Understanding the determinants of medical crowdfunding performance: A signaling theory perspective

Understanding the determinants of medical crowdfunding performance: A signaling theory perspective | 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 Article Understanding the determinants of medical crowdfunding performance: A signaling theory perspective Xiaorui Huang, Wei Sun, Ying Zhang, Qilin Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4375164/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Medical crowdfunding has emerged as a novel means of accessing financial resources, particularly in regions with disparities in healthcare access such as China. Despite the establishment of comprehensive medical security systems, many patients still face significant financial burdens. This study aims to identify the determinants of medical crowdfunding success for charitable causes, utilizing signaling theory. Analyzing data from the Sina Micro-charities platform on Sina Weibo, external and internal signals' impact on crowdfunding performance was assessed. Results indicate that both external signals (registration levels, awards) and internal factors (updates, pictures, title length) significantly influence crowdfunding success. This empirical study contributes to understanding medical crowdfunding performance and extends the application of signaling theory in this context, offering practical insights for fundraisers and platforms. Health sciences/Health care/Health policy Health sciences/Health care/Health services Health sciences/Health care/Public health Online medical crowdfunding campaigns determinants Sina Micro-Charities signaling theory external signals internal signals Figures Figure 1 Introduction Online charitable crowdfunding, characterized by the practice of funding projects through soliciting financial contributions from the public within a limited timeframe 1 , has reshaped the landscape of charitable giving by merging traditional methods with IT-enabled crowdfunding 2 . Particularly prominent in the health sector, online charitable crowdfunding has garnered considerable attention 3 . Recent studies indicate that a majority of crowdfunding campaigns focus on medical or health-related fundraising 4 . This trend is attributed to gaps in social welfare systems, escalating healthcare costs and debt burdens, and inadequate healthcare coverage 5 , 6 . Half the global population still lacks access to required healthcare services 7 . China has established a relatively comprehensive medical security system, yet several patients still have to bear hefty medical costs, leading to considerable healthcare expenses and impoverishment 8 . Medical crowdfunding plays a pivotal role in addressing the high cost of treatment. According to statistics, over the eight years leading up to 2023, more than 51 billion individuals in China have engaged in Internet charity, raising 35 billion yuan 9 , which warrants further discussion. Despite the high demand for medical crowdfunding, its success rates remain modest, with failure rates reaching 60% in the UK 10 and 90% in China 11 . Prior research highlights a dearth of empirical studies on the key factors contributing to project success 12 , 13 . Hence, there is a pressing need for academia and industry to investigate and analyze the determinants of success in online medical crowdfunding projects, facilitating more efficient project design and implementation. Scholars have examined how the characteristics of fundraisers and organizations influence the performance of medical crowdfunding efforts 14 , 15 , 16 . Additionally, context-related characteristics 17 , such as persuasive narratives 18 , 19 and platform features 20 , 21 , 22 significantly impact fundraising outcomes. Previous research on the determinants of successful donation campaigns has produced inconsistent results. This may be due to variations in the urgency of medical demand and consequences. Further investigation is, therefore, necessary to identify these determinants in the context of medical crowdfunding to enhance crowdfunding performance and improve patient well-being. Another research gap lies in the predominant use of data from North America and Europe or platforms like GoFundMe, Kickstarter, and Indiegogo in major studies on online medical crowdfunding 23 , and cultural differences between Chinese, European, and American make the previous research not applicable to charity crowdfunding in the context of China 24 . Furthermore, most existing studies on online medical crowdfunding in China concentrate on platforms like Tencent GongYi, Qingsongchou, or social crowdfunding 16 , lacking research on online medical crowdfunding from Sina Micro-charities platform on Sina Weibo, one of the leading online medical crowdfunding platforms. According to the report of China Philanthropy Times in 2021, over 7 million individuals donated on this platform and the funding was more than 700 million yuan. Charitable Crowdfunding on Sina Weibo plays a dominant role in the market 25 , including detailed information on charity crowdfunding projects, which provides sufficient data for our research. To address these research gaps, our study aims to identify the factors influencing the success of medical crowdfunding for charitable purposes. Building on Spence's signaling theory, we examine the impact of external and internal signals on medical crowdfunding performance. Our data, sourced from Sina Micro-charities, a prominent medical crowdfunding platform in China, sheds light on the determinants of medical crowdfunding performance, thereby enhancing social welfare by meeting unmet medical needs. Literature review and hypothesis Signaling theory and its applicability to donation-based crowdfunding Spence introduced signaling theory, defining signals as "the activities or attributes of individuals in a market, by design or accident" 26 . This theory provides a framework for understanding how one party can employ signals to convey limited or obscured quality information to another party, thereby facilitating a purchase or exchange 27 . Within information asymmetry, signaling theory examines how signalers utilize observable features (signals) to communicate information about their unobservable attributes to others 28 , 29 . Signaling theory has found utility as an analytical tool in various contexts, notably reward-based crowdfunding 30 , 31 , equity-based crowdfunding 32 , 33 , and donation-based crowdfunding 22 , 34 . According to the previous study 35 , asymmetric information between the providers and the contributors is ubiquitous in crowdfunding markets, where charitable donations are a significant source of revenue. Consequently, signaling likely plays a crucial role in charitable crowdfunding. However, research applying signaling theory to donation-based charitable crowdfunding remains limited. For instance, a study examined the relationship between external and internal quality signals and the success of 427 COVID-19 crowdfunding campaigns 22 . Similarly, scholars investigated the factors that affect medical crowdfunding outcomes on the Qingsongchou platform in China using a signaling theory framework 36 . Despite these efforts, a more precise theoretical framework is needed to fully comprehend the function of signaling in charitable crowdfunding. External and Internal Signals in Charitable Crowdfunding External Signals External signals refer to endorsements from third parties. Seals indicating verification by or affiliation with well-recognized external entities generally enhance trustworthiness and imply higher quality 29 . According to the Resource Dependence Theory, charities must acquire resources from their environment for sustainable development 37 . It is crucial for them to gain recognition from third parties in public fundraising. Moreover, endorsements from governmental entities can serve as effective external signals easily noticeable to donors 38 . In China, charitable organizations are registered at national or local levels, with national-level organizations enjoying superior resources, opportunities, and credibility among the public 39 . However, some studies have noted a declining success rate trend for programs initiated by national-level organizations 40 . In addition, a charity’s past achievements can serve as a signaling mechanism 38 . Thus, we propose: Hypothesis 1 (H1) The Charitable organizations at the national level positively influence crowdfunding success. The Ministry of Civil Affairs (MCA), as the main regulator of charitable organizations, conducts comprehensive assessments across four categories in China, including basic requirements, internal management, performance, and social impact analysis 41 . After evaluation, organizations are rated on a five-grade scale, with 5A being the highest rating. This rating system also indicates an approval of the organization's past achievements. Consequently, we suggest: Hypothesis 2 (H2) The Charitable organizations rating higher influence crowdfunding success. Internal Signals Internal signals arise from the seller's internal decisions to project a particular image or communicate a specific company policy, offering evidence of the seller's commitments 29 . Given the information asymmetry inherent in medical charitable crowdfunding 42 , charities earn donor trust by pledging to deliver anticipated outcomes. Consequently, some project indicators can be signals from the charity to the potential donor. Firstly, updates play a crucial role in medical crowdfunding performance. Fundraisers providing project feedback can benefit donors by informing them about the effectiveness of their donations, potentially motivating more contributions 43 . Scholars have found that including any project update can increase the likelihood of success by 5% 44 while omitting updates reduces the chance of success by 13% 45 . Campaigns with frequent updates on fundraising progress tend to achieve better results 22 , 46 . However, some scholars suggest that updates represent one-sided communication tools used by fundraisers to convey the value and legitimacy of their campaigns, potentially impacting trustworthiness and credibility to some extent 47 . Thus, we propose: Hypothesis 3 (H3) The presence of any update will positively affect the successful probability of a crowdfunding campaign. Secondly, the duration of a crowdfunding campaign refers to the timeframe during which project initiators seek financial contributions from the crowd 48 . It is found that lengthy fundraising activities suggest a lower fundraising success rate for project sponsors 45 and provide evidence that project sponsors do not prioritize completing fundraising as soon as possible, as this can diminish supporters' confidence in the project’s ability to achieve its goal within the designated timeframe 48 . When investigating the duration of crowdfunding, scholars