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Investigating the Mediating Role of Trust in Nurses in the Effect of Patient Negotiation on Patient Experience and Self-advocacy
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Yeganeh Salehi1   , Mostafa Rad2 , Simin Sharafi * |
1- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
2- Sabzevar
Birjand University of Medical Sciences, Birjand, Iran , siminsharafi68@gmail.com |
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Abstract: (17 Views) |
Introduction: Modern healthcare approaches emphasize active patient participation in the treatment process. Patient negotiation has emerged as a key strategy in this domain, which may enhance patient self-advocacy and positive healthcare experiences. However, the role of trust in nurses as a mediating variable in this relationship has been less investigated. Using data from a randomized controlled trial, this study examined whether trust in nurses mediates the relationship between patient negotiation and patient experience and self-advocacy.
Methods: This randomized controlled trial was conducted on 70 patients allocated to intervention (n=35) and control (n=35) groups. The study protocol was approved by the Ethics Committee of Birjand University of Medical Sciences (Ethics Code: IR.BUMS.REC.1404.360) and was formally registered with the Iranian Registry of Clinical Trials (IRCT20251123068093N1). The intervention group received a 10-15 minute structured negotiation session based on the Botelho model, while the control group received routine care. Data were collected at pre-test and post-test using the validated Persian versions of the Brashers et al. Patient Self-Advocacy Scale (PSAS), the Radwin and Cabral Trust in Nurses Scale (TINS), and Picker Patient Experience Questionnaire .Multivariate analysis of covariance (MANCOVA) and structural equation modeling (SEM) were used for data analysis.
Results: The results showed that the patient negotiation intervention had a significant direct effect on trust in nurses (F = 43.27, p < 0.001, η² = 0.400), self-advocacy (F = 87.09, p < 0.001, η² = 0.573), and patient experience (F = 39.41, p < 0.001, η² = 0.377). The SEM analysis demonstrated an adequate fit of the conceptual model to the observed data (χ²/df = 1.653, p = 0.085, CFI = 0.967, RMSEA = 0.097). However, the mediating role of trust in nurses in the relationship between the intervention and self-advocacy (β = 0.013, Z = 0.351, p = 0.725) as well as between the intervention and patient experience (β = 0.035, Z = 0.777, p = 0.437) was not statistically significant. Although the negotiation intervention successfully enhanced trust in nurses (β = -0.479, CR = -6.692, p < 0.001), this increased trust did not serve as a mediating mechanism for improving self-advocacy and patient experience.
Conclusion: While patient negotiation interventions directly and effectively improve trust in nurses, Self-advocacy and patient experience, trust in nurses does not play a significant mediating role in these relationships. The negotiation process appears to operate through its inherent empowering mechanisms—such as patient activation and enhanced self-efficacy—independent of trust in nurses. These findings emphasize the importance of integrating negotiation skills training into nursing education as a cost-effective strategy for improving patient-centered outcomes.
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| Keywords: Negotiating, Trust, Patient Advocacy, Patient-Centered Care, Structural Equation Modeling |
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Type of Study: Research |
Subject:
Special
Received: 2026/Jul/Sun | Accepted: 2026/Aug/Sun | Published: 2025/Jul/Tue
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