. than in Spain, given that health care systems and types of users in both countries differ in many ways. Although the two contexts involve very different ways of organizing service delivery, we can conclude that patients' cognitions, emotions and behaviors and their relationships were similar in both contexts. 5. Strengths and limitations The current study has several strengths, including the use of a comprehensive model that encompasses constructs to understand patients’ experience and how to use this understanding in health care services management, and also, that it was confirmed in two countries with different healthcare systems. The usual limitations of cross-sectional designs regarding the difficulties of establishing causality apply to the present study. Although we have a well-established theoretical basis, longitudinal studies that strengthen the relationships found need to be conducted. The data collection method was the same for all variables. Thus, the possible variance common to the method should be considered because it may artificially strengthen the relationships between the variables. In general, self-reports have proven to be a valid data collection method; however, they tend to yield slightly overestimated results [ 47 ]. Conclusions Patients’ perceptions of interactional and informational justice play an essential role in fostering trust and satisfaction in health services. Trust is always related to adherence to treatments and loyalty to the service, while patient satisfaction relates to loyalty but not adherence. We also found that the perception of informational justice has remarkable influence on patients’ adherence to professional advice. Thus, if we want better patient-centered care and better health results, health service design and practitioner behaviors should aim to foster organizational interactional and informational justice perceptions. Future lines of research include the design and test of health services aimed at supporting organizational justice, as well as the evaluation of their results from a patient-centered care approach. Declarations • Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Health Area of the Hospital of Salamanca (Spain) in accordance with international standards and the Institutional Review Board for the Protection of Human Subjects of Duke University (NC, The U.S.) in accordance with current law. Informed consent was obtained from all subjects. • Consent for publication: All authors consent to publication • Availability of data and materials: Both data bases are available to the researchers. They are not provided for public use due to current extra analysis. • Competing interests: There are not competing interests. • Funding: This study was funded by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union-Next Generation EU, Facility for Recovery and Resilience (MRR) and Investing in your Future Plan through Health Outcomes-Oriented Cooperative Research Networks (RICORS) (RD21/0016/0010). The Government of Castilla y León also collaborated with the funding of this study through the research projects BioSan 2009 and BioSan 2011. The authors played no role in the study design, data analysis, reporting of the results, or the decision to submit the manuscript for publication. • Authors' contributions: Concept and design : Pérez-Arechaederra, Briones; Acquisition of data : Pérez-Arechaederra; Analysis and interpretation of data : Pérez-Arechaederra, García; Drafting of the manuscript : Pérez-Arechaederra; Critical revision of the paper for important intellectual content : Briones, Garcia; Obtaining funding : Garcia; Supervision : Briones, Garcia. • Authors' information (optional): Diana Pérez-Arechaederra, PhD 1 * ( [email protected] ), Elena Briones, PhD 2 ( [email protected] ), Luis García-Ortiz, MD, PhD 3,4 ( [email protected] ). References Mohiuddin AK. An Extensive Review of Patient Behavior. PharmaTutor. 2019;7(8):1–21. Berry LL. Designing connection into healthcare services. J Service Manage 2020. Filler T, Foster AM, Grace SL, Stewart DE, Straus SE, Gagliardi AR. Patient-centered care for women: Delphi consensus on evidence-derived recommendations. Value in Health. 2020;23(8):1012–9. Amporfro DA, Boah M, Yingqi S, Cheteu Wabo TM, Zhao M, Ngo Nkondjock VR, Wu Q. Patients satisfaction with healthcare delivery in Ghana. BMC Health Serv Res. 2021;21(1):722. Mead KH, Wang Y, Cleary S, Arem H, Pratt-Chapman ML. Defining a patient-centered approach to cancer survivorship care: development of the patient centered survivorship care index (PC-SCI). BMC Health Serv Res. 2021;21(1):1353. Constand MK, MacDermid JC, Dal Bello-Haas V, Law M. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res. 2014;14:271. Timmermans S. The engaged patient: The relevance of patient–physician communication for twenty-first-century health. J Health Soc Behav. 2020;61(3):259–73. Mitchell KR, Brassil KJ, Fujimoto K, Fellman BM, Shay LA, Springer AE. Exploratory Factor Analysis of a Patient-Centered Cancer Care Measure to Support Improved Assessment of Patients' Experiences. Value Health. 2020;23(3):351–61. Thomas EC, Bass SB, Siminoff LA. Beyond rationality: Expanding the practice of shared decision making in modern medicine. Soc Sci Med 2021:113900. Mitchell K-AR, Brassil KJ, Fujimoto K, Fellman BM, Shay LA, Springer AE. Exploratory factor analysis of a patient-centered cancer care measure to support improved assessment of patients’ experiences. Value in Health. 2020;23(3):351–61. Durand F, Fleury MJ. A multilevel study of patient-centered care perceptions in mental health teams. BMC Health Serv Res. 2021;21(1):44. Liberati EG, Gorli M, Moja L, Galuppo L, Ripamonti S, Scaratti G. Exploring the practice of patient centered care: The role of ethnography and reflexivity. Soc Sci Med. 2015;133:45–52. Lee Y-Y, Lin JL. Do patient autonomy preferences matter? Linking patient-centered care to patient–physician relationships and health outcomes. Soc Sci Med. 2010;71(10):1811–8. Brown DJ, Hagger MS, Hamilton K. The mediating role of constructs representing reasoned-action and automatic processes on the past behavior-future behavior relationship. Soc Sci Med. 2020;258:113085. Hagger MS. Redefining habits and linking habits with other implicit processes. Psychol Sport Exerc. 2020;46:101606. Fishbein M, Jaccard J, Davidson AR, Ajzen I, Loken B. Predicting and understanding family planning behaviors. Understanding attitudes and predicting social behavior. edn.: Prentice Hall; 1980. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331–42. Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness–a systematic review and concept analysis. PLoS ONE. 2014;9(9):e107828. Gabay G, Moskowitz HR. Are We There Yet? Mind-Genomics and Data-Driven Personalized Health Plans. The Cross-Disciplinary Perspectives of Management: Challenges and Opportunities 2019. Pérez-Arechaederra D, Briones E, Lind A, García-Ortiz L. Perceived Organizational Justice in Care Services: creation and multi-sample validation of a measure. Soc Sci Med. 2014;102:26–32. Chang Y-W, Hsu P-Y, Wang Y, Chang P-Y. Integration of online and offline health services: The role of doctor-patient online interaction. Patient Educ Couns. 2019;102(10):1905–10. Espinosa A, Kadić-Maglajlić S. The role of health consciousness, patient–physician trust, and perceived physician’s emotional appraisal on medical adherence. Health Educ Behav. 2019;46(6):991–1000. Hong H, Oh HJ. The effects of patient-centered communication: exploring the mediating role of trust in healthcare providers. Health Commun. 2020;35(4):502–11. Qin H, Sanders C, Prasetyo Y, Syukron M, Prentice E. Exploring the dynamic relationships between risk perception and behavior in response to the Coronavirus Disease 2019 (COVID-19) outbreak. Soc Sci Med. 2021;285:114267. Mallou JV, Boubeta AR, Cueto EG. Presentación de una escala de satisfacción con los servicios sanitarios de atención primaria. Psicothema. 2003;15(4):656–61. Aryee S, Budhwar PS, Chen ZX. Trust as a mediator of the relationship between organizational justice and work outcomes: Test of a social exchange model. J Organizational Behavior: Int J Industrial Occup Organizational Psychol Behav. 2002;23(3):267–85. DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol. 2004;23(2):207. Mattila AS. The effectiveness of service recovery in a multi-industry setting. J Serv Mark 2001. Maxham IIIJG, Netemeyer RG. Modeling customer perceptions of complaint handling over time: the effects of perceived justice on satisfaction and intent. J Retail. 