Facilitators and barriers to chronic non-communicable disease management under family doctor contracting services in China.

Abstract

Background: Chronic non-communicable diseases (NCDs) pose a significant health burden in China exacerbated by population aging and rapid urbanization. The Family Doctor Contracting Service has been implemented in China as a primary health care approach to improve NCD management and overall health outcomes. This study aims to identify factors associated with implementing chronic NCD management under the FDCS in the Chinese primary health care system.

Methods: This qualitative study was conducted in 4 purposively selected cities in China. Health administrators from the local health commission, staff members from local primary health care facilities, and community-dwelling individuals with NCDs were recruited using purposive and snowball sampling. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was adopted to inform our interview guides and data collection and analysis. Themes regarding barriers and facilitators were generated using deductive and inductive approaches.

Results: A total of 140 participants were interviewed 82 (58.6%) were female and the mean (SD) age was 51.0 (13.68) years. Significant barriers included low health literacy levels, limited awareness about NCD, insufficient healthcare professionals and medical resources, poor publicity and regulation, limited multisectoral collaboration, and inadequate audit and feedback systems. Facilitators included affordable and convenient primary health services, recognition of the indispensable benefits of NCD management, good patient-physician bonds, and the high priority given by local governments.

Conclusion: This qualitative study identified significant facilitators and barriers to the implementation of NCD management under the FDCS at the primary care level. These insights can contribute to better NCD prevention and management implementation in the Chinese primary health care system.