Changing of China׳s health policy and Doctor–Patient relationship: 1949–2016

Has China's hierarchical medical system improved doctor-patient relationships?

BACKGROUND AND OBJECTIVE

Developing harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China's hierarchical medical system on doctor-patient relationships, thus contributing to China's medical and health system reform.

METHODS

With panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy.

RESULTS

Hierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger.

CONCLUSION

While reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries.

Barriers and facilitators to guideline for the management of pediatric off-label use of drugs in China: a qualitative descriptive study

BACKGROUND

Despite being a global public health concern, there is a research gap in analyzing implementation strategies for managing off-label drug use in children. This study aims to understand professional health managers' perspectives on implementing the Guideline in hospitals and determine the Guideline's implementation facilitators and barriers.

METHODS

Pediatric directors, pharmacy directors, and medical department directors from secondary and tertiary hospitals across the country were recruited for online interviews. The interviews were performed between June 27 and August 25, 2022. The Consolidated Framework for Implementation Research (CFIR) was adopted for data collection, data analysis, and findings interpretation to implement interventions across healthcare settings.

RESULTS

Individual interviews were conducted with 28 healthcare professionals from all over the Chinese mainland. Key stakeholders in implementing the Guideline for the Management of Pediatric Off-Label Use of Drugs in China (2021) were interviewed to identify 57 influencing factors, including 27 facilitators, 29 barriers, and one neutral factor, based on the CFIR framework. The study revealed the complexity of the factors influencing managing children's off-label medication use. A lack of policy incentives was the key obstacle in external settings. The communication barrier between pharmacists and physicians was the most critical internal barrier.

CONCLUSION

To our knowledge, this study significantly reduces the implementation gap in managing children's off-label drug use. We provided a reference for the standardized management of children's off-label use of drugs.

Determinants of parental self-reported uptake of influenza vaccination in preschool children during the COVID-19 pandemic

In China, the coverage rate of influenza vaccination among the general population is significantly lower than that of high-income countries, with only 2.46% of the population vaccinated. Preschool-aged children are particularly susceptible to influenza viruses, yet the factors that influence parents' willingness to vaccinate their children are not well understood. To address this research gap, we developed a theoretical model grounded in the Unified Theory of Acceptance and Use of Technology (UTAUT), which explores six key factors influencing parental self-reported uptake of influenza vaccination in preschool children: performance expectancy, effort expectancy, social influence, facilitating conditions, knowledge, and behavioral intention. We collected data from 872 parents of children in five major cities in China and employed structural equation modeling to examine the significance of the theoretical model and explore the potential moderating effects of demographic variables on path relationships. Our analysis revealed that several positive factors influenced parents' intention of influenza vaccination for preschool children, including effort expectancy (β = 0.38), social influence (β = 0.17), and knowledge (β = 0.52). Facilitating conditions (β = 0.34), knowledge (β = 0.40), and behavioral intention (β = 0.34) were found to be associated with self-reported uptake. Furthermore, we observed significant moderating effects of the child's gender and age, as well as the guardian's category and income, on the theoretical models. Parents' willingness to vaccinate preschool children against influenza is influenced by both psychological and demographic variables. Further studies are needed to determine if these relationships persist over time and across different regions.

Factors associated with graduation examination results from standardised residency training in Zhejiang Province, China: a cross-sectional analysis of medical examination results data from 2020

OBJECTIVE

Standardised residency training is an important part of postgraduation medical education in China. The graduation examination tests the effect of residency training and is an important measure to guarantee the quality of residency training. This study aimed to analyse the results and associated factors of the graduation examination of standardised residency training in Zhejiang Province in 2020.

DESIGN

Cross-sectional analysis of examination results data.

SETTING

Medical and health institutions and universities in Zhejiang Province.

PARTICIPANTS

A total of 5555 examinees took the graduation examination of standardised residency training in Zhejiang Province in 2020.

PRIMARY OUTCOMES

Pass rates of the practical skill examination and written examination.

RESULTS

The pass rates for the practical skill examination and written examination were 91.8% and 96.5%, respectively. Examinees aged 30 and above (adjusted OR (AOR)=0.48, 95% CI 0.26 to 0.89), those with 3 years (AOR=0.19, 95% CI 0.09 to 0.43) and 2 years (AOR=0.61, 95% CI 0.40 to 0.96) of training, those who retook the examination (AOR=0.28, 95% CI 0.20 to 0.391) and those from primary healthcare institutions (AOR=0.56, 95% CI 0.40 to 0.77) were less likely to pass the practical skill examination. Examinees with a postgraduate degree and those from colleges and universities had higher pass rates in the written examination (AOR=6.37, 95% CI 1.95 to 23.34; AOR=2.87, 95% CI 1.40 to 6.65, respectively). Examinees aged 30 and above (AOR=0.08, 95% CI 0.01 to 0.30), those aged between 25 and 30 (AOR=0.22, 95% CI 0.03 to 0.80), those who retook the examination (AOR=0.04, 95% CI 0.03 to 0.07), those from second-level hospitals (AOR=0.58, 95% CI 0.39 to 0.87) and those who failed the practical skill examination (AOR=0.17, 95% CI 0.12 to 0.25) were less likely to pass the written examination.

CONCLUSIONS

The pass rate of the graduation examination of standardised residency training was associated with the individual characteristics of the examinees. The results of practical skill examination were related to the results of the written examination.

Understanding workplace violence against medical staff in China: a retrospective review of publicly available reports

BACKGROUND

Workplace violence against medical staff in China is a widespread problem that has negative impacts on medical service delivery. The study aimed to contribute to the prevention of workplace violence against medical staff in China by identifying patterns of workplace violence, key risk factors, and the interplay of risk factors that result in workplace violence.

METHODS

Ninety-seven publicly reported Chinese healthcare violent incidents from late 2013 to 2017 were retrospectively collected from the internet and analysed using content analysis. A modified socio-ecological model guided analysis of the violent incidents focusing on risk.

RESULTS

Physical violence, yinao, or a combination of physical and verbal violence were the typical forms of violence reported. The findings identified risk at all levels. Individual level risk factors included service users' unreasonable expectations, limited health literacy, mistrust towards medical staff, and inadequacy of medical staff's communication during the medical encounter. Organisational level risk factors under the purview of hospital management included problems with job design and service provision system, inadequacies with environmental design, security measures, and violence response mechanisms within hospitals. Societal level risk factors included lack of established medical dispute-handling mechanisms, problems in legislation, lack of trust and basic health literacy among service users. Situational level risks were contingent on risk factors on the other levels: individual, organisational, and societal.

