BMC Health Services Research最新文献

{"title":"Between support and uncertainty: employers' perspectives on workplace inclusion of people with mental health problems.","authors":"Silvia Krumm, Lea Mayer, Sarah Feige, Nicole Stasch, Lena Renz, Christiane Braun-Volkert, Reinhold Kilian, Edith Almer","doi":"10.1186/s12913-026-15665-x","DOIUrl":"10.1186/s12913-026-15665-x","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing awareness of mental health in the workplace, people with mental health problems continue to face substantial barriers to labour market participation. While stigma-related explanations have been widely addressed, less is known about how employers respond to mental health problems within the constraints of everyday organisational practice. This study explores employers' perspectives on workplace inclusion, with a particular focus on ambivalences, facilitating orientations, and expectations towards employees with mental health problems.</p><p><strong>Methods: </strong>This study reports findings from the first, qualitative phase of a participatory mixed-methods research project conducted in Southern Germany. Between November 2022 and August 2023, we conducted 29 semi-structured interviews with employers from companies across different sectors. Data were analysed using structured qualitative content analysis.</p><p><strong>Results: </strong>Employers described ambivalent orientations towards the inclusion of people with mental health problems. While mental health issues were seen as increasingly normalised and framed within broader societal developments, employers reported uncertainties regarding work organisation, team functioning, and predictability. Facilitating orientations included social responsibility, recognition of the health-promoting role of employment, pragmatic responses to labour shortages, and positive prior experiences. At the same time, workplace participation was often described as depending on employees' transparency regarding work-related limitations, individual responsibility for managing mental health, and disclosure as a prerequisite for employers' support and mutual trust.</p><p><strong>Discussion: </strong>Workplace inclusion of people with mental health problems appears to depend not only on employers' attitudes but also on practical considerations related to work organization and team functioning. Employers' perspectives reflected ambivalence, balancing commitments to participation with concerns about predictability, fairness, and collective functioning. Expectations regarding disclosure, responsibility, and transparency were central to perceived feasibility of support.</p><p><strong>Conclusions: </strong>Addressing these organisational dynamics may help inform more context-sensitive strategies to promote sustainable labour market participation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' experiences of musculoskeletal pain self-management and perspectives on virtual physiotherapy in Saudi Arabia: a reflexive thematic analysis.","authors":"Norah AlMuhana, Dalia Alimam, Walaa Moslem, Sara Bin Shehan, Nezar Al Torairi, Hana Alsobayel","doi":"10.1186/s12913-026-15695-5","DOIUrl":"https://doi.org/10.1186/s12913-026-15695-5","url":null,"abstract":"<p><strong>Background: </strong>Patients with musculoskeletal (MSK) pain in Saudi Arabia frequently employ self-directed management strategies in the absence of timely professional physiotherapy. This qualitative study was conducted as the first phase of a research programme investigating virtual MSK self-management in Saudi Arabia. Its findings subsequently informed the development and design of a hybrid virtual self-management programme for low-risk MSK patients.</p><p><strong>Methods: </strong>Eight gender-separated focus groups (n = 36) were conducted in Arabic at a tertiary care facility in Riyadh between July and October 2025. Sessions were held in-person or via Zoom. Audio recordings were transcribed verbatim using automated transcription (TurboScribe AI) as a first-pass tool, and the resulting transcripts were subsequently verified line by line by the research team. Data were analysed using reflexive thematic analysis following Braun and Clarke's six-phase framework. The study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).</p><p><strong>Results: </strong>Four interconnected themes were constructed: (1) Self-Management Without Structured Guidance - patients enacted symptom-driven strategies as rational responses to delayed professional care access; (2) Barriers to Physiotherapy Engagement and Adherence - structural, psychological, and relational factors disrupted access and adherence; (3) Limited Health Literacy and Educational Needs - community and individual knowledge gaps were identified, including a culturally specific educational need that has received limited attention in the MSK self-management literature for guidance on adapting Islamic prayer (Salah) during MSK pain; and (4) Conditional Acceptance of Virtual and Hybrid Physiotherapy Models - participants generally preferred hybrid care in which virtual delivery served as follow-up after in-person assessment and technique acquisition, not as an entry point to rehabilitation.