have found that the success rate of projects gradually decreases as the duration increases. It is suggested that supporters associate shorter pre-set durations with more promising prospects for achieving their desired goal promptly 16 . Scholars have observed that campaigns lasting between two and five months receive better funding and are more likely to achieve their objectives 49 , with the highest success rate observed for projects lasting 0–20 days 19 . We thus hypothesize: Hypothesis 4 (H4) As the campaign duration increases, the probability of project success decreases. Thirdly, the number of pictures significantly impacts project success. Research indicates that incorporating visuals can enhance project descriptions, while well-designed project presentations demonstrate the sponsor's commitment and aspiration for success 48 . Visual elements can engage multiple sensory channels, appealing to the audience 50 . Including an image of a person making eye contact can increase individuals' willingness to donate 51 . Previous research has shown both positive 52 and negative effects 53 of presenting optimistic expressions, while including images can enhance crowdfunding success. However, displaying a picture of a distressed beneficiary may deter potential donors 54 . Consequently, we formulate the following hypothesis: Hypothesis 5 (H5) As the number of pictures increases, the probability of project success increases. Furthermore, the title description is a crucial factor in crowdfunding campaign success. The title plays an essential role in attracting and enhancing the public's understanding of the narrative description 55 . Additionally, the title length significantly predicts crowdfunding campaign success, as some readers base their decisions solely on headline information 56 . Prior studies have shown that incorporating only 4–5 words in the title can enhance the chances of campaign success 34 while engaging headlines with 6 to 11 words correlate strongly with successful fundraising 49 . We thus hypothesize: Hypothesis 6 (H6) As title length increases, the probability of project success decreases. [Figure 1 about here.] The research framework is shown in Fig. 1 . Methods Data sources and sample selection The data source for this study is the Sina Micro-charities platform, which leverages the widespread popularity of Sina Weibo, one of China's leading online social networks founded in 2012. The Sina Micro-charities platform organizes campaigns to raise funds for various categories, including medical, emergency scenarios, and charitable causes. Medical category data from the Sina Micro-charities platform spanning from 2019 to 2021 were extracted for this research. Python 3.10.1 was utilized to crawl data from the medical category. A total of 2604 medical crowdfunding campaigns were obtained through web crawling, comprising 1889 campaigns launched in 2019, 354 in 2020, and 361 in 2021. Due to format discrepancies, various information elements, including updates and the number of pictures, were manually classified. We meticulously scrutinized the contents of each program to extract relevant information. To ensure precision in the identification process, two research assistants were appointed by the authors to authenticate and input the data according to established regulations. The authors further conducted a consistency check to validate the data subsequently included in the analysis. To test the proposed hypotheses, the study utilized a systematic and random sampling technique to select 300 programs from 2,604 projects, with a yearly sample size of 100. For 2019, a total of 105 programs were sampled at a sample interval of 18. Equally, 118 and 120 programs were randomly sampled for 2020 and 2021, respectively, at a sample interval of 3 for each year. Program variables were coded based on the proposed hypotheses. Following the exclusion of samples with missing values and outliers, 340 valid samples were identified for subsequent analysis. Variables Table 1 lists all of the variables considered with their descriptions. Outcome variable . Medical crowdfunding performance in this study was measured with total donation amount, following previous research on online giving22,56. Independent Variables . Registered (H1) was examined based on the administrative level of MCA approving the establishment of the charitable foundation. Award (H2) was measured by ratings granted by MCA. Update (H3) was assessed by whether the project’s fundraising dynamic progress was updated. Duration (H4) was measured by the number of days a project runs predetermined by the fundraiser. Picture (H5) was examined by the number of images included in the project information. Title length (H6) was calculated with the number of words in the project title. Covariates in this study include the program launch year (2019/2020/2021), location (Central China/ East China\ West China\ Northeast China), goal and disease type (Hematological Disorder/ Malignancy/ Congenital Disease/ Accidental Injury/ Others), fans of the charitable organizations, and age of patient. [Table 1 about here.] Statistical strategies Descriptive analyses were conducted for all study variables presenting mean scores and standard deviations for continuous variables and estimating frequencies and proportions for categorical variables. Subsequently, Ordinary Least Squares (OLS) regression was used to test our hypotheses, given the continuous nature of the dependent variable, the total donation amount56,57. Seven regression models were executed, with multiple tests performed to assess multicollinearity in each model. The maximum variance inflation factor (VIF) values were below 5, indicating no strong multicollinearity in our models. All analyses were conducted in STATA 16.0 version. Results Descriptive analysis Table 2 presents the descriptive statistics of the sample. Among the total sample (n = 340), the mean and median sum of donations were 39752.06 RMB and 3333.83 RMB, respectively. The majority of projects were hosted on national charitable organizations’ platforms (N = 201, 59.12%) and were regularly updated (N = 242, 71.18%). Around 51.12% of the charitable organizations’ ratings were at the 5A level. The average predetermined duration was approximately 77 days. On average, projects provided 7.56 images, with a mean title length of 13.41. [Table 2 about here.] Regression Results Table 3 presents the factors influencing the success of COVID-19 crowdfunding efforts, analyzed through seven regression models. Model 1 results show that charitable organizations at the national level positively impact total donations compared to local ones (β = 1.229, p<0.01), supporting H1. Additionally, model 2 shows that 3A and 5A ratings granted by MCA positively impact total donations compared to unspecified ratings, supporting H2. Model 3 supports H3, demonstrating a significant and positive correlation between project updates and crowdfunding success. Specifically, updates correlate positively with the expected increase in donations (β = 2.509, p<0.01). The results in Model 5 show a positive and significant relationship between the pictures and crowdfunding success (β = 0.165, p<0.01), verifying H5. The results in Model 6 show a positive and significant relationship between title length and crowdfunding success (β = 0.082, p<0.05), supporting H6. Consistent results are observed in Model 7, with a positive coefficient on updates (β = 2.402, p<0.01), a positive coefficient on pictures (β = 0.120, p<0.01), and a positive coefficient on title lengths (β = 0.065, p<0.05). However, we do not find a significant relationship between duration and crowdfunding success. Covariate results indicate that crowdfunding campaigns launched in 2020 and 2021, patients from the East of China, and higher fundraising goals tend to receive more donations, showing a positive significant relationship across all models (Model 1, Model 2, Model 3, Model 4, Model 5, Model 6, Model 7). Moreover, the fans of charitable organizations between 100000 to 200000 seem to be able to attract less donations. [Table 3 about here.] Discussion In response to recent studies highlighting the remarkable growth of online medical crowdfunding campaigns, this study offers novel insights by examining the influencing factors of crowdfunding success through the lens of signaling theory. The results underscore the significant roles played by both external and internal signals in determining the total amount of donations. This study represents the first comprehensive investigation into Sina Weibo’s medical crowdfunding program from a signaling theory perspective, yielding several noteworthy findings that merit further discussion. Firstly, regarding the complex and controversial findings on the role of signaling in online crowdfunding 28 , 30 , we suggest that external signals, including registration levels and awards, influence medical crowdfunding performance on Sina Micro-charities. Signaling mechanisms can bolster trustworthiness to a certain extent, thus addressing the principal-agent problem in medical crowdfunding. According to a previous study 29 , external signals mainly come from third-party endorsements, especially the registered location and ratings of charitable organizations running medical crowdfunding initiatives. Notably, national-level charities demonstrate a positive impact on total donations. The literature on NGO legitimacy in authoritarian contexts suggests that organizations lacking state endorsement, particularly grassroots NGOs without legal protections, often seek alignment with the state for security and legal registration 58 . Consequently, nationally registered charities tend to garner more resources and legitimacy, facilitating greater donation receipt 59 . Furthermore, disclosure of rewards conferred by regulatory bodies is statistically linked with crowdfunding success, consistent with previous research 22 . Importantly, our findings suggest potential heterogeneity in the influence of registration levels on online medical crowdfunding, challenging conventional perspectives on external signaling in this domain. These findings underscore the complexity of external signaling effects, which may not always exhibit a significant impact, warranting further exploration within the realm of online charity crowdfunding. Secondly, our findings indicate the influence of internal factors, such as updates, pictures, and title length, on the success of medical crowdfunding campaigns on Sina Micro-charities. Higher frequency updates correlate positively with crowdfunding success by providing crucial information on recipients’ conditions and fund utilization, aligning with prior research demonstrating a positive correlation between update frequency and crowdfunding success 60 . Project initiators disseminate updates to reflect the progress of the project 48 . For instance, the