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He Y, Wang P, Du Y, Li H, Chen Y, Zhu J. Policy perception, job satisfaction and intentions to remain in rural area: evidence from the National Compulsory Service Programme in China. Glob Health Res Policy 2024; 9:16. [PMID: 38689363 PMCID: PMC11059768 DOI: 10.1186/s41256-024-00348-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exploring factors that may influence general practitioners (GPs)' intentions to remain in rural area is necessary to inform the training and placement of future medical workforce in rural area. However, little is known about how GPs' perception towards the National Compulsory Service Programme (NCSP) and job satisfaction impact their turnover intention. This paper explores GPs' intentions to remain in rural China and how their policy perception and job satisfaction predict the intentions. METHODS We conducted a cross-sectional, online survey from December 2021 to February 2022 to investigate GPs' perception towards NCSP, job satisfaction, and intentions to remain in rural area. Eligible participants were GPs who were required to provide health services as part of NCSP at township health centres of 9 provinces which could represent all NCSP GPs in China. Multinomial logistic regression analyses were performed to explore the associations between policy perceptions, job satisfaction, and intentions to remain. RESULTS Of 3615 GPs included in the analysis, 442 (12.2%) would like to remain in rural area and 1266 (35.0%) were unsure. Results of the multinomial logistic regression analyses showed that compared with GPs who would leave, GPs with higher perception scores for the restriction on taking postgraduate exam (RRR: 1.93, 95% CI 1.72, 2.16) and the commitment to work for six years (RRR: 1.53, 95% CI 1.31, 1.78) were more likely to remain. In contrast, GPs who had higher perception scores for completing standardised residency training (RRR: 0.75, 95% CI 0.64, 0.88) and passing National Medical Licensing Examinations (RRR: 0.74, 95% CI 0.62, 0.87) were more likely to leave. GPs who were satisfied with the freedom of choosing work methods (RRR: 1.52, 95% CI 1.25, 1.84) and chances of promotion (RRR: 1.60, 95% CI 1.32, 1.94) were more likely to remain. CONCLUSIONS This study highlights the significance of policy perception and job satisfaction on GPs' intentions to remain in rural area. Factors such as career advancement and the empowerment of GPs to build on and use their skills and abilities should be taken into account when designing rural placement programmes.
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Affiliation(s)
- Yanrong He
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Yanrong Du
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Hange Li
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Yanhua Chen
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
- School of Medicine, Tsinghua University, Beijing, China.
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
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Luo H, Gong H, Luo F, Xing Y, Wang X, Huang J, Ding M, Lin D, Lan Y. Core competence of midwives in township hospitals and its influencing factors-A cross-sectional study. Heliyon 2024; 10:e25475. [PMID: 38327397 PMCID: PMC10848002 DOI: 10.1016/j.heliyon.2024.e25475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Objective This study aimed to assess the core competence of midwives in township hospitals through a self-assessment questionnaire. The relationship between professional identity and core competence and the factors influencing midwives' core competence was also investigated. Method Convenience sampling was conducted in 77 township hospitals in Ganzhou, Jiangxi Province, China, with 150 participants. The questionnaires were distributed online in November 2021. We conducted a descriptive data analysis, a correlation analysis of the two variables of professional identity and core competencies, and multivariate linear regression to analyse the influencing factors, including the sociodemographic information, the Midwife Core Competence Scale, and the Nurses' Professional Identity Scale scores. Results The mean score for the core competence was 206.43 (±37.45) out of 270. The highest score was for pregnancy care (3.97 ± 0.70) and the lowest was for newborn care (3.72 ± 0.78). The independent sample t-test results and one-way analysis of variance showed that qualifications, midwifery training situation, and midwifery working years had differential effects on midwives' core competencies (P < 0.05). Multiple linear regression showed that qualifications, midwifery working years, and level of professional identity were influencing factors (P < 0.05). Conclusions The core competencies of midwives in township hospitals were lower than those reported in other studies. Advancements in education, midwifery working years, and professional identity may increase midwives' core competencies.