CONCLUSIONS

Interventions at individual, situational, organisational, and societal levels are needed to systematically address workplace violence against medical staff in China. Specifically, improving health literacy can empower patients, increase trust in medical staff and lead to more positive user experiences. Organizational-level interventions include improving human resource management and service delivery systems, as well as providing training on de-escalation and violence response for medical staff. Addressing risks at the societal level through legislative changes and health reforms is also necessary to ensure medical staff safety and improve medical care in China.

Bereavement After Patient Deaths Among Chinese Physicians and Nurses: A Qualitative Description Study

In order to achieve an in-depth understanding of professional caregivers' experiences of bereavement after patient deaths in Mainland China, qualitative description was employed. 24 physicians and nurses from hospitals in Nanjing, China, participated in one-to-one, semi-structured interviews. Thematic analysis was adopted for data analysis. Five themes were generated: the nature of professional bereavement experiences, the meaning of patient deaths, immediate bereavement reactions, long-term changes, and coping strategies. Each theme included personal and professional dimensions. Professional bereavement experiences in Mainland China were found to be influenced by workplace violence against professional caregivers, traditional Chinese medical ethics, the strong death taboo, and inadequacies of the healthcare system. Professional bereavement experiences are meaning-driven, comprehensive, and usually disenfranchised. They involve multidimensional reactions and have both short-term and long-lasting, both event-specific and accumulated impacts. Cultural and systemic factors could shape professional bereavement experiences.

The Chinese version of patient-doctor-relationship questionnaire (PDRQ-9): Factor structure, validation, and IRT psychometric analysis

OBJECTIVE

The patient-doctor relationship has been considered as a crucial concept in primary healthcare, while the medical reform launched by the Chinese government in 2009 has brought significant changes to the healthcare system, which made it urgent to introduce reliable measurement instruments for assessing today's doctor-patient relationship in China. This study examined the psychometric properties of the Chinese version of the Patient-Doctor-Relationship Questionnaire-9 item (PDRQ-9) scale among general hospital inpatients in China.

MATERIALS AND METHODS

A total of 203 participants responded to the survey, of which 39 completed retest after 7 days. Factor analyses were used to test the construct validity of the scale. Convergent validity was evaluated by the correlation between PDRQ-9 and depressive symptoms measured using PHQ-9 (Patient Health Questionnaire Depression Scale-9 item). Both multidimensional item response theory (MIRT) and unidimensional item response theory (IRT) framework were used to estimate the parameters of each item.

RESULTS

The two-factor model of relationship quality and treatment quality was supported (χ²/df = 1.494, GFI = 0.925, RMSEA = 0.071, RMR = 0.008, CFI = 0.985, NFI = 0.958, NNFI = 0.980, TLI = 0.980, IFI = 0.986). The PDRQ-9 and both subscales showed significant correlation with PHQ-9 (r = -0.196∼-0.309) and good internal consistency (Cronbach's alpha = 0.865∼0.933). ANCOVA analysis adjusted with age revealed significant difference in PDRQ-9 ratings between patients with or without significant depressive symptoms (P = 0.019). The 7-day test-retest reliability of the scale was 0.730. The MIRT model of full scale and IRT models of both subscales showed high discrimination of all items (a = 2.46∼38.46), and the test information within the range of low-quality relationship was relatively high.

CONCLUSION

The Chinese version of PDRQ-9 is a valid and reliable rating scale, which can measure the doctor-patient relationship among Chinese patients.

Decent Work and Workplace Deviance Among Chinese Physicians: A Relative Deprivation Perspective

Purpose

Managing workplace deviance has long been a hot topic in the organizational research. However, the mechanisms through which decent work affects workplace deviance have yet to be fully understood. Drawing upon relative deprivation theory, this study examines the relationship between decent work and workplace deviance by focusing on the mediating role of relative deprivation and the moderating role of career calling.

Methods

Two waves of data from 307 doctors and 61 supervisors of public hospitals in central China were examined using a the moderated mediation model.

Results

Decent work is negatively associated with workplace deviance via the mediation of relative deprivation, and the negative relationship between decent work and relative deprivation is negatively moderated by career calling. The mediating role of relative deprivation is moderated by career calling, and the indirect effect is stronger when career calling is high than when it is low.

Conclusion

By focusing on the mediating role of relative deprivation and the moderating role of career calling, this study contributes to the literature by addressing the previously unexamined relationship between decent work and workplace deviance. Moreover, this study responds to calls for research on decent work from the perspective of relative deprivation.

What Satisfies Parents of Pediatric Patients in China: A Grounded Theory Building Analysis of Online Physician Reviews

Patient satisfaction is an important intermediate outcome of patient-provider encounters, linking face-to-face interactions between patients and medical professionals with patients' well-being after consultations. Today, physician review websites provide a new venue for the study of patient satisfaction, as patients are utilizing such websites to evaluate their encounters with physicians. This study examined how parents of pediatric patients in China evaluated their pediatricians and factors associated with patient satisfaction through a qualitative content analysis of reviews (n = 7230) on the "Good Doctor Website" (haodf.com), China's largest physician review platform. Reviews were chosen from all reviews of pediatricians in eight top-tier hospitals in four major cities. Three dimensions of patient satisfaction were identified: pediatricians' interpersonal manners (including friendliness, listening to patients, heartfelt encouragement, and clear explanation), ethics (including rejecting red envelopes and kickbacks and cost awareness), and medical competence/overall health outcome. This study contributes to a culturally sensitive understanding of patient satisfaction and further explains the tense physician-patient relationship in China. Practically, our findings can inform the training of pediatricians in China.

Public trust in physicians: empirical analysis of patient-related factors affecting trust in physicians in China

Background

Trust between the parties is essential for the efficient functioning of the healthcare market. Physician-patient relationship represents an asymmetric information situation and trust in physicians is critical for improving health and wellbeing of patients. In China, trust in physicians appears to be quite low creating conflicts between physicians and patients. This study aims to identify some general factors associated with trust in physicians in general using a nationally representative survey.

