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Jing S, Yu Y, Yuan B. Study on the determinants of health professionals' performance on diabetes management care in China. BMC PRIMARY CARE 2023; 24:172. [PMID: 37660002 PMCID: PMC10474730 DOI: 10.1186/s12875-023-02136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND As the direct providers of diabetes management care in primary health care facilities (PHFs) in China, health professionals' performance on management care of diabetes determines the quality of services and patients' outcomes. This study aims to analyze the key determinants of health professionals' performance on diabetes management care in PHFs in China. METHODS We conducted a cross-sectional study in 72 PHFs in 6 cities that piloted the contracted family doctor service (CFDS). Self-developed questionnaire was used to measure three kinds of factors (capacity, motivation and opportunity) potentially influencing the performance of health professionals. The performance of diabetes management care in the study was measured as whether health professionals delivered 7 service items required by the National Basic Public Health Service Guideline with a total of 7 points and was divided into three grades of good, medium and bad. The questionnaire is self-administered by all the health professionals involved in the study with the number of 434. The Chi-square tests were used to compare differences of performance on diabetes management care among health professionals with different characteristics. The ordinal logistic regression was used to analyze the determinants on the performance of diabetes management care. RESULTS Health professionals who got higher score on diabetes knowledge test had odds of better performance on diabetes management care (OR = 1.529, P < 0.001). health professionals with higher degree of self-reported satisfaction on training (OR = 1.224, P < 0.05) and perception of decreasing workload (OR = 3.336, P < 0.01) had odds of better performance on diabetes management care. While health professionals with negative feeling on information system support had odds of worse performance on diabetes management care (OR = 0.664, P < 0.01). CONCLUSIONS Attention should be paid to the training of health professionals' knowledge on diabetes management capacity. Furthermore, measures to improve training for health professionals could satisfying their needs for self-growth and improve the motivation of health professionals. The information system supporting management care should be improved continuously to improve the health professionals' working opportunities and decrease the workload.
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Affiliation(s)
- Shanshan Jing
- College of Health Sciences, Shandong University of Traditional Chinese Medicine, 4655 Da Xue Road, University Science Park, Changqing District, Jinan, 250355, Shandong, China
| | - Yahang Yu
- China Center for Health Development Studies, Peking University, Xue Yuan Road 38, Haidian District, Box 505, Beijing, 100191, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Xue Yuan Road 38, Haidian District, Box 505, Beijing, 100191, China.
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Chen J, Wang L, Gu T, Wang C, Hao E. Demands for Community Services and Associated Factors among Residents in Smart Communities: A Case Study of Xuzhou City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3750. [PMID: 36834442 PMCID: PMC9964050 DOI: 10.3390/ijerph20043750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
Smart community enables a sustainable and livable community future, in which residents' demands play an important role in its success. Though great efforts have been made to encourage residents' participation in the implementation of smart communities, inefficient service supply still exists. Thus, this study aimed to classify residents' demands for community services in smart communities and to explore relevant influencing factors based on the developed conceptual framework. Data from 221 respondents in Xuzhou city of China were analyzed by using binary logistic regression. The results indicated that more than 70% of respondents had demands for all community services in smart communities. Moreover, the demands were influenced by distinct factors, including sociodemographic characteristics, living characteristics, economic characteristics, and individual attitude characteristics. The types of community services in smart communities are clarified and fresh insights are provided into associated factors related to residents' demands for these services in this study, through which enhanced provision of community services and effective implementation of smart communities can be achieved.
