Limited knowledge and distrust are important social factors of out‐patient’ s ‘inappropriate diagnosed seeking behaviour’: a qualitative research in Shanghai

Ruan, Yuhui; Zhuang, Chenyang; Chen, Weisin; Xie, Jun; Zhao, Yi; Zhang, Lufa; Lin, Hong

doi:10.1002/hpm.3134

Cited by 6 publications

(5 citation statements)

References 56 publications

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“…Between July 2016 and January 2020, our team conducted a series of studies on social adaptation, social support, and social integration of the drifting elderly in Shanghai using multiple rounds of snowball sampling as described previously [36,37]. Based on the grounded theory approach (an additional with in-depth interview approach which is known to be more fexible and can support rigorous and transparent analysis better in some ways [38]), various drifting elderly were involved in our studies.…”

Section: Methodsmentioning

confidence: 99%

Influence of Neighborhood-Based Identity and Social Participation on the Social Integration of the Drifting Elderly

Ruan

Wang

2023

Health & Social Care in the Community

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The drifting elderly are an interprovincial floating elderly population that is mainly composed of unemployed older parents in China. They have left their usual residence and relocated to urban areas, facing challenge about social integration. As a neighborhood has played important roles in the floating population’s social integration, this study was designed to investigate the influence of neighborhood-based identity and social participation on the social integration of the drifting elderly. Five rounds of data collection and analysis were conducted in a continuous crossover sequence using grounded theory. Twenty-four participants were recruited from three districts in Shanghai, China. The neighborhood was shown to play a prominent role in the drifting elderly’s perceptions of social integration. Good neighborhood relations help the drifting elderly establish effective social support networks, interact with inflowing society, get in touch with more human resources, and form social relationships and networks. Neighborhood-based participants and identity were more conducive to eliminating heterogeneity and creating homogeneity for the drifting elderly. Thus, the neighborhood affects the social integration of the drifting elderly, which directly impacts their social feelings, integrations, and networks. Management of social integration among the drifting elderly should be focused on creating general opportunities for them to participate in neighborhood-based social events with a reasonable identity.

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Section: Methodsmentioning

confidence: 99%

Influence of Neighborhood-Based Identity and Social Participation on the Social Integration of the Drifting Elderly

Ruan

Wang

2023

Health & Social Care in the Community

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“…Health-related knowledge can provide patients with needed theoretical methods to elicit health-seeking behavior change (23,26). Limited knowledge is found associated with patient's inappropriate first-diagnosed seeking behavior (27). Thus, public health policy makers, health practitioners and educators are focusing on enhancing individual's knowledge by health education to change their behaviors (28), like smoking (29), nutrition (30), practice toward epidemic (31), and so on.…”

Section: Knowledgementioning

confidence: 99%

Why Do Patients Seek Diagnose Dis-accordance With Hierarchical Medical System Related Policies in Tertiary Hospitals? A Qualitative Study in Shanghai From the Perspective of Physicians

Ruan

Luo

Lin

2022

Front. Public Health

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BackgroundAlthough the Hierarchical Medical System has been utilized in China for many years, it is inadequate for guiding patients in adopting appropriate diagnose-seeking behaviors in accordance with related policies. This study examined how patients' diagnose-seeking behavior in tertiary hospitals that is dis-accordance with Hierarchical Medical System related policy (“DSB-dis-accordance”) arise and ways to guide patients away from such behaviors, both from the perspective of physicians.MethodsA qualitative study based on a mixed method including in-depth interviews and grounded theory. Twenty-seven physicians with more than 2 years of experience serving in tertiary hospitals of Shanghai were involved after reviewing the related purposes and requirements. Patients' “DSB-dis-accordance” was studied from the perspective of physicians.ResultsPatient-related factors (habits, trust, and knowledge), physician-related factors (conservative preference, risk avoidance), and system-related factors (accessibility, operability) affected patients' diagnose-seeking behavior.ConclusionsPatient-related, physician-related, and system-related factors affecting patients' diagnose-seeking behaviors in tertiary hospitals should be addressed by investing more health resources in lower-level hospitals, enhancing dissemination of health-related and policy-related knowledge, refining the classification of diseases, incentivizing physicians, and developing appropriate follow-up measures. Physicians could then become more involved in guiding patients' “DSB-dis-accordance,” thereby benefitting development of the Hierarchical Medical System in China.

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“…Firstly, the primary diagnosis system means patients being treated first at a primary institution, which may cause problems because patients do not trust primary medical institutions in China ( 19 ), and patients and medical insurance funds are still siphoned by higher rank hospitals ( 20 ). Secondly, in terms of the two-way referral system, in reality, the number of upward referrals (to secondary and tertiary hospitals) was significantly higher than that of downward referral (to primary medical institutions), which will meanwhile increase the burden on higher ranking hospitals ( 21 ). Some research has also analyzed approaches from the perspectives of government intervention and market regulation ( 22 ), which represent two areas that could have an effect on the hierarchical medical system.…”

Section: Literature Reviewmentioning

confidence: 99%

Hierarchical medical system and local medical performance: A quasi-natural experiment evaluation in Shanghai, China

Chen

Zhao

et al. 2022

Front. Public Health

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BackgroundIn order to maintain high standards of healthcare, it is necessary for medical departments to provide high-quality and affordable medical services to local residents. This has been widely accepted in developed countries, while the medical treatment systems in developing countries remain to be improved. This research is based on a pilot of a hierarchical medical system in Shanghai, China, to evaluate the effects on policy of medical reform in developing countries.Methods and resultsBy means of the difference-in-differences (DID) method, the causal relationship between medical care services' improvement and hierarchical medical systems' implementation could be identified. This project also explores the differential effects of policy intervention and confirms that the pilot showed a significant improvement in medical performance in central districts while the result remains uncertain in terms of suburban districts. Furthermore, the dynamic effect of a hierarchical medical system has also been identified with the event study method, while the policy pilot only had short-term effects on local medical resources' improvement. In order to ascertain the function mechanisms of hierarchical medical systems and explain why the policy pilot only had short-term effects, this project also conducts influencing mechanism analysis with the triple-differences method (also known as difference-in-difference-in-differences or DDD method). According to the empirical results, there is no direct evidence indicating the hierarchical medical system could bring obvious benefits from the perspectives of patients and medical institutions.ConclusionsFor better implementation of hierarchical medical systems in the future, long-term supervision mechanisms should be given more attention in the enforcement process of hierarchical medical systems. At the same time, more safeguarding measures should be implemented, such as supervising the payment systems of the medical institution and conducting performance evaluation.

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Limited knowledge and distrust are important social factors of out‐patient’ s ‘inappropriate diagnosed seeking behaviour’: a qualitative research in Shanghai

Cited by 6 publications

References 56 publications

Influence of Neighborhood-Based Identity and Social Participation on the Social Integration of the Drifting Elderly

Influence of Neighborhood-Based Identity and Social Participation on the Social Integration of the Drifting Elderly

Why Do Patients Seek Diagnose Dis-accordance With Hierarchical Medical System Related Policies in Tertiary Hospitals? A Qualitative Study in Shanghai From the Perspective of Physicians

Hierarchical medical system and local medical performance: A quasi-natural experiment evaluation in Shanghai, China

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