The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation

Gong, Enying; Li-xin, Sun; Long, Qian; Xu, Hanzhang; Gu, Wanbing; Bettger, Janet Prvu; Tan, Jingru; Ma, Jixiang; Jafar, Tazeen H.; Oldenburg, Brian; Yan, Lijing L.

doi:10.3389/fpubh.2021.774907

Cited by 9 publications

(34 citation statements)

References 40 publications

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“…It was interesting to note that VDs below 40 years of age also tended to choose to leave their current job, which might be explained by the fact that the majority of the younger VDs had more choices to make an occupational career decision. Though a small part of this population had turnover behavior for reasons such as lack of interest or severe workload, most of them might still choose it based on income and social status ( 78 ). Similarly, in job burnout, low personal achievement become the most important factor affecting the occurrence and severity of job burnout among VDs, as mentioned above.…”

Section: Discussionmentioning

confidence: 99%

Village doctors' dilemma in China: A systematic evaluation of job burnout and turnover intention

Chen

You

Shen

et al. 2022

Front. Public Health

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BackgroundVillage doctors (VDs) in China undertook arduous primary healthcare missions. However, they received little attention in comparison to doctors in urban public secondary and tertiary hospitals. There is an urgent need to explore the overall situation of turnover intention and job burnout among VDs to evaluate and adjust current health manpower policy.MethodsIn this study, seven databases like PubMed, EMBASE, Web of Science (WOS), WanFang, China Science and Technology Journal Database (VIP), Chinese BioMedical Literature Database (CBM), and China National Knowledge Infrastructure (CNKI) were systematically searched, relevant experts were consulted, and empirical research on job burnout and turnover intention among VDs in international publications was evaluated. Therefore, we evaluated the prevalence of job burnout among VDs in general, across all dimensions and different severity levels, as well as the scores of each category. For turnover intention, we assessed the prevalence of different groups and their overall situation and also identified significant contributors.ResultsIn this study, we integrated 20 research evidences on job burnout and turnover intention among 23,284 VDs from almost all provinces in China, and the prevalence of turnover intention among VDs in China was as high as 44.1% [95% confidence interval (CI): 34.1–54.2], which was two to four times that of primary health workers in high-income countries, but not much different from some developing countries. Simultaneously, VDs with the highest risk of turnover intention were men [odds ratio (OR): 1.22 (1.05–1.43)], those with a monthly income below USD 163.4 [OR: 0.88 (0.78–0.98)], those with a high educational level [OR: 0.88 (0.78–0.98)], and those <40 years old [OR: 1.27 (1.16–1.40)]. Similarly, the detection rate of job burnout toward them was 59.8% (95% CI: 38.7–79.1) with the MBI-GS score being 44.44 (95% CI: 37.02–51.86) in a total of 90, while the detection rate of job burnout in moderate and above almost reached 20%. The most significant contributor that affects job burnout was low personal accomplishment (LPA), and the detection rate for moderate and higher severity was 65.2% (95% CI: 58.7–71.7).ConclusionAttention should be paid to the high turnover intention and severe job burnout of primary health workers in rural areas of developing countries, and targeted measures should be taken to improve the situation. Health policymakers should increase financial subsidies for VDs, set a reasonable workload, improve various health policies such as pension insurance for VDs, and encourage “targeted training” for medical students to enrich and expand their team.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021289139.

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Section: Discussionmentioning

confidence: 99%

Village doctors' dilemma in China: A systematic evaluation of job burnout and turnover intention

Chen

You

Shen

et al. 2022

Front. Public Health

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“…Salienta-se que a relação com o cuidador/familiar, quando bem estabelecida, impulsiona a resultados de saúde satisfatórios no âmbito domiciliar, pela possibilidade maior de inseri-lo na resolução de problemas e compartilhar a responsabilização pelo cuidado (12,17) , constituindo-se em importante ferramenta no processo de transição do cuidado do hospital para o domicilio.…”

Section: Discussionunclassified

“…A influência do hábito cultural na adesão e qualidade dos cuidados dispensados no domicílio foi outro aspecto identificado como interferente no processo de preparo/treinamento dos cuidadores. Esse achado ressalta a importância de as estratégias de ensino serem adaptadas ao contexto cultural de cada indivíduo, utilizando-se das tecnologias leves de cuidado, de forma a valorizar o princípio da equidade e propiciar a qualidade da prática no domicílio (17) .…”

