Dong Roman Xu

Southern Medical University | FIMMU · Acacia Lab for Implementation Science | School of Health Management

Introduction Clinical practice guidelines are essential tools for standardizing medical practices and improving healthcare quality. However, current guideline implementation is unsatisfactory. Barriers to guideline implementation include external environmental factors (e.g., medical personnel, medical institutions, local policies) and intrinsic cha...

Background: China's healthcare system for children faces significant challenges, particularly due to the limited pediatric service capacity of primary healthcare institutions. A shortage of effective and accessible training tools for primary care doctors further hinders progress in addressing this gap. Technological advancements, especially in arti...

Background While influenza vaccines are the most effective measure for preventing influenza, uptake rates in China remain relatively low. Rapid Verbal Persuasion (RVP), due to its highly rapid fashion, involving just 1–2 minutes, has a strong evidence base in promoting behavior change. Despite this, it is underused or rarely evaluated in the contex...

This editorial updates the scope and submission expectations of Implementation Science and Implementation Science Communications . We refine our protocol publishing policies and set out new expectations for reporting studies describing determinants and their relationship with implementation outcomes. Our central focus remains on the implementation...

Background Diabetes is a major global health concern and a leading cause of morbidity and mortality. Shared medical appointment (SMA), an integrated treatment and health management service, is effective in improving the clinical and behavioral outcomes of people with diabetes (PWD). Using the Reach, Effectiveness, Adoption, Implementation, and Main...

High maternal and neonatal mortality rates persist in Mozambique, with stillbirths remaining understudied. Most maternal and neonatal deaths in the country are due to preventable and treatable childbirth-related complications that often occur in low-resource settings. The World Health Organization introduced the Safe Childbirth Checklist (SCC) in 2...

Background Seasonal influenza poses an enormous burden worldwide, with older adults facing preventable morbidity and mortality. However, seasonal influenza vaccination coverage is poor among older populations in China. Pay-it-forward (giving a person a free vaccine and an opportunity to donate to support others) and financial incentives (e.g. free...

Background It is unclear how temporal trends in dementia incidence, alongside fast-changing demography, will influence China's future dementia burden. We developed a Markov model that combines population trends in dementia, mortality, and dementia-related comorbidities, to forecast and decompose the burden of dementia in China to 2050. Methods Pop...

Background Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving acces...

Background The current situation regarding tobacco consumption in China is grave, posing a significant threat to the health of smokers. The Chinese government has implemented several policies aimed at controlling tobacco use. Brief verbal Intervention for Smoking Cessation (BISC) has been demonstrated as highly effective and cost-efficient. Primary...

Background: Traditional Chinese medicine (TCM) is commonly used alongside western medicine for stroke management in China. However, there is significant variation in TCM practice, and the utilization of evidence-based clinical practice guidelines is inadequate.This study aims to evaluate the effectiveness of three popular frameworks (Consolidated F...

Background and Objective Diabetes mellitus (DM) is a mounting public health concern in China, home to the largest number of patients with diabetes globally. A primary challenge has been the integration of high-quality chronic disease services, with poor outcomes and inefficient health management intensifying the disease burden. Shared Medical Appoi...

Direct-to-onsumer telemedicine (DTCT) has become popular as an alternative to traditional care. However, uncertainties about the potential risks associated with the lack of comprehensive quality evaluation could influence its long-term development. This study aimed to assess the quality of care provided by DTCT platforms in China using unannounced...

Background The hospitalization rate of ambulatory care sensitive conditions (ACSCs) has been recognized as an essential indicator reflective of the overall performance of healthcare system. At present, ACSCs has been widely used in practice and research to evaluate health service quality and efficiency worldwide. The definition of ACSCs varies acro...

Aims To examine the effectiveness of Self-Help Plus (SH+) as an intervention for alleviating stress levels and mental health problems among healthcare workers. Methods This was a prospective, two-arm, unblinded, parallel-designed randomised controlled trial. Participants were recruited at all levels of medical facilities within all municipal distr...

