Dataset Information

Changing community health service delivery in economically less-developed rural areas in China: impact on service use and satisfaction.

ABSTRACT:

Objective

To evaluate the impact of a model of rural community health service (CHS) on the use and acceptability of primary healthcare services.

Design

Quasi-experimental.

Setting

Two adjacent rural counties in China.

Participants

5842 residents in 2009 and 3807 in 2010 from 980 households in 7 intervention townships and 49 villages; 2232 residents in 2009 and 2315 in 2010 from 628 households in 3 comparison townships and 9 villages. All residents were approached to participate, with no significant differences in age or sex between groups.

Intervention

Multilevel intervention in 2009 including training rural practitioners, encouraging clinic improvements, providing clinical guidelines, standards and subsidies.

Data collection

Surveys of community members from randomly sampled households in 2009 and 2010.

Primary outcome measures

Satisfaction with and utilisation of outpatient and public health services.

Analysis

Factor analysis confirmed two components of satisfaction. Univariate and multilevel analysis was used.

Results

Satisfaction scores for intervention county respondents increased from 21.4 (95% CI 21.1 to 21.7) to 22.1 (95% CI 21.7 to 22.4) with no change in comparison area. In multilevel analysis, satisfaction with patient-centred care was associated with chronic disease, shorter waiting times and county. Satisfaction with clinic environment and cost was associated with female gender, shorter waiting times but not county. The proportion of children receiving immunisation in intervention village clinics increased from 42.5% (95% CI 27.9% to 47.1%) to 59.2% (95% CI 53.8% to 64.6%) whereas this decreased in comparison villages (16.5%; 95% CI 10.3% to 22.7% to 6.0%; 95% CI 1.3% to 10.7%). Antenatal visits increased in intervention villages (from 69.0%, 95% CI 65.8% to 73.1% to 75.8%, 95% CI 72.2% to 79.4%) with no change in comparison villages.

Conclusions

Introduction of a CHS model adapted to economically less-developed rural areas was associated with some improvements in satisfaction with care and use of some village-based public health services. Further research is needed to determine its public health impact and application to other areas.

SUBMITTER: Liu Y

PROVIDER: S-EPMC3939668 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Changing community health service delivery in economically less-developed rural areas in China: impact on service use and satisfaction.

Liu Yong Y Yuan Zhaokang Z Liu Yuxi Y Jayasinghe Upali W UW Harris Mark F MF

BMJ open 20140228 2

<h4>Objective</h4>To evaluate the impact of a model of rural community health service (CHS) on the use and acceptability of primary healthcare services.<h4>Design</h4>Quasi-experimental.<h4>Setting</h4>Two adjacent rural counties in China.<h4>Participants</h4>5842 residents in 2009 and 3807 in 2010 from 980 households in 7 intervention townships and 49 villages; 2232 residents in 2009 and 2315 in 2010 from 628 households in 3 comparison townships and 9 villages. All residents were approached to ...[more]

PMID: 24583760

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Project description:BACKGROUND:Insufficient physical activity (PA) is a major public health issue. Whilst PA is an important contributor to disease prevention, engagement in PA decreases with age, particularly among women in socio-economically disadvantaged areas. Research using existing support networks to engage 'hard to reach' populations in PA interventions is sparse. We developed and tested the feasibility of a PA-promoting intervention for older women within existing community groups in socio-economically disadvantaged areas. METHODS:The Medical Research Council guidelines for complex interventions were used to guide the intervention's development. We recruited participants (n?=?40) from older (aged ?50?years) women's groups from four different community centres. A 12-week programme was delivered during existing sessions, informed by Social Practice Theory. The sessions provided education about PA, social support in the form of a PA 'buddy', group discussion and follow-up telephone calls, as well as printed information about local opportunities to participate in PA. The main uncertainties tested were rates of participant recruitment, retention, and completion of assessments of PA by accelerometry and of mental health using the Hospital Anxiety and Depression Scale (HADS). Intervention acceptability was assessed by questionnaire, and focus group interviews elicited participants' views about the intervention. Qualitative data were subjected to framework analysis. RESULTS:The recruitment rate was high; 87% (n?=?40/46) of women consented to participate, and 78% (n?=?31) attended all education sessions. Uptake of follow-up telephone calls and PA 'buddies' was low. Few participants provided valid accelerometer data, but 63% (n=25) completed the HADS questionnaire at all time points. The printed materials and education sessions were viewed positively; telephone calls and 'buddy' support were not valued. Participants believed that organised group activities would lead to increased PA engagement, and whilst participants disliked wearing a waist accelerometer, they thought that regular PA feedback would facilitate necessary goal-setting. CONCLUSIONS:High recruitment and retention rates suggest that use of existing social support groups is an acceptable and attractive method of delivering a PA intervention to this population. A randomised controlled trial of the intervention appears feasible, but its design requires refinement of the social support component, facilitation of goal-setting and reconsideration of the assessment of PA. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02880449 . Registered on 26 August 2016.

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Dataset Information

Changing community health service delivery in economically less-developed rural areas in China: impact on service use and satisfaction.

Objective

Design

Setting

Participants

Intervention

Data collection

Primary outcome measures

Analysis

Results

Conclusions

Publications

Changing community health service delivery in economically less-developed rural areas in China: impact on service use and satisfaction.

Similar Datasets

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