2002;78(4):239–52. Martín-Pérez P, Quintano-Jiménez J, Hidalgo-Requena A, Ginel-Mendoza L. Inercia terapéutica en asma. SEMERGEN Soc Esp Med Rural Gen(Ed impr) 2014:291–2. Hunter-Jones P, Line N, Zhang JJ, Malthouse EC, Witell L, Hollis B. Visioning a hospitality-oriented patient experience (HOPE) framework in health care. J Service Manage 2020. Conn VS, Ruppar TM, Enriquez M, Cooper P. Medication adherence interventions that target subjects with adherence problems: systematic review and meta-analysis. Res Social Administrative Pharm. 2016;12(2):218–46. Young GJ, Meterko M, Desai KR. Patient satisfaction with hospital care: effects of demographic and institutional characteristics. Med Care 2000:325–34. Maxham IIIJG, Netemeyer RG. Firms reap what they sow: the effects of shared values and perceived organizational justice on customers’ evaluations of complaint handling. J Mark. 2003;67(1):46–62. Hillen M, Koning C, Wilmink J, Klinkenbijl J, Eddes E, Kallimanis-King B, De Haes J, Smets E. Assessing cancer patients' trust in their oncologist: development and validation of the Trust in Oncologist Scale (TiOS). Support Care Cancer. 2012;20(8):1787–95. Duckett K. Behind the mask: new challenges to gaining patient trust. Home Healthc Now. 2020;38(6):327–30. Nikbin D, Marimuthu M, Hyun SS, Ismail I. Relationships of perceived justice to service recovery, service failure attributions, recovery satisfaction, and loyalty in the context of airline travelers. Asia Pac J Tourism Res. 2015;20(3):239–62. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97. Zolnierek KBH, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826. Dang BN, Westbrook RA, Black WC, Rodriguez-Barradas MC, Giordano TP. Examining the link between patient satisfaction and adherence to HIV care: a structural equation model. PLoS ONE. 2013;8(1):e54729. Thom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999;37(5):510–7. Zhou W-J, Wan Q-Q, Liu C-Y, Feng X-L, Shang S-M. Determinants of patient loyalty to healthcare providers: An integrative review. Int J Qual Health Care. 2017;29(4):442–9. Ghorbanzadeh D, Rahehagh A, Botelho D. The role of emotional structures in the relationship between satisfaction and brand loyalty. Cogent Psychol 2020, 7(1). Torres E, Vasquez-Parraga AZ, Barra C. The path of patient loyalty and the role of doctor reputation. Health Mark Q. 2009;26(3):183–97. Leninkumar V. The Relationship between Customer Satisfaction and Customer Trust on Customer Loyalty. Int J Acad Res Bus Social Sci. 2017;7:450–65. Nguyen N, Leclerc A, LeBlanc G. The Mediating Role of Customer Trust on Customer Loyalty. J Service Sci Manage. 2013;06(01):96–109. DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42(3):200–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Mar, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 08 Jan, 2024 Editor assigned by journal 04 Jan, 2024 Submission checks completed at journal 04 Jan, 2024 First submitted to journal 24 Dec, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-3801299","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":265249589,"identity":"da523c93-ec98-4432-883d-44e3f6b6d79f","order_by":0,"name":"Diana Pérez-Arechaederra","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYDCCw3AW8wGStbAlEKkFYTSPAXE6+I4zP3vwc4dNPj//mY8Pf9TcYeCXIGCb5GE2c8PeM2mWMxvObjbmOfaMQXIGAS0GhxnMJHjbDhsYHOzdJs3YcJjB4AZBLezfJP+2/TewP8zz/OdPoBZ7wlp4zKR52w4YGLDxsDHwgmwh7BeeMmnZM8kGEmfYjKWBfuGROPMAvxa+88e3Sb7dYWfA33/44UdgiMnxtxOwBQwYG+DMAzxEqEfTQpyOUTAKRsEoGFEAAN3ERKH6qQSKAAAAAElFTkSuQmCC","orcid":"","institution":"ESCP Business School","correspondingAuthor":true,"prefix":"","firstName":"Diana","middleName":"","lastName":"Pérez-Arechaederra","suffix":""},{"id":265249590,"identity":"dfb9c4b2-0c12-41a5-a132-9e53eb6cd1cd","order_by":1,"name":"Elena Briones","email":"","orcid":"","institution":"University of Cantabria","correspondingAuthor":false,"prefix":"","firstName":"Elena","middleName":"","lastName":"Briones","suffix":""},{"id":265249591,"identity":"4b5641f3-cc01-4221-aca5-1b8648e2f588","order_by":2,"name":"Luis García-Ortiz","email":"","orcid":"","institution":"Gerencia de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL)","correspondingAuthor":false,"prefix":"","firstName":"Luis","middleName":"","lastName":"García-Ortiz","suffix":""}],"badges":[],"createdAt":"2023-12-24 17:14:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3801299/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3801299/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-12461-x","type":"published","date":"2025-03-06T15:57:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":49325267,"identity":"47142a45-9fc4-4042-9665-c120da09b914","added_by":"auto","created_at":"2024-01-08 17:23:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24410,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA priori model of relationships showing the influence of justice perception on the attitudes and behaviors of health service users.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"F1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3801299/v1/856d2fef791c37e65449bbe9.jpg"},{"id":49325265,"identity":"c2dbf327-0852-48b7-b86e-c12148e99210","added_by":"auto","created_at":"2024-01-08 17:23:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45680,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHypothetical (I and III) and final (II, IV) path analysis models predicting treatment adherence and user loyalty in relation to the perception of interactional justice (I and II) and for informational justice (III and IV). Standardized trajectory coefficients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*p \u0026lt; .05, **p \u0026lt; .01, ***p \u0026lt; .001.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"F2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3801299/v1/c34620301d3647044eb84bdf.jpg"},{"id":78192005,"identity":"ee228896-4af7-4c28-8f02-b4a8411785af","added_by":"auto","created_at":"2025-03-10 20:15:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1099455,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3801299/v1/5256347b-515c-4ad2-9a17-8e809c701703.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Communication and relationships: how patients’ perceived informational and interactional justice can improve patient-centered care","fulltext":[{"header":"Highlights","content":"\u003cp\u003e1.- Patients perceive how fairly treated they are by policies and practitioners when using health care services, and these perceptions influence their health behaviors.\u003c/p\u003e\n\u003cp\u003e2.- Patients\u0026rsquo; perceptions of organizational justice in relation to information handling (perceived as sufficient, accurate, suitable, clear, thorough, or timely) directly relate to adherence to professional advice (e.g., changes in diet, exercise habits, or drug prescriptions).\u003c/p\u003e\n\u003cp\u003e3.- Patients\u0026rsquo; interactional and informational perceived organizational justice relates to service loyalty through the mediation of patient trust and satisfaction with the service.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eWorldwide, the major causes of death by 2030 are expected to be HIV/AIDS, depressive disorders, and heart disease; as chronic diseases, their trajectory may be influenced by the application of effective health behavior interventions, as individual behaviors increase the risk of morbidity and mortality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In this context, health care service management should improve connections with patients to enhance their performance and strengthen efforts toward accomplishing general public health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This patient-centered care approach is recognized as an essential dimension of healthcare systems' missions worldwide and an important condition for ensuring the quality of care [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Thus, health policy makers have advocated for patient-centered care, shared decision-making, and the engaged patient as a more accurate conceptualization of this new patient role [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is evidence that a better connection with patients and good patient-centered care imply the consideration of multiple streams, from an individual one focusing on preferences or characteristics of the patient in the health care process [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] to a dyadic stream centered on interactions and communications [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and even an organizational approach including structural levers (design, technology, spaces, organizational models); procedural levers (e.g., care pathways); cultural levers (organizational climate, professional cultures such as the interprofessional collaboration level [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]; and professional and job training to convey relational skills [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, patients' levels of information preference and perceived autonomy support are important for their trust, satisfaction, and mental health-related quality of life [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, there is a lack of research on patients\u0026rsquo; psychological variables that can help in enhancing the effectiveness of patient-centered care.