project has updated the information that it has supported patients to go to the hospital for treatment, which may increase donors' awareness of the project’s efforts 61 and increase potential donors’ trust 62 . Moreover, based on the relationship between the number of images and crowdfunding success 54 , the results indicate that the number of pictures positively impacts crowdfunding success. As a relatively low-cost signal, pictures can effectively convey information about a project, appealing to different sensory channels 50 . As the number of images increases, supporters gain better insight into project objectives and features, signaling the project sponsor’s commitment to success 48 . Additionally, longer titles, which provide more information 63 , 64 , and reduced information asymmetry 65 play a positive role in crowdfunding success, consistent with previous studies. However, the present study should be interpreted considering certain limitations, including focusing on a single platform during a limited timeframe. Moreover, the information obtained via web crawlers represents only a fraction of the factors influencing medical crowdfunding success 48 , with additional factors such as social network effects 66 and message characteristics warranting consideration. Despite these limitations, this research offers valuable practical implications. Project initiators are furnished with a taxonomy of signals, categorized as external and internal, enabling informed decision-making regarding signal selection. Notably, not all analyzed signals necessarily lead to crowdfunding success, necessitating careful signal selection aligned with project objectives. Fundraisers are encouraged to deploy signals to enhance project success probabilities strategically. Moreover, platforms serving as intermediaries in medical crowdfunding can facilitate project initiators by providing tools and resources of signals. For instance, platforms can offer guidance on best practices via online tutorials, aiding project creation and execution. Effective communication of the potential impact of signals by platforms can further bolster project success rates. Conclusion Using data from the Sina micro-charity platform, this study is the first to test the applicability of signaling theory to online medical crowdfunding campaigns in China. We examine how external and internal signals influence medical crowdfunding performance. The study finds that external signals, such as registration with national charities and awards, play an important role in crowdfunding success, while internal signals play a mixed role in crowdfunding success, suggesting that more images, longer title lengths and more updates are among the effective positive signals. The results of this study could help lay the foundation for a deeper understanding of charitable giving in China and enhance the success of crowdfunding campaigns. Declarations Conflict of Interest The authors declare no competing interests. Funding This study was supported by the National Social Science Fund of China (21CGL059), the Key Project of the Key Research Institute of Humanities and Social Science of the Chinese Ministry of Education (22JJD630016). Author Contribution XH designed the study and drafted the manuscript. WS revised the manuscript. YZ assisted in data collection and data analysis. QZ designed the study and revised the manuscript. All authors have read and approved the manuscript. Data Availability The data supporting this study’s findings are available on request from the corresponding author. References Belleflamme, P., Lambert, T. & Schwienbacher, A. Crowdfunding: Tapping the Right Crowd. Journal of Business Venturing 29, 585–609 (2014). Gleasure, R. & Feller, J. Does Heart or Head Rule Donor Behaviors in Charitable Crowdfunding Markets? International Journal of Electronic Commerce 20, 499–524 (2016). The Lancet Oncology. Mind the gap: charity and crowdfunding in health care. The Lancet Oncology 18, 269 (2017). Sisler, J. Crowdfunding for medical expenses. Canadian Medical Association Journal 184, E123–E124 (2012). Kenworthy, N. J. Crowdfunding and global health disparities: an exploratory conceptual and empirical analysis. Globalization and Health 15, 71–83 (2019). Kubheka, B. Z. Bioethics and the use of social media for medical crowdfunding. BMC Medical Ethics 21, 96–100 (2020). World health statistics 2018: Monitoring health for the SDGs, sustainable development goals. World Health Organization https://iris.who.int/bitstream/handle/10665/272596/9789241565585-eng.pdf?sequence=1 (2018). Zhang, F., Xue, B., Li, Y., Li, H. & Liu, Q. Effect of Textual Features on the Success of Medical Crowdfunding: Model Development and Econometric Analysis from the Tencent Charity Platform. Journal of Medical Internet Research 23, e22395 (2021). China’s Internet Charity Achievements Remarkable to the World, Gongyi.gmw.cn. https://gongyi.gmw.cn/2023-05/26/content_36589449.htm (2023). Coutrot, I. P., Smith, R. D. & Cornelsen, L. Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care? Journal of Health Services Research & Policy 25, 181–186 (2020). Jin, P. Medical crowdfunding in China: empirics and ethics. Journal of Medical Ethics 45, 538–544 (2019). Renwick, M. J. & Mossialos, E. Crowdfunding our health: Economic risks and benefits. Social Science & Medicine 191, 48–56 (2017). Snyder, J., Mathers, A. & Crooks, V. A. Fund my treatment!: A call for ethics-focused social science research into the use of crowdfunding for medical care. Social Science & Medicine 169, 27–30 (2016). Song, Y., Berger, R., Yosipof, A. & Barnes, B. R. Mining and investigating the factors influencing crowdfunding success. Technological Forecasting and Social Change 148, 119723 (2019). van Duynhoven, A. et al. Spatially exploring the intersection of socioeconomic status and Canadian cancer-related medical crowdfunding campaigns. BMJ Open 9, e026365 (2019). Ba, Z., Zhao, Y. (Chris), Song, S. & Zhu, Q. Understanding the determinants of online medical crowdfunding project success in China. Information Processing & Management 58, 102465 (2021). Kamatham, S. H., Pahwa, P., Jiang, J. & Kumar, N. Effect of appeal content on fundraising success and donor behavior. Journal of Business Research 125, 827–839 (2021). Parhankangas, A. & Renko, M. Linguistic style and crowdfunding success among social and commercial entrepreneurs. Journal of Business Venturing 32, 215–236 (2017). Xu, K. & Wang, X. ‘Kindhearted People, Please Save My Family’: Narrative Strategies for New Media Medical Crowdfunding. Health Communication 35, 1–9 (2019). Bassani, G., Marinelli, N. & Vismara, S. Crowdfunding in healthcare. The Journal of Technology Transfer 44, 1290–1310 (2018). Zhang, Y., Tan, C. D., Sun, J. & Yang, Z. Why do people patronize donation-based crowdfunding platforms? An activity perspective of critical success factors. Computers in Human Behavior 112, 106470 (2020). Pan, X., Dong, L. What Determines the Success of Charitable Crowdfunding Campaigns? Evidence from China During the COVID-19 Pandemic. Voluntas 34, 1284–1298 (2023). Hou, X., Wu, T., Chen, Z. & Zhou, L. Success Factors of Medical Crowdfunding Campaigns: Systematic Review. Journal of Medical Internet Research 24, e30189 (2022). Zhai, Y. & Shen, W. Signaling theory in charity-based crowdfunding: Investigating the effects of project creator characteristics and text linguistic style on fundraising performance. Heliyon 10, e25756 (2024). Tsai, K. S. & Wang, Q. Charitable Crowdfunding in China: An Emergent Channel for Setting Policy Agendas? The China Quarterly 240, 936–966 (2019). Spence, M. Job Market Signaling. Uncertainty in Economics 87, 281–306 (1978). Wells, J. D., Valacich, J. S. & Hess, T. J. What Signal Are You Sending? How Website Quality Influences Perceptions of Product Quality and Purchase Intentions. MIS Quarterly 35, 373–396 (2011). Ahlers, G. K. C., Cumming, D., Günther, C. & Schweizer, D. Signaling in Equity Crowdfunding. Entrepreneurship Theory and Practice 39, 955–980 (2015). Mavlanova, T., Benbunan-Fich, R. & Lang, G. The role of external and internal signals in E-commerce. Decision Support Systems 87, 59–68 (2016). Davies, W. E. & Giovannetti, E. Signalling experience & reciprocity to temper asymmetric information in crowdfunding evidence from 10,000 projects. Technological Forecasting and Social Change 133, 118–131 (2018). Chan, H. F., Moy, N., Schaffner, M. & Torgler, B. The effects of money saliency and sustainability orientation on reward-based crowdfunding success. Journal of Business Research 125, 443–455 (2021). Piva, E. & Rossi-Lamastra, C. Human capital signals and entrepreneurs’ success in equity crowdfunding. Small Business Economics 51, 667–686 (2017). Kleinert, S., Volkmann, C. & Grünhagen, M. Third-party signals in equity crowdfunding: the role of prior financing. Small Business Economics 54, 367–372 (2020). Ho, H. et al. The Influence of Signals on Donation Crowdfunding Campaign Success during COVID-19 Crisis. International Journal of Environmental Research and Public Health 18, 7715 (2021). Weisbrod, B. A. & Dominguez, N. D. Demand for collective goods in private nonprofit markets: Can fundraising expenditures help overcome free-rider behavior? Journal of Public Economics 30, 83–96 (1986). Chen, Y., Zhou, S., Jin, W. & Chen, S. Investigating the determinants of medical crowdfunding performance: a signaling theory perspective. Internet Research 33, 1134–1156 (2023). Pfeffer, J. & Salancik, G. The External Control of Organizations: A Resource Dependence Perspective. in Organizational Behavior 2 355–371 (Routledge, 2006). Handy, F. How We Beg: The Analysis of Direct Mail Appeals. Nonprofit and Voluntary Sector Quarterly 29, 439–454 (2000). Chen, L. Zhang, L. Yang, P. Characteristics of charitable organizations, information disclosure and donation income, Contemporary Finance & Economics 11, 107–117 (2015). Li, G. Bu, D. The Effectiveness of commonweal projects' online crowd-funding and its influencing factors, Youth Studies 5, 14–23 (2021). Pang, B. Regulation on the Evaluation of National Social Organisations, www.gov.cn. https://www.gov.cn/zhengce/zhengceku/2021-12/11/content_5659896.htm (2021). Wang, Z. Wang, X. Trust and Donation: The Role of Social Network in Donation-based Crowdfunding, Management World 3, 34–50 (2021). Salido-Andres, N., Rey-Garcia, M., Alvarez-Gonzalez, L. I. & Vazquez-Casielles, R. Nonprofit Organizations at the Crossroads of Offline Fundraising and Social Innovation: The Influence of Promoter Behavior on the Success of Donation-Based Crowdfunding Through Digital Platforms, Lecture Notes in Electrical Engineering. in Lecture Notes in Electrical Engineering (eds. Machado, J., Soares, F. & Veiga, G.) 946–952 (Springer, Cham., 2018). Lagazio, C. & Querci, F. Exploring the multi-sided nature of crowdfunding campaign success. Journal of Business Research 90, 318–324 (2018). Mollick, E. The