Factors associated with the uptake of national essential public health service package for hypertension and type-2 diabetes management in China's primary health care system: a mixed-methods study

Xiong, Shangzhi; Jiang, Wei; Meng, Ruilin; Hu, Chi; Liao, Hui; Wang, Yongchen; Chang, Cai; Zhang, Xinyi; Ye, Pengpeng; Ma, Yanqiuzi; Liu, Tingzhuo; Peng, Dandan; Yang, Jiajuan; Gong, L.; Wang, Qiujun; Peiris, David; Mao, Limin; Tian, Maoyi

doi:10.1016/j.lanwpc.2022.100664

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…Given that sub-optimal management targets are associated with an increased risk of diabetic complications, this will substantially increase the disease burden in years to come. Although several studies have investigated the barriers or facilitators associated with diabetes management in China, they have tended to focus exclusively on either patient self-management [ 14 , 15 ] or provider service delivery factors [ 16 ], and few have combined patient and provider perspectives together.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to primary care management of type 2 diabetes in Shijiazhuang City, China: a mixed methods study

Tao,

Mao,

Zhang

et al. 2024

BMC Prim. Care

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Background The prevalence of type 2 diabetes (T2DM) in China is over 10%, affecting around 114 million people. Despite the inclusion of T2DM in the National Basic Public Health Service Program (NBPHSP), most people with T2DM experience challenges in achieving optimal management targets. This study aimed to identify barriers and facilitators of diabetes management from the perspectives of primary health care (PHC) service providers and recipients. Methods This mixed-methods study was conducted in Shijiazhuang City, Hebei Province, China. A quantitative PHC facility assessment survey was conducted in all administrative districts and qualitative in-depth interviews were conducted in one district to government officials, medical staff, patients with T2DM, and their family members. Interviews were thematically analyzed, and all findings were synthesized using Michie’s COM-B theory. Results A total of 197 village/community level PHC facilities and 66 township/street level PHC facilities answered the survey, and 42 in-depth interviews were conducted. The key facilitators stemmed from the NBPHSP policy, which standardized the basic infrastructure, medical equipment, and medication for the PHC facilities, provided training on NCD prevention and control, and compensated the PHC workers. However, we identified a detrimental cycle among PHC providers characterized by inadequate capacity, overwhelming workloads, insufficient income, limited career development opportunities, and challenges in attracting young talents. Although patients were covered by the national medical insurance schemes, they experienced capability constraints primarily driven by low education levels, advanced age, low health literacy, and a proliferation of misinformation. These factors influenced patients’ motivation to be actively engaged in care and contributed to inertia to intensify treatment and achieve their clinical management goals. Conclusion This study identifies several major facilitators and barriers from the perspectives of both PHC providers and patients with T2DM. Our findings suggest there are substantial opportunities to strengthen the NBPHSP, including improving the capacity and the income level of the PHC providers, attracting and retaining skilled health workers in rural areas, supporting patients to improve their health literacy and take a more active role in their health care, and improving access to high-quality care through digital health approaches. Trial registration ClinicalTrials.gov (record NCT02726100, 03/22/2016).

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Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to primary care management of type 2 diabetes in Shijiazhuang City, China: a mixed methods study

Tao,

Mao,

Zhang

et al. 2024

BMC Prim. Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…This program included the establishment of health records for all, health education, elderly care, care for major chronic diseases (including hypertension and type-2 diabetes) and infectious diseases, vaccinations, hygiene monitoring and more [25]. For patients with hypertension or type-2 diabetes, the service package includes screening, monitoring, routine follow-up and customized interventions [41]. PHC facilities provide these basic public health services to residents free of charge.…”

Section: Discussionmentioning

confidence: 99%

Quality of primary healthcare for chronic diseases in low-resource settings: evidence from a mixed methods study in rural China

