Abstract
Background
The shortage of health personnel facing China, particularly in rural areas, has posed a great obstacle to the sustainable development of its health system. The Chinese government has, therefore, implemented the Rural-Oriented Tuition-Waived Medical Higher Education (ROTWMHE) program to address this issue, which recruits and trains medical students (oriented medical students) with contracts to serve in designated areas. This study attempts to identify the contract compliance intention of medical students in the ROTWMHE program and investigate the influencing factors and mechanisms.Methods
From May to June 2023, a total of 1130 oriented medical students engaged in the ROTWMHE program were selected from oriented medical student educational institutions in Hubei Province to conduct questionnaire surveys. The questionnaire, based on the Theory of Planned Behavior, consisted of four parts: demographics, attitudes, subjective norms, and perceived behavioral control. Descriptive analysis, chi-square test, and multivariate logistic regression analysis were employed to identify the factors influencing the contract compliance intention of oriented medical students.Results
A total of 1114 (98.58%) valid questionnaires were included, and the contract compliance intention rate of oriented medical students in Hubei Province was 75.31%. Regression analysis showed that attitudes, subjective norms, and perceived behavioral control all had statistically significant effects (P Conclusions
The contract compliance intention among oriented medical students in Hubei Province was relatively positive, but negative attitudes and the adverse effects of subjective norms have weakened their intention. Policymakers and medical educational institutions should formulate differentiated enrollment policies, reinforce integrity mechanisms in the employment sector, strengthen practice-based education and value cultivation related to rural healthcare, leverage new media platforms to enhance policy outreach, and improve the benefits and compensations to further enhance the contract compliance intention in oriented medical students.