</p><p><strong>Conclusions: </strong>Patients described relying on informal self-management strategies, which they attributed to the systemic lack of timely access to professional care. To our knowledge, a culturally specific finding that has received limited attention in the musculoskeletal self-management literature is patients' need for guidance on adapting Islamic prayer (Salah) during MSK pain. These findings informed the development of a culturally adapted hybrid virtual self-management programme, with implications for patient education and physiotherapy service design at the study institution and similar tertiary settings in Saudi Arabia, aligned with the national Vision 2030 health strategy.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: AI-assisted health management and older adults' autonomy: an empirical ethics study of privacy, algorithmic reliance, and relational dynamics.","authors":"Xindi Shen, Meirong Zhang, Chen Yang, Taiyong Zhong","doi":"10.1186/s12913-026-15622-8","DOIUrl":"10.1186/s12913-026-15622-8","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and feasibility evaluation of a standard set of intensive care unit discharge criteria in a prospective before-after observational pilot study.","authors":"Maike Hiller, Antonia Brugger, Svea Nies, Alina Schenk, Maria Wittmann, Jan-Karl Schütte, Stefan Schröder, Reimer Riessen, Hendrik Bracht, Jan Bakker","doi":"10.1186/s12913-026-15656-y","DOIUrl":"10.1186/s12913-026-15656-y","url":null,"abstract":"<p><strong>Background: </strong>Identifying ICU patients stable enough for discharge to lower care levels is usually subjective. We previously derived a standardized discharge criteria set including patient-specific aspects and organizational capabilities. This study evaluated its implementation feasibility, clinical utility for objective discharge readiness assessment, and descriptive patient flow and safety related outcome parameters in routine care.</p><p><strong>Methods: </strong>A prospective two-phase before-after observational pilot study was conducted in two German ICUs in 2022. During baseline, discharge-readiness workflows were observed. After criteria-set implementation and pre-testing, criteria completion, user feedback, patient-flow, acuity, and capacity parameters were collected. Due to small cohorts, only descriptive statistics were reported.</p><p><strong>Results: </strong>Eleven mainly patient-specific and some organization-specific criteria reached > 80% completion at discharge decision and were defined as a core set. User feedback supported extending this core set with organization-related criteria according to clinical setting, patient groups, pathways, and receiving-unit capabilities. Discharge readiness assessment should involve all relevant stakeholders to align care needs with available capabilities.</p><p><strong>Conclusions: </strong>A core set of eleven criteria indicated ICU discharge readiness in clinical routine. Organization-specific criteria can support adaptation to different patient subgroups and pathways. Workflow integration may support timely and safe transfers, but patient flow and safety effects require validation in larger studies. Holistic discharge readiness assessment requires coordinated pathway-management processes along the care continuum. Future implementation should prioritize reporting automation, intuitive visualization, and workflow-integrated documentation, ideally supported by a patient data management system.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-based traditional Chinese medicine health service use among older adults and provider-reported delivery barriers in Wuhan, China: an explanatory sequential mixed-methods study.","authors":"Yake Yue, Jiaying Fu, Juan Gu, Mengjie Tong, Yufei Qiu, Jiali Liu, Jianxiong Du, Fen Yang","doi":"10.1186/s12913-026-15625-5","DOIUrl":"https://doi.org/10.1186/s12913-026-15625-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Population ageing and multimorbidity are increasing the need for accessible community-based care, while service use may vary according to service availability, affordability, and delivery capacity. In China, community-based traditional Chinese medicine (TCM) health services represent one model of primary care support for prevention and chronic disease management, but evidence rarely integrates older adults' service use with frontline providers' delivery experiences within the same setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An explanatory sequential mixed-methods design was used in Wuhan, China, from December 2024 to July 2025. The quantitative phase involved a structured survey of 1,195 adults aged ≥ 60 years who were recruited on site at selected community health service centres. The qualitative phase included in-depth interviews with 11 primary care providers. Quantitative data were analysed using descriptive statistics, Pearson's χ² tests or Fisher's exact test, and multivariable binary logistic regression. Two multivariable binary logistic regression models were fitted: a primary model excluding awareness of services and an exploratory model including it. Firth's penalised likelihood was used as a sensitivity analysis for the small uninsured subgroup.