Methods

A cross-sectional analysis using data from 2018 China Family Panel Study (CFPS). Survey responses of individuals aged 16 years or above were extracted from CFPS and the final sample consisted of 29,192 individuals. An ordered probit model was used to identify factors causing heterogeneity in the levels of trust in physicians.

Results

Higher educational attainment and having medical insurance coverage are associated with higher likelihood of trusting physicians. Older adults (> = 30 years), males, urban residents, wage-earners, and self-employed persons are less likely to trust physicians. People who are diagnosed as chronic diseases or current smokers indicate lower level of trust in physicians. Higher perceived quality of services improves trust.

Conclusion

Socioeconomically disadvantaged population groups and uninsured individuals are less likely to trust physicians. Health care delivery system needs to address the concerns of these specific population groups to reduce tensions between physicians and patients. Increasing health insurance coverage and offering insurance with low out-of-pocket expenses should reduce the perception that physicians are more guided by their income rather than the wellbeing of patients. The system should also develop a comprehensive bill of rights of patients to improve patient-physician relationship.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01832-6.

Patient Toward Physician Occupational Stigma Scale: Development of the Chinese Version

Background/Objective

Physicians’ occupational stigma could eradicate physician-patient trust, threatening physicians’ social status and occupational reputation. Hitherto, there has been no scale obtaining good psychometric properties to assess patients’ stigma toward physicians. The present study aimed to develop the Patient toward Physician Occupational Stigma Scale (PPOSS) and examine its reliability and validity.

Methods

The questionnaire comprising sociodemographic information and the PPOSS were employed to survey 645 Chinese patients in two phases. In Sample 2, the Wake Forest Physician Trust Scale (WFOTS), the Intolerance of Uncertainty Scale-12 (IUS-12), and the Brief Illness Perception Questionnaire (BIPQ) were tested.

Results

The PPOSS includes 19 items subsumed into three dimensions of stereotype, discrimination, and prejudice. According to the results of confirmatory factor analysis (CFA), the three-factor model fitted well (χ²/df=2.065, RMSEA=0.057, SRMR=0.045, RFI=0.904, CFI=0.956, IFI=0.956, PNFI=0.779, PCFI=0.811). The PPOSS was significantly negatively correlated with the WFOTS, and significantly positively correlated with the IUS-12 and the BIPQ. The Cronbach’s alpha coefficients for the total scale and each dimension were between 0.87 and 0.94, and the split-half reliability coefficients were between 0.84 and 0.93. Besides, the PPOSS had the measurement invariance across gender.

Conclusion

With its satisfactory psychometric properties, the PPOSS can be used as an effective instrument to assess patients’ stigma toward physicians.

Patient-centred care and patient autonomy: doctors' views in Chinese hospitals

Background

Patient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients’ trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of patient-centred care among doctors in the Chinese public hospitals.

Methods

A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China.

Results

In total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes.

Conclusion

The study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00777-w.

Job demands and resources and their relationship with satisfaction and thriving at work in a sample of Chinese doctors: a cross-sectional study

OBJECTIVES

The current study aimed to evaluate the status quo of perceived job demands and resources respectively among Chinese doctors, to examine the mediating role of work-family conflicts in the relationship between perceived job demands and various indicators of well-being, and to test the mediating role of psychological attachment in the relationship between perceived job resources and thriving at work among Chinese doctors.

DESIGN

A cross-sectional online survey study.

SETTING

Online questionnaires were administered across 30 provinces.

PARTICIPANTS

A total of 2617 doctors provided sufficiently complete responses to be used in the study.

RESULTS

Perceived job demands (M=3.843, SD=0.791) of participants were positively associated with work-family conflicts (B=0.454, p<0.001) and negatively associated with job satisfaction (B=-0.065, p<0.001) and life satisfaction (B=-0.261, p<0.001). Work-family conflicts partially mediated the relationship between job demands and life satisfaction and fully mediated the relationship between job demands and job satisfaction. Perceived job resources (M=2.474, SD=0.740) among Chinese doctors were positively associated with psychological attachment (B=0.988, p<0.001) and thriving at work (B=0.582, p<0.001). Furthermore, psychological attachment partially mediated the relationship between perceived job resources and thriving at work.

CONCLUSION

Doctors in China with high-level job demands tended to exhibit increased work-family conflicts, which in turn threatened their job and life satisfaction. On the contrary, doctors with greater job resources were more likely to thrive at work by increasing their degree of psychological attachment. The current study suggested that Chinese health policymakers and hospital administrators should provide a work environment with a dynamic equilibrium between doctors' job demands and resources.

The Experience of Patients with COVID-19 in China: An Interpretative Phenomenological Analysis

Aim

The present study examined the experiences of patients diagnosed with COVID-19 to better understand their concerns and inspiration and provide better care.

Methods

Semistructured interviews were performed with 10 COVID-19 patients from the Optical Valley Branch of Maternity and Child Healthcare Hospital of Hubei Province. Interviews were recorded on audiotape and transcribed verbatim. Transcripts were analysed using an interpretative phenomenological analysis.

Results

Four superordinate themes emerged: psychological distress caused by COVID-19 uncertainty, ethical dilemmas that will be faced after returning to the family and society, resources to cope with COVID-19, and event-related growth experience.

Conclusion

Patients with COVID-19 were generally at high risk of having mental and social health challenges. Although the epidemic obviously affected their overall health, which led to their negative emotions or concerns, it also had a positive effect, such as viewing their relationship with families or others more positively and having more thoughts and outlooks on life. The study prompted medical staff to take their time listening to patients and pay more attention to specific psychological and social health problems in future care.

Status, causes and consequences of physicians' self-perceived professional reputation damage in China: a cross-sectional survey

BACKGROUND

Conflict between physicians and patients is an increasingly serious problem, leading to the disrepute attached to Chinese physicians' social image and position. This study assesses the status of physicians' self-perceived professional reputation damage and explains it's the adverse outcomes including withdrawal behavior and workplace well-being. Moreover, potential causes of Chinese physicians' disrepute have been outlined.

METHODS

Primary data were collected through a cross-sectional online survey of physicians from 10 provinces in China, who were invited to complete an anonymous survey from December 2018 to January 2019. A total of 842 physicians (effective response rate: 92.22%) were recruited as participants.