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Affiliation(s)
- Huiyi Luo
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huping Gong
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Feng Luo
- Department of Obstetrics, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Ying Xing
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xin Wang
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Jingwen Huang
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Mei Ding
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Dongmei Lin
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yanli Lan
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi, China
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Jin R, Chen Y. Job satisfaction of village doctors in a rural-oriented tuition-waived medical education program in China. Front Psychol 2023; 14:1184430. [PMID: 37560095 PMCID: PMC10408449 DOI: 10.3389/fpsyg.2023.1184430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/22/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION To address health inequity and relieve shortage of rural doctors, China initiated Rural-oriented Tuition-waived Medical Education (RTME) to train doctors in rural areas for free since 2010. Little is known about job satisfaction of this particular group of rural doctors. METHODS Job Satisfaction Questionnaires for Village Doctors were distributed to 240 village doctors with RTME program in China, and 40 received in-depth semi-structured interviews. Descriptive analysis, chi-square test, univariate and multivariate logistic regressions in SPSS23.0 were conducted, and thematic analysis was applied to interviews. RESULTS Job satisfaction rate of village doctors with RTME program was 56.50%. Full understanding of RTME policy, recognition of rural medical work, relevance of RTME curriculum with present job, education background, rural origin and renumeration were positively correlated with job satisfaction. Preferential policies of RTME program, relaxing working atmosphere, more promotion opportunity, and easier access to higher technical titles were the key factors to retain rural doctors. CONCLUSION Our findings may interest healthcare authorities, medical colleges and primary healthcare establishments. Studying the job satisfaction of village doctors in China may also be beneficial in developing community and rural health services, and provide valuable insights into the training and retention of primary healthcare providers in other countries.
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Affiliation(s)
- Renmin Jin
- Party School of Anhui Provincial Committee of C.P.C, Hefei, China
| | - Yan Chen
- Anhui Medical College, Hefei, China
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The relationship between organisational support for career development, organisational commitment, and turnover intentions among healthcare workers in township hospitals of Henan, China. BMC PRIMARY CARE 2022; 23:136. [PMID: 35655133 PMCID: PMC9161467 DOI: 10.1186/s12875-022-01753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 05/25/2022] [Indexed: 11/12/2022]
Abstract
Background Township hospitals in China face the challenge of shortage and turnover of healthcare workers. This study aims to evaluate the relationship between organisational support for career development (OSCD), organisational commitment, and turnover intentions among healthcare workers in township hospitals. Methods The data in this study were obtained from the Health Service Capacity Survey of Primary Health Institutions (2020), one of the special surveys of rural health poverty alleviation in Henan, China. The sample comprised 298 healthcare workers. Three standardised instruments were used: the turnover intention scale, OSCD scale, and organisational commitment scale. Descriptive statistics, One-way Analysis of Variance, Pearson correlation analysis, and the simple mediation model were used for data analysis. Results The results showed that the mean score of the healthcare workers’ turnover intentions was 2.21 ± 0.77, which was low. The healthcare workers’ turnover intentions had significant differences in gender, age, marital status, education, professional title, and organisational tenure. OSCD had no significant direct relationship with turnover intentions, while having a significant positive direct relationship with organisational commitment. Organisational commitment had a significant negative direct relationship with turnover intentions, and played a fully mediating role in the relationship between OSCD and turnover intentions. Conclusions OSCD had an indirect negative effect on healthcare workers’ turnover intentions in township hospitals through the full mediation of organisational commitment. The findings of this study suggest the importance of policymakers and organisation managers to improve OSCD practice and pay attention to ‘humanistic management’. In addition, the formulation and implementation of talent retention policies should consider socio-demographic differences. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01753-4.
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Zou Q, He X, Zhang L. Community health workers' mobility in China: Evidence from 2008 to 2017. Front Public Health 2022; 10:947984. [PMID: 36081472 PMCID: PMC9446455 DOI: 10.3389/fpubh.2022.947984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023] Open
Abstract
Background Community health workers (CHWs) are essential to improve the responsiveness of the national health system and the capacity of community health services. Since the implementation of the new program for health system reform in 2009, China has adopted an unprecedented policy to attract and retain CHWs to increase the quantity and quality of CHWs equitably. The policy's effects need to be further determined. The purpose of this study was to illustrate the temporal and spatial dynamics of CHWs' mobility in China from 2008 to 2017. Methods This study used a multistage stratified sampling method to collect 14,094 CHW mobility records from 24 counties and 12 districts in six provinces in China for analysis. The data cover the period from 2008 to 2017. Descriptive statistics and chi-square test were adopted to analyse the distribution of mobile CHWs across different years and different subgroups from 2008 to 2017. Results This study found that China's CHWs were in a state of net inflow from 2008 to 2017. The number of net inflows continued to increase from 2008 to 2011 and had a slight downward trend afterwards. CHW turnover occurred more in rural areas and amongst males, physicians, management and support staff, intermediate and senior professional titles, ≥30 years old group and contractual temporary employees. By contrast, the attraction and retention of CHWs are remarkable amongst nurses, pharmacists, imaging and laboratory technicians, junior title, junior college degree and above and <30 years old group. Conclusions China has made great achievements with the policy targeting the attraction and retention of CHWs since the implementation of the new program for health system reform in 2009. However, CHWs in China are faced with the dilemma of an extremely high total mobility, the attraction of CHWs in rural areas is still insufficient, the professional structure of CHWs is unreasonable, and the attrition of high-quality health workers exists. China must pay attention to the fair allocation of urban and rural areas, dynamically adjust the recruitment structure of health technicians, improve the mechanism for attracting and retaining technicians with higher titles and guarantee the benefits of temporary employees.
