Institutional pathways to TCM psychological acceptance abroad: A fuzzy Delphi evaluation of four Chinese colleges

The "Plan for Promoting High-Quality Integration of Traditional Chinese Medicine into the Joint Construction of the 'Belt and Road' (2021-2025)" underscores strategic initiatives to advance TCM (Traditional Chinese Medicine) globally, including establishing overseas cultural brands (e.g., "Consular Officials in Chengdu Experience TCM" programs), integrating TCM into higher education systems of partner nations, and amplifying academic influence through research.

This study develops an expert-validated assessment model to evaluate the institutional capacity of four TCM internationalization entities (Colleges 1-4) to serve as effective proximal enablers of psychological acceptance-operationalized as cognitive understanding, affective trust, and behavioral adoption of TCM in target populations. Rather than measuring psychological acceptance directly in foreign audiences, the model identifies and weights the institutional preconditions theorized to enable it: transmission mechanisms, cultural-conceptual alignment, market positioning, and perceived efficacy. From an initial pool of 21 indicators across five dimensions, the FDM consensus process retained 15 indicators across four dimensions after eliminating six items that failed to meet the d < 0.2 threshold.

The Fuzzy Delphi Method (FDM) was employed to refine criteria and prioritize pathways based on expert input. Two survey rounds were required: the first round did not achieve the pre-specified 75% agreement threshold (criteria weight consensus: 52%; rating consensus: 64%), necessitating a second round, which achieved 85% criteria weight consensus and 75% rating consensus. Criterion weights and institutional rankings were derived from the second-round data. Evaluation Framework: Four dimensions comprising 15 indicators were identified: Cultural-Conceptual Compatibility, International Environment and Market, Perceived Efficacy and Safety, and Dissemination Capacity. Expert judgments were transformed into triangular fuzzy numbers; six cost-type indicators were reverse-coded to ensure uniform polarity.

College 4 ranked highest in transmission efficacy, followed by College 1, providing policymakers a validated tool to screen and optimize TCM dissemination strategies.