RESULTS

About 83% of the participants self-perceived professional reputation damage from the sense of the public opinion concept. Approach half of participants exhibited the idea of turnover intention (47.3%) and one or more symptoms of burnout (46.4%). About 74.9% of the participants experienced a degree of stress. Additionally, three out of five participants reported low-level subjective well-being. More than 70% of the participants disapproved of their offspring becoming a physician. Four factors leading to physicians' damaged professional reputations are those addressed: conflict transfer, cognitive bias, improper management, and individual deviance. Stigmatised physicians are more likely to practice high-frequent defensive medicine (β = 0.172, P <0.001), intend to leave the profession (β = 0.240, P <0.001), disapprove of their children becoming physicians (β = 0.332, P<0.001) and yield worse levels of workplace well-being, including high levels of perceived stress (β = 0.214, P <0.001), increasing burnout (β = 0.209, P <0.001), and declining sense of well-being (β = - 0.311, P<0.001).

CONCLUSION

Chinese physicians were aware of damaged professional reputations from the sense of the public opinion concept, which contributes to increasing withdrawal behaviors and decreasing workplace well-being-a worsening trend threatening the entire health system. This novel evidence argues a proposal that Chinese health policy-makers and hospital administrators should promote the destigmatization of physicians immediately.

A meta-analysis of Watson for Oncology in clinical application

Using the method of meta-analysis to systematically evaluate the consistency of treatment schemes between Watson for Oncology (WFO) and Multidisciplinary Team (MDT), and to provide references for the practical application of artificial intelligence clinical decision-support system in cancer treatment. We systematically searched articles about the clinical applications of Watson for Oncology in the databases and conducted meta-analysis using RevMan 5.3 software. A total of 9 studies were identified, including 2463 patients. When the MDT is consistent with WFO at the ‘Recommended’ or the ‘For consideration’ level, the overall concordance rate is 81.52%. Among them, breast cancer was the highest and gastric cancer was the lowest. The concordance rate in stage I–III cancer is higher than that in stage IV, but the result of lung cancer is opposite (P < 0.05).Similar results were obtained when MDT was only consistent with WFO at the "recommended" level. Moreover, the consistency of estrogen and progesterone receptor negative breast cancer patients, colorectal cancer patients under 70 years old or ECOG 0, and small cell lung cancer patients is higher than that of estrogen and progesterone positive breast cancer patients, colorectal cancer patients over 70 years old or ECOG 1–2, and non-small cell lung cancer patients, with statistical significance (P < 0.05). Treatment recommendations made by WFO and MDT were highly concordant for cancer cases examined, but this system still needs further improvement. Owing to relatively small sample size of the included studies, more well-designed, and large sample size studies are still needed.

Smartphone and web-based independent consultation and feedback for joint replacement surgeries: a randomized control trial protocol

Background

Cost control and usage regulation of medical materials (MMs) are the practical issues that the government pays close attention to. Although it is well established that there is great potential to mobilize doctors and patients in participating MMs-related clinical decisions, few interventions adopt effective measures against specific behavioral deficiencies. This study aims at developing and validating an independent consultation and feedback system (ICFS) for optimizing clinical decisions on the use of MMs for inpatients needing joint replacement surgeries.

Methods

Development of the research protocol is based on a problem or deficiency list derived on a trans-theoretical framework which incorporates including mainly soft systems-thinking, information asymmetry, crisis-coping, dual delegation and planned behavior. The intervention consists of two main components targeting at patients and doctors respectively. Each of the intervention ingredients is designed to tackle the doctor and patient-side problems with MMs using in joint replacement surgeries. The intervention arm receives 18 months' ICFS intervention program on the basis of the routine medical services; while the control arm, only the routine medical services. Implementation of the intervention is supported by an online platform established and maintained by the Quality Assurance Center for Medical Care in Anhui Province, a smartphone-based application program (APP) and a web-based clinical support system.

Discussion

The implementation of this study is expected to significantly reduce the deficiencies and moral hazards in decision-making of MMs using through the output of economic, efficient, sustainable and easy-to-promote cooperative intervention programs, thus greatly reducing medical costs and standardizing medical behaviors.

Trial registration number

ISRCTN10152297.

Progress of Artificial Intelligence in Gynecological Malignant Tumors

Artificial intelligence (AI) is a sort of new technical science which can simulate, extend and expand human intelligence by developing theories, methods and application systems. In the last five years, the application of AI in medical research has become a hot topic in modern science and technology. Gynecological malignant tumors involves a wide range of knowledge, and AI can play an important part in these aspects, such as medical image recognition, auxiliary diagnosis, drug research and development, treatment scheme formulation and other fields. The purpose of this paper is to describe the progress of AI in gynecological malignant tumors and discuss some problems in its application. It is believed that AI improves the efficiency of diagnosis, reduces the burden of clinicians, and improves the effect of treatment and prognosis. AI will play an irreplaceable role in the field of gynecological malignant oncology and will promote the development of medicine and further promote the transformation from traditional medicine to precision medicine and preventive medicine. However, there are also some problems in the application of AI in gynecologic malignant tumors. For example, AI, inseparable from human participation, still needs to be more “humanized”, and needs to further protect patients’ privacy and health, improve legal and insurance protection, and further improve according to local ethnic conditions and national conditions. However, it is believed that with the continuous development of AI, especially ensemble classifier, and deep learning will have a profound influence on the future of medical technology, which is a powerful driving force for future medical innovation and reform.

Doctors in Chinese public hospitals: demonstration of their professional identities

BACKGROUND

An increase in the number of medical disputes and violence against doctors indicates a lack of trust in the medical profession by society in Chinese public hospitals. Empirical evidence confirms that one cause is the lack of professional identity demonstrated by doctors. Medical professionals are required to maintain high standards of competence and moral responsibility, and demonstrate qualities such as respect, compassion, integrity, responsiveness to needs, and commitment to sound ethical practice in order to maintain professional privilege. These principles and appropriate professional conduct are the foundation of the professional identity of the medical profession.

METHODS

A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China.

FINDINGS

In total, 614 doctors and 1184 inpatients on discharge from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the variation amongst doctors in demonstrating their professionalism in terms of respecting patients' views and preferences when determining diagnostic procedures and treatment plans, and when making ethical decisions. Although 90% patients indicated that they showed respects to doctors, close to 20% of the doctors disagreed that they received high respect from patients. About 12% of doctors prescribed unnecessary diagnostic procedures to patient for the purpose of generating profit and more than 20% of patients indicated that they gave gifts to doctors in order to receive better treatment.