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Affiliation(s)
| | - Linxiu Wang
- School of Mechanics and Civil Engineering, China University of Mining and Technology, Xuzhou 221116, China
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Li J, Yu Y, Hei L, Yuan B. Correlation between input on public health services and work motivation among primary health workers in China. BMC PRIMARY CARE 2023; 24:35. [PMID: 36707761 PMCID: PMC9883953 DOI: 10.1186/s12875-023-01986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND The integration of public health services into primary health care has been advocated and practiced worldwide for better management of preventable diseases. Health policy makers in China have started the reforms to better integrate public health services and clinical services, but public health services in China still remained neglected in primary health system. This study aimed to explore the input of Chinese primary health workers on delivering public health services and its association with their intrinsic working motivation in China. METHODS Data were collected from a cross-sectional survey conducted in 2019. Participants in this survey included 803 primary health workers in 75 primary health institutions in China. Questions about the input on clinical and public health services delivery and intrinsic working motivation were asked. A multiple linear regression model was adopted to investigate the correlation between intrinsic working motivation and the time input on public health service. The robustness of this model was checked with a generalized linear model. RESULTS Intrinsic motivation was found to have negative association with health workers' input on public health (β: -1.01, p < 0.05), with the robustness checked with a generalized linear model. The significance of this association differed in the group of urban community health centers and rural township health center. Other factors that had significant relationship with the input on public health services include the being nurses instead of doctors (p < 0.01), being a member of family doctor team (p < 0.01), recognition on relative importance of clinical services (p < 0.01), and perception on better exterior support (p < 0.01). CONCLUSION With higher intrinsic working motivation, primary health workers tended to spend less time on public health services. It reflected that doctors and nurses in primary healthcare institutions still perceived clinical treatment services as their main work responsibility and source of career recognition. Organizational level supports and system level policies should guide the primary health workers to increase their awareness on the importance of public health services and to cultivate their internal interests on public health services, in order to ensure sustainable input and performance improvement on public health services in primary health system in China.
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Affiliation(s)
- Jia Li
- grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Yahang Yu
- grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Luping Hei
- grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Beibei Yuan
- grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, Beijing, China
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Li M, Wang Z, Zhang B, Wei T, Hu D, Liu X. Job Performance of Medical Graduates With Compulsory Services in Underserved Rural Areas in China: A Cohort Study. Int J Health Policy Manag 2022; 11:2600-2609. [PMID: 35184509 PMCID: PMC9818097 DOI: 10.34172/ijhpm.2022.6335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 01/18/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND China started a national program in 2010 to train qualified general practitioners with compulsory services program (CSP) in rural and remote areas. While the program has shown positive effects on staffing primary healthcare (PHC) in rural areas, very little is known about how well they perform. This study aims to evaluate the job performance of medical graduates from this program and the influence of program design on job performance. METHODS A cohort study was conducted with graduates from CSP and non-CSP (NCSP) from four medical universities in central and western China. Baseline and three waves of follow-up surveys were conducted from 2015-2020. The pass rate of China National Medical Licensing Examinations (NMLE) and self-reported job performance were used as measurements. Multivariable regressions were used to identify factors affecting job performance. RESULTS 2154 medical graduates were included, with 1586 CSP and 568 NCSP graduates. CSP (90.6%) and NCSP (87.5%) graduates showed no difference in passing the NMLE (P=.153). CSP graduates reported similar job performance with NCSP graduates (CSP, 63.7; NCSP, 64.2); in the multivariable regression, CSP graduates scored 0.32 and 1.36 points lower in the total sample and graduates of 2015-2017, respectively, but not significantly. Having formally funded positions improved the job performance of CSP (β coefficient=4.87, P<.05). After controlling for Qinghai which adopted a different contracting strategy, "working in hometown" showed significant influence on job performance (β coefficient = 1.48, P<.05). CONCLUSION CSP graduates have demonstrated as good job performance as NCSP, proving the competency to provide high-quality care for remote and rural areas. The contracted township health centers (THCs) should provide guidance for CSP graduates, especially in the first few years after graduation. The local government should provide formally funded positions on time and prioritize signing contracts with hometowns or places nearby.
