Lingjie Wang’s research while affiliated with Fujian Medical University and other places

Background Medical consortiums have been extensively established to facilitate the integration of health resources and bridge the technical gap among member institutions. However, some commonly appropriate technologies remain stagnant in subordinate hospitals, although they have been routinely applied in leading hospitals. Besides, the mechanism underlying differences in clinicians’ adoption behavior at different levels of institutions was unknown. Therefore, this study aimed to investigate the differences in influencing mechanisms of clinicians’ hepatic contrast-enhanced ultrasound technology (CEUS) utilization behavior between leading and subordinate hospitals within medical consortiums, thus providing clues for expanding effective and appropriate technologies within integrated care systems. Methods A self-designed scale was developed based on the theory of planned behavior (TPB). A multistage sampling method was applied to investigate clinicians who were aware of CEUS and worked in liver disease-related departments within the sampled medical institutions. The final sample size was 289. AMOS 24.0 software was used to construct multi-group structural equation modeling (SEM) to validate the hypotheses and determine the mechanism of hepatic CEUS utilization. Results It revealed that behavioral intention significantly influenced adoption behavior, regardless of whether it was in leading hospitals or subordinate hospitals (β = 0.283, p < 0.001). Furthermore, behavioral attitude (β = 0.361, p < 0.001) and perceived behavioral control (β = 0.582, p < 0.001) exerted significant effects on adoption behavior through behavioral intention. However, in leading hospitals, subjective norm had a significant positive effect on behavioral intention (β = 0.183, p < 0.01), while it had a significant negative impact on behavioral intention in the subordinate hospitals (β = -0.348, p < 0.01). Conclusion To effectively translate the adoption intention into actual behavior, it is recommended to elucidate the demand and facilitators involved in the process of health technology adoption across leading and subordinate hospitals. Additionally, bolstering technical support and knowledge dissemination within subordinate hospitals while harnessing the influential role of key individuals can further enhance this transformative process.

Background With the improper use of antimicrobials becoming a major public health concern globally, poor compliance of clinical practice guidelines(CPGs) on antimicrobials is still prominent, especially in less developed regions. Although social norms have received increasing attention as the determinants of physicians’ CPGs use, most studies set forth only a single level of social norms. Therefore, this study aims to investigate the impact of multifaceted social norms on physician’ use of CPGs on antimicrobials, and further reveal the temporal effects of social norms. Methods Based on integration of Theory of Planned Behavior and Theory of Normative Social Behavior, a questionnaire survey was conducted covering social norms at individual level (subjective norms), organizational level (organization criterion) and social level (social identity), as well as other potential factors (attitudes, behavioral intention, etc) for the use of CPGs on antimicrobials. Data were collected by multi-stage random sampling from 502 physicians in secondary and tertiary general hospitals in central-western China. Structural equation model (SEM) was used to link the three-level factors with physician's behavior. And with reflected by the moderating effects of professional titles in this study, the temporal effects of social norms were examined by multi-group SEM. Results Nearly 70% of the participants had a good practice of using CPGs on antimicrobials. Reliability and validity analysis shows that the questionnaire developed from the theoretical model is acceptable. Subjective norms, organization criterion and social identity were linked to higher behavioral intentions(β = 0.212, p < 0.01; β = 0.254, P < 0.01; β = 0.212, P < 0.01). The direct effect of behavior intentions on physicians' practice was 0.822, and the indirect effects of subjective norms, organizational criterion and social identity on practice were 0.308, 0.236 and 0.235. The effects of organization criterion and social identity on behavior were moderated by the professional title, and regarding effects would be weakened with the rise of professional title. Conclusion This study reveals the importance of multifaceted social norms in enhancing physicians’ use of CPGs on antimicrobials and the moderating effects of professional titles on the role of social norms at organizational level (organizational criterion) and social level (social identity).

Background Despite growing evidence of health inequalities, equity of inpatient health service utilization(IHSU) among middle-aged and elderly people with multiple chronic conditions(MCCs) have received little attention. Therefore, this study aims to access the inequities of IHSU among middle-aged and elderly people with MCCs in China, and determine the contributing social factors and their influences by using the national data. Methods This study used two cross-sectional data from the 2013 and 2018 China Health and Retirement Longitudinal Study(CHARLS) The inequities of IHSU were illustrated and quantified by the concentration curve and normalized concentration index. Multivariate logistic regression was conducted to identify the associated factors of IHSU. And decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities of IHSU. Results The study indicated that the rate of IHSU among Chinese middle-aged and elderly people with MCCs was 16.6% in 2013 and 17.7% in 2018. The overall concentration index for IHSU was − 0.0301 in 2013 and 0.0354 in 2018, which suggested a higher concentration of IHSU among economically disadvantaged middle-aged and elderly people with MCCs in recent year. The results showed the rate of IHSU was associated with age, sex, household income per capita, self-rated health, smoking, and drinking. Decomposition results further revealed the contributions of the determinants to the inequalities of IHSU. Specifically, age (43.16%), sex (-12.46%), household income per capita (-8.89%), self-rated health (-35.71%), smoking (63.70%), and drinking (59.90%) have varying degrees of contributions to the inequality in IHSU. Conclusion This study sheds light on the pro-rich inequality in IHSU among Chinese middle-aged and elderly people with MCCs. It suggests that policymakers should pay more attention to middle-aged and elderly adults who are male, old, economically disadvantaged, smoking, and drinking. In addition, more targeted interventions should be taken to improve the economic situation of these vulnerable individuals and strengthen their ability to cope with MCCs.

Background Family doctor contract services (FDCS) has played a key role in diabetes management in China since 2016. The influence of FDCS on the physiological indexes of individuals with diabetes has been examined. However, little attention has been paid to its effect on the Health-Related Quality of Life (HRQoL). This study aims to fill this knowledge gap by evaluating the effect of FDCS on the HRQoL of individuals with diabetes. Methods We identified 382 individuals with diabetes receiving all follow-up surveys in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study (CHARLS). The HRQoL of the included individuals was estimated using results from the Short Form 36 (SF-36) questionnaire. The propensity score matching with the difference-in-differences (PSM-DID) approach was applied to quantify the effect of FDCS on the HRQoL among individuals with diabetes. A robust test was performed by setting the 2015 data as the treatment group for the placebo test. Results The mean score of role-emotional (RE) increased from 54.25 to 61.63 among those who signed up to receive FDCS, while the corresponding score decreased from 57.77 to 51.04 among those who did not receive FDCS. Results from the regression analysis indicated that the use of FDCS was associated with significant improvement in RE (+14.10, p = 0.04) among individuals with diabetes. We did not find a statistically meaningful association between the FDCS and any of the other HRQoL domains: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), and mental health (MH), respectively. The robustness analysis of the model indicated that the results were robust. Conclusion The FDCS for diabetes in China was associated with a significant improvement in RE. Due to a limited time since the launch of FDCS (i.e., 2016), the recipient's physical health did not show marked improvement. In the future, FDCS should pay more attention to the physiological health of individuals with diabetes. Moreover, psychological services also need to be maintained and not slackened. At the same time, it is strongly recommended to pay more attention to the HRQoL of individuals with diabetes and more comprehensive health.