CONCLUSIONS

Although about 80% of doctors demonstrated certain aspects of professionalism required by practitioners, the inconsistency across the medical workforce may exacerbate tense doctor-patient relationships. A review of medical curricula and focus of the internship program is required in order to assist medical graduates with forming required professional identity in order to improve patient satisfaction and better clinical outcomes. To be effective, a more systematic approach is recommended.

Cultivation of humanistic values in medical education through anatomy pedagogy and gratitude ceremony for body donors

BACKGROUND

One of the most important objectives of modern medical education is to empower medical students to become humanistic clinicians. Human anatomy plays a crucial role in this mission by using cadavers to cause reflections on death, dying, illness, and the role of medical practitioners in humanistic care. The objective of this study was to introduce, describe, and evaluate the impact of a ceremony in honor of the body donors on ethical and humanistic attitudes of medical students.

METHODS

We used a phenomenological research approach to explore and understand the lived experiences of the anatomy teachers as they teach anatomy in the context of humanism and ethics. A separate survey of third-year medical students was carried out to understand their perceptions of changes in themselves, respect for donors and donor families, and their relationship with patients. Data were collected in two phases: a desktop review of teaching materials followed by in-depth interviews of the main anatomy teachers followed by a self-administered, 5-item Likert scaled questionnaire given to students.

RESULTS

In the present article, we describe the rituals conducted in honor of body donors at our School of Medicine. We also describe the lived experiences of anatomy teachers as they work on improving humanistic education quality through the introduction of the concept of "silent mentor" which refers to a cadaver that quietly allows medical students to learn from it. In turn, a ceremony in honor of body donors who have altruistically donated their bodies so that learning anatomy through dissection would be possible is also introduced. A survey of the impact of the ceremony in honor of body donors on medical students revealed positive responses in terms of promoting studying anatomy (3.96 Vs 3.95) as well as reflections on own death (4.44 Vs 4.35), the life of body donors (4.07 Vs 4.04), and how to humanely view future patients and their significant others (4.32 Vs 4.24) relative to those that did not attend the ceremony (5-item Likert scale). The majority of the students that attended the ceremony also indicated that it had a positive impact on their future doctor-patient relationship, thinking about the possibility of donating their body for teaching as well as about medical ethics. Most of them also think that attending the ceremony helped reduce their anxiety, fear, and disgust of seeing corpses or dissecting and 90% insisted that memorial ceremonies should continue being conducted at Zhongshan Medical School.

CONCLUSION

The combination of the anatomy component of the basic medical curriculum and gratitude ceremonies as well as activities to promote body bequeathal programs might help to accomplish the goal of cultivating high-quality medical students and professionals for the future. The long-term benefits would be a medical graduate who exudes empathy, relates well with patients and their significant others, leading to a productive doctor-patient relationship.

A Call for Leadership and Management Competency Development for Directors of Medical Services-Evidence from the Chinese Public Hospital System

Background: A competent medical leadership and management workforce is key to the effectiveness and efficiency of health service provision and to leading and managing the health system reform agenda in China. However, the traditional recruitment and promotion approach of relying on clinical performance and seniority provides limited incentive for competency development and improvement. Methods: A three-component survey including the use of a validated management competency assessment tool was conducted with Directors of Medical Services (n = 143) and Deputy Directors of Medical Services (n = 152) from three categories of hospital in Jinan, Shandong Province, China. Results: The survey identified the inadequacy of formal and informal management training received by hospital medical leaders before commencing their management positions and confirms that the low self-perceived competency level across two medical management level and three hospitals was beyond acceptable. The study also indicates that the informal and formal education provided to Chinese medical leaders have not been effective in developing the required management competencies. Conclusions: The study suggests two system level approaches (health and higher education systems) and one organization level approach to formulate overall medical leadership and management workforce development strategies to encourages continuous management competency development and self-improvement among clinical leaders in China.

Concordance between treatment recommendations provided by IBM Watson for Oncology and a multidisciplinary tumor board for breast cancer in China

OBJECTIVE

Watson for Oncology (WFO), an artificial intelligence from IBM Corporation, can provide a treatment plan by analyzing patient's disease characteristics. The present study was performed to examine the concordance between treatment recommendations proposed by WFO and the multidisciplinary tumor board at our center. The aim was to explore the feasibility of using WFO for breast cancer cases in China and to ascertain the ways to make WFO more suitable for Chinese patients with breast cancer.

METHODS

Data from 302 breast cancer patients treated at the Second Affiliated Hospital of Xi'an Jiaotong University between October 2016 and February 2018 was retrieved and retrospectively analyzed by WFO. The recommendations were divided into 'recommended', 'considered' and 'not recommended' groups. Results were considered concordant when oncologists' recommendations were categorized as 'recommended' or 'for consideration' by WFO.

RESULTS

The concordance rate of 200 subjects with postoperative adjuvant therapy was 77%. However, the rate was 27.5% in the remaining 102 cases with metastatic disease receiving either first-line or no treatment. Further analysis demonstrated that inconsistencies were mainly due to different choices of chemotherapy regimens. Subgroup study indicates that tumor stage, receptor status and age also had influences at the concordance rate.

CONCLUSION

The results of this study suggest that WFO is a promising artificial intelligence system for the treatment of breast cancer. These findings can also serve as a reference framework for the inclusion of artificial intelligence in the ongoing medical reform in China.

Parental self-medication with antibiotics for children promotes antibiotic over-prescribing in clinical settings in China

Background

Self-medication with antibiotics (SMA) is one of the most dangerous inappropriate antibiotic use behaviors. This study aims to investigate the impact of parental SMA for children before a consultation on their doctor’s subsequent antibiotic prescribing behavior, including intravenous (IV) antibiotic use in the clinical setting of China.

Methods

A cross-sectional survey was conducted between June 2017 and April 2018 in three provinces of China. A total of 9526 parents with children aged 0–13 years were investigated. Data from 1275 parents who had self-medicated their children and then visited a doctor in the past month were extracted and analyzed.

