Skip to main content

Table 4 Results of qualitative study about barriers to carry out HMA management

From: Achievements and challenges in health management for aged individuals in primary health care sectors: a survey in Southwest China

Core PRISM domainsThemesResultsQuotation
Interventions –HMA program designHMA systemMajority LHWs and all leaders reported HC items in national guideline cannot meet various needs of the elderly. In Chongqing, LHWs also reported that though HC has increased several items with funding support from local government, the HC items cannot meet needs of the elderly. The elderly in FGDs did not satisfy with HC items.Given the limited HC items provided by HMA, the elderly can’t take HC items according to their actual needs. Each elderly has different kinds of health problems and thus their needs for HC items are different (LHWs on HMA in THC).
The elderly reported that they can’t take HC items on their needs, though added chest radiography, they need more items like gastroscope, colonoscope and rheoencephalogram (LHWs on HMA in CHC)
It can only be said that I am basically satisfied with HC items. I think it is not good enough because the items of HC are too less (Male elderly, Shapingba Community, FGD).
Performance assessmentAll LHWs responded that performance assessment mainly through reviewing the program form was inappropriate as LHWs had to pay more attention to complete the form for assessment. On the other hand, all LHWs reported that the assessment just using the rate of the elderly included in HMA program instead of the quality of HMA delivery. As the current policy for the elderly participating in HMA is optional, instead of compulsory, it is hard to reach the rate required by BPHS guideline.There are many challenges, one is that it is hard for us to achieve the required the rate of HMA, for example, there are 6000 elderly in this area, at least 65% of them should take HC items according to the requirement because the policy for the elderly to take HMA is optional, but we may achieve just around 40% and cannot met the requirement which directly impacts on funding for HMA and our income (LHWs on HMA in CHC).
In fact, we are serious on delivering HMA for each elderly, however, the forms required us to fill for the elderly are too complicated and the assessment on our work strictly based on the forms, which leads us take a lot of time to fill the form instead of provide actual HMA for the elderly We hope to leave more time to do some actual service for the elderly (LHWs on HAM in THC).
Inadequate investmentMajority of LHWs and leaders reported the funds for HMA program were insufficient to meet the various needs of the elderly. Almost all LHWs were unsatisfied with the low salary.
Most leaders and HCWs reported PHC sectors took the measure of “clinical bring up public health” to improve salary for LHWs who deliver BPHS including HMA (to improve salary for HCWs deliver BPHS by using the revenue from the clinic department in PHC sectors) and it is in urgent need of increasing investment.
Funding for HMA could just meet the basic needs for the HMA delivery at present; and there is short of funds to pay for health lecturers for HMA (LHWs on HMA in THC).
In certain, the funding is not as much as we think, and the government subsidies are not enough (LHWs on HMA in THC).
In our community, the department of clinic medicine has a considerable revenue, which help our public health get through difficulties in funding, that is to say, we use the revenue from the clinic medicine to supplement our the public health, to improve salary for HCWs deliver BPHS (HMA) (Leader in CHC).
Truthfully, regard to the income, we are really not satisfied (LHWs on HMA in CHC).
To be honest, the clinic department in our THC has helped BPHS a lot in funds. It would be very difficult to deliver HMA and the whole BPHS if it relies on government subsidies only (LHWs on HMA in THC).
RecipientsPoor health literacyVast majorities of LHWs agreed that the poor literacy of the elderly was reasons for them to participate in HMA program in actively as the elderly only would like to receive HC once they recognize it is important.
Many LHWs reported that the elderly fear heavy disease burden and so they rejected to take diseases screening due to lack of health literacy. Notably, some aged people had difficulty to access HMA just because of the low literacy of their families.
As for the poor health literacy, the greatest difficulty is the misunderstanding on HMA and reluctance by the residents, which is a big challenge to deliver HMA (LHWs on HMA in THC).
Our work is difficult because some residents are lack of health literacy and they would come to check their blood pressure only after we call them twice or more, while some others are unwilling to come no matter we give them how many calls (LHWs on HMA in THC).
At present, lack of knowledge on HMA among residents is one of the challenges. It is not all of the elderly know HMA. Secondly, some elderly unwilling to take part in HMA, especially those in low income, they worry about the economic burden on solve the health problems which are identified by health check during participating HMA. They think it is good to let it on even they have any health problem (LHWs on HMA in THC).