dynamics of crowdfunding: An exploratory study. Journal of Business Venturing 29, 1–16 (2014). Clauss, T., Breitenecker, R. J., Kraus, S., Brem, A. & Richter, C. Directing the wisdom of the crowd: the importance of social interaction among founders and the crowd during crowdfunding campaigns. Economics of Innovation and New Technology 27, 709–729 (2017). Block, J., Hornuf, L. & Moritz, A. Which updates during an equity crowdfunding campaign increase crowd participation? Small Business Economics 50, 3–27 (2017). Kunz, M. M., Bretschneider, U., Erler, M. & Leimeister, J. M. An empirical investigation of signaling in reward-based crowdfunding. Electronic Commerce Research 17, 425–461 (2016). Ren, J., Raghupathi, V. & Raghupathi, W. Understanding the Dimensions of Medical Crowdfunding: A Visual Analytics Approach. Journal of Medical Internet Research 22, e18813 (2020). Usman, S. M., Bukhari, F. A. S., Usman, M., Badulescu, D. & Sial, M. S. Does the Role of Media and Founder’s Past Success Mitigate the Problem of Information Asymmetry? Evidence from a UK Crowdfunding Platform. Sustainability 11, 692 (2019). Kelsey, C., Vaish, A. & Grossmann, T. Eyes, More Than Other Facial Features, Enhance Real-World Donation Behavior. Human Nature 29, 390–401. (2018) Perrine, R. M. & Heather, S. Effects of Picture and Even-a-Penny-Will-Help Appeals on Anonymous Donations to Charity. Psychological Reports 86, 551–559 (2000). Chang, C. & Lee, Y. Effects of message framing, vividness congruency and statistical framing on responses to charity advertising. International Journal of Advertising 29, 195–220 (2010). Isen, A. M. & Noonberg, A. R. The Effect of Photographs of the Handicapped on Donation to Charity: When a Thousand Words May be too Much. Journal of Applied Social Psychology 9, 426–431 (1979). Defazio, D., Franzoni, C. & Rossi-Lamastra, C. How Pro-social Framing Affects the Success of Crowdfunding Projects: The Role of Emphasis and Information Crowdedness. J Bus Ethics 171, 357–378 (2021). Bhati, A. & McDonnell, D. Success in an Online Giving Day: The Role of Social Media in Fundraising. Nonprofit and Voluntary Sector Quarterly 49, 74–92 (2019). Saxton, G. D. & Wang, L. The Social Network Effect. Nonprofit and Voluntary Sector Quarterly 43, 850–868 (2013). Heurlin, C. Governing Civil Society: The Political Logic of NGO–State Relations Under Dictatorship. VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations 21, 220–239 (2009). Hsu, C. Beyond Civil Society: An Organizational Perspective on State–NGO Relations in the People’s Republic of China. Journal of Civil Society 6, 259–277 (2010). Kuppuswamy, V. & Bayus, B. L. Crowdfunding Creative Ideas: The Dynamics of Project Backers in Kickstarter . SSRN Electronic Journal (2013) Mejia, J., Urrea, G. & Pedraza-Martinez, A. J. Operational Transparency on Crowdfunding Platforms: Effect on Donations for Emergency Response. Production and Operations Management 28, 1773–1791 (2019). Sargeant, A., Ford, J. B. & West, D. C. Perceptual determinants of nonprofit giving behavior. Journal of Business Research 59, 155–165 (2006). Crosetto, P. & Regner, T. It’s never too late: Funding dynamics and self pledges in reward-based crowdfunding. Research Policy 47, 1463–1477 (2018). Zhou, M., Lu, B., Fan, W. & Wang, G. A. Project description and crowdfunding success: an exploratory study. Information Systems Frontiers 20, 259–274 (2016). Dorfleitner, G. et al. Description-text related soft information in peer-to-peer lending – Evidence from two leading European platforms. Journal of Banking & Finance 64, 169–187 (2016). Wang, L. & Graddy, E. Social Capital, Volunteering, and Charitable Giving. VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations 19, 23–42 (2008). Tables Tables 1-3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.pdf Cite Share Download PDF Status: Posted Version 1 posted 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-4375164","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":311299003,"identity":"498614ec-0a73-43ec-9bbb-045272525987","order_by":0,"name":"Xiaorui Huang","email":"","orcid":"","institution":"Huaqiao University","correspondingAuthor":false,"prefix":"","firstName":"Xiaorui","middleName":"","lastName":"Huang","suffix":""},{"id":311299004,"identity":"5b4bd606-4b59-4d1a-89db-ddc18c3e6041","order_by":1,"name":"Wei Sun","email":"","orcid":"","institution":"Center for Social Security Studies of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Sun","suffix":""},{"id":311299005,"identity":"c228e689-4d4f-43c1-9371-5c0396cd540c","order_by":2,"name":"Ying Zhang","email":"","orcid":"","institution":"Beijing Jinkaiweiye Consulting Co., Ltd","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Zhang","suffix":""},{"id":311299006,"identity":"39189e4f-251b-4ab4-b0c0-6ee82c05293d","order_by":3,"name":"Qilin Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYDACZuaGAwwMB0CsA8xgkQMEtTDCtLAlEKmFgbEBqozHgDgtfMcZGw8X/Lkjb86/5pt0YRuDHN+NBMbPBXi0SB5mbDg8g+eZ4c4Zb7dJz2xjMJa8kcAsPQOPFgOQFh6Jw4wbbpzddpu3jSFxw40ENmYegloMDttvuHHmGUhLPZFaEg4nbjjfwwbSkmBASAvYLzwHDidvuMFm/pvnnIThzDMPm6XxaeE7f/jwZ54/h203nD/82JinzEae73jywc/4tCBiQSIBTDJAY4oYLfwHcCsaBaNgFIyCkQ0A1HNWAheX138AAAAASUVORK5CYII=","orcid":"","institution":"Center for Social Security Studies of Wuhan University","correspondingAuthor":true,"prefix":"","firstName":"Qilin","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-05-06 08:15:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4375164/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4375164/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58152933,"identity":"0e3d2599-f8e1-4a44-b20a-c84fa82723b3","added_by":"auto","created_at":"2024-06-11 20:24:42","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":204337,"visible":true,"origin":"","legend":"\u003cp\u003eResearch Framework. Resource: Own elaboration\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4375164/v1/08aab9b709f048f6715c1f5b.jpg"},{"id":58154668,"identity":"d9044c24-00f4-439c-a9a2-fbbaaf56bd54","added_by":"auto","created_at":"2024-06-11 20:40:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":632198,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4375164/v1/abfac78c-c644-40ff-8aab-ea3ecdd61d78.pdf"},{"id":58153752,"identity":"b7230e25-4afb-4ddf-b7fa-c2bd679bd0b5","added_by":"auto","created_at":"2024-06-11 20:32:42","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":205583,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4375164/v1/cd6691d9ffa0b50e553ea8b8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Understanding the determinants of medical crowdfunding performance: A signaling theory perspective","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOnline charitable crowdfunding, characterized by the practice of funding projects through soliciting financial contributions from the public within a limited timeframe\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, has reshaped the landscape of charitable giving by merging traditional methods with IT-enabled crowdfunding\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Particularly prominent in the health sector, online charitable crowdfunding has garnered considerable attention \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Recent studies indicate that a majority of crowdfunding campaigns focus on medical or health-related fundraising\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. This trend is attributed to gaps in social welfare systems, escalating healthcare costs and debt burdens, and inadequate healthcare coverage\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Half the global population still lacks access to required healthcare services\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. China has established a relatively comprehensive medical security system, yet several patients still have to bear hefty medical costs, leading to considerable healthcare expenses and impoverishment\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Medical crowdfunding plays a pivotal role in addressing the high cost of treatment. According to statistics, over the eight years leading up to 2023, more than 51\u0026nbsp;billion individuals in China have engaged in Internet charity, raising 35\u0026nbsp;billion yuan\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, which warrants further discussion.\u003c/p\u003e \u003cp\u003eDespite the high demand for medical crowdfunding, its success rates remain modest, with failure rates reaching 60% in the UK\u003csup\u003e10\u003c/sup\u003e and 90% in China\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Prior research highlights a dearth of empirical studies on the key factors contributing to project success\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Hence, there is a pressing need for academia and industry to investigate and analyze the determinants of success in online medical crowdfunding projects, facilitating more efficient project design and implementation. Scholars have examined how the characteristics of fundraisers and organizations influence the performance of medical crowdfunding efforts\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Additionally, context-related characteristics\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, such as persuasive narratives\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e and platform features\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e significantly impact fundraising outcomes. Previous research on the determinants of successful donation campaigns has produced inconsistent results. This may be due to variations in the urgency of medical demand and consequences. Further investigation is, therefore, necessary to identify these determinants in the context of medical crowdfunding to enhance crowdfunding performance and improve patient well-being.\u003c/p\u003e \u003cp\u003eAnother research gap lies in the predominant use of data from North America and Europe or platforms like GoFundMe, Kickstarter, and Indiegogo in major studies on online medical crowdfunding\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, and cultural differences between Chinese, European, and American make the previous research not applicable to charity crowdfunding in the context of China\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Furthermore, most existing studies on online medical crowdfunding in China concentrate on platforms like Tencent GongYi, Qingsongchou, or social crowdfunding\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, lacking research on online medical crowdfunding from Sina Micro-charities platform on Sina Weibo, one of the leading online medical crowdfunding platforms. According to the report of China Philanthropy Times in 2021, over 7\u0026nbsp;million individuals donated on this platform and the funding was more than 700\u0026nbsp;million yuan. Charitable Crowdfunding on Sina Weibo plays a dominant role in the market\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, including detailed information on charity crowdfunding projects, which provides sufficient data for our research.