\u003c/p\u003e \u003cp\u003eTheories of social cognition guide investigations aimed at identifying the determinants of health behaviors and, importantly, the processes by which these determinants relate to each other and to behavior [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To better understand health-related behaviors and patients\u0026rsquo; experiences with health care, we consider patients\u0026rsquo; perceptions of interactional and informational organizational justice, as well as some of their attitudes and emotions, for the first time in this field of research following the theory of reasoned action (TRA) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], a widely used theory of social cognition. Perceived interactional justice refers to patients\u0026rsquo; subjective perception of the quality of the interactions between health care providers and users. This dimension measures the extent to which users felt listened to and treated with respect and dignity [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Perceived informational justice refers to users\u0026rsquo; perceptions of information as sufficient, accurate, suitable, clear, thorough, and timely in their exchanges with health care services [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These two dimensions of organizational justice will add detail and accuracy to understanding the patient-centered care tenants of communication and relationship principles of patient-centered care provision [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn response to the calls in recent research to explore nonconscious and automatic processes to explain engagement in health behaviors [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], our study also considered satisfaction and trust. Satisfaction has been linked to treatment adherence [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and loyalty to service [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, user satisfaction is related to perceived organizational justice in health care [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Patient‒physician trust promotes medical adherence and is a mediator between health consciousness and medical adherence [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and between patient-centered communication and patients\u0026rsquo; perceptions of healthcare quality [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, the main objective of this study was to test the role of patients\u0026rsquo; perceived interactional and informational organizational justice in health service performance with respect to their adherence to professional advice and loyalty to the service as indicators of health-related behaviors. Furthermore, we studied the mediating effect of patient satisfaction with health services and trust in health providers in two different health care systems and countries. These are graphically represented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eWe conducted a cross-sectional study using two data samples from Spain and the U.S. The data were collected with the help of a self-administered survey at one point in time in each country. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample recruitment\u003c/h2\u003e \u003cp\u003ePatients included in the study were aged 18 years or older and had visited a health care center in the last 6 months. The study was approved by the Ethics Committee of the Health Area of the Hospital of Salamanca (Spain) in accordance with international standards and the Institutional Review Board for the Protection of Human Subjects of Duke University (NC, The U.S.) in accordance with current law. Informed consent was obtained from all subjects.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDescription of Spanish sample recruitment\u003c/h2\u003e \u003cp\u003eThe sample comprised 473 participants who visited two health care services in a medium-sized city in Spain located in two distinct neighborhoods of the urban area. Considering the list of physicians currently working at the health care service, we randomly selected one of them and made appointments with the patients for the next day, inviting them to arrive early to participate in our study. Subsequently, two new doctors and their patients were selected every day. Informed consent was provided to the patients, who read and signed the form. The general purpose of the study was explained, and anonymity was guaranteed. The survey was then conducted with the help of a research assistant who provided the required instructions to the patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDescription of the US sample recruitment\u003c/h2\u003e \u003cp\u003eA sample of 450 participants was selected using a national paid panel of adult respondents on a web platform following previous studies [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The survey design included quality control procedures for the data. The information provided by participants who completed the survey in less than 10 minutes was excluded from the analyses because of unreliable information. First, participants were invited to participate in the survey. Second, they read an informed consent statement with details regarding the characteristics of the survey and guarantee anonymity. After providing their consent, we proceeded with the survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eThe demographics and characteristics of health care customers and the Perceived Organizational Justice in Care Services scale (PJustCS) were used to measure the interactional and informational dimensions of justice [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The interactional justice measure included seven items. An example of these is \u0026ldquo;In terms of how people treated you personally during this health care experience, to what extent were they really concerned with you as a person?\u0026rdquo;. Informational justice was measured using six questions. An example of these: \u0026ldquo;In terms of the information you received during your visit to the health care service, to what extent were your questions answered clearly?\u0026rdquo;\u003c/p\u003e \u003cp\u003eWe used the Satisfaction With Health Care Services Scale [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] to measure satisfaction with different aspects of health services, including practitioner staff, support staff, center facilities, and center accessibility and procedures, by utilizing 11 items. An example of these is \u0026ldquo;To what extent were you satisfied with the time spent with your health care provider (nurse/physician)?\u0026rdquo;\u003c/p\u003e \u003cp\u003eTrust in the health provider was assessed using two items: \u0026ldquo;Were you willing to rely on the health care professional\u0026rsquo;s judgment on important matters?\u0026rdquo;, and \u0026ldquo;Did you trust the health care provider you dealt with?\u0026rdquo; [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo measure adherence, participants were required to respond to the following item about how far they followed the advice provided on their visit [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]: \u0026ldquo;To what extent did you follow the advice or take the prescription provided by the health care worker?\u0026rdquo;.\u003c/p\u003e \u003cp\u003eThe user loyalty to the service measure included two items: 1) the intention to give a positive word of mouth, which was inferred from \u0026ldquo;Would you recommend this service to your friends and family?\u0026rdquo;, and 2) the intention to return to the service, which was inferred from \u0026ldquo;Would you willingly visit this health care center again if you needed health care?\u0026rdquo;[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. All the items were answered on a five-point Likert scale ranging from 1 \u0026ldquo;not at all\u0026rdquo; to 5 \u0026ldquo;totally.