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As a type of donation-based crowdfunding, medical crowdfunding has gradually become an important way for patients who have difficulty paying medical bills to seek help from the public. However, many people still have limited confidence in donating money to medical crowdfunding projects.
Given that the features of a medical crowdfunding website may be important to gain users’ trust, this study draws upon two-factor and trust theories to explore how different design features of medical crowdfunding websites affect potential donors’ cognition-based trust and affect-based trust, and how these types of trust affect the intention to donate.
A 2 (informativeness: high vs low) × 2 (visual cues: cool color vs warm color) × 2 (social cues: with vs without) between-subject laboratory experiment was performed to validate our research model. A total of 320 undergraduate students recruited from a university in China participated in the controlled laboratory experiment.
Cognition-based trust (β=.528,
This study deepens our understanding of the relationships among the design features of medical crowdfunding websites, trust, and intention to donate, and provides guidelines for managers of medical crowdfunding platforms to enhance potential donors’ trust-building by improving the website design features.
Medical expenses are forcing a staggering number of people into poverty worldwide [
In the context of charitable giving, the information asymmetry that exists between charitable project promoters and potential donors is a barrier to successfully soliciting individual donations. Potential donors are often deprived of complete (and updated) information about how their donations will be used [
Despite the popularity of medical crowdfunding, the failure rate of crowdfunded projects is reported to be high. Many promising projects have failed to meet their fundraising goals for different reasons. The lack of experience in the use of information technology (eg, computers and the internet), insufficient health care literacy, and poor writing skills can all contribute to the failure of a medical crowdfunding project [
Recently, several studies have recognized trust as a critical determinant of funding intention in different crowdfunding contexts [
Despite the increasing number of studies on the relationship between trust and crowdfunding investments, less attention has been paid to the factors that build trust in the context of medical crowdfunding. Therefore, the second focus of this study was on the antecedents of cognition-based and affect-based trust in medical crowdfunding, which can help us to better understand the development of trust. Among the limited research on the antecedents of trust in the field of crowdfunding and charitable giving, most studies have focused on the project type, project content, and fundraisers’ expertise and reputation [
To bridge the aforementioned research gaps, in this study, we adopted two-factor and trust theories to identify hygiene and motivation factors in the website design of a medical crowdfunding website, and examined how they affect people’s cognition-based trust and affect-based trust, and their ultimate intention to donate.
The rapid growth of crowdfunding platforms has attracted the attention of scholars, and numerous studies have been performed on the factors that influence crowdfunding success. In these studies, trust has emerged as a key determinant of funding intention in different crowdfunding contexts [
Similar to other types of crowdfunding, potential donors of medical crowdfunding need to scrutinize the quality of the projects and judge their credibility before deciding to donate. In addition, medical crowdfunding can be regarded as an act of philanthropy where potential donors are incentivized to donate out of sympathy for specific patients seeking help. Therefore, the emotional dimension of trust is also noteworthy because it can evoke an emotional response and inspire people to donate. Hence, this study attempts to contribute to trust theory and the crowdfunding literature by examining whether cognition-based trust and affect-based trust exert positive effects on intention to donate in the context of medical crowdfunding.
Representative previous research on the role of trust in crowdfunding.
Reference | Context | Dependent variable | Trust-related variable |
Zhang et al [ |
Donation-based crowdfunding | Actual donation | Platform trust |
Behl et al [ |
Donation-based crowdfunding | Operational performance | Cognitive trust, |
Kim et al [ |
Incentive crowdfunding | Willingness to crowdfund | Trust in platform, |
Kim et al [ |
Incentive crowdfunding | Crowdfunding participation | Trust in platform, |
Chen et al [ |
Donation-based crowdfunding | Intention to donate | Trust |
Wehnert et al [ |
Crowdfunding | Trust | Trust |
Strohmaier et al [ |
Reward-based crowdfunding | Pledging intention | Trust in creators, |
Liang et al [ |
Reward-based crowdfunding | Investment intention | Funder’s trust |
Cascino et al [ |
Reward-based crowdfunding | Consumer protection regulation, project funding | Perceived credibility of disclosure |
Rodriguez-Ricardo et al [ |
Crowdfunding | Intention to participate in crowdfunding | Trust in crowdfunding |
Yang et al [ |
Crowdfunding | Investment intention | Trust |
Jones and Moncur [ |
Reward-based crowdfunding | Likelihood to invest | Funder’s trust |
Xiao [ |
Equity-based crowdfunding | Investment intention | Competence trust, relational trust |
Klement and Teubner [ |
Equity-based crowdfunding | Number of investments | Trustworthiness |
Generally, cognition-based trust is grounded in careful and rational reasoning [
H1: Potential donors’ cognition-based trust is positively correlated with intention to donate.