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Affiliation(s)
- Qi Zou
- College of Public Administration, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqun He
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Liang Zhang
- School of Political Science and Public Administration, Wuhan University, Wuhan, China,*Correspondence: Liang Zhang
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Tang XY, Cheng M, Geater A, Deng QY, Zhong G, Lin YD, Chen N, Lan T, Jiang LY, Zhu MT, Li Q. Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study. Infect Dis Poverty 2021; 10:102. [PMID: 34294157 PMCID: PMC8296749 DOI: 10.1186/s40249-021-00885-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/12/2021] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Measles outbreaks re-emerged in 2013-2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system barriers to timely vaccination. Using integrated evidence at the household, village clinic, and township hospital levels, this study aimed to identify the determinants of failure in receiving timely measles vaccinations among children in rural Guangxi. METHODS A multi-stage stratified cluster sampling survey with a nested qualitative study was conducted among children aged 18-54 months in Longan, Zhaoping, Wuxuan, and Longlin counties of Guangxi from June to August 2015. The status of timely vaccinations for the first dose of measles-containing vaccine (MCV1) and the second dose of measles-containing vaccine (MCV2) was verified via vaccination certificates. Data on household-level factors were collected using structured questionnaires, whereas data on village and township-level factors were obtained through in-depth interviews and focus group discussions. Determinants of untimely measles vaccinations were identified using multilevel logistic regression models. RESULTS A total of 1216 target children at the household level, 120 villages, and 20 township hospitals were sampled. Children were more likely to have untimely vaccination when their primary guardian had poor vaccination knowledge [MCV1, odds ratio (OR) = 1.72; MCV2, OR = 1.51], had weak confidence in vaccines (MCV1, OR = 1.28-4.58; MCV2, OR = 1.42-3.12), had few practices towards vaccination (MCV1, OR = 12.5; MCV2, OR = 3.70), or had low satisfaction with vaccination service (MCV1, OR = 2.04; MCV2, OR = 2.08). This trend was also observed in children whose village doctor was not involved in routine vaccination service (MCV1, OR = 1.85; MCV2, OR = 2.11) or whose township hospital did not provide vaccination notices (MCV1, OR = 1.64; MCV2, OR = 2.05), vaccination appointment services (MCV1, OR = 2.96; MCV2, OR = 2.74), sufficient and uniformly distributed sessions for routine vaccination (MCV1, OR = 1.28; MCV2, OR = 1.17; MCV1, OR = 2.08), or vaccination service on local market days (MCV1, OR = 2.48). CONCLUSIONS Guardians with poor knowledge, weak beliefs, and little practice towards vaccination; non-involvement of village doctors in routine vaccinations; and inconvenient vaccination services in township hospitals may affect timely measles vaccinations among children in rural China.
