BackgroundThe proliferation of mobile health apps has greatly changed the way society accesses the health care industry. However, despite the widespread use of mobile health apps by patients in China, there has been little research that evaluates the effect of mobile health apps on patient experience during hospital visits.ObjectiveThe purpose of our study was to examine whether the use of mobile health apps improves patient experience and to find out the difference in patient experience between users and nonusers and the characteristics associated with the users of these apps.MethodsWe used the Chinese Outpatient Experience Questionnaire to survey patient experience. A sample of 300 outpatients was randomly selected from 3 comprehensive public hospitals (3 tertiary hospitals) in Hubei province, China. Each hospital randomly selected 50 respondents from mobile health app users and 50 from nonusers. A chi-square test was employed to compare the different categorical characteristics between mobile health app users and nonusers. A t test was used to test the significance in continuous variables between user scores and nonuser scores. Multiple linear regression was conducted to determine whether the use of mobile health apps during hospital visits was associated with patient experience.ResultsThe users and nonusers differed in age (χ22=12.2, P=.002), education (χ23=9.3, P=.03), living place (χ21=7.7, P=.006), and the need for specialists (χ24=11.0, P=.03). Compared with nonusers, mobile health app users in China were younger, better educated, living in urban areas, and had higher demands for specialists. In addition, mobile health app users gave significantly higher scores than nonusers in total patient experience scores (t298=3.919, P<.001), the 18 items and the 5 dimensions of physician-patient communication (t298=2.93, P=.004), health information (t298=3.556, P<.001), medical service fees (t298=3.991, P<.001), short-term outcome (t298=4.533, P<.001), and general satisfaction (t298=4.304, P<.001). Multiple linear regression results showed that the use of mobile health apps during hospital visits influenced patient experience (t289=3.143, P=.002). After controlling for other factors, it was shown that the use of mobile health apps increased the outpatient experience scores by 17.7%. Additional results from the study found that the self-rated health status (t289=3.746, P<.001) and monthly income of patients (t289=2.416, P=.02) influenced the patient experience as well.ConclusionsThe use of mobile health apps could improve patient experience, especially with regard to accessing health information, making physician-patient communication more convenient, ensuring transparency in medical charge, and ameliorating short-term outcomes. All of these may contribute to positive health outcomes. Therefore, we should encourage the adoption of mobile health apps in health care settings so as to improve patient experience.

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Background Internet hospitals show great potential for adequately fulfilling people’s demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients’ intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients’ behavioral intention is necessary to support the development of internet hospitals in China and promote patients’ intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic. Objective The purpose of this study is to identify the determinants of patients’ intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB). Methods The hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses. Results A total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (β=.624, P=.004 and β=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (β=.207; P=.001). Conclusions Perceived behavioral control and perceived severity of disease are the most important determinants of patients’ intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients’ adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients’ intention to use online inquiry services provided by internet hospitals.

ObjectiveThe purpose of our study is to develop a mental workload scale for physicians in China and assess the scale’s reliability and validity.DesignThe instrument was developed over three phases involving 396 physicians from different tiers of comprehensive public hospitals in China. In the first phase, an initial item pool was developed through a systematic literature review. The second phase consisted of two rounds of Delphi expert consultations and a pilot survey. The third phase tested the reliability and validity of the instrument.SettingPublic hospitals in China.ParticipantsA total of 396 physicians from different tiers of comprehensive public hospitals in China participated in this study in 2018.Primary and secondary outcome measuresCronbach’s α, content validity index, item-total score correlation coefficient, dimension-total score correlation coefficient and indices of confirmatory factor analysis.ResultsSix dimensions (mental demands, physical demands, temporal demands, perceived risk, frustration level and performance) and 12 items were identified in the instrument. For reliability, Cronbach’s α for the whole scale was 0.81. For validity, the corrected item-content validity index of each item ranged from 0.85 to 1, item-total score correlation coefficients ranged from 0.31 to 0.75, and the correlation coefficients between the dimensions and total score ranged from 0.37 to 0.72. The results of the confirmatory factor analysis showed that the goodness-of-fit indices of the scale were satisfactory.ConclusionThe instrument showed good reliability and validity, and it is useful for diagnosing the mental workload of physicians.

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The OPEQ is a promising instrument covering the most important aspects which influence outpatient experiences of comprehensive public hospital in China. It has good evidence for acceptability, validity and reliability.

Objective: The purpose of this study is to investigate the mental workload level of physicians in outpatient practice since the normalization of prevention and control of the COVID-19 pandemic in China and explore the subtypes of physicians regarding their mental workload.Methods: A cross-sectional survey of 1,934 physicians primarily in 24 hospitals in 6 provinces in Eastern, Central, and Western China was conducted from November 2020 to February 2021. A latent profile analysis was performed to identify clusters based on the six subscales of the Chinese version of physician mental workload scale developed by our research team. Chi-square tests were performed to explore the differences in demographic characteristics of the subtypes among the subgroups, and multinomial logistic regression analysis was further conducted to identify the determinants of the subtypes of physicians.Results: Overall, the participating physicians reported high levels of task load but with high self-assessed performance (68.01 ± 14.25) while performing communication work tasks characterized by direct patient interaction in outpatient clinics. About 33.8% of the participating physicians were identified as “high workload and high self-assessment” subtype, compared to 49.7% “medium workload and medium self-assessment” subtype and 16.4% “low workload and low self-assessment” subtype. Physicians in “high workload and high self-assessment” subtype had the highest mean mental workload score. Physicians who were female, younger, married, worse health status, those who had lower educational level and an average monthly income of 5,001–10,000 RMB, those who worked in tertiary A hospitals, more hours per week and more than 40 h per week in outpatient clinics, and those who saw more outpatients per day, and spent more time per patient but with higher outpatient satisfaction were more likely to belong to “high workload and high self-assessment” subtype.Conclusion: Our findings can help provide a solid foundation for developing targeted interventions for individual differences across physicians regarding their mental workload. We suggest the hospital managers should pay more attention to those physicians with characteristics of the “high workload and high self-assessment” subtype and strengthen the management of the workload of this subtype of physicians to reduce the risks of their mental health, and to maintain their high work performance in outpatient clinics.

Background Existing patient safety culture assessment tools are mostly developed in western countries and may not be suitable for Chinese primary health care institutions. Primary care plays an important role in China’s medical system, and a targeted tool for its patient safety culture is urgently needed. Objective The aim of the study was to develop a dependable instrument to assess the patient safety culture in Chinese primary health care institutions. Methods Three phases were undertaken to develop the scale. The first phase developed a pilot scale by literature review, focus groups, and 2-round Delphi expert consultation. The second phase conducted a pilot survey. The third phase carried out a formal survey to test reliability and validity, involving 369 participants from 9 primary health care institutions. Results The final scale included 32 items under 7 dimensions. For reliability, the Cronbach α coefficients among dimensions varied from 0.754 to 0.926, and the Cronbach α for the scale was 0.940. For content validity, the corrected item-level content validity varied between 0.64 and 1, the scale-level content validity index/universal agreement was 0.625, and the scale-level content validity index/average was 0.93. For construct validity, the Spearman correlations of dimension-total score varied between 0.129 and 0.851, all Spearman correlations of the dimension-total score were greater than that of interdimensions and the Spearman correlations of item-total score ranged from 0.042 to 0.775. The results of the confirmatory factor analysis indicated that the model fitted well. Conclusions The Patient Safety Culture Scale for Chinese primary health care institutions demonstrated good reliability and acceptable validity; thus, it can be used as an assessment instrument for patient safety culture in Chinese primary health care institutions.