By contrast, affect-based trust focuses on the “emotional bond” between parties. This type of trust is derived not from one’s understanding and reasoning but rather from their instincts and feelings [
H2: Potential donors’ affect-based trust is positively correlated with intention to donate.
Previous studies have argued that individuals will invest further in a relationship only when their basic expectations about the reliability of the relationship are met [
H3: Potential donors’ cognition-based trust is positively correlated with their affect-based trust.
Considering that trust can be easily broken in virtual environments, some studies have been performed on how to establish and maintain trust in various contexts [
Existing research in the field of crowdfunding has mainly examined three categories of antecedent variables of trust: project-, fundraiser-, and platform-related characteristics [
Representative previous research on antecedents of trust in crowdfunding.
Reference | Context | Project-related characteristics | Fundraiser-related characteristics | Platform-related characteristics |
Kim et al [ |
Incentive crowdfunding | Network externality, perceived informativeness | Value congruence, social interaction ties | Perceived accreditation, structural assurance, third-party seal |
Strohmaier et al [ |
Reward-based crowdfunding | N/Aa | Perceived monitoring | Perceived platform rules, perceived monitoring, perceived pledging security |
Liang et al [ |
Reward-based crowdfunding | Project information quality | Fundraiser’s ability/expertise, fundraiser’s reputation | N/A |
Rodriguez-Ricardo et al [ |
Crowdfunding | N/A | Altruism, internal locus of control | N/A |
Yang et al [ |
Crowdfunding | Perceived benefits, perceived risk | Communication, shared value | N/A |
Kang et al [ |
Reward-based crowdfunding | Network externality, |
Value congruence, social interaction ties | Perceived accreditation, structural assurance |
Zheng et al [ |
Reward-based crowdfunding | N/A | Crowdfunding success experience, investment in others | N/A |
Liu et al [ |
Donation-based crowdfunding | Project popularity, |
Initiator reputation | Website quality (navigability, security, visual appeal), |
aN/A: not applicable.
A substantial body of literature in the field of information systems has investigated the relationship between website design features and trust. Several website design features have been identified as antecedent variables of trust in various contexts such as navigation design [
The two-factor theory was proposed by Herzberg in 1959 [
Hygiene factors are a collection of attributes closely related to the basic functionality of a website [
H4a: Informativeness is positively correlated with potential donors’ cognition-based trust.
Previous research on shopping websites has revealed that the informativeness of a website positively influences consumers’ emotional responses [
H4b: Informativeness is positively correlated with potential donors’ affect-based trust.
Motivation factors are a collection of attributes that are closely related to the additional value-added services offered by a website [
The visual design of a website has proven to be an impactful determinant of trust [
H5a: Potential donors’ cognition-based trust in a medical crowdfunding website with a cool-toned (blue) interface is higher than that in a warm-toned (orange) interface.
Previous studies have documented that perceived warmth is associated with interpersonal intimacy; that is, perceived warmth creates feelings of interpersonal closeness [
H5b: Potential donors’ affect-based trust in a medical crowdfunding website with a warm-toned (orange) interface is higher than that in a cool-toned (blue) interface.
Social cues in web design refer to social presence and social interaction embedded in the web interface through various communication tools [
H6a: Potential donors’ cognition-based trust in a medical crowdfunding website with social cues is higher than that without social cues.
The presentation of social cues on a website leads to a perception of warmth and friendliness, which triggers a sense of social presence [
H6b: Potential donors’ affect-based trust in a medical crowdfunding website with social cues is higher than that without social cues.
On the basis of these hypotheses, we propose the research model shown in
Research model.