Li,

Zhang,

Tang

et al. 2024

Preprint

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Background There is a paucity of evidence regarding the definition of the quality of primary healthcare (PHC) in China. This study aims to develop a modified conceptual framework PHC quality based on the context of rural China and evaluate the PHC quality for chronic diseases in rural areas. Methods This mixed-methods study, involving a patient survey, a provider survey and chart abstraction, and second-hand registered data, was set in three low-resource counties in rural China from 2021 to 2022. Rural patients with hypertension or type 2 diabetes, health care workers providing care on hypertension or diabetes were involved. Standardized PHC quality score was generated by arithmetic means or Rasch models of Item Response Theory. Results A modified PHC quality framework was presented. High-quality PHC for chronic diseases encompasses three core domains: a competent PHC system (comprehensiveness, accessibility, continuity, and coordination), effective clinical care (assessment, diagnosis, treatment, disease management, and provider competence), and positive user experience (information sharing, shared decision-making, respect for patients’ preferences, and family-centeredness). This study included 1355 patients, 333 healthcare providers and 2203 medical records. Ranging from 0 (the worst) to 1 (the best), the average quality score for PHC system was 0.718, with 0.887 for comprehensiveness, 0.781 for accessibility, 0.489 for continuity, 0.714 for coordination. For clinical care, average quality was 0.773 for disease assessment, 0.768 for diagnosis, 0.677 for treatment, 0.777 for disease management, and 0.314 for provider competence. The average quality for user experience was 0.727, with 0.933 for information sharing, 0.657 for shared decision-making, 0.936 for respect for patients’ preferences, and 0.382 for family-centeredness. The differences in quality among population subgroups, although statistically significant, were small. Conclusion The PHC quality in rural China has showed strengths and limitations. We identified large gaps in continuity of care, treatment, provider competence, family-centeredness, and shared decision-making. Policymakers should invest more effort in addressing these gaps to improve PHC quality.

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“…[12] Given that sub-optimal management targets are associated with an increased risk of diabetic complications, this will substantially increase the disease burden in years to come. Although several studies have investigated the barriers or facilitators associated with diabetes management in China, they have tended to focus exclusively on either patient self-management [13,14] or provider service delivery factors, [15] and few have combined patient and provider perspectives together.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Primary Care Management of Type 2 Diabetes in China: A Mixed Methods Study

Tao,

Mao,

Zhang

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Diabetes mellitus has surged to become a global health emergency. The prevalence of type 2 diabetes (T2DM) in China is over 10%, affecting around 114 million people. Despite the inclusion of T2DM in the National Basic Public Health Service Program (NBPHSP), most people with T2DM experience challenges in achieving optimal management targets. This study aimed to identify barriers and facilitators of diabetes management from the perspectives of primary health care (PHC) service providers and recipients. Methods: This mixed-methods study was conducted in Shijiazhuang City, Hebei Province, China. A quantitative PHC facility survey was conducted in all administrative districts and qualitative in-depth interviews were conducted in one district with government officials, medical staff, patients with T2DM, and their family members. Interviews were thematically analyzed, and findings were synthesized using Michie’s COM-B theory. Results: A total of 197 village/community level PHC facilities and 66 township/street level PHC facilities answered the survey, and 42 in-depth interviews were conducted. The primary facilitators stemmed from the NBPHSP policy, which standardized the basic infrastructure, medical equipment (99% equipped with blood pressure measuring devices and glucometers), and medication for the PHC facilities, provided training on NCD prevention and control (95% received training workshops), and compensated the healthcare workers based on the quantity of public health service they provided. However, we found that PHC providers have become ensnared in a detrimental cycle characterized by inadequate capacity, overwhelming workloads, insufficient income, limited career development opportunities, and challenges in attracting young talents. Although all covered by the national medical insurance schemes, patients experienced capability constraints primarily driven by low education levels, advanced age, low health literacy, and a proliferation of misinformation. These factors influenced patients’ motivation to be actively engaged in care and contributed to inertia to intensify treatment and achieve their clinical management goals. Conclusion: This study identifies several major barriers from the perspectives of both PHC providers and patients with T2DM. Our findings suggest there are substantial opportunities to strengthen the NBPHSP, including improving the capacity and the income level of the PHC providers, attracting and retaining skilled health workers in rural areas, supporting patients to improve their health literacy and take a more active role in their health care, and improving access to high-quality care through digital health approaches. Trial registration: ClinicalTrials.gov (record NCT02726100, 03/22/2016).

show abstract

Factors associated with the uptake of national essential public health service package for hypertension and type-2 diabetes management in China's primary health care system: a mixed-methods study

Cited by 13 publications

References 19 publications

Barriers and facilitators to primary care management of type 2 diabetes in Shijiazhuang City, China: a mixed methods study

Barriers and facilitators to primary care management of type 2 diabetes in Shijiazhuang City, China: a mixed methods study

Quality of primary healthcare for chronic diseases in low-resource settings: evidence from a mixed methods study in rural China

Barriers and Facilitators to Primary Care Management of Type 2 Diabetes in China: A Mixed Methods Study

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