The Interactive Effect of Performance Criticism and Empathy Induction on Citizens' Supportive Behavior Towards Public Sector Nurses

Subject Areas : Health Management Services

Mina Alavi ¹ , Seyyedeh Laya Mortazavi ²

1 - Assistant Professor, Department of Public Administration, Qazvin Branch, Islamic Azad University, Qazvin, Iran
2 - Department of Public Administration, Astara Branch, Islamic Azad University, Astara, Iran

Received: 2025-09-06 Accepted : 2025-10-19 Published : 2025-12-17

Keywords: Supportive Behavior, Empathy, Performance Criticism, Citizen-Nurse Interaction, Public Hospital, Experimental Study, Zanjan,

Abstract :

Background and Aim: The quality of interaction between citizens and healthcare staff is a key factor affecting the quality of care and the mental well-being of nurses. This study aimed to experimentally investigate the factors influencing the supportive behavior of citizens in Zanjan towards nurses in public hospitals. Specifically, it analyzed the effects of empathy elicitation, performance criticism, their interaction, and the moderating role of age.

Methods: This research was an online experimental study with a 2×2 between-subjects factorial design. The statistical population comprised all citizens over 18 years of age residing in the city of Zanjan (approx. population: 369,300). The initial sample size was calculated as 450 using Cochran's formula. After removing incomplete responses, data from 404 participants, selected through convenience stratified sampling, were analyzed. The data collection tool was a researcher-developed online questionnaire, and the analyses were conducted using logistic regression and Generalized Linear Models (GLM) in SPSS-26.

Results: The results showed that empathy elicitation alone did not have a significant effect on increasing citizens' supportive behavior (p=0.687). Conversely and contrary to expectations, direct criticism of nurses' performance significantly increased the likelihood of supportive behavior (B=-2.180, p<0.001). Furthermore, the interaction effect between empathy and criticism was significant (B=-0.946, p=0.001), meaning that empathy amplified the positive effect of criticism on supportive behavior. The variable of age also significantly moderated this relationship (B=-0.356, p=0.018), such that the positive effect of criticism on support decreased as participants' age increased.

Conclusion: Citizens' supportive behavior towards nurses is a complex phenomenon that is not enhanced merely by raising awareness of their professional challenges. This study revealed that performance criticism, especially when combined with empathy elicitation, can be a powerful catalyst for garnering public support. These findings underscore the need to revise the communication strategies of the healthcare system and hospitals, suggesting that actively managing citizen feedback and criticism plays a key role in improving interactions and strengthening support for healthcare staff.

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