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Affiliation(s)
- Mingyue Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ziyue Wang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Baisong Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Tiantian Wei
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Dan Hu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
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Wang H, Zhao S, Liu Q, Wang J, Yuan B. The Association Between Financial Incentives and Job Performance Among Primary Care Providers in Six Provinces of China. Healthc Policy 2022; 15:2323-2334. [DOI: 10.2147/rmhp.s384114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
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Wang Q, Liu X, Wang T, Zhu Z, Yang L, Guo S, Li H, Sun Q. Primary care provider's job satisfaction and organizational commitment after COVID-19 restrictions ended: A mixed-method study using a mediation model. Front Psychol 2022; 13:873770. [PMID: 36312180 PMCID: PMC9606785 DOI: 10.3389/fpsyg.2022.873770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/16/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives More and more countries have decided to cancel most or even all COVD-19 restrictions. However, it is unclear how ending of restrictions will affect primary care providers' job satisfaction and organizational commitment. Our objectives are to explore the current status and possible change in primary care providers' job satisfaction and organizational commitment after massive restriction policies ended in China. Methods This was a mixed-method study that utilized structured questionnaires and semi-structured qualitative individual interviews. The 20-item Minnesota Satisfaction Questionnaire (MSQ) and 25-item organizational commitment survey were adopted to assess job satisfaction and organization commitment. Descriptive statistics and mediation models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data. Results A total of 18 interviews and 435 valid survey responses were included in our analysis. The average scores for job satisfaction and organizational commitment were 80.6 and 90.8. The thematic analysis revealed one major theme: ethical and moral responsibility to provide care as primary care providers, on which we established a mediation model. The mediation analysis revealed that normative commitment could positively affect the other four dimensions of organizational commitment and job satisfaction. The direct effect of affective commitment on job satisfaction was significant (LLCI = 0.11, ULCI = 0.31), and the mediators were identified to have a partial mediating effect instead of a total mediating effect. Conclusion After COVID-19 restrictions end, the job satisfaction and organizational commitment of primary care providers will return to levels before the pandemic and during this estimated process, a brief rise in resignation is predictable. The normative commitment positively affects the other four dimensions of organizational commitment and job satisfaction for primary care providers, which suggests a possible way to motivate primary care providers when restrictions end.
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Affiliation(s)
- Quan Wang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xinyu Liu
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Ting Wang
- School of Public Health, Peking University, Beijing, China
| | - Zemeng Zhu
- School of Basic Medicine Science, Shandong University, Jinan, China
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical University, Yantai, China
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Shasha Guo
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Hui Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Qiang Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- *Correspondence: Qiang Sun
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Li H, Yuan B, Yu Y, Li J, Meng Q. Work Motivation of Primary Health Workers in China: The Translation of a Measurement Scale and Its Correlation with Turnover Intention. Healthc Policy 2022; 15:1369-1381. [PMID: 35873113 PMCID: PMC9304633 DOI: 10.2147/rmhp.s366389] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background High turnover intention, as a manifestation of low work motivation, is a crucial barrier to strengthening primary health systems worldwide, including in China. Targeting those being less motivated will be a realistic choice to retain primary health workers. This study translate, adapt, and validate the Work Motivation Scale for Health Workers (WMSHW) scale to directly measure and rate health workers' motivation composition based on Self-Determination Theory, and assessed how health workers with different levels of motivation being associated with the turnover intention. Methods The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. Participants include 1341 health workers within 75 primary health institutions from 6 provinces in China. The reliability and validity of the scale was analyzed. Cluster analysis in a person-centered approach and logistic regression analysis was used to understand how different combinations of motivations related to intention to leave. Results Confirmatory factor analysis indicated that the modified five-factor model had a better fit than the other models in accordance with the original English version. The factor loads were high and ranged from 0.70 to 0.9. Cronbach's alpha coefficients for five dimensions of the Chinese WMSHW ranged from 0.81 to 0.94, indicating the scale's high internal consistency. Four distinct clusters of work motivation were found in this study, representing low motivated, highly controlled, highly autonomous and highly motivated primary health workers. Compared with low motivation group, both controlled and autonomous motivation groups were more likely to have lower turnover intention. The negative relationship between motivation and intention to leave became stronger with the level of motivation increasing: highly controlled cluster (OR: 0.47; 95% CI: 0.35-0.63), highly autonomous (OR: 0.27; 95% CI: 0.18-0.41) and highly motivated (OR: 0.20; 95% CI: 0.15-0.27). Conclusion The Chinese version of WMSHW showed satisfactory reliability and validity and can be used as an instrument for measuring and rating the work motivation of Chinese health workers. The primary health workers were grouped into four motivation levels based on this scale. Both controlled and autonomous motivation could work in reduce the turnover intention, and the influence of autonomous motivation on retaining was stronger.