To test how the design features of medical crowdfunding websites influence potential donors’ intention to donate, we performed a laboratory experiment with a 2 (informativeness: high vs low) × 2 (visual cues: cool color vs warm color) × 2 (social cues: with vs without) between-subject factorial design to test the hypotheses. We designed eight medical crowdfunding webpages for the experiment.
The webpages were developed to mimic the layout of the mobile versions of Qingsongchou, a major medical crowdfunding platform in China, to enhance the external validity. A fictional medical crowdfunding project was shown in these webpages. The project began with a charity appeal about a patient with cancer who cannot pay his medical bills. We chose cancer for two reasons. First, cancer is one of the most common disease types with a high mortality rate. Second, we crawled the information of medical crowdfunding projects on the Qingsongchou website, and found that cancer is the most common cause in medical crowdfunding projects. To protect patient privacy, we made changes to basic patient information (eg, profile picture, nickname, name, and home address). Eight screenshots of the experimental webpages are presented in
We used a laboratory experimental approach because it allowed us to examine the effects of website design features on users’ intention to donate. Three website design features needed to be manipulated in our study: informativeness, visual cues, and social cues.
This study manipulated the informativeness of the medical crowdfunding webpages into two groups: high informativeness and low informativeness. The high informativeness group presented more categories of information (ie, patient’s charity appeal, goals and progress of crowdfunding, medical certificate, proof of the patient’s financial hardship, and information about the disease) in the webpage, along with more pictures and longer text. The low informativeness group contained fewer categories of information (ie, only the patient’s charity appeal, goals and progress of crowdfunding, and medical certificate), along with fewer pictures and shorter text.
The visual cues in this study focused on the overall color of the webpages, including the background color of the pages and the font colors. The main color of the pages in the cool color groups was blue (hue: 170, saturation: 239, luminance: 128, transparency: 90%), whereas the main color of the warm color groups was orange (hue: 15, saturation: 239, luminance: 128, transparency: 90%) [
Webpages in the “with social cues” group showed the buttons for retweeting the project to social media, social endorsement from others, and information about other people’s donations. Those in the “without social cues” groups did not contain such information.
This research model includes three latent constructs: cognition-based trust, affect-based trust, and intention to donate. We selected the scales of these constructs from previous research with adaptive modifications to fit the context of medical crowdfunding. All of the measurements were scored on a 7-point scale (1: absolutely disagree, 7: absolutely agree). To eliminate the influence of the participants’ mood on the results of the experiment, we introduced participants’ mood as a covariate in the research model. Mood was measured by the item “How would you rate your current emotional state?”, which was scored from 1 (negative) to 7 (positive). The scale showed good reliability and validity.
We used the backtranslation method to translate the original English scale into the Chinese version and compared the two versions of the scales to check for translation accuracy. Four experts in the field of information systems were invited to evaluate the content validity of the scales. Following the opinions of the survey experts, we made some revisions to the items, such as revising the wording to improve clarity and accuracy, shortening the length of items to reduce survey fatigue, modifying ambiguous items, and revising items to make them more tailored to the medical crowdfunding context.
Research constructs and measurements.
Construct | Measurement items | References |
Cognition-based trust | (1) I can rely on this medical crowdfunding platform and project; (2) the medical crowdfunding platform and project have my confidence; (3) the medical crowdfunding platform and project have high integrity | Kang et al [ |
Affect-based trust | (1) If I share my problems with this medical crowdfunding platform, it would respond caringly; (2) the medical crowdfunding platform displays a warm and caring attitude toward me; (3) I can talk freely with the medical crowdfunding platform about my problems | Ranganathan et al [ |
Intention to donate | (1) The probability that I would donate money to the medical crowdfunding project is high; (2) my donation intention to the medical crowdfunding project is high; (3) the likelihood of my donating money to the medical crowdfunding project is high | Liu et al [ |
A total of 320 undergraduate students recruited from a university in China participated in the controlled laboratory experiment. Each participant was assigned to one of eight webpages varying in informativeness, color, and social cues. The participants were then asked to complete the questionnaire after viewing the webpage. The age of the participants ranged from 18 to 26 years (mean 21.719 years). Analysis of variance showed no significant differences in gender (
We performed manipulation checks using the measurement items adapted from previous studies. The item “The medical crowdfunding platform offers relevant, timely, and accurate information about the project” was adopted from the works of Kang et al [
The results from a
Cronbach α for checking the internal consistency was initially computed using SPSS 24.0.
