Basic Public Health Research Articles

Analysis of the status and influential factors for prenatal care and postpartum visit among pregnant women based on the First Health Service Survey in Hunan Province

To evaluate the status and influential factors for prenatal care and postpartum visit among pregnant women in Hunan Province from 2008 to 2013 based on the data from the First Health Service Survey in Hunan Province. Methods: Based on the data of prenatal care and postpartum visit among pregnant women from the First Health Service Survey of Hunan Province in 2013, proportion of pregnant women, who didn't meet the criteria for prenatal care and postpartum visit, were calculated (≥5 times for prenatal care and ≥2 times for postpartum visit, according to the National Basic Public Health Service program, 2009 Edition). Multivariable logistic regression models were used to identify the influencial factors. Results: A total of 1 035 eligible women were included in data analysis. The proportion of pregnant women who did not meet the criteria were 40.12% (95% CI 24.91%-55.33%) for prenatal care and 64.88% (95% CI 39.70%-90.06%) for postpartum visit. After adjusting other confounding factors, pregnant women with middle- and high-income had lower proportions of not meeting the criteria than those with low-income, with adjusted odds ratios of 0.41 and 0.39, respectively. Multiparae had higher proportion of not meeting the criteria than primiparas, with adjusted odds ratio of 1.54, and pregnant women with age 25-34 years and 35-64 years had lower proportions of not meeting the criteria than those with age 15-24 years. In term of postpartum visit, pregnant women with middle- to high-income had lower proportions of not meeting the criteria than those with low-income, with adjusted odds ratios of 0.50, 0.46 and 0.54, respectively; multiparae had higher proportion of not meeting the criteria than primiparas, with the adjusted odds ratio of 2.30. Conclusion: Proportions of pregnant women of not meeting the criteria are high in Hunan Province. Local government should strengthen the management to decrease the proportions of pregnant women who do not meet the standard in prenatal care and postpartum visit, especially for those mulparae with low family income and young age.

Using the concept of universal health coverage to promote the health system reform in China

The paper is systematically explained the definition, contents of universal health coverage (UHC). Universal health coverage calls for all people to have access to quality health services they need without facing undue financial burden. The relationship between five main attributes, i.e., quality, efficiency, equity, accountability and resilience, and their 15 action plans has been explained. The nature of UHC is belonged to the State and government. The core function is commitment with equality. The whole-of-system method is used to promoting the health system reform. In China, the universal health coverage has been reached to the preliminary achievements, which include universal coverage of social medical insurance, basic medical services, basic public health services, and the provision of essential medicines. China has completed millennium development goals (MDG) and is being stepped to the sustainable development goals (SDG).

The attitudes of primary healthcare providers towards web-based training on public health services in rural China: a cross-sectional study

ObjectivesTo explore the attitudes of primary healthcare workers, including township public health workers (TPHWs) and village doctors (ViDs), towards web-based training on basic public health services (BPHS) and to examine the factors influencing their attitudes. Study designCross-sectional study. MethodsQuestionnaires addressing training status, needs, and attitudes towards web-based public health training were administered to 2768 primary healthcare workers from May to September 2013. Multivariate logistic regression models were used to identify the factors that were significantly associated with a positive attitude towards web-based public health training. ResultsAmong the 2768 participants, 90.6% of the TPHWs and 86.9% of the ViDs expressed a positive attitude towards web-based BPHS training. TPHWs who had a positive attitude towards previous public health training (odds ratio [OR] = 2.75, 95% confidence interval [CI] = 1.28–5.93) and better computer skills (OR = 2.59, 95% CI = 1.03–6.48) were more likely to adopt web-based training on BPHS, as were ViDs who had better computer skills (OR = 2.54, 95% CI = 1.58–4.11) and better Internet speeds (neutral: OR = 2.81, 95% CI = 1.58–5.01; satisfied: OR = 2.53, 95% CI = 1.28–5.01). TPHWs who tended to read papers (OR = 0.24, 95% CI = 0.11–0.50) and were aged 50 years or older (OR = 0.34, 95% CI = 0.14–0.87), as were ViDs who tended to read papers (OR = 0.48, 95% CI = 0.29–0.77), expressed a more negative attitude towards web-based BPHS training. ConclusionsThe findings indicated that most primary healthcare workers have a positive attitude towards web-based BPHS training. More priority measures, such as conducting computer training, improving Internet quality and integrating mobile technology, are recommended and will further improve the implementation of web-based public health training programs.