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Affiliation(s)
- Huiwen Li
- China Population and Development Research Center, Beijing, People's Republic of China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, People's Republic of China
| | - Yahang Yu
- School of Public Health, Peking University, Beijing, People's Republic of China
| | - Jia Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, People's Republic of China
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Zou G, McPake B, Kielmann K. 'You say you are a TB doctor, but actually, you do not have any power': health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China. HUMAN RESOURCES FOR HEALTH 2022; 20:55. [PMID: 35739586 PMCID: PMC9229519 DOI: 10.1186/s12960-022-00745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into 'designated' public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB 'designated' hospitals in Zhejiang province, we explored factors influencing hospital-based health workers' motivation in the context of integrated TB service delivery. METHODS We conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation. RESULTS Health workers tasked with TB care in 'designated' hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their salaries compared with other clinical staff. In both sites, health workers were concerned about poor infection control and weak risk management assessment systems. CONCLUSIONS Inadequate attention to workforce issues for TB control in China, specifically the professional status, welfare, and development as well as incentivization of infectious disease control workers has contributed to dissatisfaction and consequently poor motivation to serve TB patients within the integrated model of TB care. It is important to address the failure to motivate health workers and maximize public good-oriented TB service provision through improved government funding and attention to the professional welfare of health workers providing TB care in hospitals.
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Affiliation(s)
- Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Cui C, Meng K. Development of an index system for evaluating the organisational capabilities of primary medical institutions: a modified Delphi study in China. BMJ Open 2021; 11:e055422. [PMID: 34921088 PMCID: PMC8689195 DOI: 10.1136/bmjopen-2021-055422] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The low performance of primary medical institutions (PMIs) in China is a significant issue. The WHO proposed that the main reason for the failure of the healthcare system in developing countries is poor organisational capabilities. However, there is no international tool for evaluating the organisational capabilities of PMIs. Therefore, this study aimed to develop an index system for evaluating the organisational capabilities of PMIs. DESIGN We searched the literature (English and Chinese) published before June 2020 in the PubMed, China National Knowledge Infrastructure and Wanfang databases to conduct a literature review and develop a preliminary indicator pool. Then, two rounds of Delphi expert consultations were conducted by email from June to September 2020, followed by screening, revision and supplementation of the indicators using the boundary value method. Finally, the analytic hierarchy process was used to determine the weight of the indicators. SETTING The Delphi consultation questionnaire was distributed to the leaders of PMIs in districts D, F and S in Beijing, China. PARTICIPANTS Nineteen leaders of PMIs who had a profound understanding of PMI operations and management and were able to participate in Delphi research from a professional and comprehensive perspective were included in this study. RESULTS The Cr values were 0.76 (first-level indicators) and 0.78 (second-level indicators), indicating that the expert consultation results were accurate and reliable. The result of the expert coordination coefficient test was significant at the p<0.01 level, suggesting that the experts' views were consistent. The organisational capability index system includes 3 first-level indicators, 9 second-level indicators and 37 third-level indicators. CONCLUSIONS An index system for the organisational capabilities of PMIs was developed. This index system is a scoring system that focuses on basic service capabilities, management capabilities and sustainable development capabilities, and it can determine the priority of improvement areas for PMIs.
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Affiliation(s)
- Chengsen Cui
- School of Public Health, Capital Medical University, Beijing, China
| | - Kai Meng
- School of Public Health, Capital Medical University, Beijing, China
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State Incentives and Sustainable Motivation System in the Health Sector. SUSTAINABILITY 2021. [DOI: 10.3390/su132413592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Now that the pandemic has entered the second phase, in which countries are adapting to the crisis, governments need to determine incentives that will contribute to the sustainability of the health system and human health. Regarding this, human resources are a significant factor, which affects the sustainability of any system, and it is important to establish a relevant motivation system that will withstand the challenges that society will face in the coming period. The aim of this paper is to analyse three dimensions of state incentives (employment program, COVID-19 bonus, training opportunities) and to examine their influence on healthcare workers’ motivation and the sustainability of the health system in the Republic of Serbia. The empirical research was conducted on a sample of 207 respondents employed in the tertiary level of healthcare. Data analysis included exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation modelling (SEM). The research results confirmed the existence of all three incentives and indicated that state incentive “training opportunities” has the strongest effect on the motivation of health workers and the sustainability of the healthcare system.