Convergent validity and internal reliability.
Construct | Factor loading | Cronbach α | AVEa | CRb | |||||
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.909 | 0.773 | 0.911 | ||||||
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CT1 | 0.814 |
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CT2 | 0.907 |
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CT3 | 0.913 |
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.865 | 0.686 | 0.867 | |||||
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AT1 | 0.780 |
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AT2 | 0.848 |
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AT3 | 0.854 |
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.915 | 0.784 | 0.916 | |||||
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ID1 | 0.881 |
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ID2 | 0.903 |
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ID3 | 0.872 |
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aAVE: average variance extracted.
bCR: construct reliability.
Finally, we computed the square root of the AVE values of all constructs and the correlation coefficients between these constructs to test the discriminant validity. The square roots of the AVE values were greater than other correlation coefficients, which indicated adequate discriminant validity [
We utilized AMOS22.0 to test the hypotheses regarding the effects of cognition-based trust and affect-based trust on intention to donate. As predicted, cognition-based trust had a significant and positive influence on intention to donate (β=.528,
Given that we have two dependent variables (ie, cognition-based trust and affect-based trust), we performed multivariate analysis of variance to check whether the experimental treatments had a general effect on both variables. Three website design features (ie, informativeness, visual cues, and social cues) were modeled as the fixed factors, and participants’ mood was included as a covariate. The main effects of informativeness (Wilks λ=0.862,
A three-way ANCOVA was initially performed on cognition-based trust. The main effect of informativeness on cognition-based trust was significant (
A three-way ANCOVA was then performed on affect-based trust. The results indicated a significant main effect of informativeness (
To further verify whether the two different types of trust mediate the effects of website design features on intention to donate, we performed a mediation analysis in SPSS 24.0 with the PROCESS plugin developed by Hayes [
Next, we used intention to donate as the dependent variable, three website design features (ie, informativeness, social cues, and visual cues) as independent variables, and cognition-based trust as the mediator to test the mediating mechanisms involved. The effects of informativeness (β=.545, 95% CI 0.380-0.721) and social cues (β=.454, 95% CI 0.297-0.629) on intention to donate were mediated by cognition-based trust. However, cognition-based trust did not mediate the relationship between visual cues and intention to donate (β=−.102, 95% CI –0.271 to 0.692).
Finally, we examined the mediation role of affect-based trust. Affect-based trust mediated the relationship between informativeness (β=.159, 95% CI 0.105-0.214), visual cues (β=.325, 95% CI 0.178-0.482), social cues (β=.299, 95% CI 0.141-0.464), and intention to donate.
This study reveals that cognition- and affect-based trust significantly influence medical crowdfunding users’ intention to donate. This finding is in line with previous studies that demonstrate the salient impact relationship between trust and intention to donate [
Furthermore, this study introduced Hertzberg two-factor theory into the research model and identified two types of medical crowdfunding website design features (ie, hygiene and motivator factors). The results indicate that informativeness as a hygiene factor positively influences potential donors’ cognition-based trust and affect-based trust. Among the motivation factors, social cues significantly influence potential donors’ cognition-based trust and affect-based trust. However, webpage color as a visual cue affects the two dimensions of trust differently. Specifically, medical crowdfunding webpages with a warm color were more likely to induce affect-based trust than those with a cool color, whereas no significant difference was found between the effects of cool and warm colors on cognition-based trust. One possible explanation for this finding is that cognitive processes are not instantaneous, and cognition-based trust is formed only after individuals can cognitively process and evaluate available evidence [
Our results also indicate that cognition- and affect-based trust have mediating effects on the relationship between website design features and intention to donate. Different website design features have different influences on cognition- and affect-based trust, which in turn exert different effects on intention to donate. Particularly, informativeness and social cues indirectly affect intention to donate through cognition- and affect-based trust. Webpage colors significantly affected intention to donate through affect-based trust, whereas cognition-based trust had no mediating effect on the relationship between webpage colors and intention to donate.
