# How does bitterness perception correlate with the intention to use traditional Chinese medicine? An analysis of double-edged sword effects based on the stimuli–organism–response framework

## TL;DR

This study explores how perceiving bitterness in traditional Chinese medicine (TCM) influences people's intention to use it, finding that bitterness can both encourage and discourage use depending on cultural identity and perception.

## Contribution

The study introduces a novel framework showing how bitterness perception in TCM can have dual effects on usage intention through perceived usefulness and uncertainty.

## Key findings

- TCM bitterness perception positively affects perceived usefulness and negatively affects perceived uncertainty.
- Higher TCM cultural identity strengthens the bitterness-usefulness association and weakens the bitterness-uncertainty link.
- Bitterness perception's dual effects are counterbalanced, leading to equal opposing influences on TCM usage intention.

## Abstract

This study investigates the relationship between TCM bitterness perception and individuals’ intention to use traditional Chinese medicine (TCM), employing the ‘stimuli–organism–response’ (SOR) framework. The study considers bitterness perception of TCM as stimuli that correlate with two organisms, that are perceived TCM usefulness and perceived TCM uncertainty toward intention to use TCM (response).

In total, 467 responses are collected from a purposive sample of medical university affiliates with fundamental TCM knowledge using a survey method, and structural equation modeling and ordinary least square regression are applied to provide empirical results.

The result indicates that TCM bitterness perception is positively related to perceived TCM usefulness (perceived TCM uncertainty), through which exerts positive (negative) indirect effect on intention to use TCM. Moreover, high levels of TCM strengthens (attenuates) the relationship between TCM bitterness perception and perceived TCM usefulness (uncertainty), results in more positive indirect effect of TCM bitterness perception on intention to use TCM.

The double-edged sword effects of bitterness perception arise from an asymmetric activation of perceived TCM usefulness and perceived TCM uncertainty at the cognitive stage, which is subsequently counterbalanced through differential transmission strengths, resulting in relatively equal opposing forces on the intention to use TCM. Individuals’ TCM cultural identity plays a contingent role that individuals will make more bitterness-usefulness association and less bitterness-uncertainty association when they hold higher degree of TCM cultural identity, relating to more intention to use TCM. Thus, the results of this study encourage TCM promotion actors leverage the double-edged sword effects of TCM bitterness and the deep power of TCM culture in transforming simple bitterness sensory judgment and sublimates into cultural consciousness. However, due to the specific TCM-literate sample, findings regarding the ‘bitterness-usefulness’ association may not generalize to the general public, where such cultural bridging is weak. And cross-sectional data only demonstrate associations within the tested model.