Section: Discussionunclassified

“…Contudo, é importante considerar que, por vezes, a dificuldade de adesão do cuidador às orientações ofertadas pode ser influenciada pela dificuldade do profissional em lidar com o cuidador/família, o que pode ser reflexo de um modelo assistencial ainda voltado ao tecnicismo e às tecnologias duras, centradas em equipamentos e procedimentos (17) . Neste sentido, a influência negativa do modelo hospitalocêntrico, ainda enraizado na perspectiva de famílias e profissionais de saúde, também foi apontado como interferente na consolidação da Atenção Domiciliar.…”

Section: Discussionunclassified

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Preparing caregivers for dehospitalization of technology-dependent patients: perspective of Home Care professionals

Sato¹,

Teston²,

Marcon³

et al. 2022

Rev Rene

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Objective: to know how the preparation of caregivers of technology-dependent patients is conducted from the perspective of professionals from the Home Care Service. Methods: a qualitative study, conducted with nine professionals from the Home Care Service teams. The data was collected through semi-structured interviews and submitted to Content Analysis, thematic modality. Results: two categories emerged: Strategies and resources used in the preparation of caregivers for dehospitalization and Factors that influence the preparation of caregivers for dehospitalization, which show that this preparation involves the use of soft technologies, based on the interaction and valorization of learning, besides aspects related to the organization of the service in the intra-hospital and home contexts. Conclusion: the preparation of caregivers is permeated with concern for facilitating the acquisition of knowledge and skills for care at home; it involves the use of specific resources and strategies and is influenced positively by technologies and negatively by factors related to hospital structure and organization. Contributions to practice: the findings of the study can subsidize the practices of multiprofessional teams working in the home scenario, since they point out aspects that

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“…Such activities may be effective in yielding positive changes in certain groups, but, in the real world, a model with a more person-directed approach to engaging individuals in decision-making is needed. In contrast to the geriatric model, several integrated care approaches at the community setting have been proposed, but they have only targeted a single chronic disease (e.g., stroke), outcomes (e.g., quality of care, costs), or process (communication, team building) [ 10 – 12 ].…”

Section: Introduction {6a}mentioning

confidence: 99%

Evaluation of a community-based integrated care model (CIE) for frail older people in rural Foshan, China: study protocol for a stepped-wedge cluster randomized controlled trial {1}

Xie

Wen

Deng

et al. 2023

Trials

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Background While community-based eldercare has proven to be effective in qualitative studies, there is limited evidence on the effectiveness of this geriatric care model in rural communities where caring for older people is traditionally the responsibility of family members, but a formal long-term care was recently introduced in China. CIE is a rural community-embedded intervention using multidisciplinary team, to provide evidenced-based integrated care services for frail older people including social care services and allied primary healthcare and community-based rehabilitation services. Methods CIE is a prospective stepped-wedge cluster randomized trial conducted at 5 community eldercare centers in rural China. The multifaceted CIE intervention, guided by chronic care model and integrated care model, consists of five components: comprehensive geriatric assessment, individualized care planning, community-based rehabilitation, interdisciplinary case management, and care coordination. The intervention is rolled out in a staggered manner in these clusters of centers at an interval of 1 month. The primary outcomes include functional status, quality of life, and social support. Process evaluation will also be conducted. Generalized linear mixed model is employed for binary outcomes. Discussion This study is expected to provide important new evidence on clinical effectiveness and implementation process of an integrated care model for frail older people. The CIE model is also unique as the first registered trial implementing a community-based eldercare model using multidisciplinary team to promote individualized social care services integrated with primary healthcare and community-based rehabilitation services for frail older people in rural China, where formal long-term care was recently introduced. Trial registration {2a} China Clinical Trials Register (http://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2200060326). May 28th, 2022.

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The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation

Cited by 9 publications

References 40 publications

Village doctors' dilemma in China: A systematic evaluation of job burnout and turnover intention

Village doctors' dilemma in China: A systematic evaluation of job burnout and turnover intention

Preparing caregivers for dehospitalization of technology-dependent patients: perspective of Home Care professionals

Evaluation of a community-based integrated care model (CIE) for frail older people in rural Foshan, China: study protocol for a stepped-wedge cluster randomized controlled trial {1}

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