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Affiliation(s)
- Xian-Yan Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
| | - Man Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Qiu-Yun Deng
- Institute of Vaccination, Guangxi Centre for Disease Control and Prevention, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Ge Zhong
- Institute of Vaccination, Guangxi Centre for Disease Control and Prevention, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yue-Dong Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Ning Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Tao Lan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Long-Yan Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Man-Tong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Qiao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, China. No. 22nd, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
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Wu Y, Zhu L, Yu T, Zhang S. A Comprehensive Evaluation of Township Hospitals in the Severely Cold Areas of China. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:93-113. [PMID: 34000857 DOI: 10.1177/19375867211010268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aims of this study are to establish an evaluation system and find the existing problems in the architectural design of township hospitals in the severely cold regions of China. BACKGROUND Due to the geographical location and economic factors, development still has some key problems, such as inadequate construction, old facilities, and backward technology, which are more prominent in the severely cold regions. METHODS First, evaluation factors have been selected and determined by literature review and on-site investigation. Evaluation rules have been determined using fuzzy membership function. Then, the analytic hierarchy process is used to determine the weights of the evaluation factors at all levels. Finally, take a township hospital as an example to calculate the comprehensive evaluation results. RESULTS A comprehensive evaluation index system with 28 elements and 76 factors for the township hospitals in severely cold regions including the basic health service capacity, the emergency capacity, and the climate fitness. CONCLUSIONS The establishment of the comprehensive evaluation system of township hospitals in severely cold areas in this study aims to find out the problems through the evaluation of the existing township hospitals in the severely cold areas and provide guidance for the transformation of existing township hospitals in the severely cold areas. By comparing the scheme evaluation for building hospitals, we shall look for the optimal solution to provide reference for future development in the construction of township hospitals.
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Affiliation(s)
- Yue Wu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
| | - Lei Zhu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
| | - Tingting Yu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
| | - Shanshan Zhang
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
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Wang L, Yang Y, Zhu J, Xie H, Jiang C, Zhang C, Li J, Huang F. Professional identity and mental health of rural-oriented tuition-waived medical students in Anhui Province, China. BMC MEDICAL EDUCATION 2019; 19:199. [PMID: 31196087 PMCID: PMC6567401 DOI: 10.1186/s12909-019-1603-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/13/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND The shortage of primary care physicians in rural China is an enduring problem with serious implications for access to care. In response to the shortage in health workforce in rural areas, China government has launched the rural-oriented tuition-waived medical education (RTME) programme since 2010, aiming to train more general practitioners to address the rural health workforce requirements in middle and west areas. This study aims to investigate the prevalence of mental illness and the level of professional identity in the rural-oriented tuition-waived medical students (RTMSs), and to explore the impact of the RTMSs' professional identity and related cognition and satisfaction with the RTME programme on mental health. METHODS We conducted a descriptive, cross-sectional study. A total of 1103 RTMSs and 1095 non-oriented medical students from seven medical universities (colleges) in Anhui province completed a demographic questionnaire, the Depression, Anxiety, Stress Scales and the Professional Identity Questionnaire for Undergraduate Students. Cognition and satisfaction with the RTME programme of the RTMSs were collected. Multiple linear regression analysis was used to analyze the data. RESULTS The prevalence of depression, anxiety, and stress in RTMSs were 11.8, 22.9 and 3.4%, respectively. The mean total scores of the Professional Identity Questionnaire for Undergraduate Students were 3.58 (SD = 0.61). Results of multiple linear regression model indicated that students who are dissatisfied with targeted primary healthcare institution are likely to suffer from depression and anxiety; moreover, students who enrolled in the rural-oriented tuition-waived medical education programme due to economic reason are more likely to suffer from anxiety. Furthermore, a significant positive correlation was found between professional identity and mental health. CONCLUSIONS Providing better information about the RTME programme prior to enrollment and improving the students' cognition of the policy's effectiveness and the social value of rural healthcare work may contribute to improving the professional identity of the RTMSs. Meanwhile, a significant positive association was found between professional identity and mental health. This is a new perspective that shows that developing and improving professional identity may help medical students reduce the risk of psychological illness.