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Cai J, Wu D, Sun KS, Yang S, Lam KF, Li L, Lam TP, Zhou X. Primary care physicians' views on the factors for enhancing patients' trust in rural areas of Zhejiang province, China: a cross-sectional study. BMJ Open 2021; 11:e049114. [PMID: 34315796 PMCID: PMC8317079 DOI: 10.1136/bmjopen-2021-049114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To examine primary care physicians' (PCPs) perception of patients' trust and associated factors for enhancing perceived trust in rural China. DESIGN A cross-sectional questionnaire study. SETTING All township health centres (primary care facilities in rural areas of China) in both developed and less developed counties of Zhejiang province, China, were chosen as the study sites. PARTICIPANTS A total of 849 questionnaires were distributed from December 2019 to January 2020, and 673 PCPs working in township health centres completed the questionnaires. The response rate was 79.3%. OUTCOME MEASURES PCPs' perceived patients' trust in them, PCPs' practices to meet patients' expectations and PCPs' perceived conflicting patient and employer interests were measured by a self-designed and verified questionnaire. Confirmatory factor analysis was applied to verify the measurement model of PCPs' practices. Multivariable logistic regression analyses were performed to explore the association between clinical practice characteristics, discordant patient and employer interests and perceived patient trust after controlling for social-demographic characteristics. RESULTS Among all participants, 572 (85.0%) PCPs often/always perceived patients' trust in their clinical competence, and over two-thirds of PCPs reported ever perceived patient worries about overprescriptions. After adjustment for social-demographic characteristics, regression model results indicated that, among PCPs' clinical practices characteristics, emotional support (OR=1.23, 95% CI=1.06 to 1.42) and accurate diagnosis and treatment (OR=1.35, 95% CI=1.17 to 1.55) were positively associated with PCPs' perceived patients' trust in their clinical competence. A strong association was found between accurate diagnosis and treatment (OR=1.20, 95% CI=1.08 to 1.34, p<0.001; OR=1.22, 95% CI=1.10 to 1.35, p<0.001), conflicting patient and employer interests (OR=1.35, 95% CI=1.12 to 1.63, p<0.01; OR=1.29, 95% CI=1.07 to 1.54, p<0.01) and PCPs' perceived patient worries about unnecessary medicine or tests, respectively. CONCLUSIONS PCPs' emotional support to patients as well as their abilities to make accurate diagnosis and provide appropriate treatment is positively associated with PCPs' self-reported patients' trust. It is recommended that reforms to realign patient and employer's interests be investigated.
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Affiliation(s)
- Jingjing Cai
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Dan Wu
- International Diagnostic Centre, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Kai Sing Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, People's Republic of China
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Shengzhi Yang
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Lu Li
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Xudong Zhou
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Huang J, Wang L, Liu S, Zhang T, Liu C, Zhang Y. The Path Analysis of Family Doctor's Gatekeeper Role in Shanghai, China: A Structural Equation Modeling (SEM) Approach. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211009667. [PMID: 33870745 PMCID: PMC8058791 DOI: 10.1177/00469580211009667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies globally have provided substantial evidence that PHC could conduct doctor-visiting behaviors, control medical expense, and improve population health. This study aimed to map how family doctor (FD) in Shanghai achieved gate-keeper goals including health management, medical expense control, and conducting ordered doctor-visiting behavior. A total of 2754 and 1995 valid questionnaires were collected in 2013 and 2016 respectively in Shanghai. The data were analyzed using structural equation modeling (SEM). Invariance analysis was also performed for 2 waves of data. We found that the coefficient of cognition on health management (β5 = 0.26, P < .05) was larger than that of signing with FD (β4 = 0.06, P < .05). SEM model also showed that first-contact at community health service center (CHSC) had a positive effect on health management (β6 = 0.30, P < .05), and the latter also affected health management results positively (β8 = 0.39, P < .05), suggesting that the path for FD was through first-contact and health management. Besides, the gate-keeper role of medical expense control was significant through the first-contact (β10 = −0.12, P < .05) mediation rather than health management (β9 = 0.03, P > .05). The model fit was acceptable (RMSEA = 0.033). A “cognition-behavior-outcomes (health and medical expense)” path of FD’s gate-keeper role was found. It is necessary to consolidate FD contracted services rather than reimbursement discount the latter of which is proved to be unsustainable.