\u0026rdquo; The Cronbach\u0026rsquo;s alpha of each measure can be found in the \u003cspan refid=\"Sec8\" class=\"InternalRef\"\u003eResults\u003c/span\u003e section.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe results are expressed as the means and standard deviations for quantitative variables and as frequency distributions (n and %) for qualitative variables. Student\u0026rsquo;s t test (2-tailed) and the chi-square test were used to determine differences in baseline characteristics between the two samples (Spanish and American). Pearson correlations were used to analyze the relationship between quantitative variables in each sample. The internal consistency and reliability of each scale were assessed using Cronbach\u0026rsquo;s alpha. We performed multigroup path analysis using Amos software to test the hypothesized, best-fitting models and multigroup analysis.\u003c/p\u003e \u003cp\u003eThe hypotheses established an alpha of.05. The data were analyzed using SPSS version 23.0 (IBM Corp, Armonk, NY, USA) and AMOS version 16.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eSample characteristics\u003c/h2\u003e\n \u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows the demographic characteristics of the participants. In the Spanish sample, the proportion of women is slightly greater. In addition, visits to health care services are more recent in Spain than in the US. The number of people with private health insurance is greater in the U.S. than in Spain.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of the data samples\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSpain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnited States\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLevel of significance\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWomen (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (\u003cem\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.75\u0026thinsp;\u0026plusmn;\u0026thinsp;16.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.24\u0026thinsp;\u0026plusmn;\u0026thinsp;14.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYears of schooling (\u003cem\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecent health service visits (in the last month) (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContact professional: doctor (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate insurance (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote. N: number of observations, %: percentage, M: mean, SD: standard deviation.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eDescriptive results\u003c/h2\u003e\n \u003cp\u003eThe mean values of the variables analyzed in the model by country of sample origin and the differences between them are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. In the U.S. sample, informational justice, satisfaction and loyalty scores were higher, and in the Spanish sample, adherence was greater.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelations and descriptive data of each variable for both samples of health care users (below Spain/ above U.S)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Informational Justice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(.96/.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.79\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.70\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.75\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.70\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.19\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2. Interactional Justice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.66**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(.91/.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.76\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.81\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.79\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.18\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3. Trust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.61**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.56**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(.89/.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.75\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.76\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.18\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4. Satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.57**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.50**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.50**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(.89/.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.82\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.18\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5. Loyalty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.45**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.45**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.46**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.59**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(.87/.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.16\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6. Adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.19**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.15**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.17**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.15**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Spain)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (U.S.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. Cronbach\u0026rsquo;s alpha for each scale in each sample are given in the diagonal between brackets (Spain/U.S.) where n.a.: not available; SD: standard deviation, significance level: *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01.\u003c/p\u003e\n \u003cp\u003eThe correlation coefficients and reliability of the scales for each sample are also presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. All reliabilities are shown on the diagonal for the Spanish/U.S. samples, indicating a good level of reliability in all the cases (all above .87). Significant Pearson\u0026rsquo;s correlations are found in both samples for each justice dimension.\u003c/p\u003e\n \u003cp\u003eAdditionally, patients\u0026rsquo; attitudes, such as trust in the clinician and satisfaction with the service, are strongly related (significant Pearson\u0026rsquo;s correlations in all cases, except between patients\u0026rsquo; satisfaction and adherence for the Spanish sample).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eModel tests\u003c/h2\u003e\n \u003cp\u003eWe present two models computed with the whole sample (n\u0026thinsp;=\u0026thinsp;923), the hypothesized (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, I \u0026amp; III) and the best-fitting models (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, II \u0026amp; IV), for interactional justice perception and for informational justice perception (see Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The fit indices can be found in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Afterwards, a multigroup analysis was computed using the country-of-origin data separately for each justice perception to test the model in both the U.S. and Spain.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eInteractional justice perception path analyses\u003c/h2\u003e\n \u003cp\u003eThe fit indices were acceptable in the case of the hypothesized model (see Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e), but they could be improved. The best-fitting model showed that the effect of satisfaction on adherence (g) was not maintained in the case of interactional justice [\u0026Delta;\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.1, df\u0026thinsp;=\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.00]. The best-fitting model (see Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, II) excluded the direct effect of interactional justice on adherence and the effect of satisfaction on adherence, showing a satisfactory better fit with respect to the hypothesized model [\u0026Delta;\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.3, df\u0026thinsp;=\u0026thinsp;2, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.86].\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePath analysis data of the nested interactional and informational justice models to test trust and satisfaction mediation hypotheses\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"11\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModels for Interactional J.