\u003c/p\u003e \u003cp\u003eTo address these research gaps, our study aims to identify the factors influencing the success of medical crowdfunding for charitable purposes. Building on Spence's signaling theory, we examine the impact of external and internal signals on medical crowdfunding performance. Our data, sourced from Sina Micro-charities, a prominent medical crowdfunding platform in China, sheds light on the determinants of medical crowdfunding performance, thereby enhancing social welfare by meeting unmet medical needs.\u003c/p\u003e \n\u003ch3\u003eLiterature review and hypothesis\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eSignaling theory and its applicability to donation-based crowdfunding\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eSpence introduced signaling theory, defining signals as \"the activities or attributes of individuals in a market, by design or accident\"\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. This theory provides a framework for understanding how one party can employ signals to convey limited or obscured quality information to another party, thereby facilitating a purchase or exchange\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Within information asymmetry, signaling theory examines how signalers utilize observable features (signals) to communicate information about their unobservable attributes to others\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSignaling theory has found utility as an analytical tool in various contexts, notably reward-based crowdfunding\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, equity-based crowdfunding\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, and donation-based crowdfunding\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. According to the previous study\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e, asymmetric information between the providers and the contributors is ubiquitous in crowdfunding markets, where charitable donations are a significant source of revenue. Consequently, signaling likely plays a crucial role in charitable crowdfunding. However, research applying signaling theory to donation-based charitable crowdfunding remains limited. For instance, a study examined the relationship between external and internal quality signals and the success of 427 COVID-19 crowdfunding campaigns\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Similarly, scholars investigated the factors that affect medical crowdfunding outcomes on the Qingsongchou platform in China using a signaling theory framework\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Despite these efforts, a more precise theoretical framework is needed to fully comprehend the function of signaling in charitable crowdfunding.\u003c/p\u003e\n\u003ch3\u003eExternal and Internal Signals in Charitable Crowdfunding\u003c/h3\u003e\n\u003cp\u003eExternal Signals\u003c/p\u003e \u003cp\u003eExternal signals refer to endorsements from third parties. Seals indicating verification by or affiliation with well-recognized external entities generally enhance trustworthiness and imply higher quality\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. According to the Resource Dependence Theory, charities must acquire resources from their environment for sustainable development\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. It is crucial for them to gain recognition from third parties in public fundraising. Moreover, endorsements from governmental entities can serve as effective external signals easily noticeable to donors\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. In China, charitable organizations are registered at national or local levels, with national-level organizations enjoying superior resources, opportunities, and credibility among the public\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. However, some studies have noted a declining success rate trend for programs initiated by national-level organizations\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. In addition, a charity’s past achievements can serve as a signaling mechanism\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Thus, we propose:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 1\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e(H1) The Charitable organizations at the national level positively influence crowdfunding success.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eThe Ministry of Civil Affairs (MCA), as the main regulator of charitable organizations, conducts comprehensive assessments across four categories in China, including basic requirements, internal management, performance, and social impact analysis\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. After evaluation, organizations are rated on a five-grade scale, with 5A being the highest rating. This rating system also indicates an approval of the organization's past achievements. Consequently, we suggest:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 2\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e(H2) The Charitable organizations rating higher influence crowdfunding success.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eInternal Signals\u003c/p\u003e \u003cp\u003eInternal signals arise from the seller's internal decisions to project a particular image or communicate a specific company policy, offering evidence of the seller's commitments\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Given the information asymmetry inherent in medical charitable crowdfunding\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e, charities earn donor trust by pledging to deliver anticipated outcomes. Consequently, some project indicators can be signals from the charity to the potential donor.\u003c/p\u003e \u003cp\u003eFirstly, updates play a crucial role in medical crowdfunding performance. Fundraisers providing project feedback can benefit donors by informing them about the effectiveness of their donations, potentially motivating more contributions\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. Scholars have found that including any project update can increase the likelihood of success by 5%\u003csup\u003e44\u003c/sup\u003e while omitting updates reduces the chance of success by 13%\u003csup\u003e45\u003c/sup\u003e. Campaigns with frequent updates on fundraising progress tend to achieve better results\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. However, some scholars suggest that updates represent one-sided communication tools used by fundraisers to convey the value and legitimacy of their campaigns, potentially impacting trustworthiness and credibility to some extent\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. Thus, we propose:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 3\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e(H3) The presence of any update will positively affect the successful probability of a crowdfunding campaign.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eSecondly, the duration of a crowdfunding campaign refers to the timeframe during which project initiators seek financial contributions from the crowd\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. It is found that lengthy fundraising activities suggest a lower fundraising success rate for project sponsors\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e and provide evidence that project sponsors do not prioritize completing fundraising as soon as possible, as this can diminish supporters' confidence in the project’s ability to achieve its goal within the designated timeframe\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. When investigating the duration of crowdfunding, scholars have found that the success rate of projects gradually decreases as the duration increases. It is suggested that supporters associate shorter pre-set durations with more promising prospects for achieving their desired goal promptly\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Scholars have observed that campaigns lasting between two and five months receive better funding and are more likely to achieve their objectives\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e, with the highest success rate observed for projects lasting 0–20 days\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. We thus hypothesize:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 4\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e(H4) As the campaign duration increases, the probability of project success decreases.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eThirdly, the number of pictures significantly impacts project success. Research indicates that incorporating visuals can enhance project descriptions, while well-designed project presentations demonstrate the sponsor's commitment and aspiration for success\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. Visual elements can engage multiple sensory channels, appealing to the audience\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. Including an image of a person making eye contact can increase individuals' willingness to donate\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. Previous research has shown both positive\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e and negative effects\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e of presenting optimistic expressions, while including images can enhance crowdfunding success. However, displaying a picture of a distressed beneficiary may deter potential donors\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. Consequently, we formulate the following hypothesis:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 5\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e(H5) As the number of pictures increases, the probability of project success increases.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eFurthermore, the title description is a crucial factor in crowdfunding campaign success. The title plays an essential role in attracting and enhancing the public's understanding of the narrative description \u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e. Additionally, the title length significantly predicts crowdfunding campaign success, as some readers base their decisions solely on headline information\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e. Prior studies have shown that incorporating only 4–5 words in the title can enhance the chances of campaign success \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e while engaging headlines with 6 to 11 words correlate strongly with successful fundraising \u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. We thus hypothesize:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 6\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e(H6) As title length increases, the probability of project success decreases.