Results

One-third (410) of the studied children had parental SMA before the consultation and 83.9% of them were subsequently prescribed antibiotics by doctors. Children with parental SMA were more likely to be prescribed antibiotics (aOR = 7.79, 95% CI [5.74–10.58]), including IV antibiotics (aOR = 3.05, 95% CI [2.27–4.11]), and both oral and IV antibiotics (aOR = 3.42, 95% CI [2.42–4.84]), than children without parental SMA. Parents with SMA behaviors were more likely to request antibiotics (aOR = 4.05, 95% CI [2.59–6.31]) including IV antibiotics (aOR = 2.58, 95% CI [1.40–4.76]), and be fulfilled by doctors (aOR = 3.22, 95% CI [1.20–8.63]).

Conclusions

Tailored health education for parents is required in both community and clinical settings to discourage parental SMA for children. The doctors should not prescribe unnecessary antibiotics to reinforce parents’ SMA behaviors. We recommend expanding the current IV antibiotics ban in outpatient settings of China to cover outpatient pediatrics.

Evaluation of the association between presenteeism and perceived availability of social support among hospital doctors in Zhejiang, China

Background

This study investigated the association between presenteeism and the perceived availability of social support among hospital doctors in China.

Methods

A questionnaire was administered by doctors randomly selected from 13 hospital in Hangzhou China using stratified sampling. Logit model was used for data analysis.

Results

The overall response rate was 88.16%. Among hospital doctors, for each unit increase of the perceived availability of social support, the prevalence of presenteeism was decreased by 8.3% (OR = 0.91, P = 0.000). In particular, if the doctors perceived availability of appraisal support, belonging support and tangible support as sufficient, the act of presenteeism was reduced by 20.2% (OR = 0.806, P = 0.000) 20.4% (OR = 0.803, P = 0.000) and 21.0% (OR = 0.799, P = 0.000) respectively with statistical differences.

Conclusion

In China, appraisal support, belonging support and tangible support, compared to other social support, had a stronger negative correlation with presenteeism among hospital doctors. The benefits of social support in alleviating doctors’ presenteeism warrant further investigation.

Patient resistance towards clinicians' diagnostic test-taking advice and its management in Chinese outpatient clinic interaction

Performing diagnostic tests is a fundamental information-gathering activity in diagnostic process. However, little attention has been paid to the interactional process where a diagnostic test is advised and received, especially in Chinese medical settings. Decision making over prescribing diagnostic tests consists of clinicians' advice and patients' acceptance or resistance/rejection. Drawing on audio-recordings of clinician-patient encounters in Chinese outpatient clinics as data and conversation analysis as a method, we discuss how patient resistance to clinicians' diagnostic test-taking advice is displayed and managed over sequences of interaction. Two types of advice deliveries have been identified: advice either with no diagnostic utterances or with indeterminate diagnostic utterances. We find that patients demonstrate their resistance towards the former type of advice in two ways: questioning clinicians' decisions and proposing an alternative plan. Displaying resistance to the latter type of advice, patients have been found to recurrently resort to one way: proffering additional information about personal experience. Confronted with resistance, clinicians generally proceed to justify decisions by either asserting their epistemic primacy in determining a test or lowering certainty in the original speculative diagnosis. Towards persistent resistance, clinicians mainly employ two techniques to impose acceptance onto patients: repeating the initial advice and terminating forcefully current sequence. This study adds to a growing body of research on resistance in medical settings and contributes to our understanding of the decision making over medical investigations in Chinese outpatient clinic interaction.

The Communicative Ecology of Chinese Patients' Experiences with Health Care

Patient satisfaction and trust are important intermediate outcomes along pathways linking clinician-patient communication to improve well-being, but they are difficult to achieve in Chinese health care. Problematic physician-patient interactions, questionable health-care organizational practices, and media coverage of medical scandals may have contributed to this problem. Nevertheless, there isscant literature documenting reasons underlying dissatisfaction with Chinese health care. Using Street's ecological model of communication in medical encounters as a conceptual framework, this study explores how media and organizational factors affect Chinese patients' satisfaction and trust both directly and as mediated by the quality of patients' past communication experiences with clinicians. A survey was conducted among 257 Ob-gyn patients in a top-tier hospital in Sichuan, China. The results show that several organizational and media factors, along with patients' experiences with physician communication, predict patient satisfaction and trust. Perceptions of physician communication mediated some of the relationships between organizational and media factors with outcomes. Theoretical and practical implications are discussed, particularly with respect to improving health-care services in China.

The Antecedents of Poor Doctor-Patient Relationship in Mobile Consultation: A Perspective from Computer-Mediated Communication

This study aims to understand the underlying reasons for poor doctor-patient relationships (DPR). While extant studies on antecedents of poor DPR mainly focus on the offline context and often adopt the patients' perspective, this work focuses on the mobile context and take both doctors' and mobile consultation users' perspectives into consideration. To fulfill this purpose, we first construct a theoretical framework based on the Computer-Mediated Communication (CMC) literature. Then we coded 592 doctor-user communication records to validate and elaborate the proposed theoretical model. This work reveals that characteristics of mobile technologies pose potential challenges on both doctors' and patients' information providing, informative interpreting, and relationship maintaining behaviors, resulting in 10 and 6 types of inappropriate behaviors of doctors and users, respectively, that trigger poor DPR in the mobile context. The findings enrich the research on online DPR and provide insights for improving DPR in the mobile context.

A nationwide cross-sectional study of 15,611 lesbian, gay and bisexual people in China: disclosure of sexual orientation and experiences of negative treatment in health care

BACKGROUND

Lesbian, gay and bisexual (LGB) people often face individual- and system-level barriers in health care. However, LGB people's experiences of health care in non-European and non-American settings have been scarcely studied. In China, while it has been estimated that there are at least 70 million gender and sexual minorities, there has been no larger-scale study on LGB people's experiences of health care beyond a focus on gay men and HIV. This study is the first larger-scale quantitative study to investigate LGB people's experiences of health care in China, where non-heterosexuality is officially silenced and the needs of non-heterosexual people are largely ignored by service providers.

METHODS

An online survey was designed in joint partnership by academic, community groups and the United Nations Development Programme. Targeted and snowball sampling was adopted for participant recruitment. Such unique cross-sectoral partnership made this research possible in the authoritarian state of China where data collection on LGB people is extremely rare. For the analysis in this paper, a sample of 15,611 Chinese LGB people were included. Frequency and descriptive statistics were conducted to describe the LGB respondents' demographic characteristics and their experiences in health care settings. Chi-square tests were conducted to test how experiences vary across LGB people with different demographic characteristics.