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026chi;2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026Delta; \u0026chi;2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta;df\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHypothesized Model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e236.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.960\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout b\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e238.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e293.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.931\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.933\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e236.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.960\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModel 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout b and g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e239.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.959\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModels for Informational J.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026Delta; \u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026Delta;\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHypothesized Model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e281.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.948\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewithout b\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e293.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewithout c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e296.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.931\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewithout g\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e283.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.946\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003eNote. Model 1 excludes the relationship between justice and adherence (b). Model 2 excludes the relationship between justice and loyalty (c). Model 3 excludes the relationship between satisfaction and adherence (g). Model 4 excludes the relationship between justice and adherence as well as satisfaction and adherence (b \u0026amp; g). RMSA\u0026thinsp;=\u0026thinsp;root mean square error of approximation; IFI\u0026thinsp;=\u0026thinsp;incremental fit index; CFI\u0026thinsp;=\u0026thinsp;comparative fit index; GFI\u0026thinsp;=\u0026thinsp;goodness of fit index.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAccording to our multigroup analysis, the CFI was close to the critical recommended value of 0.01 (\u0026chi;2\u0026thinsp;=\u0026thinsp;95.18, df\u0026thinsp;=\u0026thinsp;6, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; CFI\u0026thinsp;=\u0026thinsp;0.042). Testing the final model for each of the samples yielded a good fit for Spain [\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e (4)\u0026thinsp;=\u0026thinsp;34.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; CFI\u0026thinsp;=\u0026thinsp;.961, RMSEA\u0026thinsp;=\u0026thinsp;.126, TLI\u0026thinsp;=\u0026thinsp;.902] and the US [\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e (4)\u0026thinsp;=\u0026thinsp;51.7, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; CFI\u0026thinsp;=\u0026thinsp;.965, RMSEA\u0026thinsp;=\u0026thinsp;.172, TLI\u0026thinsp;=\u0026thinsp;.914]. Nevertheless, significant differences appeared in specific relationships, between interactional justice and trust (z\u0026thinsp;=\u0026thinsp;2.94, p\u0026thinsp;\u0026lt;\u0026thinsp;.05), interactional justice and satisfaction (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9.04, p\u0026thinsp;\u0026lt;\u0026thinsp;.05), and satisfaction and loyalty (\u003cem\u003ez\u003c/em\u003e = -2.50, p\u0026thinsp;\u0026lt;\u0026thinsp;.05), with loadings in the same direction but significantly greater in the U.S. sample. The model that did not include these three relationship parameters was invariant between samples (\u0026chi;2\u0026thinsp;=\u0026thinsp;8.19, df\u0026thinsp;=\u0026thinsp;3, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.04; CFI\u0026thinsp;=\u0026thinsp;0.003), indicating a proper fit [\u0026chi;\u003csup\u003e2\u003c/sup\u003e (13)\u0026thinsp;=\u0026thinsp;106.8, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; CFI\u0026thinsp;=\u0026thinsp;.956, RMSEA\u0026thinsp;=\u0026thinsp;.091, TLI\u0026thinsp;=\u0026thinsp;.933].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eInformational justice perception path analyses\u003c/h2\u003e\n \u003cp\u003eIn this case, the direct effect of informational justice on adherence must be maintained (see Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, III \u0026amp; IV, and fit indices in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Otherwise, the model worsened significantly when it was eliminated [\u0026Delta;\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;11.7, df\u0026thinsp;=\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001]. Additionally, we found that satisfaction had no influence on adherence, in contrast to what was hypothesized [\u0026Delta;\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.2, df\u0026thinsp;=\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.14]. The modification indices with respect to this model indicated that if covariance was added between the measurement errors of trust and satisfaction, the model fit improved substantially [\u0026chi;\u003csup\u003e2\u003c/sup\u003e (17)\u0026thinsp;=\u0026thinsp;174.2, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; CFI\u0026thinsp;=\u0026thinsp;.996, RMSEA\u0026thinsp;=\u0026thinsp;.040, TLI\u0026thinsp;=\u0026thinsp;.986].\u003c/p\u003e\n \u003cp\u003eWhen we performed the multigroup analysis, the group fit of the final model for each sample did not work invariably for the two samples (\u0026chi;2\u0026thinsp;=\u0026thinsp;95.54, df\u0026thinsp;=\u0026thinsp;7, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; CFI\u0026thinsp;=\u0026thinsp;0.04), although its fit was good in both Spain [\u0026chi;\u003csup\u003e2\u003c/sup\u003e (2)\u0026thinsp;=\u0026thinsp;5.4, p\u0026thinsp;\u0026lt;\u0026thinsp;.001; CFI\u0026thinsp;=\u0026thinsp;.996, RMSEA\u0026thinsp;=\u0026thinsp;.060, TLI\u0026thinsp;=\u0026thinsp;.979] and the US [\u0026chi;\u003csup\u003e2\u003c/sup\u003e (2)\u0026thinsp;=\u0026thinsp;0.05, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; CFI\u0026thinsp;=\u0026thinsp;1.00, RMSEA\u0026thinsp;=\u0026thinsp;.00 (.00-.00), TLI\u0026thinsp;=\u0026thinsp;1.008]. Specifically, differences in the characteristics of the countries appeared in the relationship between informational justice and trust (z\u0026thinsp;=\u0026thinsp;3.97, p\u0026thinsp;\u0026lt;\u0026thinsp;.05), informational justice and satisfaction (z\u0026thinsp;=\u0026thinsp;9.59, p\u0026thinsp;\u0026lt;\u0026thinsp;.05), and trust with patient loyalty (z\u0026thinsp;=\u0026thinsp;2.58, p\u0026thinsp;\u0026lt;\u0026thinsp;.05), with higher loadings in the U.S. sample.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis paper answers how patients\u0026rsquo; perceived organizational justice matters and how it should be considered when delivering patient-centered care and providing better health care results (i.e., adherence to clinical advise and loyalty to the service) and health care policies. In this sense, we showed that patients' perception of informational justice directly influenced adherence to professional advice, whereas their perceptions of interactional or informational justice fostered their satisfaction with health services, trust in health providers, and loyalty to services. In addition, trust in health providers acted as a mediator of the influence of interactional justice on adherence. These findings have major implications for the management of healthcare services and policies and, ultimately, for contributing to the quality of healthcare and patient-centered care. We will offer guidelines of the implications of each finding next.