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Affiliation(s)
- Jiaoling Huang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luan Wang
- Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Shanshan Liu
- Pudong Institute for Health Development, Shanghai, China
| | - Tao Zhang
- Jinyang Community Health Service Center of Pudong New Area, Shanghai, China
| | - Chengjun Liu
- Fudan University, Shanghai, China.,Eye and Dental Diseases Prevention & Treatment of Pudong New Area, Shanghai, China
| | - Yimin Zhang
- Pudong Institute for Health Development, Shanghai, China
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13
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Abstract
BACKGROUND There is still a lack of evidence focusing on primary care supply in developing countries where the educational achievement of primary care practitioners is relatively low. OBJECTIVES By using a nationally representative longitudinal and prospective cohort study, this study examined whether primary care supply, measured by the availability and the number of community health centres (CHCs), was associated with 4-year mortality risk among community-dwelling participants aged 45 and above in urban China. METHODS Using the 2011 and 2015 waves of the China Health and Retirement Longitudinal Survey (CHARLS), we conducted a longitudinal mixed-level logistic analysis to study the impact of the availability and the number of CHC on 4-year follow-up mortality risk, after adjusting community- and individual-level covariates. RESULTS Individuals living in communities with CHC were 31% less likely to die during the 4-year follow-up (P < 0.05) conditional on community-level characteristics, including the basic facilities availability, population size and physical area, and individuals' socio-demographic and health characteristics and health behaviours. Also, an increased number of community-level CHC was shown to decrease residents' 4-year mortality risk significantly (odds ratio = 0.82, P < 0.05). Furthermore, the association was more pronounced among adults aged 65 and above. CONCLUSION This study provides additional evidence of the health-promoting effect of primary care supply among urban residents in China. Improving primary care coverage in China should be necessary to improve health care access, thus promoting population health.
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Affiliation(s)
- Quan Zhang
- Health and Science Centre and National School of Development, Peking University, Beijing, China
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14
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He R, Liu J, Zhang WH, Zhu B, Zhang N, Mao Y. Turnover intention among primary health workers in China: a systematic review and meta-analysis. BMJ Open 2020; 10:e037117. [PMID: 33067275 PMCID: PMC7569945 DOI: 10.1136/bmjopen-2020-037117] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To analyse the prevalence and determinants of turnover intention (TI) among primary health workers (PHWs) in China to provide evidence for improving retention measures. DESIGN Systemic review and meta-analysis. DATA SOURCES Four English-language databases (PubMed, EMBASE, Cochrane Library, PsycINFO) and three Chinese databases (CNKI, CSPD, CBM) were searched up to October 2019. ELIGIBILITY CRITERIA Eligible studies were observational or descriptive studies conducted in mainland China. The prevalence of TI among health workers and related factors had to be explicitly reported in each included study. DATA EXTRACTION AND SYNTHESIS Data were extracted by one author and reviewed independently by two other authors. For each factor analysed by a meta-analysis, the factor was required to be the same across different studies, and at least three studies had to include it. The quality of studies was assessed using the Newcastle-Ottawa Scale and heterogeneity was evaluated using the I2 statistic. RESULTS We identified 16 cross-sectional studies investigating a total of 37 672 PHWs. The prevalence of TI was 30.4%. Subgroup analysis revealed that the highest prevalence was observed in the community primary healthcare institutions and the eastern provinces of China. Meta-analyses indicated that 21 factors were significantly associated with TI, including demographic factors (gender, age, education, marital status), job characteristic factors (title, work seniority, remuneration, social status, organisational affiliation, work stress) and job satisfaction factors (learning and training opportunity, interpersonal relationship, work condition and environment, and so on). CONCLUSION This study highlights the problem of TI among PHWs in China. Efforts should be made to improve conditions in both work-related areas and areas outside of work. Policymakers should continue to improve reward systems, the construction of infrastructure and promotion systems, and pay more attention to PHWs' lives outside of work and meet their living needs.
