Qin Tingting, Li Xingming, Qiao Kun, Bai Xinyuan, Gu Mingyu, Wang Yao
School of Public Health, Capital Medical University, Beijing, People's Republic of China.
Risk Manag Healthc Policy. 2024 May 13;17:1227-1237. doi: 10.2147/RMHP.S454748. eCollection 2024.
Group Model Building (GMB) is a qualitative method that refers to a participatory process. This project aims to identify barriers and facilitators of hypertension management in primary health care in China, through which, the leverage point for intervention may be found.
The GMB was used to identify the factors influencing hypertension management. Graphs over time and causal loop diagram (CLD) were main tools of GMB. To propose the influencing factors, key stakeholders were invited to participate in a workshop. During the workshop, stakeholders were encouraged to plot the graphs over time of the variables about research issues and give a descriptive explanation. And based on this, a CLD was initially developed to establish a model of the interaction of factors. After the workshop, the research group further improved the CLD through repeated mutual discussions, and gave feedback to the participants. The Vensim PLE 9.0 software package was used to build CLD.
A total of 14 key stakeholders were invited to participate in the workshop. Finally, 26 influencing factors were identified, which were divided into three dimensions, including the institutional, the community health workers (CHWs), and the patient level. And 5 reinforcing loops and 4 balancing loops were formed in the CLD. Promoting the building of the Medical Community/Regional Medical Association, implementing the family doctor contract service (FDCS), and enhancing the motivation of CHWs may be potential leverage points for hypertension management in China.
By using GMB, we have identified key factors in the management of hypertension in primary health care and provided comprehensive suggestions to overcome the obstacles.
群体模型构建（GMB）是一种涉及参与式过程的定性方法。本项目旨在识别中国基层医疗中高血压管理的障碍和促进因素，借此找到干预的杠杆点。
采用群体模型构建来识别影响高血压管理的因素。随时间变化的图表和因果循环图（CLD）是群体模型构建的主要工具。为提出影响因素，邀请关键利益相关者参加研讨会。在研讨会上，鼓励利益相关者绘制关于研究问题的变量随时间变化的图表并给出描述性解释。在此基础上，初步构建因果循环图以建立因素相互作用模型。研讨会结束后，研究小组通过反复相互讨论进一步完善因果循环图，并向参与者反馈。使用Vensim PLE 9.0软件包构建因果循环图。
共邀请14名关键利益相关者参加研讨会。最终识别出26个影响因素，分为三个维度，包括机构、社区卫生工作者（CHW）和患者层面。因果循环图中形成了5个增强回路和4个平衡回路。推动医疗共同体/区域医学协会建设、实施家庭医生签约服务（FDCS）以及提高社区卫生工作者的积极性可能是中国高血压管理的潜在杠杆点。
通过使用群体模型构建，我们识别了基层医疗中高血压管理的关键因素，并提供了克服障碍的综合建议。