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 1,195 older adults recruited during designated survey sessions at seven selected community health service centres, 729 (61.0%) reported receiving at least one community-based TCM health service during the past 12 months. In bivariate analyses, the proportion reporting use during the past 12 months differed significantly by sex, education level, medical insurance status, monthly household income, smoking status, drinking status, number of chronic conditions, awareness of community-based TCM health services, perceived convenience of access, and perceived complexity of the service process (all P &lt; 0.05). In the primary multivariable model excluding awareness, higher educational attainment, higher monthly household income, and a greater number of chronic conditions were associated with higher odds of reported use. Participants without medical insurance had lower odds of reported use than those covered by urban employee basic medical insurance (aOR = 0.30, 95% CI: 0.11-0.77). The Firth penalised logistic regression sensitivity analysis yielded a directionally consistent estimate for the small uninsured subgroup. Thematic analysis of interviews with primary care providers identified three themes of provider-reported or provider-perceived contextual barriers to service delivery: perceived limitations in policy and support systems, workforce and material resources, and barriers related to community awareness and acceptance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among older adults recruited on site at selected community health service centres, reported use of community-based TCM health services during the past 12 months was associated ","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): a cost-effectiveness analysis comparing team-based rehabilitation in primary care vs treatment as usual.","authors":"Lena Bornhöft, Annika Ekhammar, Mikael Svensson, Maria Dottori, Maria E H Larsson","doi":"10.1186/s12913-026-15652-2","DOIUrl":"10.1186/s12913-026-15652-2","url":null,"abstract":"<p><strong>Background: </strong>The PREVention of Sickness Absence through early identification and rehabilitation of at-risk patients with Musculoskeletal disorders (PREVSAM) model for team-based rehabilitation in primary care of patients with higher risk for sickness absence was investigated in a randomised controlled trial. Participants were screened with the Örebro Musculoskeletal Pain Screening Questionnaire - short form using a minimum value of 40 points for inclusion in the trial.</p><p><strong>Methods: </strong>This cost-effectiveness analysis (CEA) was performed alongside the PREVSAM trial from both healthcare and societal perspectives regarding costs in relation to change in quality-adjusted life-years (QALYs) over one year for groups receiving care according to the PREVSAM model and treatment as usual.</p><p><strong>Results: </strong>Both team-based rehabilitation and treatment as usual led to similar QALYs over one year. From the healthcare perspective, the PREVSAM model was somewhat more costly, with higher rehabilitation costs not being fully outweighed by lower costs for other primary care, specialised care, and medication. From the societal perspective, there was essentially no difference in total costs, as lower production loss costs essentially compensated for the higher rehabilitation costs. The probability that the PREVSAM model is cost-effective was close to 50% across conventional Swedish cost-effectiveness thresholds (€43 000 to €86 000 per QALY).</p><p><strong>Conclusions: </strong>The PREVSAM model and treatment as usual led to similar health outcomes and to similar total societal costs. Neither strategy was shown to be preferable on economic grounds at conventional cost-effectiveness thresholds. High individual variation implies that the screening process needs to be further refined to better identify those patients truly in need of team-based care and to facilitate appropriate resource stratification.</p><p><strong>Trial registration: </strong>The trial was registered with ClinicalTrials.gov, Protocol ID: NCT03913325. Study Registration Date, First submitted 09/04/2019, First posted 12/04/2019.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical disputes and turnover intention among physicians and medical technicians: evidence from a cross-sectional study in Xuzhou, China.","authors":"Zijian Qi, Ziyang Liu, Liang Shen, Junbo Li, Saiping Wu, Xiaoxu Chen","doi":"10.1186/s12913-026-15679-5","DOIUrl":"https://doi.org/10.1186/s12913-026-15679-5","url":null,"abstract":"<p><strong>Background: </strong>Physicians and medical technicians' turnover intention (TI) poses a growing threat to healthcare workforce stability. Medical disputes are increasingly recognized as a salient occupational stressor, however, their adjusted association with TI remains unclear. This study aimed to examine the association between medical disputes and TI.