基于史密斯执行模型的乡镇卫生院基本公共卫生服务项目执行效能及其影响因素甄别

Identification of the Effectiveness and Influencing Factors of the Basic Public Health Service Project in Townsnip Healtn Centers Based on Smith Implementation Model

目的:探讨乡镇卫生院基本公共卫生服务项目的执行效能及其影响因素,为提高乡镇卫生院的服务质量和公共卫生水平提供参考和建议。方法:以史密斯执行模型为理论框架,通过分层整群抽样的方法,对四川省绵阳市和巴中市,以及黑龙江省哈尔滨市和齐齐哈尔市的乡镇卫生院人员进行问卷调查,分析基本公共卫生服务项目的执行效能及其驱动因素。结果:52.9%的被调查者对所在乡镇卫生院的基本公共卫生服务项目的执行效能评价较低。影响执行效能的八个显著预测因素分别是:人员职责划分不合理(OR=2.695)、人员胜任力低(OR=2.258)、项目执行不均衡(OR=1.724)、项目执行缺乏持久力(OR=1.541)、群众健康观念不足(OR=2.026)、群众对乡镇卫生院的信任程度低(OR=1.361)、乡镇卫生院各利益相关方的业务协同机制不完善(OR=1.346)和信息化协同机制不完善(OR=1.095)。结论:乡镇卫生院应加强人员培训和管理,优化项目执行流程和策略,提高群众的健康意识和信任度,完善业务协同和信息化协同机制,以提高基本公共卫生服务项目的执行效能。

Objective To explore the implementation effectiveness and influencing factors of basic public health service project in township health centers,and provide references and suggestions for improving the service quality and public health level of township health centers.Methods Based on the theoretical framework of Smith implementation model,by using stratified cluster sampling method,the staff of township health centers in Mianyang and Bazhong Cities of Sichuan Province,and Harbin and Qiqihar Cities of Heilongjiang Province were conducted a questionnaire survey to analyze the implementation effectiveness and its driving factors of the basic public health service project.Results 52.9%of these respondents rated the implementation effectiveness of basic public health service project in their township health centers as low.The eight predictors that significantly affected the implementation effectiveness were unreasonable division of staff responsibilities(OR=2.695),low staff competence(OR=2.258),unbalanced project implementation(OR=1.724),lack of persistence in project implementation(OR=1.541),insufficient public health awareness(OR=2.026),low public trust in township health centers(OR=1.361),imperfect business coordination mechanism among the stakeholders of township health centers(OR=1.346),and imperfect information coordination mechanism(OR=1.095).Conclusion It is suggested for the township health centers to strengthen staff training and management,optimize project implementation process and strategy,enhance public health awareness and trust,perfect business coordination and information coordination mechanism,so as to improve the implementation effectiveness of basic public health service project.