\u003c/p\u003e \u003cp\u003e[Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e about here.]\u003c/p\u003e \u003cp\u003eThe research framework is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e "},{"header":"Methods","content":"\u003ch2\u003eData sources and sample selection\u003c/h2\u003e\u003cp\u003eThe data source for this study is the Sina Micro-charities platform, which leverages the widespread popularity of Sina Weibo, one of China's leading online social networks founded in 2012. The Sina Micro-charities platform organizes campaigns to raise funds for various categories, including medical, emergency scenarios, and charitable causes. Medical category data from the Sina Micro-charities platform spanning from 2019 to 2021 were extracted for this research. Python 3.10.1 was utilized to crawl data from the medical category.\u003c/p\u003e\u003cp\u003eA total of 2604 medical crowdfunding campaigns were obtained through web crawling, comprising 1889 campaigns launched in 2019, 354 in 2020, and 361 in 2021. Due to format discrepancies, various information elements, including updates and the number of pictures, were manually classified. We meticulously scrutinized the contents of each program to extract relevant information. To ensure precision in the identification process, two research assistants were appointed by the authors to authenticate and input the data according to established regulations. The authors further conducted a consistency check to validate the data subsequently included in the analysis.\u003c/p\u003e\u003cp\u003eTo test the proposed hypotheses, the study utilized a systematic and random sampling technique to select 300 programs from 2,604 projects, with a yearly sample size of 100. For 2019, a total of 105 programs were sampled at a sample interval of 18. Equally, 118 and 120 programs were randomly sampled for 2020 and 2021, respectively, at a sample interval of 3 for each year. Program variables were coded based on the proposed hypotheses. Following the exclusion of samples with missing values and outliers, 340 valid samples were identified for subsequent analysis.\u003c/p\u003e\u003ch2\u003eVariables\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;1 lists all of the variables considered with their descriptions.\u003c/p\u003e\u003cp\u003e \u003cb\u003eOutcome variable\u003c/b\u003e. Medical crowdfunding performance in this study was measured with total donation amount, following previous research on online giving22,56.\u003c/p\u003e\u003cp\u003e \u003cb\u003eIndependent Variables\u003c/b\u003e. Registered (H1) was examined based on the administrative level of MCA approving the establishment of the charitable foundation. Award (H2) was measured by ratings granted by MCA. Update (H3) was assessed by whether the project’s fundraising dynamic progress was updated. Duration (H4) was measured by the number of days a project runs predetermined by the fundraiser. Picture (H5) was examined by the number of images included in the project information. Title length (H6) was calculated with the number of words in the project title.\u003c/p\u003e\u003cp\u003eCovariates in this study include the program launch year (2019/2020/2021), location (Central China/ East China\\ West China\\ Northeast China), goal and disease type (Hematological Disorder/ Malignancy/ Congenital Disease/ Accidental Injury/ Others), fans of the charitable organizations, and age of patient.\u003c/p\u003e\u003cp\u003e[Table\u0026nbsp;1 about here.]\u003c/p\u003e\u003ch2\u003eStatistical strategies\u003c/h2\u003e\u003cp\u003eDescriptive analyses were conducted for all study variables presenting mean scores and standard deviations for continuous variables and estimating frequencies and proportions for categorical variables. Subsequently, Ordinary Least Squares (OLS) regression was used to test our hypotheses, given the continuous nature of the dependent variable, the total donation amount56,57. Seven regression models were executed, with multiple tests performed to assess multicollinearity in each model. The maximum variance inflation factor (VIF) values were below 5, indicating no strong multicollinearity in our models. All analyses were conducted in STATA 16.0 version.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive analysis\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;2 presents the descriptive statistics of the sample. Among the total sample (n\u0026thinsp;=\u0026thinsp;340), the mean and median sum of donations were 39752.06 RMB and 3333.83 RMB, respectively. The majority of projects were hosted on national charitable organizations\u0026rsquo; platforms (N\u0026thinsp;=\u0026thinsp;201, 59.12%) and were regularly updated (N\u0026thinsp;=\u0026thinsp;242, 71.18%). Around 51.12% of the charitable organizations\u0026rsquo; ratings were at the 5A level. The average predetermined duration was approximately 77 days. On average, projects provided 7.56 images, with a mean title length of 13.41.\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;2 about here.]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eRegression Results\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;3 presents the factors influencing the success of COVID-19 crowdfunding efforts, analyzed through seven regression models. Model 1 results show that charitable organizations at the national level positively impact total donations compared to local ones (β\u0026thinsp;=\u0026thinsp;1.229, p\u0026lt;0.01), supporting H1. Additionally, model 2 shows that 3A and 5A ratings granted by MCA positively impact total donations compared to unspecified ratings, supporting H2. Model 3 supports H3, demonstrating a significant and positive correlation between project updates and crowdfunding success. Specifically, updates correlate positively with the expected increase in donations (β\u0026thinsp;=\u0026thinsp;2.509, p\u0026lt;0.01). The results in Model 5 show a positive and significant relationship between the pictures and crowdfunding success (β\u0026thinsp;=\u0026thinsp;0.165, p\u0026lt;0.01), verifying H5. The results in Model 6 show a positive and significant relationship between title length and crowdfunding success (β\u0026thinsp;=\u0026thinsp;0.082, p\u0026lt;0.05), supporting H6. Consistent results are observed in Model 7, with a positive coefficient on updates (β\u0026thinsp;=\u0026thinsp;2.402, p\u0026lt;0.01), a positive coefficient on pictures (β\u0026thinsp;=\u0026thinsp;0.120, p\u0026lt;0.01), and a positive coefficient on title lengths (β\u0026thinsp;=\u0026thinsp;0.065, p\u0026lt;0.05). However, we do not find a significant relationship between duration and crowdfunding success.\u003c/p\u003e \u003cp\u003eCovariate results indicate that crowdfunding campaigns launched in 2020 and 2021, patients from the East of China, and higher fundraising goals tend to receive more donations, showing a positive significant relationship across all models (Model 1, Model 2, Model 3, Model 4, Model 5, Model 6, Model 7). Moreover, the fans of charitable organizations between 100000 to 200000 seem to be able to attract less donations.\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;3 about here.]\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn response to recent studies highlighting the remarkable growth of online medical crowdfunding campaigns, this study offers novel insights by examining the influencing factors of crowdfunding success through the lens of signaling theory. The results underscore the significant roles played by both external and internal signals in determining the total amount of donations. This study represents the first comprehensive investigation into Sina Weibo\u0026rsquo;s medical crowdfunding program from a signaling theory perspective, yielding several noteworthy findings that merit further discussion.\u003c/p\u003e \u003cp\u003eFirstly, regarding the complex and controversial findings on the role of signaling in online crowdfunding\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, we suggest that external signals, including registration levels and awards, influence medical crowdfunding performance on Sina Micro-charities. Signaling mechanisms can bolster trustworthiness to a certain extent, thus addressing the principal-agent problem in medical crowdfunding. According to a previous study\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, external signals mainly come from third-party endorsements, especially the registered location and ratings of charitable organizations running medical crowdfunding initiatives. Notably, national-level charities demonstrate a positive impact on total donations. The literature on NGO legitimacy in authoritarian contexts suggests that organizations lacking state endorsement, particularly grassroots NGOs without legal protections, often seek alignment with the state for security and legal registration\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e. Consequently, nationally registered charities tend to garner more resources and legitimacy, facilitating greater donation receipt\u003csup\u003e\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e. Furthermore, disclosure of rewards conferred by regulatory bodies is statistically linked with crowdfunding success, consistent with previous research\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Importantly, our findings suggest potential heterogeneity in the influence of registration levels on online medical crowdfunding, challenging conventional perspectives on external signaling in this domain. These findings underscore the complexity of external signaling effects, which may not always exhibit a significant impact, warranting further exploration within the realm of online charity crowdfunding.