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e1. Perceived organizational justice and adherence to clinical advice and loyalty to the service\u003c/h2\u003e \u003cp\u003ePerceptions of interactional and informational justice were related to adherence to professional advice, which is in line with the findings of previous studies highlighting the importance of the communication process with health care users [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] but here we add the necessary characteristics of patients\u0026rsquo; perceived justice to foster adherence and then, to generate good patient-centered care results [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The direct effects of perceived justice on loyalty to the service are also aligned with previous research involving workers and users of other services. This finding demonstrates the importance of the perception of interactional justice in variables related to loyalty, such as the intention to leave an organization [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], behaviors related to reusing the same service [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], or providing positive references [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Therefore, the connection between health service management and users can be improved by fostering interactional and informational justice perceptions related to creating spaces and procedures that allow interactional exchanges, sufficient time to interact and an adequate exchange of information [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2. Adherence to professional advice\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e2.1. Perceived interactional justice\u003c/h2\u003e \u003cp\u003eIn the context of best-fitting models, the results of the present study indicate that trust in the health provider acts as a mediator in the influence of interactional justice on adherence to professional advice. Thus, the perception that interactions with professionals show respect and dignity seems to foster the trust that generates adherence to advice, which is consistent with the findings of previous research [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The quality of interaction with health personnel is essential in building trust [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], especially in contexts in which building trust is particularly challenging, such as those imposed by the COVID-19 pandemic and the use of masks [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In our study, we verified that the interactional dimension of organizational justice perception supports these assertions. Thus, perceiving interactions characterized by showing interest in the patient, willingness to listen, respect for their dignity, or treating the patient with respect and politeness are characteristics of interactional justice perception that foster the patient's trust in the health provider. This trust leads to better treatment adherence, service performance, and service-user connection as an important condition for ensuring the quality of care [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Perceived informational justice\u003c/h2\u003e \u003cp\u003eHowever, informational justice has such a powerful relationship with treatment adherence that the effect of total mediation of trust in the health provider can be neglected. This finding also adds to the trend regarding the importance of the quality of the information provided for treatment, which is essential in patient-centered care [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Patients\u0026rsquo; positive perceptions of the information provided and clarity regarding the effects, dosage, and characteristics of treatments increase the probability of adherence to the professional\u0026rsquo;s recommendations. Additionally, we know that when patients are ready for future procedures or outcomes through informational interventions, uncertainty levels decrease, and clinical outcomes improve [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Therefore, service design should try to provide well-tailored information to patients because if they do not perceive it as sufficient, accurate, suitable, clear, thorough, and timely (i.e., fair), the likelihood of adherence decreases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Patients\u0026rsquo; satisfaction\u003c/h2\u003e \u003cp\u003eSeveral contradictions have been found in previous research on the relationship between patient satisfaction and adherence. While certain studies [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] have found evidence of the existence of such a relationship, others have contradicted it [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In our study, satisfaction was not related to adherence in any of the models that we computed. This could be related to differences in satisfaction and adherence in terms of time, with satisfaction being an immediate and ephemeral reaction, while adherence is a behavior requiring long-term motivation. As both variables were at different levels, the relationship was ambiguous. These results suggest that satisfaction could have limited explanatory power for users\u0026rsquo; long-term behavior.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3. Loyalty to the service\u003c/h2\u003e \u003cp\u003eRegarding patient loyalty, the current study showed that both dimensions of organizational justice have such a strong influence on this behavior that the loyalty of patients to health services is linked directly to their perceptions of justice and through their trust and satisfaction with the service. This result corroborates previous findings on the promotion of loyalty through patient satisfaction and trust [\u003cspan additionalcitationids=\"CR43 CR44 CR45\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsequently, this research supports the importance of implementing a health service design that promotes the perception of organizational interactional and informational justice in health services, as these factors are directly and indirectly associated with patients returning to health services and their tendency to provide positive references. This would lead not only to better service performance, cost savings in resources, and an improved image of the services [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] but also to better patient-centered care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4. Country comparison\u003c/h2\u003e \u003cp\u003eTesting the relational models with each country\u0026rsquo;s sample separately confirmed their robustness since the relationships were maintained in the health care systems of both countries. Differences were found only in terms of the strength of certain relationships but not in the direction of the proposed links. There may be various reasons why the perception of justice is more closely linked to trust and satisfaction among users in the U.S. than in Spain, given that health care systems and types of users in both countries differ in many ways. Although the two contexts involve very different ways of organizing service delivery, we can conclude that patients' cognitions, emotions and behaviors and their relationships were similar in both contexts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e5. Strengths and limitations\u003c/h2\u003e \u003cp\u003eThe current study has several strengths, including the use of a comprehensive model that encompasses constructs to understand patients\u0026rsquo; experience and how to use this understanding in health care services management, and also, that it was confirmed in two countries with different healthcare systems.\u003c/p\u003e \u003cp\u003eThe usual limitations of cross-sectional designs regarding the difficulties of establishing causality apply to the present study. Although we have a well-established theoretical basis, longitudinal studies that strengthen the relationships found need to be conducted. The data collection method was the same for all variables. Thus, the possible variance common to the method should be considered because it may artificially strengthen the relationships between the variables. In general, self-reports have proven to be a valid data collection method; however, they tend to yield slightly overestimated results [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePatients\u0026rsquo; perceptions of interactional and informational justice play an essential role in fostering trust and satisfaction in health services. Trust is always related to adherence to treatments and loyalty to the service, while patient satisfaction relates to loyalty but not adherence. We also found that the perception of informational justice has remarkable influence on patients\u0026rsquo; adherence to professional advice. Thus, if we want better patient-centered care and better health results, health service design and practitioner behaviors should aim to foster organizational interactional and informational justice perceptions.