Background and purpose Diabetes is a highly prevalent non-communicable disease with severe clinical consequences. China has 140.9 million diabetes patients aged 20–79 years, with a prevalence of 10% in 2021. The Shared Medical Appointment (SMA) is a group-based Chronic Care Model that has improved patient health outcomes and integration of treatmen...

疾病控制优先（disease control priority, DCP）是一种重要的公共健康干预策略。该策略首先依据疾病负担严重程度、疾病防治技术有效性、现有卫生系统的防治能力等一系列标准筛选出应作为优先防控的疾病，然后就这些疾病的防控技术展开定性（如面对面访谈、专家咨询、研讨会等）和定量（如成本效益分析、多准则决策分析等）评估，最终确定应作为优先推进的公共卫生举措。从理念的产生，到概念的正式提出，再到实践的指导，DCP历经70多年，为提高发展中国家医疗卫生服务体系效率，促进人群健康做出了重要贡献。本研究系统梳理DCP产生背景、发展历程、实现方法和实践应用，旨在探讨DCP在卫生治理中的应用潜能，为全面推进健康中国建设提供技术支撑和决策参考。

Background: Community pharmacies are the most accessible healthcare providers l which plays a key role in primary healthcare services managing minor ailment and ensure the quality use of drugs. Our study aimed to assess the quality care from community pharmacies using unannounced standardized patient. Methods: All community pharmacies from three mu...

Background An English version of the Patient Perception of Patient-Centeredness (PPPC) scale was recently revised, and it is necessary to test this instrument in different primary care populations. Aim This study aimed to assess the validity and reliability of a Chinese version of the PPPC scale. Design A mixed method was used in this study. The...

The burden of sexually transmitted infections (STIs) continues to increase in developing countries like China, but the access to STI care is often limited. The emergence of direct-to-consumer (DTC) telemedicine offers unique opportunities for patients to directly access health services when needed; However, the quality of STI care provided by telem...

Objective Primary health workers (PHWs) are a critical pillar of health systems but primary health care centers often struggle to attract and retain talented staff. To better understand why this is, we investigated the job preference of PHWs in a Chinese urban setting. Methods In a discrete choice experiment, PHWs from 15 primary health care cente...

Background Diabetes mellitus is a prevalent and potentially devastating chronic illness affecting many older adults. Given spousal involvement in many aspects of diabetes management, coping with their partners is increasingly seen as a potential solution to make up for limited resources. This study aimed to identify the key conditions for optimal i...

Background Current research underscores the necessity of assessing the quality of health systems from the people's perspective. The Lancet Global Health Commission has proposed a High-Quality Health System (HQHS) framework, which covers system foundations, care quality, user experience, outcomes, and confidence. The commission has also developed an...

Background This study aims to evaluate primary care providers' adherence to the standard of measuring blood pressure for people aged 35 or above during their initial visit, as per Chinese guidelines, and to identify factors affecting their practices. Methods We developed 11 standardized patients (SP) cases as tracer conditions to evaluate primary...

Background The hospitalization rate of ambulatory care sensitive conditions (ACSCs) has been recognized as an essential indicator reflective of the overall performance of healthcare system. At present, ACSCs has been widely used in practice and research to evaluate health service quality and efficiency worldwide. The definition of ACSCs varies acro...

Todd Lewis and co-authors discuss development and use of the People's Voice Survey for health system assessment.

Background Chlamydia Trachomatis (CT) is among the most prevalent sexually transmitted diseases (STDs) globally. According to the World Health Organization, more than 131 million people get infected with CT annually. CT is usually transmitted via sexual contact or perinatal exposure and can result in severe long-term complications. In developing na...

Background: Community pharmacy services play a crucial role in China's primary healthcare system. However, the COVID-19 pandemic has introduced unprecedented challenges. Assessing the impact of COVID-19 closure policies on patient satisfaction and evaluating the underlying mechanisms are essential for enhancing the quality of pharmacy services. Met...

