基于混合方法的信息采集类APP在农村基本公共卫生服务中的可持续性研究

Research on the sustainability of information collection APP in rural basic public health services based on mixed-method

目的公共卫生信息采集是提升基层公共卫生服务能力的抓手,本研究以“卫健E通”APP为例,分析农村公共卫生服务人员持续使用该类APP的意愿及影响因素。方法采用混合方法研究中的探索性序列设计,选择四川省仁寿县为代表地区进行调研。首先,采用个人深入访谈法初步探索APP的使用现状、适用性、持续使用意愿等问题;其次,借鉴信息技术接受和使用整合理论、期望确认理论等构建乡医/村医使用满意度影响因素假设模型,并设计涵盖7个测量维度的结构化问卷,对调查地所有APP使用者进行调查,最后采用结构方程模型进行模型验证。结果本次访谈人员包括乡镇卫生院院长、公共卫生医生、乡村医生三类人群,共计21人,结果显示APP在推广应用中主要存在经费、政策支持不足,其次也存在软件功能欠缺、系统兼容性不足等问题。乡医/村医满意度影响因素定量调查共回收有效问卷593份。结构方程模型结果显示,有7个维度符合最初的假设,与满意度相关的维度降次排序为软件兼容性(r=0.617)、促成条件(r=0.211)、绩效期望(r=0.137)、努力期望(r=0.091)、社会影响(r=0.068)。结论为促进信息采集类APP在基层公共卫生服务中的应用,提升用户使用满意度,需要重点解决软件兼容性问题,打造各级医疗系统互联互通。同时,要统筹解决经费问题,优化软件功能,完善绩效考核体系,做好培训推广工作。

Objective Public health information collection is critical in improving the capacity of basic public health services. Our study took the "Wei Jian E Tong" APP as an example to evaluate the willingness and influencing factors of rural public health service personnel to continue using such APPs. Methods We applied exploratory sequential design in mixed-method research and chose Renshou county in Sichuan province as the representative region. Firstly, we used the personal in-depth interview to initially explore the status quo, applicability, continued willingness to use APP and other issues. Secondly, we used unified theory of acceptance and use of technology(UTAUT) and expectation confirmation theory(ECT) to construct a hypothetical model of influencing factors of user satisfaction. We then designed a structured questionnaire covering 7 measurement dimensions to survey all users of the APP at the survey site. Finally, we used structural equation model to verify the research hypothesis. Results A total of 21 individuals were interviewed in this survey, including leaders of township health centers, public health doctors, and rural doctors.Qualitative results showed the major defects were insufficient funds and policy support in the promotion and application,additionally lack of software functionalities and system incompatibility. A total of 593 valid questionnaires were collected from the quantitative survey on the satisfaction of township doctors and village doctors. Structural equation model results showed that seven direct hypotheses were established, of which compatibility had the largest effect value user satisfaction with a total effect value of 0.617, followed by facilitating condition(r=0.211), performance expectancy(r=0.137), effort expectancy(r=0.091) and social influence(r=0.068). Conclusions To promote the application of information collection apps in primary public health services and improve user satisfaction, the focus should be on solving software incompatibility and create interconnection among all levels of medical systems. At the same time, it is necessary to solve funding problems as a whole, optimize software functions, improve the performance evaluation system, and improve software training and promotion.