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 [17-20]. Trust can be defined as a willingness to accept vulnerability based on beliefs about the trustee’s ability and character, and the emotional bond between the trustor and the trustee [23]. This definition indicates that trust includes not only the intellectual/cognitive dimension (ie, cognition-based trust) but also the emotional/affective dimension (ie, affect-based trust [24]). Table 1 presents a sampling of quantitative research on the role of trust in crowdfunding, revealing the relatively minimal research that has focused on the context of donation-based crowdfunding. Moreover, these studies have provided only partial insight into the two dimensions of trust in crowdfunding. Most of them have conceptualized trust as a one-dimensional construct and revealed that trust in the crowdfunding platform or project creators has a positive effect on individuals’ investment decisions [25]. Some other scholars have primarily addressed donors’ cognition-based trust, arguing that the credibility and the trustworthiness of the fundraiser and platform are vital factors that influence investors to fund the project [26]. However, little attention has been devoted to the cognitive and affective dimensions of trust simultaneously in the context of crowdfunding.

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.

Generally, cognition-based trust is grounded in careful and rational reasoning [36]; it focuses on the “good reasons” why individuals are trustworthy and calls for rational choices based on credible information about the intentions or capabilities of others [37]. Previous research has found that potential sponsors often depend on their evaluation of a crowdfunding project’s credibility when they decide whether or not to donate their money to the cause [15,38]. In the field of medical crowdfunding, if potential donors believe that the crowdfunding platform is reliable and the charitable appeal of the fundraiser is logical and reasonable, then their cognition-based trust will be promoted, thereby increasing their intention to donate. Thus, we propose the following hypothesis:

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 [23,37]. Kang et al [18] provided evidence that investors’ trust related to emotions has a positive effect on their willingness to invest in crowdfunding platforms. Liu et al [15] also revealed that individuals will increase their willingness to donate because of their affective state derived from the concerns of the charitable crowdfunding fundraiser’s situation. Patients can use crowdfunding platforms to connect emotionally with potential donors to raise funds for health care [39]. Thus, we propose the following hypothesis:

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 [24]. Cognition-based trust influences affect-based trust, particularly in the beginning of relationship formation [23]. In many online contexts, cognition-based trust has been empirically demonstrated to be an antecedent of affect-based trust [23,40]. Kang et al [18] investigated the crowdfunding field and found that a rational assessment of the crowdfunding project allows the investor to decide whether to trust the fundraiser, which can enhance their communication and help establish a strong emotional connection. Xu and Wang [41] also argued that logically coherent and complete stories are a prerequisite for eliciting potential donors’ empathy and to inspire their charitable behavior. In the context of medical crowdfunding, the cognition-based trust that potential donors develop from carefully reviewing the information provided by the patients can reduce their feelings of insecurity, which in turn arouse emotional responses and facilitate a higher level of affect-based trust. Hence, we propose the following hypothesis:

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 [42]. The building of trust in online communities has been wildly studied. For example, Mpinganjira [43] revealed that information usefulness, community responsiveness, and shared vision have a significant influence on consumers’ overall trust in health-related virtual communities. Nadeem et al [44] found that social presence of online brand communities, social presence of others, and social presence of interaction have positive effects on social commerce trust. Given that online communities are groups of people with common interests and shared goals, community members gradually develop trust in the community through long-term social interaction. Unlike online communities, people do not need long-term interactions to build trust in a crowdfunding context, but rather rely on a direct and rapid appraisal of the crowdfunding website and the project. Thus, understanding the antecedents of trust in the context of crowdfunding is critical in improving the success rate of crowdfunding projects [45].