RESULTS

More than three quarters of the respondents said they would be willing to disclose to their medical care providers their sexual orientation if asked. However, only 5.7% of the respondents said that medical care providers ever asked them about their sexual orientation. About 8.0% of the LGB people surveyed reported having experienced negative treatment in medical care settings. Six percent (5.7%) of the Chinese LGB people said in accessing mental health care services, they were recommended, coaxed into, or provided conversion therapy for sexual orientation, gender identity or gender expression.

CONCLUSIONS

There is a strong need to enhance LGB cultural competence among health care providers. Policymakers in China should also formulate laws, policies, regulations, clearly articulated codes of conduct, and transparent procedures and practices to ensure non-discrimination of LGB people in the health care system, with a particular focus on banning conversion therapy.

Adoption intention and usage behavior of mHealth services in Bangladesh and China

Purpose

The purpose of this paper was to explore the comparative influential factors affecting the behavioral intention and actual usage of mHealth services in two distinct national environments, i.e. China and Bangladesh, in relation to the international expansion of mHealth services.

Design/methodology/approach

In this study, widely accepted Unified Theory of Acceptance and Use of Technology (UTAUT) with two additional variables, i.e. Perceived Reliability and Price Value have been selected as a theoretical framework. Primary data were collected from existing mHealth users among generation Y in both China and Bangladesh. A total of 296 and 250 questionnaires were deemed as usable for data analysis for Bangladesh and China, respectively.

Findings

Performance expectancy and social influence had significant impact on the adoption intention of mHealth services for both countries. Effort expectancy and price value were insignificant factors for Bangladesh, whereas facilitating condition and perceived reliability were insignificant for China.

Practical implications

The insights from this study could benefit mHealth services providers and those policymakers who seek to enter the Chinese and the Bangladeshi healthcare market. The dimensions identified in the study are based on a full assessment of mHealth usages experiences. Global service providers can use the dimensions identified by the paper to better assess their service performance on an international level.

Originality/value

The paper is unique in that it is one of the first cross-country examinations of influential factors affecting the adoption of mHealth services in two different countries. This study confirms the applicability of extended UTAUT model in the context of mHealth services among the generation Y in developing countries such as China and Bangladesh.

Culture, Self, and Medical Decision Making in Australia and China: A Structural Model Analysis

Objective. To explore and compare the influences of individual-level cultural values and personal attitudinal values on the desire for medical information and self-involvement in decision making in Australia and China. Methods. A total of 288 and 291 middle-aged adults from Australia and China, respectively, completed an online survey examining cultural and personal values, and their desired level of self-influence on medical decision making. Structural equation modeling was used to test 15 hypotheses relating to the effects of cultural and personal antecedents on the individual desire for influence over medical decision making. Results. Similar factors in both Australia and China (total variance explained: Australia 29%; China 35%) predicted desire for medical information, with interdependence (unstandardized path coefficient β_Australia = 0.102, P = 0.014; β_China = 0.215, P = 0.001), independence (β_Australia = 0.244, P < 0.001; β_China = 0.123, P = 0.037), and health locus of control (β_Australia = −0.140, P = 0.018; β_China = −0.138, P = 0.007) being significant and positive predictors. A desire for involvement in decisions was only predicted by power distance, which had an opposite effect of being negative for Australia and positive for China (total variance explained: Australia 11%; China 5%; β_Australia = 0.294, P < 0.001; China: β_China = −0.190, P = 0.043). National culture moderated the effect of independence on desire for medical information, which was stronger in Australia than China (Z score = 1.687, P < 0.05). Conclusions. Study results demonstrate that in both countries, desire for medical information can be influenced by individual-level cultural and personal values, suggesting potential benefits of tailoring health communication to personal mindsets to foster informed decision making. The desired level of self-involvement in decision making was relatively independent of other cultural and personal values in both countries, suggesting caution against cultural stereotypes. Study findings also suggest that involvement preferences in decision making should be considered separately from information needs at the clinical encounter.

Patient experience of hospital care in China: major findings from the Chinese Patient Experience Questionnaire Survey (2016-2018)

OBJECTIVES

China launched the National Healthcare Improvement Initiative (NHII) in 2015 to improve patient experiences in healthcare. This study aimed to generate evidence of hospital care quality from the patients' perspective.

DESIGN

This nationwide cross-sectional study interviewed participants from 31 provinces, municipalities and autonomous regions across China.

SETTING

A total of 117 tertiary hospitals in mainland China.

PARTICIPANTS

48 422 responses from outpatients and 35 957 responses from inpatients were included in this study.

PRIMARY OUTCOME MEASURE

The scores of six predefined domains in the Chinese Patient Experience Questionnaire, five of which were designed to reflect specific dimensions of care, and one of which indicated the overall rating.

RESULTS

More than 80% of the respondents viewed their care experiences as positive. The NHII seems to have had a positive impact, as indicated by the steady, although unremarkable, increase in the patient experience scores over the 2016-2018 period. The Chinese patients generally reported a positive experience with the clinical aspects of care, but reported a less positive experience with the environmental, interpersonal and social services aspects of care. The institutional factors, including region and type of hospital, and personal factors, such as gender, age, education and occupation, were factors affecting the patient experience in China. Humanistic care was the aspect of care with the greatest association with the overall patient experience rating in both the outpatient and inpatient settings.

CONCLUSIONS

The national survey indicated an overall positive patient perspective of care in China. Older age, higher education level and formal employment status were found to be correlated with positive care experiences, as were higher levels of economic development of the region, a more generous insurance benefits package and a higher degree of coordinated care. The interpersonal-related initiatives had substantial roles in the improvement of the patient experience. In the regions where farmers and users of traditional Chinese medicine services constitute a greater proportion of the population, improvement of patient experiences for these groups deserves special policy attention.