\u003c/p\u003e \u003cp\u003e Future lines of research include the design and test of health services aimed at supporting organizational justice, as well as the evaluation of their results from a patient-centered care approach.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u0026bull;\u0026nbsp;Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Health Area of the Hospital of Salamanca (Spain) in accordance with international standards and the Institutional Review Board for the Protection of Human Subjects of Duke University (NC, The U.S.) in accordance with current law. Informed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Consent for publication: All authors consent to publication\u003c/p\u003e\n\u003cp\u003e\u0026bull; Availability of data and materials: Both data bases are available to the researchers. They are not provided for public use due to current extra analysis.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Competing interests: There are not competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Funding:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis study was funded by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union-Next Generation EU, Facility for Recovery and Resilience (MRR) and Investing in your Future Plan through Health Outcomes-Oriented Cooperative Research Networks (RICORS) (RD21/0016/0010). The Government of Castilla y Le\u0026oacute;n also collaborated with the funding of this study through the research projects BioSan 2009 and BioSan 2011. The authors played no role in the study design, data analysis, reporting of the results, or the decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Authors\u0026apos; contributions:\u0026nbsp;\u003cem\u003eConcept and design\u003c/em\u003e: P\u0026eacute;rez-Arechaederra, Briones; \u003cem\u003eAcquisition of data\u003c/em\u003e: P\u0026eacute;rez-Arechaederra; \u003cem\u003eAnalysis and interpretation of data\u003c/em\u003e: P\u0026eacute;rez-Arechaederra, Garc\u0026iacute;a; \u003cem\u003eDrafting of the manuscript\u003c/em\u003e: P\u0026eacute;rez-Arechaederra; \u003cem\u003eCritical revision of the paper for important intellectual content\u003c/em\u003e: Briones, Garcia; \u003cem\u003eObtaining funding\u003c/em\u003e: Garcia; \u003cem\u003eSupervision\u003c/em\u003e: Briones, Garcia.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Authors\u0026apos; information (optional):\u0026nbsp;Diana P\u0026eacute;rez-Arechaederra, PhD \u003csup\u003e1\u003c/sup\u003e* ([email protected]), Elena Briones, PhD \u003csup\u003e2\u003c/sup\u003e ([email protected]), Luis Garc\u0026iacute;a-Ortiz, MD, PhD \u003csup\u003e3,4\u003c/sup\u003e([email protected]).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMohiuddin AK. An Extensive Review of Patient Behavior. PharmaTutor. 2019;7(8):1\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerry LL. Designing connection into healthcare services. J Service Manage 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFiller T, Foster AM, Grace SL, Stewart DE, Straus SE, Gagliardi AR. Patient-centered care for women: Delphi consensus on evidence-derived recommendations. Value in Health. 2020;23(8):1012\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmporfro DA, Boah M, Yingqi S, Cheteu Wabo TM, Zhao M, Ngo Nkondjock VR, Wu Q. Patients satisfaction with healthcare delivery in Ghana. BMC Health Serv Res. 2021;21(1):722.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMead KH, Wang Y, Cleary S, Arem H, Pratt-Chapman ML. Defining a patient-centered approach to cancer survivorship care: development of the patient centered survivorship care index (PC-SCI). BMC Health Serv Res. 2021;21(1):1353.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConstand MK, MacDermid JC, Dal Bello-Haas V, Law M. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res. 2014;14:271.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTimmermans S. The engaged patient: The relevance of patient\u0026ndash;physician communication for twenty-first-century health. J Health Soc Behav. 2020;61(3):259\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitchell KR, Brassil KJ, Fujimoto K, Fellman BM, Shay LA, Springer AE. Exploratory Factor Analysis of a Patient-Centered Cancer Care Measure to Support Improved Assessment of Patients' Experiences. Value Health. 2020;23(3):351\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas EC, Bass SB, Siminoff LA. Beyond rationality: Expanding the practice of shared decision making in modern medicine. Soc Sci Med 2021:113900.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitchell K-AR, Brassil KJ, Fujimoto K, Fellman BM, Shay LA, Springer AE. Exploratory factor analysis of a patient-centered cancer care measure to support improved assessment of patients\u0026rsquo; experiences. Value in Health. 2020;23(3):351\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDurand F, Fleury MJ. A multilevel study of patient-centered care perceptions in mental health teams. BMC Health Serv Res. 2021;21(1):44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiberati EG, Gorli M, Moja L, Galuppo L, Ripamonti S, Scaratti G. Exploring the practice of patient centered care: The role of ethnography and reflexivity. Soc Sci Med. 2015;133:45\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee Y-Y, Lin JL. Do patient autonomy preferences matter? Linking patient-centered care to patient\u0026ndash;physician relationships and health outcomes. Soc Sci Med. 2010;71(10):1811\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown DJ, Hagger MS, Hamilton K. The mediating role of constructs representing reasoned-action and automatic processes on the past behavior-future behavior relationship. Soc Sci Med. 2020;258:113085.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHagger MS. Redefining habits and linking habits with other implicit processes. Psychol Sport Exerc. 2020;46:101606.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFishbein M, Jaccard J, Davidson AR, Ajzen I, Loken B. Predicting and understanding family planning behaviors. Understanding attitudes and predicting social behavior. edn.: Prentice Hall; 1980.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScholl I, Zill JM, H\u0026auml;rter M, Dirmaier J. An integrative model of patient-centeredness\u0026ndash;a systematic review and concept analysis. PLoS ONE. 2014;9(9):e107828.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGabay G, Moskowitz HR. Are We There Yet? Mind-Genomics and Data-Driven Personalized Health Plans. \u003cem\u003eThe Cross-Disciplinary Perspectives of Management: Challenges and Opportunities\u003c/em\u003e 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eP\u0026eacute;rez-Arechaederra D, Briones E, Lind A, Garc\u0026iacute;a-Ortiz L. Perceived Organizational Justice in Care Services: creation and multi-sample validation of a measure. Soc Sci Med. 2014;102:26\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang Y-W, Hsu P-Y, Wang Y, Chang P-Y. Integration of online and offline health services: The role of doctor-patient online interaction. Patient Educ Couns. 2019;102(10):1905\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEspinosa A, Kadić-Maglajlić S. The role of health consciousness, patient\u0026ndash;physician trust, and perceived physician\u0026rsquo;s emotional appraisal on medical adherence. Health Educ Behav. 2019;46(6):991\u0026ndash;1000.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong H, Oh HJ. The effects of patient-centered communication: exploring the mediating role of trust in healthcare providers. Health Commun. 2020;35(4):502\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin H, Sanders C, Prasetyo Y, Syukron M, Prentice E. Exploring the dynamic relationships between risk perception and behavior in response to the Coronavirus Disease 2019 (COVID-19) outbreak. Soc Sci Med. 2021;285:114267.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMallou JV, Boubeta AR, Cueto EG. Presentaci\u0026oacute;n de una escala de satisfacci\u0026oacute;n con los servicios sanitarios de atenci\u0026oacute;n primaria. Psicothema. 2003;15(4):656\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAryee S, Budhwar PS, Chen ZX. Trust as a mediator of the relationship between organizational justice and work outcomes: Test of a social exchange model. J Organizational Behavior: Int J Industrial Occup Organizational Psychol Behav. 2002;23(3):267\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol. 2004;23(2):207.