Ethics approval and consent to participate
Ethical approval of this study was obtained from the Research Ethics Committee at School of Business, Macau University of Science and Technology (No: MUST/MSB/D/19/0128). Verbal informed consent procedure was approved by the Research Ethics Committee. The questionnaire has a brief cover letter in written form, describing the research purpose of the collected information and the confidential guarantee policy. Before starting the survey questionnaire, the ethics statement was disclosed to all respondents and verbal informed consents were obtained from all respondents. All respondents were voluntary and the responses were anonymous.
This study focuses on nine representative cities from five provinces/municipalities in Southeastern China. With the most developed economy in China, Southeastern China area has many public hospitals with top accreditations as well as high quality private healthcare providers. As the pioneer region in China influenced by Western medicine since a century ago, the residents in Southeastern China have a higher preference for choosing private dental care than that of the rest of the country .
The nine cities sampled include Shanghai, Guangzhou, Shenzhen, Nanjing, Nanchang, Hefei, Foshan, Zhuhai, and Zhongshan. Among them, Shanghai, Guangzhou, and Shenzhen are the top cities in China. Nanjing, Nanchang and Hefei are provincial capital cities. Located in the Pearl River Delta area in Guangdong province, Foshan, Zhongshan and Zhuhai are reprehensive cities in Southeastern China that enjoy a developed economy and a high level of personal income.
The questionnaire adopted an established scale to measure the key concepts of entrepreneurial intention and behaviors  and was pre-tested for validity by collegiate faculty, dentists, and dental students randomly selected from major public hospitals in Guangzhou, China. The reliability of the scales was estimated to be 0.81. (See “Additional files” in the appendix for the full version of the questionnaire.)
A Snowball sampling method was adopted. Two or three senior dentists and professionals in the major public hospitals in each city were first randomly sampled, then each of them gave multiple referrals to other qualified dentists in their cities. This pattern was repeated until a sufficient number of dentists were available for the sample. The number of dentist respondents is proportional to the dental healthcare workforce population in each city/municipality.
The sampling and survey process was performed during ten months between September 2018 and June 2019. A total of 400 questionnaires were distributed in either paper or electronic forms through WeChat (the dominant social media App in China), depending on the respondents’ preference and convenience. Eventually, 336 valid responses were received (effective returning rate = 84%). All questionnaires were self-administrated. All data collected through questionnaires were entered and coded.
Entrepreneurial intention (EI) is defined as “the conscious state of mind that precedes action and directs attention toward entrepreneurial behaviors such as starting a new business and becoming an entrepreneur” [20, 21]. EI is a useful and practical approach to understanding actual entrepreneurial behavior. As the first stage of a series of actions in organizational founding, EI is an important part of the business planning process [22, 23], reflecting an individual’s readiness to engage in subsequent entrepreneurial activities [24-28]. This survey of dentists’ EI captures their objective orientation, such as plans, wishes and preference of engaging in entrepreneurial dental business activities .
It was measured by one single question adapted from Krueger et al. , “It is likely that I will start and run my business in dentistry in a near future.” Responses were measured with a 5-point Likert scale, with 1 being least likely and 5 being most likely. For logistic regression analysis, a dummy variable of EI was then created according to the number values of the answers. EI was assigned with the value of “1” if answers were “5 = most likely”, or “4 = likely”. EI took the value of “0” for other answers (3=neutral, 2=unlikely, 1=very unlikely).
The entrepreneur’s demographic, technical knowledge and skills, entrepreneurial behaviors, as well as psychological characteristics are often cited as the most influential factors to their entrepreneurial activities and performance [31, 32]. This study hence includes these relevant factors accordingly.
Demographic and professional characteristics. This part contains questions about gender, age, education level, professional qualification and years of practice. The hospital workplace was measured in terms of employee numbers, rather than bed numbers, because most dental treatment is performed with outpatients, rather than inpatients.
Entrepreneurial behavior. This variable reflects personalities and skills associated with identifying and exploring business opportunities, taking risks and being engaged in implementation of business plans . The scale for measuring entrepreneurial behaviors in this study was adopted from Afsar et al., that is especially designed for employee’s entrepreneurial behavior in knowledge–intensive industries [31, 32, 34]. Accordingly, the level of a dentists’ entrepreneurial behavior is the average score of six dimensions. (1) “Encourage team members to take the initiative with their own ideas.”; (2) “Inspire team members to think about their work in innovative perspectives”; (3) “Devote time to help team members improve the products and services”; (4) “Vividly describe how things could be in the future and what is needed to reach the goal”; (5) “Effectively organize team to meet a challenge”; (6) “Create an environment where people get excited about making improvement”. All measurements are based on a 5-point Likert scale from 1 (“disagree strongly”) to 5 (“agree strongly”).
Risk aversion. An individual’s risk-taking attitude may have direct and significant effects on EIs . Strong perceptions regarding a potential loss of business, would lead to a lower level of EI . Risk aversion in this study was measured by the established tool developed by Barbosa et al. Presented with the statement, “The failure of starting a private business will have a negative impact on my future career.” respondents were asked to rate how closely this statement reflected their perceptions and responses using a 5-point Likert scale from 1 (“disagree strongly”) to 5 (“agree strongly”).
Entrepreneurial family background. Family background and parental role models can affect EI through attitudes [38, 39], innovation and creative capacities [40, 41]. There is a question asked about whether or not a respondent had family/relative members who engaged in entrepreneurship.
The baseline model was a multivariate logistic regression model analyzing the major factors associated with the dependent variable, the dentists’ EI, that is a dummy variable, taking the value of “1” if answering “having entrepreneurial intention”. The independent variables included basic demographic and professional characteristics of the dentists.
The full model added additional variables to capture potential influences from the dentists’ personalities, personal skills and resources, such as ‘entrepreneurial behavior’, ‘risk aversion’ and ‘entrepreneurial family background’. All statistical analyses were performed with STATA (version 15).