Existing research in the field of crowdfunding has mainly examined three categories of antecedent variables of trust: project-, fundraiser-, and platform-related characteristics [15,18,20]. Table 2 provides examples of representative studies focusing on the antecedents of trust. Only a few studies investigated the platform-related characteristics that affect trust. Among these limited investigations, attention was mainly focused on the overall quality or functional features of the platform. For example, Liu et al [15] revealed that website quality and transaction convenience have positive effects on the perceived credibility of a charitable crowdfunding project. Kang et al [18] found that perceived accreditation, structural assurance, and a third-party seal of a crowdfunding platform exert different effects on investors’ trust beliefs. However, little attention has been paid to the question of how website design features affect individuals’ trust and intention to donate. Website design factors have been demonstrated to be critical in affecting user response and experience [46]. As people learn the details of funding projects by viewing medical crowdfunding websites, exploring the design features of medical crowdfunding websites may contribute to an improved appreciation of trust and intention to donate.

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 [47,48], privacy and security [47,49], website quality [50], and ease of use [46,48]. However, these antecedents have been examined in a disjointed manner and lack a holistic view of how website design features influence trust. Moreover, existing research has mainly identified the usability and functional features of websites from a cognitive perspective, with less consideration given to the emotional aspects of website design features [46]. Some researchers have demonstrated that a website that meets most usability guidelines does not necessarily lead to higher user favorability [51]. Other scholars have also argued that users’ evaluations of a website are often determined by their overall impression of the website, thereby requiring an examination of the holistic aspects of website design features [46,52]. Medical crowdfunding platforms not only need to cognitively enhance the design of their websites to persuade potential donors but should also harness the affective features of their website to evoke potential donors’ emotional response and facilitate their willingness to donate. Therefore, in this study, we adopted the Herzberg two-factor theory as a theoretical framework for integrating the cognitive and affective aspects of website design features that influence users’ trust in the context of medical crowdfunding.

The two-factor theory was proposed by Herzberg in 1959 [53], which is also known as the hygiene motivation theory. This theory was initially used to explain factors that lead to satisfaction or dissatisfaction in employees’ work environment and has gradually been used in a wide range of different domains [54]. Recently, an increasing number of studies have been performed using two-factor theory to examine website design features, and their effects on user attitudes and behaviors in different types of websites [55-57]. In these studies, website design features are systematically distinguished into two categories: hygiene and motivation factors.

Hygiene factors are a collection of attributes closely related to the basic functionality of a website [58]. As the primary purpose of a medical crowdfunding website is to provide the visitors with information about the crowdfunding project, informativeness was selected as the hygiene factor of a medical crowdfunding website in this study. Informativeness can be defined as the extent to which a website offers rich and useful information to users [59,60]; thus, it reflects a website’s ability to provide information to its visitors [61]. Previous research has demonstrated that website informativeness is an important prerequisite for users’ attitudes toward the website [62], and that it also plays a crucial role in reducing risk and building trust [63]. In the field of crowdfunding, few studies have explored the relationship between informativeness and trust. For example, Kang et al [18] found that funders’ cognition-based trust in crowdfunding projects is enhanced if the crowdfunding website provides funders with complete and timely information about the project through a bulletin board. In medical crowdfunding websites, greater informativeness (eg, charitable appeals with several texts and images) helps donors make rational judgments, which in turn makes it easier for them to develop cognition-based trust in the project and the platform. Therefore, we propose the following hypothesis:

Previous research on shopping websites has revealed that the informativeness of a website positively influences consumers’ emotional responses [64]. Majumdar and Bose [13] also demonstrated that charitable crowdfunding fundraisers use detailed information to emphasize their needs and suffering to attract others’ attention. On the basis of emotional contagion theory, fundraisers’ suffering and sadness presented in their stories may increase potential donors’ affective reactions. Similarly, detailed information about a medical crowdfunding project not only gives the potential donor insight into the fundraiser’s situation but also serves as a means for the fundraiser to get others to listen and alleviate their own suffering. Adding words and images that describe the patient’s suffering can result in easily evoking potential donors’ affect response and enhancing their emotional bonding with the fundraiser. At the same time, rich project information allows potential donors to know more about the fundraiser and shorten the perceived psychological distance between them, thereby inspiring a higher level of affect-based trust. Hence, we propose the following hypothesis:

Motivation factors are a collection of attributes that are closely related to the additional value-added services offered by a website [58]. Previous studies have found that in contrast to hygiene factors, motivation factors are crucial for website users’ satisfaction [55,57]. In the medical crowdfunding context, motivation factors are the website design features of a medical crowdfunding website that stimulate potential donors to make donation decisions beyond meeting their basic information needs. In this study, the website’s visual cues (ie, warm or cool colors) and social cues were selected as motivation factors.

