Table 2

Commitment constructs and illustrative quotes

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