Background Improper refractive correction can be harmful to eye health, aggravating the burden of vision impairment. During most optometry clinical consultations, practitioner-patient interactions play a key role. Maybe it is feasible for patients themselves to do something to get high-quality optometry. But the present empirical research on the qu...

Background: Disclosure of infectious disease status to social network peers can facilitate reaching and early detection among high-risk populations. In this era of social media, globally, HIV/AIDS represents a high burden of infectious disease. Thus, delivery of an HIV result e-report via social media presents a new approach that has the potential...

Background: Nepal moved from a unitary government to a federal system of government in 2015 under its constitution. Nepal is a federal democratic republic governed by three levels of government: a federal, provincial, and local level. The response to COVID-19 in Nepal has been majorly led and controlled by the federal government. All three levels...

BACKGROUND Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving acces...

The call for decolonization in global health is growing alongside China’s increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing fro...

Background: This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability. Methods: This study set up a multidisciplinary working group including guideline methodologists, statisti...

Introduction As direct-to-consumer teleconsultation (hereafter referred to as ‘teleconsultation’) has gained popularity, an increasing number of patients have been leaving online reviews of their teleconsultation experiences. These reviews can help guide patients in identifying doctors for teleconsultation. However, few studies have examined the va...

Objectives To systematically explore how the sources of evidence, types of primary studies, and tools used to assess the quality of the primary studies vary across systematic reviews (SRs) in public health. Methods We conducted a methodological survey of SRs in public health by searching the of literature in selected journals from electronic bibli...

Maternal and perinatal healthcare remain insufficient in impoverished regions such as sub-Saharan Africa (SSA), and removing geographic barriers to access continuous maternal and perinatal healthcare services (CMPHS) has been addressed as a critical strategy. Based on the framework of maternal, neonatal, and child health (MNCH) proposed by WHO, acc...

Background: Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparitie...

Background The Patient Perception of Patient-Centeredness (PPPC) scale in English was recently revised, and it is necessary to test this instrument in different primary care populations. Aim This study aimed to assess the validity and reliability of a Chinese version of the PPPC scale. Design Delphi method was used to address the content validity o...

The journals Implementation Science and Implementation Science Communications are focused on the implementation of evidence into healthcare practice and policy. This editorial offers reflections on how we handle this as editors. Studies that focus on the simultaneous implementation of implementation objects and (technological or other) structures t...

Background Meaning in life could be of clinical importance in stimulating healthy and preventive behaviors. The study aimed to investigate the association between meaning in life and preventive healthcare use among Chinese adults, and to assess their age and gender differences in the association. Methods A cross-sectional online survey was conduct...

Background: Community pharmacies are the most accessible healthcare providers l which plays a key role in primary healthcare services managing minor ailment and ensure the quality use of drugs. Our study aimed to assess the quality care from community pharmacies using unannounced standardized patient. Methods: All community pharmacies from three mu...

Background: Improper refractive correction can be harmful to eye health, aggravating the burden of vision impairment. During most optometry clinical consultations, practitioner-patient interactions play a key role. Maybe it is feasible for patients themselves to do something to get high-quality optometry. But the present empirical research on the q...

Background The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whethe...

BACKGROUND The unannounced standardized patient (USP) is the gold standard for primary healthcare (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software for simulating clinical scenarios, and is widely used in medical education. Whether it can be used to a...

Introduction Understanding location-specific travel modes and acceptable travel time to primary healthcare institutions across large regions is important for measuring accessibility and allocation of health resources. However, few studies have either focused on such analysis or provided efficient methods. Methods We developed a framework to unders...

Health care in China suffers from substantial allocative inefficiency in the delivery system and technical inefficiency within hospitals. To ameliorate this problem in rural areas, the Analysis of Provider Payment Reforms on Advancing China's Health (APPROACH) project shifted the payment method of China's rural health insurance scheme for county ho...