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Affiliation(s)
- Rongxin He
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Jinlin Liu
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Bin Zhu
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Ning Zhang
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Ying Mao
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
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15
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Ran L, Chen X, Peng S, Zheng F, Tan X, Duan R. Job burnout and turnover intention among Chinese primary healthcare staff: the mediating effect of satisfaction. BMJ Open 2020; 10:e036702. [PMID: 33033013 PMCID: PMC7542935 DOI: 10.1136/bmjopen-2019-036702] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Although China has done a lot in strengthening the primary healthcare system, the high turnover intention is still a social problem to be reckoned with. The objective of this study is to explore the mediating effect of satisfaction between job burnout and turnover intention. DESIGN Cross-sectional study. METHODS A cross-sectional study was conducted to make sense of the job burnout, satisfaction and turnover intention among primary healthcare workers in central China. Structural equation modelling (SEM) was performed to study the mediating effect of satisfaction between job burnout and turnover intention with maximum likelihood estimation. The mediation effect test was carried out by using the bootstrap method. RESULTS SEM showed that job burnout was positively related to the turnover intention with the standard path coefficient of 0.845 (C.R.=34.055, p<0.001). The partial mediating effect of satisfaction was 0.047, making up 5.32% of the total effect. The goodness-of-fit was acceptable (Goodness of Fit Index=0.947, Comparative Fit Index=0.975, root mean square error of approximation=0.067, Non-Normed Fit Index=0.971, Incremental Fit Index=0.975). Age, education level, monthly income, hire form and night shift were also found significantly correlated with turnover intention, and no difference was found between physicians and nurses. CONCLUSIONS The turnover intention is significantly affected by job burnout, satisfaction and demographical characteristics including age, education level, monthly income, hire form and night shift. Satisfaction can be regarded as a mediator between job burnout and turnover intention. Relative measures can be taken to promote enthusiasm and satisfaction thus decreasing the turnover rate.
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Affiliation(s)
- Li Ran
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xuyu Chen
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Shuzhen Peng
- Department of Health Management, Huangpi People's Hospital, Wuhan, China
| | - Feng Zheng
- Department of Health Managment, Health Committee of Huangpi District of Wuhan, Wuhan, China
| | - Xiaodong Tan
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
- School of Nursing, Wuchang University of Technology, Wuhan, China
| | - Ruihua Duan
- Department of Health Management, Huangpi People's Hospital, Wuhan, China
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16
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Li Z, Hung P, He R, Zhang L. Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China. Int J Equity Health 2020; 19:135. [PMID: 32778111 PMCID: PMC7418383 DOI: 10.1186/s12939-020-01248-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background Comprehensive primary care practices, through preconception, preventive, curative, and rehabilitative care, have been a global priority in the promotion of health. However, the scope of primary care services has still been in decline in China. Studies on the factors for primary care service scope have centred on human resources and infrastructure; the role of direct government subsidies (DGS) on services scope of primary care facilities were left unanswered. This study aimed to explore the association between the DGS and services scope of primary care facilities in China. Methods A multi-stage, clustered cross-sectional survey using self-administrated questionnaire was conducted among primary care facilities of 36 districts/counties in China. A total of 770 primary care facilities were surveyed with 757 (98.3%) valid respondents. Of the 757 primary care facilities, 469 (62.0%) provided us detailed information of financial revenue and DGS from 2009 to 2016. Therefore, 469 primary care facilities from 31 counties/districts were included in this study. Sasabuchi-Lind-Mehlum tests and multivariate regression models were used to examine the inverted U-shaped relationship between the DGS and service scope. Results Of 469 PCFs, 332 (70.8%) were township health centres. Proportion of annul DGS to FR arose from 26.5% in 2009 to 50.5% in 2016. At the low proportion of DGS to financial revenue, an increase in DGS was associated with an increased service scope of primary care facilities, whereas the proportion of DGS to financial revenue over 42.5% might cause narrowed service scope (P = 0.023, 95% CI 11.59–51.74%); for the basic medical care dimension, the cut point is 42.6%. However, association between DGS and service scope of public health by primary care facilities is statistically insignificant. Conclusion While the DGS successfully achieved equalization of basic preventive and public health services, the disproportionate proportion of DGS to financial revenue is associated with narrowed service scope, which might cause underutilization of primary care and distorted incentive structure of primary care. Future improvements of DGS should focus on the incentive of broader basic medical services provision, such as clarifying service scope of primary care facilities and strategic procurement with a performance-based subsidies system to determine resource allocation.