Development and Validation of Online Textual Pediatrician-Parent Communication Instrument Based on the SEGUE Framework

The prevalence and feature of online textual pediatrician-parent communication (OPPC) have been recognized, but evidence on OPPC assessment remains insufficient. This study aimed to develop and validate an OPPC instrument to provide measurement and quality characteristics for quality assessment and management. 490 OPPC exchanges of 61 tertiary hospitals from 9 Chinese provinces were obtained from the Spring Rain Doctor website. The SEGUE framework, OPPC feature, and a pilot study were considered to establish the instrument. An empirical study was conducted to validate it and the incidence of OPPC items was also analyzed. As a result, a four-dimensional, 15-item OPPC instrument was developed. The empirical results are as follows. Cronbach's α values of dimensions were 0.80, 0.62, 0.64, and 0.60; the mean interrater reliability was 0.93; the correlation coefficients between items and their corresponding dimensions' scores ranged from 0.51 to 0.89 (P<0.001). The goodness-of-fit indices were acceptable. The overall incidence rate of parent-dominated/cooperative items (46.9%) was higher than that of pediatrician-dominated items (39.6%). Thus, the instrument is acceptable and OPPC quality is characterized by more parent-dominated and cooperative behaviors.

Public Perception on Healthcare Services: Evidence from Social Media Platforms in China

Social media has been used as data resource in a growing number of health-related research. The objectives of this study were to identify content volume and sentiment polarity of social media records relevant to healthcare services in China. A list of the key words of healthcare services were used to extract data from WeChat and Qzone, between June 2017 and September 2017. The data were put into a corpus, where content analyses were performed using Tencent natural language processing (NLP). The final corpus contained approximately 29 million records. Records on patient safety were the most frequently mentioned topic (approximately 8.73 million, 30.1% of the corpus), with the contents on humanistic care having received the least social media references (0.43 Million, 1.5%). Sentiment analyses showed 36.1%, 16.4%, and 47.4% of positive, neutral, and negative emotions, respectively. The doctor-patient relationship category had the highest proportion of negative contents (74.9%), followed by service efficiency (59.5%), and nursing service (53.0%). Neutral disposition was found to be the highest (30.4%) in the contents on appointment-booking services. This study added evidence to the magnitude and direction of public perceptions on healthcare services in China’s hospital and pointed to the possibility of monitoring healthcare service improvement, using readily available data in social media.

Using Artificial Intelligence (Watson for Oncology) for Treatment Recommendations Amongst Chinese Patients with Lung Cancer: Feasibility Study

BACKGROUND

Artificial intelligence (AI) is developing quickly in the medical field and can benefit both medical staff and patients. The clinical decision support system Watson for Oncology (WFO) is an outstanding representative AI in the medical field, and it can provide to cancer patients prompt treatment recommendations comparable with ones made by expert oncologists. WFO is increasingly being used in China, but limited reports on whether WFO is suitable for Chinese patients, especially patients with lung cancer, exist. Here, we report a retrospective study based on the consistency between the lung cancer treatment recommendations made for the same patient by WFO and by the multidisciplinary team at our center.

OBJECTIVE

The aim of this study was to explore the feasibility of using WFO for lung cancer cases in China and to ascertain ways to make WFO more suitable for Chinese patients with lung cancer.

METHODS

We selected all lung cancer patients who were hospitalized and received antitumor treatment for the first time at the Second Xiangya Hospital Cancer Center from September to December 2017 (N=182). WFO made treatment recommendations for all supported cases (n=149). If the actual therapeutic regimen (administered by our multidisciplinary team) was recommended or for consideration according to WFO, we defined the recommendations as consistent; if the actual therapeutic regimen was not recommended by WFO or if WFO did not provide the same treatment option, we defined the recommendations as inconsistent. Blinded second round reviews were performed by our multidisciplinary team to reassess the incongruent cases.

RESULTS

WFO did not support 18.1% (33/182) of recommendations among all cases. Of the 149 supported cases, 65.8% (98/149) received recommendations that were consistent with the recommendations of our team. Logistic regression analysis showed that pathological type and staging had significant effects on consistency (P=.004, odds ratio [OR] 0.09, 95% CI 0.02-0.45 and P<.001, OR 9.5, 95% CI 3.4-26.1, respectively). Age, gender, and presence of epidermal growth factor receptor gene mutations had no effect on consistency. In 82% (42/51) of the inconsistent cases, our team administered two China-specific treatments, which were different from the recommendations made by WFO but led to excellent outcomes.

CONCLUSIONS

In China, most of the treatment recommendations of WFO are consistent with the recommendations of the expert group, although a relatively high proportion of cases are still not supported by WFO. Therefore, WFO cannot currently replace oncologists. WFO can improve the efficiency of clinical work by providing assistance to doctors, but it needs to learn the regional characteristics of patients to improve its assistive ability.

Predicting behavioral intentions to children vaccination among Chinese parents: an extended TPB model

Parental behavioral intentions play a key role in children vaccination. The present study looks at how parental expectations for the vaccination influence their attitudes and behavioral intentions toward children's immunization. The theoretical model is developed on TPB model and empirically tested with sample data from 380 children aged 0-7 years in mainland China. The structural equation modeling and multi-group analysis were used in the model to demonstrate the impact of the vaccination services quality, vaccination promotions and public opinions on attitudes and vaccination behavioral intention. Results support the study's hypotheses and indicate that Vaccination Services Quality (VSQ), Vaccination Promotions (VAP) and Public Opinions (PUO) have positive effects on Attitudes (ATT) and Vaccination Behavioral Intention (VAI), VSQ has the strongest standardized path (.594) while PUO has the least influence (.131), and Attitude is complete mediation in all paths. Attitude is key factor that determine the parental behavioral intentions, and the internal perception comes from the vaccination services quality and the external influence comes from the social environment affect the parental attitude. Governments should implement effective policies and improve vaccination services quantity to eliminate parental misunderstandings.

Effect of the treatment-before-deposit policy on trust in physicians and perceived service quality among patients in 12 hospitals in China

This study examined effects of the treatment-before-deposit policy on Chinese patients' trust in physicians and perceived service quality. This study included 3313 patients recruited from 12 hospitals in China. The research team used cross-sectional survey to examine Chinese patients' experience with the treatment-before-deposit policy, perceived service quality, and trust in their physicians. Using mediation analysis, we estimated direct and indirect effects of the treatment-before-deposit policy on patients' perceived service quality and trust in their physicians. Patients who benefitted from the treatment-before-deposit policy reported greater service quality and higher trust in their physicians. The impacts of whether patients benefitted from the policy on trust in physicians were fully mediated by perceived service quality with statistically significant indirect effect. The results support the hypothesis that the treatment-before-deposit policy improves patients' perceived service quality and trust in physicians.