We analyzed COVID-19 influences on the design, implementation, and validity of assessing the quality of primary health care using unannounced standardized patients (USPs) in China. Because of the pandemic, we crowdsourced our funding, removed tuberculosis from the USP case roster, adjusted common cold and asthma cases, used hybrid online–offline tr...

Background: Reducing the treatment gap for mental health in low-and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China....

Background Public health emergencies may lead to severe psychological stress, especially for healthcare workers, including frontline healthcare workers and public health workers. However, few stress management interventions have been implemented for healthcare workers even though they require more comprehensive interventions than the general public...

Purpose: To compare the characteristics of depression-related symptoms identified by individual EPDS items in women who screened positive and negative, and to describe the occurrence of thoughts of self-harm in these women. Methods: Based on a Chinese cohort of 1,112 women, scores on each EPDS item were analyzed at 7 time points from the first t...

Objectives This study aims to examine the mediation role of satisfaction with children on the association between contact with children (CCT) and healthy aging among middle-aged and older parents in China. Methods Data from 9,575 parents over 45 years old were obtained from the 2018 China Health and Retirement Longitudinal Survey. A multinomial lo...

There has been little research investigating the effects of caregiving for grandchildren on grandparents’ mental health from a dynamic perspective. The aim of this study was to evaluate the effects on caregivers’ depression of changes in grandparenting intensity. The study population included 8,157 respondents obtained from the China Health and Ret...

This is a presentation about PEDALs model which we have developed to help researchers quickly understand the common procedures of conducting implementation research. The presentation in Chinese can be accessed at https://www.bilibili.com/video/BV1Vb4y1q7Ef?share_source=copy_web

This editorial provides a comprehensive consolidated overview of the scope and expectations of Implementation Science and Implementation Science Communications. We remain most interested in rigorous empirical studies of the implementation of evidence-based healthcare practices (including interventions, technologies, and policies) and the de-impleme...

Objectives: Primary health workers are the first fine to identify postpartum depression, which is important for patients with this disease to get early specialist diagnosis and treatment. The smartphone-based virtual patient is economical, convenient and effective, and has been applied extensively to evaluate the competency to detect postpartum de...

BACKGROUND Direct to Consumer (DTC) telemedicine platforms are digital platforms that enable patients to match with and initiate online consultations. This growing area of digital health has the potential to expand access to quality outpatient care by extending patient choice of providers and providers’ ability to interact with new patients online....

Objectives This study aims to investigate the potential factors associated with mental health outcomes among Chinese adults during the Coronavirus disease 2019 (COVID-19) epidemic. Methods This is an online cross-sectional survey conducted among Chinese adults in February 2020. Outcome measurements included the three-item UCLA Loneliness Scale (UC...

Introduction Geographical accessibility is important against health equity, particularly for less developed countries as Nepal. It is important to identify the disparities in geographical accessibility to the three levels of public health facilities across Nepal, which has not been available. Methods Based on the up-to-date dataset of Nepal formal...

Background Reducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China....

BACKGROUND Reducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China....

Background: China has a large urban-rural disparity in terms of socioeconomic level, family structure, proportion of older people, etc. These factors may cause disparities in healthy aging status and trajectory. The aim of this study is to explore the differences and evaluate the equity in healthy aging trajectories between urban and rural areas in...

Backgrounds This study examined the dynamic association between risk communication and the public’s risk perception and action across the COVID-19 outbreak timeline in China. Methods This study collected publicly available information on COVID-19 released on official channels (e.g., government websites and official media) by the Parehub tool. Also...

Background HIV testing is an essential gateway to HIV prevention and treatment thus controlling the HIV epidemic. More innovative interventions are needed to increase HIV testing among men who have sex with men (MSM) since their testing rate is still low. We proposed an online HIV test results exchange mechanism whereby the one without a certified...