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 1570 physicians and medical technicians in public hospitals in Xuzhou, China. Propensity score matching (PSM) was used to balance baseline characteristics between participants with and without dispute experience. Hierarchical logistic regression was then applied to identify factors associated with TI.</p><p><strong>Results: </strong>Overall, 24.8% of participants reported TI. Higher perceived healthcare service quality (OR = 0.973, 95% CI: 0.952, 0.994), neutral income level (OR = 0.604, 95% CI: 0.417, 0.876), and neutral or reasonable performance appraisal (OR = 0.470, 95% CI: 0.264, 0.840; OR = 0.310, 95% CI: 0.159, 0.603) were associated with lower odds of TI. In addition, higher burnout level (OR = 1.096, 95% CI: 1.066, 1.127) and experiencing disputes (OR = 1.682, 95% CI: 1.165, 2.430) were associated with higher odds of TI.</p><p><strong>Conclusions: </strong>Nearly one-quarter of participants in this study reported TI, indicating a persistent workforce challenge. Physicians and medical technicians' TI are shaped by a combination of professional experiences, organizational conditions, and personal health factors. Addressing these interconnected factors is essential for improving health workforce retention and ensuring the long-term stability of healthcare systems.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging gaps in the care of people under the age of 60 with complex impairments through cross-indication home-based rehabilitation: a cross-sectional survey with experts in Germany.","authors":"Christoph Armbruster, Christian Schlett, Erik Farin-Glattacker","doi":"10.1186/s12913-026-15682-w","DOIUrl":"10.1186/s12913-026-15682-w","url":null,"abstract":"<p><strong>Background: </strong>In Germany, medical rehabilitation services are generally well developed. However, first evidence suggests that there are care gaps in the current outpatient and inpatient indication-specific rehabilitation landscape, which may particularly affect people under 60 with complex impairments. Home-based rehabilitation could help to bridge these care gaps by providing access to rehabilitation for this group of patients. Currently, there are only a few such services for patients under 60. In this context, a cross-indication approach for needs-based care could be relevant to ensure adequate treatment of rehabilitation needs in their entirety. A systematic survey of a broad sample of experts in this field of research is still lacking. The aim of this exploratory study was therefore to assess the views of experts on (1) care needs of people under 60 with complex impairments that are insufficiently covered by current rehabilitation services, (2) the need and associated benefits of home-based rehabilitation as well as perceptions regarding a cross-indication approach, and (3) indication and allocation criteria for a cross-indication approach of home-based rehabilitation.</p><p><strong>Methods: </strong>We performed a cross-sectional online survey between 03/2024 and 05/2024 with experts from six professional fields from across Germany. We report descriptive statistics on experts' assessments of a wide range of aspects of rehabilitation care and exploratively examined whether experts from different professional fields differ in their assessments.</p><p><strong>Results: </strong>A total of n = 136 experts took part in the survey. The majority of them were physicians in private practice. The experts tend to see a high level of unmet care needs in current rehabilitation services. Their positive assessment of home-based rehabilitation in terms of need and benefits, as well as their positive perception of a cross-indication approach, indicate that home-based rehabilitation conceptualised across all indications may help to bridge these care gaps.</p><p><strong>Conclusions: </strong>From the experts' perspective, there are various care gaps in current rehabilitation services for people under 60 with complex impairments in Germany. As a complementary service, cross-indication home-based rehabilitation may be a promising but still empirically under-evaluated approach to optimise the functioning of this patient group.</p><p><strong>Trial registration: </strong>German Clinical Trials Register (DRKS): DRKS00029068; Date of registration: 28.06.2022.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development process of a regional dementia strategy: a Delphi study and deliberative dialogues.","authors":"Christine Schiller, Gabriele Meyer, Anja Bieber","doi":"10.1186/s12913-026-15595-8","DOIUrl":"10.1186/s12913-026-15595-8","url":null,"abstract":"<p><strong>Background: </strong>Over the past decade, numerous countries have adopted national dementia strategies to address the growing societal impact of dementia. In Germany, six federal states have regional strategies to address local demographic and structural challenges, such as those in Saxony-Anhalt, Germany's fastest shrinking and ageing federal state with the highest dementia prevalence. In 2022, the State Competence Center for Dementia Saxony-Anhalt was established to develop a comprehensive regional Dementia Strategy. The aim of this study was to generate consensus on the objectives required to ensure adequate care and improve the quality of life of people living with dementia and their families in Saxony-Anhalt. To achieve this, the study used a participatory approach to identify and prioritize strategic objectives for the regional Dementia Strategy.