The theoretical contributions of this study are as follows. First, this study contributes to the theory of trust and enriches the literature on crowdfunding. Despite the existence of impressive studies that have examined trust and willingness to fund in different crowdfunding contexts, few of them have discussed trust issues in the context of medical crowdfunding. This study identifies the importance of affect-based trust in medical crowdfunding, which is often ignored in other crowdfunding contexts. Specifically, affect-based trust not only influences intention to donate for medical crowdfunding projects simultaneously with cognition-based trust but it also mediates the influence of cognition-based trust on intention to donate.
Second, identifying the antecedents that influence cognition- and affect-based trust is important for trust development. This study explored the holistic aspects of the design features of medical crowdfunding websites to understand how users develop trust to medical crowdfunding platforms and projects. We applied Hertzberg two-factor theory to identify hygiene and motivation factors in website design features as antecedent variables that influence the two types of trust. We validated the positive influence of informativeness as a hygiene factor of website design on cognition- and affect-based trust, and demonstrated the motivating effects of visual and social cues on trust. These findings enrich the literature on website design by broadening the application of two-factor theory to the design of medical crowdfunding websites.
Third, previous studies have briefly introduced the relationships between website design features and users’ behavioral intention; however, few studies have attempted to reveal the mechanisms underlying the effects of website design features on the intention to donate in medical crowdfunding. By integrating the design features of medical crowdfunding websites, trust, and intention to donate, we contribute to filling this gap, while demonstrating the mediating role of cognition-based trust and affect-based trust on such impacts.
This study has important implications for medical crowdfunding platform operators and users. First, our empirical results reveal the significant effects of cognition- and affect-based trust on intention to donate. Therefore, platform operators and project initiators of medical crowdfunding should not only enhance the authenticity and credibility of their platforms and projects but also emphasize their affective elements.
Second, the informativeness of the projects presented on medical crowdfunding platforms is a hygiene factor that can elicit users’ trust. Medical crowdfunding platform operators should develop more functions that contribute to the information richness of the website, such as providing a wider range of information categories and the functions of uploading pictures and videos. Moreover, project initiators need to elaborate more on their situations and charitable appeals to inspire potential donors logically and emotionally.
Third, visual and social cues on medical crowdfunding platforms also have significant effects on potential donors’ trust. This finding provides medical crowdfunding website designers with some guidelines. They can enhance the usage of warm colors to create a warm and caring atmosphere to boost users’ affect-based trust. They can also provide more social cues such as other peoples’ comments to increase potential donors’ cognition- and affect-based trust.
Despite the contributions of this study, we have identified several limitations. First, the subjects in this experiment were undergraduate students. Our primary reason for choosing students as subjects was that students are easier to recruit than other social groups and are more obedient, which is beneficial to the success of laboratory experiments. In addition, as Chinese medical crowdfunding projects are mainly diffused through internet apps such as Weibo and WeChat, social media users have become the main source of donations. Weibo users under the age of 25 account for 57.4% of the total number of users [
Second, this study focused on three website design features based on the previous literature and the context of medical crowdfunding. However, there may be other website design features that can influence users’ trust and donations. For example, we only focused on color in visual cues, whereas font styles or page layout may also affect users’ trust in the platform and the project. Future research can identify more website design features of relevance.
Third, this study manipulated informativeness as a one-dimensional variable incorporating text length, number of pictures, and categories of information without considering the interactions among these features. Future research can introduce new content-related features and further explore the interactions among these factors.
Finally, individuals may perceive colors in varied and nuanced ways. In our study, we only focused on one color feature that is most likely to be noticed by the user (ie, hue) and ignored the other features of color. Future research can explore the effects of other color features (eg, saturation and luminance) on potential donors’ trust.
The purpose of this study was to explore the role of cognition- and affect-based trust in the medical crowdfunding context and to test the effects of medical crowdfunding website design features on these two dimensions of trust. By applying trust theory and Hertzberg two-factor theory, we identified several hygiene and motivation website design factors, and confirmed their influencing mechanisms on trust in our empirical study. This study not only enriches the literature on crowdfunding but also provides implications for medical crowdfunding platform operators and users on how to promote trust.
Eight screenshots of the experimental webpages.
analysis of covariance
average variance extracted
This work was supported by grants from the National Natural Science Foundation of China (71974152 and 71861014). We deeply appreciate the Research Center of Enterprise Decision Support, a key research institute of humanities and social sciences in the universities of Hubei province.
None declared.