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Affiliation(s)
- Ling Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Shushan Districts, Hefei, 230032 Anhui China
| | - Yuwei Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Shushan Districts, Hefei, 230032 Anhui China
| | - Jimin Zhu
- Department of Public Health and General Medicine, Anhui University of Chinese Medicine, 103 Meishan Road, Shushan District, Hefei, 230038 Anhui China
| | - Hong Xie
- School of Nursing, BengBu Medical College, 2600 East Sea Avenue, Longzi Lake District, Bengbu, 233030 Anhui China
| | - Chunxiao Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Shushan Districts, Hefei, 230032 Anhui China
| | - Chi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Shushan Districts, Hefei, 230032 Anhui China
| | - Jie Li
- Department of Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, 230032 Anhui China
| | - Fen Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Shushan Districts, Hefei, 230032 Anhui China
- Central Laboratory of Preventive Medicine, School of Public Health, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, 230032 Anhui China
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Determinants and Differences of Township Hospital Efficiency among Chinese Provinces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091601. [PMID: 31067779 PMCID: PMC6539220 DOI: 10.3390/ijerph16091601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 12/27/2022]
Abstract
This study aimed to measure the efficiency and change in efficiency over time of township hospitals among Chinese provinces, to decompose the difference in efficiency between districts, and to study the correlations between the difference in efficiency and its determinants. Based on Chinese provincial panel data, the empirical analysis was established using data envelopment analysis (DEA), Malmquist index, Theil index decomposition method and Grey correlation analysis method. First, it was found that the township hospitals in most provinces were operating in an inefficient state, and the township hospitals in most provinces achieved gains in efficiency. Second, from 2003 to 2016 the shrinkage of the difference in provincial efficiency of township hospitals progressed slowly. Intra-regional difference is the main cause of the overall provincial efficiency difference of Chinese township hospitals, while inter-regional difference is the minor cause of the overall difference. Third, the correlation between the difference of overall provincial efficiency and the difference of economic development level is the highest among all the correlations, while other determinants rank second to seventh place in their degree of correlation with respect to the overall difference in provincial efficiency. Furthermore, the correlations between the intra-regional difference of provincial efficiency of Chinese township hospitals and its determinants vary tremendously across regions. Based on our findings, we can conclude, first, that efforts should be made to improve the overall provincial difference in efficiency of Chinese township hospitals, and enhance the utilization level of input resources, and to reduce resource waste. Second, in order to shrink the overall provincial efficiency of Chinese township hospitals, the most important measure that should be taken is to improve the economic development level in relatively backward provinces in order to lay a solid economic foundation for the improvement of efficiency and shrink the differences in efficiency between provinces. Third, more attention should be paid to the shrinkage of intra-regional efficiency differences in Chinese township hospitals, while the narrowing of inter-regional efficiency difference should not be ignored. For each region, it is necessary to recognize the difference in the relative importance of determinants, and to make development strategies according to local conditions so as to make full use of local characteristics and advantages.
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Liu J, Zhu B, Wu J, Mao Y. Job satisfaction, work stress, and turnover intentions among rural health workers: a cross-sectional study in 11 western provinces of China. BMC FAMILY PRACTICE 2019; 20:9. [PMID: 30642261 PMCID: PMC6330754 DOI: 10.1186/s12875-019-0904-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/07/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Health workforce turnover remains a global concern, particularly in rural and remote areas. Western rural areas are the least developed in China, where it faces the serious challenge on the rural health worker (RHW) management. This study aimed to investigate job satisfaction, work stress, and turnover intentions of RHWs, and to explore prominent factors associated with turnover intentions of RHWs in rural western China. METHODS From June to September 2013, based on a three-stage random sampling method, a cross-sectional survey was conducted among RHWs in 11 western provinces in China. A brief, structured questionnaire filled in by RHWs was used for data collection. A total of 5046 RHWs participated in the study. The response rate was approximately 93.1%. Exploratory factor analyses, Pearson's chi-squared tests, one-way ANOVA, binary logistic regression analyses, and mediating effect tests were performed for data analyses. RESULTS Approximately 29.1% of the 5046 RHWs indicated turnover intentions. Most of the RHWs disclosed low educational levels, income levels, and professional technical titles. The RHWs expressed slight job satisfaction (mean 3.20) and moderate work stress (mean 3.22). Age, income, medical institution, and job satisfaction (i.e., organizational management, reward, and occupation satisfaction) were significant predictors of the RHWs' turnover intentions. The RHWs, who were younger (less than 41 years), receiving an income of $326.8-$490.1 per month, working in township hospitals, and having low job satisfaction, were more likely to have turnover intentions. Work stress had an indirect and positive effect on RHWs' turnover intentions. Job satisfaction weakened the positive effect of work stress on turnover intentions of RHWs by playing a total mediating role. Reward satisfaction was the strongest mediator. CONCLUSIONS The turnover intentions of RHWs in western China are significantly associated with job satisfaction, work stress, age, income, and medical institution. Appropriate strategies should be implemented to improve RHWs' job satisfaction and reduce their work stress. Meanwhile, providing more attractive wages and non-monetary support, improving working conditions, etc. could be effective to reduction in RHWs' turnover intentions.