I want to receive health check of HMA from our THC, but my daughter in law does not believe HMA, and she told me THCs would cheat me even I have no any health problem. Thus, I hesitate to take HMA (Female elderly, Zhongliangzhen township, FGD).
Human resource deficiency in PHCsAll LHWs and leaders agreed that PHC sectors has shortage of adequate qualified LHWs to undertake HMA program and LHWs for HMA often undertook more than one BPHS program.
In terms of the quality, majorities of the leaders and LHWs reported PHC sectors extremely lacked of general practitioners and the quality of current LHWs for HMA is not good enough; more than half were major in nursing with the primary title; they had difficult in delivering specific and individualized HG and also inability to do a comprehensive and systematic health needs assessment for the elderly.
THCs are definitely short of LHWs for HMA. On the other hand, LHWs are unstable because of the low salary (LHWs on HMA in THC).
LHWs are not enough and we have to arrange our time more appropriately, however, if the residents are not free on weekdays, we have to work on weekend, thus sometimes we can only have a day off at weekends (LHWs on HMA in THC).
There is short of personnel in THC, I’ll be easier if there were 2-3LHWs for HMA. I would be anxious while I provide health check by myself for more than 20 elderly at the same time (LHWs on HMA in THC).
There is lack of LHWs, for example, there are not enough health workers to provide health check for the elderly, moreover, we lack a radiologist and have to find part-time worker in other hospital now (LHWs on HMA in THC).
We (nurses) cannot guide the elderly patients on medicine intake because we have no doctors in our team of HMA while we (nurses) have relatively less knowledge and skills (LHWs on HMA in THC).
We need more general practitioners (GP). If there were no team of GP, nurses could not solve many health problems due to their insufficient professional knowledge and skills. The most in need now is professional GP (Leader in CHC).
External environmentIn-coordinate cooperation Of multisectoralAlmost all LHWs and leaders reported less multi-sectors cooperation from broadcasting and television media, sub-district office, neighborhood committee, urban management, and community management in HMA publicity, assisting in informing elderly to take HC, health lectures and providing propaganda materials which resulted
All LHWs reported PHCs need share information about medical services received by the elderly in hospitals. Moreover, some PHC sectors had poor internal cooperation between clinical and public health departments.
The propaganda is not enough, a lot of residents have no any information on HMA. They do not understand why you provide them health check for free, do not believe this work is good for them, and unwilling to leave their true ID or phone information, which make our work hard to carry out. We try to explain at first, but now we feel disappointed by residents’ misunderstanding (LHWs on HMA in THC).
In our CHC, the department of clinical medicine completely was separated from the department of public health, and clinicians are unwilling to support the work of public health (LHWs on HMA in CHC).
Poor coordination of community management and community health service. When we provide health service in community, the urban management officers and the community managers could not support us and even come to impede us (LHWs on HMA in THC).
Many elderly have their own units which organize them to do regular physical examination in big hospitals. We hope to share the health information with the big hospitals, but now, we are totally separated with those big hospitals (LHWs on HMA in THC).
Implementation infrastructureShortage of equipment and medicineThough infrastructure has improved in most of PHC sectors recent years, many LHWs reported outdated equipment and limited medicine in PHC sectors. Moreover, some leaders reported PHC sectors in city lacked of adequate space and barrier-free facilities like elevator, and some PHC sectors in rural area were located in area with underdeveloped transportationThere has traffic problem while we visit resident in rural area. Usually, when we get off the bus, we still have to walk at least a quarter of an hour to resident’s home, with the medical equipment in hand, which is definitely inconvenient (LHWs on HMA in THC).
Limited drugs and equipment in THC lead we cannot identify health problems of the elderly and provide therapy to their health problems (LHWs on HMA in THC).
It is incontinent for the elderly because we do not have elevators in the building (Leader in CHC).
  1. Notes: BPHS refers to basic public health service; PHC refers to primary health care; CHCs refers to community health centers; THCs refers to township hospital centers; HMA refers to health management of the aged; LHWs refers to health care workers; HC refers to health check-up; HG refers to health guidance; FGDs refers to focus group discussions