The visual design of a website has proven to be an impactful determinant of trust [48]. Among the many visual design elements, color serves as a specific visual stimulus that shapes a visitor’s perception of the ambient temperature [65]. Such perceived cool or warmth on temperature elicits varying degrees of social proximity, language concreteness, and relational focus, and exerts an effect on individual behavior through the mechanism of insula [66]. Williams and Bargh [67] showed that the warmth sensed by the body can influence interpersonal judgments and prosocial behavior. Literature from several fields has noted that red and orange tend to evoke warmth, whereas blue and green are reminiscent of cold [68]; this comparison seems to convey a more positive role of warm colors. However, an ever-increasing number of studies in recent years have challenged this view by emphasizing the effects of cool colors. Rizomyliotis et al [69] found that cool backgrounds are more likely to inspire stronger positive attitudes and behavioral intentions than warm colors, and cool colors usually create a sense of relaxation and calm [70]. On the one hand, cool colors are often linked to competence, trust, safety, and sincerity, such that many companies incorporate blue into their brand logos to create a professional and trustworthy image, and consumers regard blue logos to be more reliable than other colors [71]. On the other hand, in terms of the information processing of individuals, Ettis [72] suggested that cool colors (eg, blue) facilitate individuals’ information seeking, processing, and consideration. Therefore, medical crowdfunding sites with more cool-colored elements may be more conducive to donor attention, and could promote rational and logical reasoning about the help-seeking information on the platform, which in turn will enhance the donors’ cognition-based trust in the platform and the project. Thus, we propose the following hypothesis:

Previous studies have documented that perceived warmth is associated with interpersonal intimacy; that is, perceived warmth creates feelings of interpersonal closeness [73], and promotes interpersonal trust, cooperation, and friendship [74]. Specifically, warm colors are more evocative of warmth than cool colors [66] and provide consumers with a sense that their surroundings are more socially dense [75]. In this manner, a warm-toned interface of a medical crowdfunding website will bring warm psychological perceptions and positive attitudes to donors, making them feel less distant from the medical crowdfunding platform and other help-seekers, and thus more likely to evoke their emotional trust toward the platform and project. Hence, we posit the following hypothesis:

Social cues in web design refer to social presence and social interaction embedded in the web interface through various communication tools [76]. These cues have been shown to have important influences on individuals’ cognition-based trust in various contexts such as online shopping and e-commerce. For example, early consumer endorsement in the form of online reviews in e-commerce can help other consumers determine the usefulness of a product, build cognition-based trust, and thus facilitate rational shopping decisions [77]. Social cues can serve as a collective endorsement, allowing the crowdfunding fundraisers to signal credibility [78]. In medical crowdfunding, fundraisers need to reach out to others through social networks to attract more donations. Therefore, the presence of social cues (eg, proofs and reviews from other donors) helps to exhibit the authenticity and credibility of a project, thereby inspiring a higher level of cognition-based trust from potential donors. On this basis, we posit the following hypothesis:

The presentation of social cues on a website leads to a perception of warmth and friendliness, which triggers a sense of social presence [79]. Given that social presence is strongly associated with emotional responses and interpersonal warmth [80,81], the use of social cues will help users build affect-based trust [79]. Furthermore, affect-based trust also indicates that the trustor builds trust in the trustee according to their benevolence and moral norms [82]. In medical crowdfunding websites, social cues such as other donors’ feedback and the fundraiser’s replies can be used as third-party opinions to evaluate the fundraiser’s benevolence and moral norms, which enhance affect-based trust-building. Thus, we posit the following hypothesis:

On the basis of these hypotheses, we propose the research model shown in Figure 1.

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%) [83].

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.

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.