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Affiliation(s)
- Jinlin Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Bin Zhu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Jingxian Wu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Ying Mao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
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Liu J, Zhang K, Mao Y. Attitude towards working in rural areas: a cross-sectional survey of rural-oriented tuition-waived medical students in Shaanxi, China. BMC MEDICAL EDUCATION 2018; 18:91. [PMID: 29720164 PMCID: PMC5932863 DOI: 10.1186/s12909-018-1209-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/20/2018] [Indexed: 05/08/2023]
Abstract
BACKGROUND Attracting and recruiting health workers to work in rural areas is still a great challenge in China. The rural-oriented tuition-waived medical education (RTME) programme has been initiated and implemented in China since 2010. This study aimed to examine the attitudes of rural-oriented tuition-waived medical students (RTMSs) in Shaanxi towards working in rural areas and the related influencing factors. METHODS A cross-sectional survey was conducted in 2015 among 232 RTMSs in two medical universities from the first group of students enrolled in the RTME programme in Shaanxi. Descriptive and analytical statistics were used for the data analyses. RESULTS Of the 230 valid responses, 92.6% expressed their intentions of breaking the contract for working in rural township hospitals for 6 years after their graduation under the RTME programme. After the contract expired, only 1.3% intended to remain in the rural areas, 66.5% had no intention of remaining, and 32.2% were unsure. The factors related to a positive attitude among the RTMSs towards working in rural areas (no intention of breaking the contract) included being female, having a mother educated at the level of primary school or below, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the policy. The factors related to a positive attitude of the RTMSs towards remaining in rural areas included being female, having a rural origin, having no regular family monthly income, having a father whose occupation was farmer, having a mother educated at the level of postsecondary or above, having the RTMSs be the final arbiter of the policy choice, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the educational scheme. CONCLUSIONS Related policy makers and health workforce managers may benefit from the findings of this study. Appropriate strategies should be implemented to stimulate the RTMSs' intrinsic motivation and improve their willingness to work in rural areas and to better achieve the objectives of RTME policy. Meanwhile, measures to increase the retention of RTMSs should also be advanced.
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Affiliation(s)
- Jinlin Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Kun Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
- Xi’an Health and Family Planning Commission, Xi’an, China
| | - Ying Mao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
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Cheng Z, Cai M, Tao H, He Z, Lin X, Lin H, Zuo Y. Efficiency and productivity measurement of rural township hospitals in China: a bootstrapping data envelopment analysis. BMJ Open 2016; 6:e011911. [PMID: 27836870 PMCID: PMC5129104 DOI: 10.1136/bmjopen-2016-011911] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Township hospitals (THs) are important components of the three-tier rural healthcare system of China. However, the efficiency and productivity of THs have been questioned since the healthcare reform was implemented in 2009. The objective of this study is to analyse the efficiency and productivity changes in THs before and after the reform process. SETTING AND PARTICIPANTS A total of 48 sample THs were selected from the Xiaogan Prefecture in Hubei Province from 2008 to 2014. OUTCOME MEASURES First, bootstrapping data envelopment analysis (DEA) was performed to estimate the technical efficiency (TE), pure technical efficiency (PTE) and scale efficiency (SE) of the sample THs during the period. Second, the bootstrapping Malmquist productivity index was used to calculate the productivity changes over time. RESULTS The average TE, PTE and SE of the sample THs over the 7-year period were 0.5147, 0.6373 and 0.7080, respectively. The average TE and PTE increased from 2008 to 2012 but declined considerably after 2012. In general, the sample THs experienced a negative shift in productivity from 2008 to 2014. The negative change was 2.14%, which was attributed to a 23.89% decrease in technological changes (TC). The sample THs experienced a positive productivity shift from 2008 to 2012 but experienced deterioration from 2012 to 2014. CONCLUSIONS There was considerable space for TE improvement in the sample THs since the average TE was relatively low. From 2008 to 2014, the sample THs experienced a decrease in productivity, and the adverse alteration in TC should be emphasised. In the context of healthcare reform, the factors that influence TE and productivity of THs are complex. Results suggest that numerous quantitative and qualitative studies are necessary to explore the reasons for the changes in TE and productivity.
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Affiliation(s)
- Zhaohui Cheng
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Miao Cai
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Hongbing Tao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Zhifei He
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Xiaojun Lin
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Haifeng Lin
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Yuling Zuo
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
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