\u003c/p\u003e \u003cp\u003eSecondly, our findings indicate the influence of internal factors, such as updates, pictures, and title length, on the success of medical crowdfunding campaigns on Sina Micro-charities. Higher frequency updates correlate positively with crowdfunding success by providing crucial information on recipients\u0026rsquo; conditions and fund utilization, aligning with prior research demonstrating a positive correlation between update frequency and crowdfunding success\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e. Project initiators disseminate updates to reflect the progress of the project\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. For instance, the project has updated the information that it has supported patients to go to the hospital for treatment, which may increase donors' awareness of the project\u0026rsquo;s efforts\u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e and increase potential donors\u0026rsquo; trust\u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e. Moreover, based on the relationship between the number of images and crowdfunding success\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e, the results indicate that the number of pictures positively impacts crowdfunding success. As a relatively low-cost signal, pictures can effectively convey information about a project, appealing to different sensory channels\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. As the number of images increases, supporters gain better insight into project objectives and features, signaling the project sponsor\u0026rsquo;s commitment to success\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. Additionally, longer titles, which provide more information\u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e, and reduced information asymmetry\u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u003c/sup\u003e play a positive role in crowdfunding success, consistent with previous studies.\u003c/p\u003e \u003cp\u003eHowever, the present study should be interpreted considering certain limitations, including focusing on a single platform during a limited timeframe. Moreover, the information obtained via web crawlers represents only a fraction of the factors influencing medical crowdfunding success\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e, with additional factors such as social network effects\u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e and message characteristics warranting consideration.\u003c/p\u003e \u003cp\u003eDespite these limitations, this research offers valuable practical implications. Project initiators are furnished with a taxonomy of signals, categorized as external and internal, enabling informed decision-making regarding signal selection. Notably, not all analyzed signals necessarily lead to crowdfunding success, necessitating careful signal selection aligned with project objectives. Fundraisers are encouraged to deploy signals to enhance project success probabilities strategically. Moreover, platforms serving as intermediaries in medical crowdfunding can facilitate project initiators by providing tools and resources of signals. For instance, platforms can offer guidance on best practices via online tutorials, aiding project creation and execution. Effective communication of the potential impact of signals by platforms can further bolster project success rates.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUsing data from the Sina micro-charity platform, this study is the first to test the applicability of signaling theory to online medical crowdfunding campaigns in China. We examine how external and internal signals influence medical crowdfunding performance. The study finds that external signals, such as registration with national charities and awards, play an important role in crowdfunding success, while internal signals play a mixed role in crowdfunding success, suggesting that more images, longer title lengths and more updates are among the effective positive signals. The results of this study could help lay the foundation for a deeper understanding of charitable giving in China and enhance the success of crowdfunding campaigns.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of Interest\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by the National Social Science Fund of China (21CGL059), the Key Project of the Key Research Institute of Humanities and Social Science of the Chinese Ministry of Education (22JJD630016).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXH designed the study and drafted the manuscript. WS revised the manuscript. YZ assisted in data collection and data analysis. QZ designed the study and revised the manuscript. All authors have read and approved the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data supporting this study\u0026rsquo;s findings are available on request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBelleflamme, P., Lambert, T. \u0026amp; Schwienbacher, A. Crowdfunding: Tapping the Right Crowd. Journal of Business Venturing 29, 585\u0026ndash;609 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGleasure, R. \u0026amp; Feller, J. Does Heart or Head Rule Donor Behaviors in Charitable Crowdfunding Markets? International Journal of Electronic Commerce 20, 499\u0026ndash;524 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Lancet Oncology. Mind the gap: charity and crowdfunding in health care. The Lancet Oncology 18, 269 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSisler, J. Crowdfunding for medical expenses. Canadian Medical Association Journal 184, E123\u0026ndash;E124 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKenworthy, N. J. Crowdfunding and global health disparities: an exploratory conceptual and empirical analysis. Globalization and Health 15, 71\u0026ndash;83 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKubheka, B. Z. Bioethics and the use of social media for medical crowdfunding. BMC Medical Ethics 21, 96\u0026ndash;100 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld health statistics 2018: Monitoring health for the SDGs, sustainable development goals. \u003cem\u003eWorld Health Organization\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/bitstream/handle/10665/272596/9789241565585-eng.pdf?sequence=1\u003c/span\u003e\u003cspan address=\"https://iris.who.int/bitstream/handle/10665/272596/9789241565585-eng.pdf?sequence=1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, F., Xue, B., Li, Y., Li, H. \u0026amp; Liu, Q. Effect of Textual Features on the Success of Medical Crowdfunding: Model Development and Econometric Analysis from the Tencent Charity Platform. Journal of Medical Internet Research 23, e22395 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChina\u0026rsquo;s Internet Charity Achievements Remarkable to the World, \u003cem\u003eGongyi.gmw.cn.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://gongyi.gmw.cn/2023-05/26/content_36589449.htm\u003c/span\u003e\u003cspan address=\"https://gongyi.gmw.cn/2023-05/26/content_36589449.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoutrot, I. P., Smith, R. D. \u0026amp; Cornelsen, L. Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care? Journal of Health Services Research \u0026amp; Policy 25, 181\u0026ndash;186 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin, P. Medical crowdfunding in China: empirics and ethics. Journal of Medical Ethics 45, 538\u0026ndash;544 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenwick, M. J. \u0026amp; Mossialos, E. Crowdfunding our health: Economic risks and benefits. Social Science \u0026amp; Medicine 191, 48\u0026ndash;56 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSnyder, J., Mathers, A. \u0026amp; Crooks, V. A. Fund my treatment!: A call for ethics-focused social science research into the use of crowdfunding for medical care. Social Science \u0026amp; Medicine 169, 27\u0026ndash;30 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong, Y., Berger, R., Yosipof, A. \u0026amp; Barnes, B. R. Mining and investigating the factors influencing crowdfunding success. Technological Forecasting and Social Change 148, 119723 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Duynhoven, A. et al. Spatially exploring the intersection of socioeconomic status and Canadian cancer-related medical crowdfunding campaigns. BMJ Open 9, e026365 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBa, Z., Zhao, Y. (Chris), Song, S. \u0026amp; Zhu, Q. Understanding the determinants of online medical crowdfunding project success in China. Information Processing \u0026amp; Management 58, 102465 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamatham, S. H., Pahwa, P., Jiang, J. \u0026amp; Kumar, N. Effect of appeal content on fundraising success and donor behavior. Journal of Business Research 125, 827\u0026ndash;839 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParhankangas, A. \u0026amp; Renko, M. Linguistic style and crowdfunding success among social and commercial entrepreneurs. Journal of Business Venturing 32, 215\u0026ndash;236 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu, K. \u0026amp; Wang, X. \u0026lsquo;Kindhearted People, Please Save My Family\u0026rsquo;: Narrative Strategies for New Media Medical Crowdfunding. Health Communication 35, 1\u0026ndash;9 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassani, G., Marinelli, N. \u0026amp; Vismara, S. Crowdfunding in healthcare. The Journal of Technology Transfer 44, 1290\u0026ndash;1310 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, Y., Tan, C. D., Sun, J. \u0026amp; Yang, Z. Why do people patronize donation-based crowdfunding platforms? An activity perspective of critical success factors. Computers in Human Behavior 112, 106470 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePan, X., Dong, L. What Determines the Success of Charitable Crowdfunding Campaigns? Evidence from China During the COVID-19 Pandemic. Voluntas 34, 1284\u0026ndash;1298 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHou, X., Wu, T., Chen, Z. \u0026amp; Zhou, L. Success Factors of Medical Crowdfunding Campaigns: Systematic Review. Journal of Medical Internet Research 24, e30189 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhai, Y. \u0026amp; Shen, W. Signaling theory in charity-based crowdfunding: Investigating the effects of project creator characteristics and text linguistic style on fundraising performance. Heliyon 10, e25756 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsai, K. S. \u0026amp; Wang, Q. Charitable Crowdfunding in China: An Emergent Channel for Setting Policy Agendas? The China Quarterly 240, 936\u0026ndash;966 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpence, M. Job Market Signaling. Uncertainty in Economics 87, 281\u0026ndash;306 (1978).