Human Resources for Health · Published 2026-06-23 · DOI 10.1186/s12960-026-01084-w
Li Xiao, Wang Chao, Yin Xiaoxv, Jiang Heng, Li Shaoshuai
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 < 0.05). Specifically, the gender, the matriculation year, whether you apply for the RDTWME program voluntarily, attitude toward the education program, whether rural medical work holds value, whether rural healthcare systems require high-level medical professionals, maternal education attainment, family attitude toward the ROTWMHE program, compliance rate among peers, and whether you acquaint with rural healthcare work environment were all associated with contract compliance intention. 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.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →
Xiao, L., Chao, W., Xiaoxv, Y., et al. (2026). An empirical study on the influencing factors and mechanisms of contract compliance intention among oriented medical students in China: the case of Hubei Province. Human Resources for Health. https://doi.org/10.1186/s12960-026-01084-w