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Affiliation(s)
- Zhong Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Research Center for Rural Health Services, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, 430030, Hubei, China.,Arnold School of Public Health, University of South Carolina, Columbia, 29205, SC, USA
| | - Peiyin Hung
- Arnold School of Public Health, University of South Carolina, Columbia, 29205, SC, USA
| | - Ruibo He
- School of Finance and Public Administration, Hubei University of Economics, Wuhan, 430205, Hubei, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,Research Center for Rural Health Services, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, 430030, Hubei, China.
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17
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Wang H, Jin Y, Wang D, Zhao S, Sang X, Yuan B. Job satisfaction, burnout, and turnover intention among primary care providers in rural China: results from structural equation modeling. BMC FAMILY PRACTICE 2020; 21:12. [PMID: 31941455 PMCID: PMC6961377 DOI: 10.1186/s12875-020-1083-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Low job satisfaction, severe burnout and high turnover intention are found to be prevalent among the primary care providers (PCPs) in township health centers (THCs), but their associations have received scant attention in the literature. In light of this, this study aims to examine the relationships between job satisfaction, burnout and turnover intention, and explore the predictors of turnover intention with a view to retaining PCPs in rural China. METHODS Using the multistage cluster sampling method, a cross-sectional survey was conducted in Shandong Province, China. 1148 PCPs from 47 THCs participated in this study. Job satisfaction, burnout and turnover intention were measured with a multifaceted instrument developed based on the existing literature, the Maslach Burnout Inventory and the participants' responses to a Likert item drawn from the literature, respectively. The relationships of the three factors were examined using Pearson correlation and structural equation modeling, while the predictors of turnover intention were investigated using multivariate logistic regression. RESULTS The subscale that the PCPs were most dissatisfied with was job rewards (95.12%), followed by working environment (49.65%) and organizational management (47.98%). The percentages of the PCPs reporting high-levels of emotional exhaustion, depersonalization and reduced personal accomplishment were 27.66, 6.06, and 38.74%, respectively. About 14.06% of the respondents had high turnover intention. There was a significant direct effect of job satisfaction on burnout (γ = - 0.52) and turnover intention (γ = - 0.29), a significant direct effect of burnout on turnover intention (γ = 0.28), and a significant indirect effect (γ = - 0.14) of job satisfaction on turnover intention through burnout as a mediator. Work environment satisfaction, medical practicing environment satisfaction, and organizational management satisfaction proved to be negative predictors of turnover intention (p < 0.05), whereas reduced personal accomplishment was identified as a positive predictor (p < 0.05). CONCLUSIONS Plagued by low job satisfaction and severe burnout, the PCPs in rural China may have high turnover intentions. Job satisfaction had not only negative direct effects on burnout and turnover intention, but also an indirect effect on turnover intention through burnout as a mediator. Targeted strategies should be taken to motivate and retain the PCPs.
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Affiliation(s)
- Haipeng Wang
- School of Health Care Management, Shandong University, Jinan, 250012, China.,NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Dan Wang
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Shichao Zhao
- School of Public Administration, Shandong Normal University, Jinan, 250014, China
| | - Xingang Sang
- Health Commission of Weifang, Weifang, 261061, Shandong, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
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