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMattila AS. The effectiveness of service recovery in a multi-industry setting. J Serv Mark 2001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaxham IIIJG, Netemeyer RG. Modeling customer perceptions of complaint handling over time: the effects of perceived justice on satisfaction and intent. J Retail. 2002;78(4):239\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMart\u0026iacute;n-P\u0026eacute;rez P, Quintano-Jim\u0026eacute;nez J, Hidalgo-Requena A, Ginel-Mendoza L. Inercia terap\u0026eacute;utica en asma. SEMERGEN Soc Esp Med Rural Gen(Ed impr) 2014:291\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunter-Jones P, Line N, Zhang JJ, Malthouse EC, Witell L, Hollis B. Visioning a hospitality-oriented patient experience (HOPE) framework in health care. J Service Manage 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConn VS, Ruppar TM, Enriquez M, Cooper P. Medication adherence interventions that target subjects with adherence problems: systematic review and meta-analysis. Res Social Administrative Pharm. 2016;12(2):218\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoung GJ, Meterko M, Desai KR. Patient satisfaction with hospital care: effects of demographic and institutional characteristics. Med Care 2000:325\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaxham IIIJG, Netemeyer RG. Firms reap what they sow: the effects of shared values and perceived organizational justice on customers\u0026rsquo; evaluations of complaint handling. J Mark. 2003;67(1):46\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHillen M, Koning C, Wilmink J, Klinkenbijl J, Eddes E, Kallimanis-King B, De Haes J, Smets E. Assessing cancer patients' trust in their oncologist: development and validation of the Trust in Oncologist Scale (TiOS). Support Care Cancer. 2012;20(8):1787\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuckett K. Behind the mask: new challenges to gaining patient trust. Home Healthc Now. 2020;38(6):327\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNikbin D, Marimuthu M, Hyun SS, Ismail I. Relationships of perceived justice to service recovery, service failure attributions, recovery satisfaction, and loyalty in the context of airline travelers. Asia Pac J Tourism Res. 2015;20(3):239\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZolnierek KBH, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDang BN, Westbrook RA, Black WC, Rodriguez-Barradas MC, Giordano TP. Examining the link between patient satisfaction and adherence to HIV care: a structural equation model. PLoS ONE. 2013;8(1):e54729.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999;37(5):510\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou W-J, Wan Q-Q, Liu C-Y, Feng X-L, Shang S-M. Determinants of patient loyalty to healthcare providers: An integrative review. Int J Qual Health Care. 2017;29(4):442\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhorbanzadeh D, Rahehagh A, Botelho D. The role of emotional structures in the relationship between satisfaction and brand loyalty. Cogent Psychol 2020, 7(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorres E, Vasquez-Parraga AZ, Barra C. The path of patient loyalty and the role of doctor reputation. Health Mark Q. 2009;26(3):183\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeninkumar V. The Relationship between Customer Satisfaction and Customer Trust on Customer Loyalty. Int J Acad Res Bus Social Sci. 2017;7:450\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen N, Leclerc A, LeBlanc G. The Mediating Role of Customer Trust on Customer Loyalty. J Service Sci Manage. 2013;06(01):96\u0026ndash;109.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42(3):200\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"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},"keywords":"patient-centered care, fairness perceptions, health care quality, care management, informational justice, interactional justice, communication, relationships","lastPublishedDoi":"10.21203/rs.3.rs-3801299/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3801299/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e After analyzing the three tenants of patient-centered care (i.e., communication, relationships and health promotion), we tested the role of patients’ perceived interactional and informational organizational justice in health service performance with respect to patients’ behaviors of adhering to professional advice and loyalty to the service. Literature shows that organizational variables as perceived organizational justice can influence patients’ behaviors. We have the ultimate goal of better understanding patients’ experiences with health care organizations, so health care service management can adjust to provide a better-quality patient-centered care considering patients’ inputs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We conducted a cross-sectional study using two data samples from Spain and the U.S. The sample comprised 473 (male 59.2%) health care users from Spain and 450 (male 52.0%) from the U.S. over 18 years old. We measured the interactional and informational dimensions of perceived organizational justice, participants’ trust in the health care provider, their satisfaction with health care services, their adherence to professional advice and their loyalty to the service through a self-administered survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSignificant correlations were found in both samples for each justice dimension with both behaviors: adherence to advise (interactional, \u003cem\u003er\u003c/em\u003e=.15/.18, \u003cem\u003ep\u003c/em\u003e\u0026lt;.01; informational, \u003cem\u003er\u003c/em\u003e=.19/.19, p\u0026lt;.01) and loyalty to the service (interactional, \u003cem\u003er\u003c/em\u003e=.45/.79, \u003cem\u003ep\u003c/em\u003e\u0026lt;.01; informational, \u003cem\u003er\u003c/em\u003e=.45/.70, \u003cem\u003ep\u003c/em\u003e\u0026lt;.01).\u003c/p\u003e\n\u003cp\u003eWhen we tested the model that included mediating patients' attitudes of trust and satisfaction, we found that the direct relationship between informational justice and adherence still held (standardized trajectory coefficient =.13, \u003cem\u003ep\u003c/em\u003e \u0026lt;.01) showing their consolidated relationship. For interactional fairness, trust and satisfaction significantly mediated the relationship with adherence. On the other hand, the relationships between both justices and patient loyalty to the service were always partially mediated by patient trust and satisfaction (model fit for interactional justice perceptions RMSEA=.101, CFI=.959, GFI=.959; model fit for informational justice perceptions RMSEA=.136, CFI=.937, GFI=.946).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Patients’ perceptions of interactional and informational justice play an essential role in their adherence to professional advice, their loyalty to the service, and their ability to foster trust and satisfaction in health services. When discussing communication and relationships in patient-centered care, we should also consider fostering patients’ perceptions of fairness to improve health services results. Policies, programmes and procedures for patient-centered care should consider these patients’ perceptions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArticle classification: \u003c/strong\u003eEmpirical research paper\u003c/p\u003e","manuscriptTitle":"Communication and relationships: how patients’ perceived informational and interactional justice can improve patient-centered care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-08 17:22:57","doi":"10.21203/rs.3.rs-3801299/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-08T05:22:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-04T16:25:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-04T16:25:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2023-12-24T17:11:32+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":"f5633e05-105a-40bc-8be9-f7b92a2f8d24","owner":[],"postedDate":"January 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-10T20:15:48+00:00","versionOfRecord":{"articleIdentity":"rs-3801299","link":"https://doi.org/10.1186/s12913-025-12461-x","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-03-06 15:57:57","publishedOnDateReadable":"March 6th, 2025"},"versionCreatedAt":"2024-01-08 17:22:57","video":"","vorDoi":"10.1186/s12913-025-12461-x","vorDoiUrl":"https://doi.org/10.1186/s12913-025-12461-x","workflowStages":[]},"version":"v1","identity":"rs-3801299","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3801299","identity":"rs-3801299","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}