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWells, J. D., Valacich, J. S. \u0026amp; Hess, T. J. What Signal Are You Sending? How Website Quality Influences Perceptions of Product Quality and Purchase Intentions. MIS Quarterly 35, 373\u0026ndash;396 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhlers, G. K. C., Cumming, D., G\u0026uuml;nther, C. \u0026amp; Schweizer, D. Signaling in Equity Crowdfunding. Entrepreneurship Theory and Practice 39, 955\u0026ndash;980 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMavlanova, T., Benbunan-Fich, R. \u0026amp; Lang, G. The role of external and internal signals in E-commerce. Decision Support Systems 87, 59\u0026ndash;68 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavies, W. E. \u0026amp; Giovannetti, E. Signalling experience \u0026amp; reciprocity to temper asymmetric information in crowdfunding evidence from 10,000 projects. Technological Forecasting and Social Change 133, 118\u0026ndash;131 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan, H. F., Moy, N., Schaffner, M. \u0026amp; Torgler, B. The effects of money saliency and sustainability orientation on reward-based crowdfunding success. Journal of Business Research 125, 443\u0026ndash;455 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePiva, E. \u0026amp; Rossi-Lamastra, C. Human capital signals and entrepreneurs\u0026rsquo; success in equity crowdfunding. Small Business Economics 51, 667\u0026ndash;686 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKleinert, S., Volkmann, C. \u0026amp; Gr\u0026uuml;nhagen, M. Third-party signals in equity crowdfunding: the role of prior financing. Small Business Economics 54, 367\u0026ndash;372 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHo, H. et al. The Influence of Signals on Donation Crowdfunding Campaign Success during COVID-19 Crisis. International Journal of Environmental Research and Public Health 18, 7715 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeisbrod, B. A. \u0026amp; Dominguez, N. D. Demand for collective goods in private nonprofit markets: Can fundraising expenditures help overcome free-rider behavior? Journal of Public Economics 30, 83\u0026ndash;96 (1986).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen, Y., Zhou, S., Jin, W. \u0026amp; Chen, S. Investigating the determinants of medical crowdfunding performance: a signaling theory perspective. Internet Research 33, 1134\u0026ndash;1156 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePfeffer, J. \u0026amp; Salancik, G. The External Control of Organizations: A Resource Dependence Perspective. in \u003cem\u003eOrganizational Behavior\u003c/em\u003e 2 355\u0026ndash;371 (Routledge, 2006).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHandy, F. How We Beg: The Analysis of Direct Mail Appeals. Nonprofit and Voluntary Sector Quarterly 29, 439\u0026ndash;454 (2000).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen, L. Zhang, L. Yang, P. Characteristics of charitable organizations, information disclosure and donation income, Contemporary Finance \u0026amp; Economics 11, 107\u0026ndash;117 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi, G. Bu, D. The Effectiveness of commonweal projects' online crowd-funding and its influencing factors, Youth Studies 5, 14\u0026ndash;23 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePang, B. Regulation on the Evaluation of National Social Organisations, www.gov.cn. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.cn/zhengce/zhengceku/2021-12/11/content_5659896.htm\u003c/span\u003e\u003cspan address=\"https://www.gov.cn/zhengce/zhengceku/2021-12/11/content_5659896.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, Z. Wang, X. Trust and Donation: The Role of Social Network in Donation-based Crowdfunding, Management World 3, 34\u0026ndash;50 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalido-Andres, N., Rey-Garcia, M., Alvarez-Gonzalez, L. I. \u0026amp; Vazquez-Casielles, R. Nonprofit Organizations at the Crossroads of Offline Fundraising and Social Innovation: The Influence of Promoter Behavior on the Success of Donation-Based Crowdfunding Through Digital Platforms, Lecture Notes in Electrical Engineering. in Lecture Notes in Electrical Engineering (eds. Machado, J., Soares, F. \u0026amp; Veiga, G.) 946\u0026ndash;952 (Springer, Cham., 2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagazio, C. \u0026amp; Querci, F. Exploring the multi-sided nature of crowdfunding campaign success. Journal of Business Research 90, 318\u0026ndash;324 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMollick, E. The dynamics of crowdfunding: An exploratory study. Journal of Business Venturing 29, 1\u0026ndash;16 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClauss, T., Breitenecker, R. J., Kraus, S., Brem, A. \u0026amp; Richter, C. Directing the wisdom of the crowd: the importance of social interaction among founders and the crowd during crowdfunding campaigns. Economics of Innovation and New Technology 27, 709\u0026ndash;729 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlock, J., Hornuf, L. \u0026amp; Moritz, A. Which updates during an equity crowdfunding campaign increase crowd participation? Small Business Economics 50, 3\u0026ndash;27 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKunz, M. M., Bretschneider, U., Erler, M. \u0026amp; Leimeister, J. M. An empirical investigation of signaling in reward-based crowdfunding. Electronic Commerce Research 17, 425\u0026ndash;461 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRen, J., Raghupathi, V. \u0026amp; Raghupathi, W. Understanding the Dimensions of Medical Crowdfunding: A Visual Analytics Approach. Journal of Medical Internet Research 22, e18813 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUsman, S. M., Bukhari, F. A. S., Usman, M., Badulescu, D. \u0026amp; Sial, M. S. Does the Role of Media and Founder\u0026rsquo;s Past Success Mitigate the Problem of Information Asymmetry? Evidence from a UK Crowdfunding Platform. Sustainability 11, 692 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelsey, C., Vaish, A. \u0026amp; Grossmann, T. Eyes, More Than Other Facial Features, Enhance Real-World Donation Behavior. Human Nature 29, 390\u0026ndash;401. (2018)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerrine, R. M. \u0026amp; Heather, S. Effects of Picture and Even-a-Penny-Will-Help Appeals on Anonymous Donations to Charity. Psychological Reports 86, 551\u0026ndash;559 (2000).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang, C. \u0026amp; Lee, Y. Effects of message framing, vividness congruency and statistical framing on responses to charity advertising. International Journal of Advertising 29, 195\u0026ndash;220 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsen, A. M. \u0026amp; Noonberg, A. R. The Effect of Photographs of the Handicapped on Donation to Charity: When a Thousand Words May be too Much. Journal of Applied Social Psychology 9, 426\u0026ndash;431 (1979).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDefazio, D., Franzoni, C. \u0026amp; Rossi-Lamastra, C. How Pro-social Framing Affects the Success of Crowdfunding Projects: The Role of Emphasis and Information Crowdedness. J Bus Ethics 171, 357\u0026ndash;378 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhati, A. \u0026amp; McDonnell, D. Success in an Online Giving Day: The Role of Social Media in Fundraising. Nonprofit and Voluntary Sector Quarterly 49, 74\u0026ndash;92 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaxton, G. D. \u0026amp; Wang, L. The Social Network Effect. Nonprofit and Voluntary Sector Quarterly 43, 850\u0026ndash;868 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeurlin, C. Governing Civil Society: The Political Logic of NGO\u0026ndash;State Relations Under Dictatorship. VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations 21, 220\u0026ndash;239 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsu, C. Beyond Civil Society: An Organizational Perspective on State\u0026ndash;NGO Relations in the People\u0026rsquo;s Republic of China. Journal of Civil Society 6, 259\u0026ndash;277 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuppuswamy, V. \u0026amp; Bayus, B. L. \u003cem\u003eCrowdfunding Creative Ideas: The Dynamics of Project Backers in Kickstarter\u003c/em\u003e. SSRN Electronic Journal (2013)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMejia, J., Urrea, G. \u0026amp; Pedraza-Martinez, A. J. Operational Transparency on Crowdfunding Platforms: Effect on Donations for Emergency Response. Production and Operations Management 28, 1773\u0026ndash;1791 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSargeant, A., Ford, J. B. \u0026amp; West, D. C. Perceptual determinants of nonprofit giving behavior. Journal of Business Research 59, 155\u0026ndash;165 (2006).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrosetto, P. \u0026amp; Regner, T. It\u0026rsquo;s never too late: Funding dynamics and self pledges in reward-based crowdfunding. Research Policy 47, 1463\u0026ndash;1477 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou, M., Lu, B., Fan, W. \u0026amp; Wang, G. A. Project description and crowdfunding success: an exploratory study. Information Systems Frontiers 20, 259\u0026ndash;274 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDorfleitner, G. et al. Description-text related soft information in peer-to-peer lending \u0026ndash; Evidence from two leading European platforms. Journal of Banking \u0026amp; Finance 64, 169\u0026ndash;187 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, L. \u0026amp; Graddy, E. Social Capital, Volunteering, and Charitable Giving. VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations 19, 23\u0026ndash;42 (2008).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1-3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Online medical crowdfunding campaigns, determinants, Sina Micro-Charities, signaling theory, external signals, internal signals","lastPublishedDoi":"10.21203/rs.3.rs-4375164/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4375164/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMedical crowdfunding has emerged as a novel means of accessing financial resources, particularly in regions with disparities in healthcare access such as China. Despite the establishment of comprehensive medical security systems, many patients still face significant financial burdens. This study aims to identify the determinants of medical crowdfunding success for charitable causes, utilizing signaling theory. Analyzing data from the Sina Micro-charities platform on Sina Weibo, external and internal signals' impact on crowdfunding performance was assessed. Results indicate that both external signals (registration levels, awards) and internal factors (updates, pictures, title length) significantly influence crowdfunding success. This empirical study contributes to understanding medical crowdfunding performance and extends the application of signaling theory in this context, offering practical insights for fundraisers and platforms.\u003c/p\u003e","manuscriptTitle":"Understanding the determinants of medical crowdfunding performance: A signaling theory perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 20:24:38","doi":"10.21203/rs.3.rs-4375164/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"372a1421-ba7e-498a-996f-21e7a1182879","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":32901924,"name":"Health sciences/Health care/Health policy"},{"id":32901925,"name":"Health sciences/Health care/Health services"},{"id":32901926,"name":"Health sciences/Health care/Public health"}],"tags":[],"updatedAt":"2024-06-11T20:24:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-11 20:24:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4375164","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4375164","identity":"rs-4375164","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}