</p><p><strong>Methods: </strong>A mixed-method, two-phase participatory design was employed. First, in a two-round Delphi process ratings from nine interest-holder groups were collected, including people living with dementia, informal caregivers, professionals, policymakers, and civil society representatives. Second, deliberative dialogues explored selected non-consensus objectives. Consolidated objectives were thematically grouped and aligned with state ministries to ensure policy feasibility.</p><p><strong>Results: </strong>In total, 406 participants completed round 1, with 262 participants completing round 2; 18 participants attended deliberative dialogues. Of 88 initial objectives, 47 reached consensus in round 1, 21 more in round 2, and seven were refined and validated through deliberative dialogues. The remaining 26 non-consensus items were thematically aggregated into broader strategic objectives. After ministerial alignment, the final Dementia Strategy comprises 40 strategic objectives across four main topics: social participation, medical and nursing care, support for people with dementia and informal caregivers, and promotion of dementia research. Participants also identified structural challenges, including service shortages, workforce limitations, bureaucratic barriers, and caregiver burden. These were documented as contextual factors relevant to implementation.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility of a structured participatory approach for regional dementia strategy development. The resulting strategy provides a foundation for future action, while successful implementation and the development of an implementation strategy will be essential to translate agreed objectives into practice. The approach may serve as a transferable model for evidence-informed and participatory health policy development.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring long-term retention intention and influencing factors among rural-oriented medical students in primary care in Guangxi, China: a qualitative study.","authors":"Xin Zhang, Yue Zhao, Xiaodan Li, Siying Liang, Mingzhen Lin, Boyi He, Tao Cen, Yanhu Liu, Yanli Zuo","doi":"10.1186/s12913-026-15642-4","DOIUrl":"https://doi.org/10.1186/s12913-026-15642-4","url":null,"abstract":"<p><strong>Background: </strong>Retaining qualified health professionals in remote rural areas remains a persistent global challenge. China's rural-oriented medical students programme(ROMSP) was established to address shortages of health professionals in township health centres. However, emerging evidence suggests considerable turnover intention among participants after completion of their mandatory service period This study aimed to explore long-term retention intentions and the factors influencing retention among rural-oriented medical students working in primary care in Guangxi, China.</p><p><strong>Methods: </strong>This exploratory qualitative study conducted semi-structured interviews with 26 rural-oriented medical students who had worked in their designated township health centres for between one and three years. The interview guide was developed based on a multidimensional framework of person-environment fit theory. Thematic analysis was used to code, analyse, and interpret the findings according to the theory's five dimensions.</p><p><strong>Results: </strong>Long-term retention intentions among rural-oriented medical students in Guangxi appeared limited, with only 23.1% (6/26) of participants expressing willingness to remain in their positions beyond the mandatory service period. Guided by the five dimensions of person-environment fit theory, leadership support within person-person fit emerged as a prominent factor associated with differences between participants intending to stay and those intending to leave. The person-job fit encompassed the broadest range of factors, with work-family balance identified as a facilitator. The influence of person-vocation fit was reflected through its interactions with other dimensions, whereas person-organisation fit and person-group fit appeared to play comparatively smaller roles.</p><p><strong>Conclusions: </strong>To enhance long-term retention among rural-oriented medical students in primary care, interventions should focus on strengthening leadership capacity among township health centre directors, promoting work-family balance, and improving career mobility mechanisms after the mandatory service period. This study provides empirical support for applying person-environment fit theory to contract-based health workforce programmes and offers transferable insights for other countries facing similar rural health workforce challenges.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}