The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China.
JAMA Netw Open. 2022 Aug 1;5(8):e2228960. doi: 10.1001/jamanetworkopen.2022.28960.
Falls have become a major public health issue in China with population aging. Although falls prevention for older community-dwelling people has been included in the National Essential Public Health Service Package since 2009, there is limited understanding of the implementation of this program.
To identify the associated factors and provide recommendations to inform the better implementation of falls prevention in the Chinese primary health care system.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study was conducted in 3 purposively selected cities in China from March 1 to June 7, 2021. Health administrators from the local health commission or bureau, staff members from local Centers for Disease Control and Prevention and primary health care facilities and community-dwelling older people were recruited, using a combination of purposive sampling and snowball sampling.
In-depth interviews were conducted with health administrators and focus groups with other participants. Data analysis followed the guidance of the Consolidated Framework for Implementation Research. Study outcomes included facilitators and barriers of implementing falls prevention for older people in the Chinese primary health care settings. A framework with recommendations was developed to inform the future intervention implementation.
Among a total of 130 participants interviewed, 77 (59.2%) were female and the mean (SD) age was 47.4 (16.7) years. Clear recognition of the challenges and benefits of falls prevention, adaptive regionally tailored guidance plans, and continuous governmental policy and financial support were the major facilitators, whereas the major barriers consisted of insufficient confidence in delivering interventions and poor understanding of the falls burden, low recognition of the importance of falls prevention, limited multisectoral collaboration, and weak financial incentives. A 7-strategy embedded framework-including data-driven surveillance, audit and feedback, implementation strategy, workforce strengthening, community empowerment, internal services integration, and external enabling environment-was developed to foster successful implementation.
This qualitative study identified major facilitators and barriers to the implementation of falls prevention for older people at the primary care level, which have the potential to contribute to better implementation of falls prevention for older people in the Chinese primary health care system.
随着人口老龄化，中国的跌倒问题已成为一个主要的公共卫生问题。虽然自 2009 年以来，针对老年社区居民的跌倒预防已被纳入国家基本公共卫生服务包，但对该计划的实施情况了解有限。
确定相关因素并提供建议，为中国基层医疗卫生系统更好地实施跌倒预防提供信息。
设计、地点和参与者：这项定性研究于 2021 年 3 月 1 日至 6 月 7 日在中国 3 个有针对性选择的城市进行。当地卫生委员会或局的卫生行政人员、当地疾病预防控制中心和基层医疗卫生机构的工作人员以及社区居住的老年人通过有针对性的抽样和滚雪球抽样相结合的方式招募。
对卫生行政人员进行深入访谈，并对其他参与者进行焦点小组讨论。数据分析遵循实施研究综合框架的指导。研究结果包括中国基层医疗卫生机构实施老年人跌倒预防的促进因素和障碍。制定了一个框架和建议，为未来的干预实施提供信息。
在接受采访的 130 名参与者中，77 名（59.2%）为女性，平均（SD）年龄为 47.4（16.7）岁。明确认识到跌倒预防的挑战和益处、适应性的区域定制指导计划以及持续的政府政策和财政支持是主要的促进因素，而主要障碍包括对实施干预措施的信心不足和对跌倒负担的理解不足、对跌倒预防重要性的认识有限、多部门合作有限、财政激励不足。制定了一个包含 7 项策略的嵌入式框架，包括基于数据的监测、审核和反馈、实施策略、劳动力强化、社区赋权、内部服务整合和外部有利环境，以促进成功实施。
这项定性研究确定了在基层医疗保健层面实施老年人跌倒预防的主要促进因素和障碍，这有可能有助于在中国基层医疗卫生系统中更好地实施老年人跌倒预防。