Cancer research in South African academic and research institutions

To the Editor: A valuable overview of cancer research in South African (SA) academic and research institutions during 2013 - 2014 has recently been published. The titles of 556 research projects were reviewed and divided into basic science, clinical and public health domains. These domains contained 46%, 54% and 13% of the projects, respectively. The projects could fit into more than one domain, resulting in a total of 113%.

Analysis of the efficiency of basic public health services in Chongqing in 2014

Analysis of the efficiency of basic public health services in Chongqing in 2014

Research Needs for Understanding the Biology of Overdiagnosis in Cancer Screening.

Many cancers offer an extended window of opportunity for early detection and therapeutic intervention that could lead to a reduction in cause-specific mortality. The pursuit of early detection in screening settings has resulted in decreased incidence and mortality for some cancers (e.g., colon and cervical cancers), and increased incidence with only modest or no effect on cause-specific mortality in others (e.g., breast and prostate). Whereas highly sensitive screening technologies are better at detecting a number of suspected "cancers" that are indolent and likely to remain clinically unimportant in the lifetime of a patient, defined as overdiagnosis, they often miss cancers that are aggressive and tend to present clinically between screenings, known as interval cancers. Unrecognized overdiagnosis leads to overtreatment with its attendant (often long-lasting) side effects, anxiety, and substantial financial harm. Existing methods often cannot differentiate indolent lesions from aggressive ones or understand the dynamics of neoplastic progression. To correctly identify the population that would benefit the most from screening and identify the lesions that would benefit most from treatment, the evolving genomic and molecular profiles of individual cancers during the clinical course of progression or indolence must be investigated, while taking into account an individual's genetic susceptibility, clinical and environmental risk factors, and the tumor microenvironment. Practical challenges lie not only in the lack of access to tissue specimens that are appropriate for the study of natural history, but also in the absence of targeted research strategies. This commentary summarizes the recommendations from a diverse group of scientists with expertise in basic biology, translational research, clinical research, statistics, and epidemiology and public health professionals convened to discuss research directions. J. Cell. Physiol. 231: 1870-1875, 2016. © 2015 Wiley Periodicals, Inc.

Disease prevalence in a rural Andean population of central Peru: a focus on autoimmune and allergic diseases.

Introduction The hygiene hypothesis, formulated to explain the increased incidence of allergic and autoimmune diseases observed in industrialized countries, remains controversial. We reflected upon this hypothesis during a medical mission to rural and impoverished villages of central Peru.Materials and methods The mission was carried out in July 2015 to aid three Andean villages located near Cusco, and comprised 10 American physicians, 4 nurses, and 24 students. After recording the vital signs, patients were triaged by nurses based on the major complaint, visited by physicians, and prescribed medications. Physicians wrote their notes on a one-page form and established diagnoses purely on clinical grounds, without laboratory or imaging testing. Physician notes were then analyzed retrospectively in a de-identified and double-blinded fashion.ResultsA total of 1075 patients (357 men and 718 women) were visited during 5 consecutive clinic days, 840 being adults and 235 <18 years of age. The most common complaints were back pain, stomach pain, headache, and vision loss. Osteoarthritis, gastritis, visual disturbances, and parasitic infections dominated the diagnostic categories. Thirty-seven patients (3 %) were diagnosed with an allergic or autoimmune disease, mainly represented by asthma, rheumatoid arthritis, and Hashimoto’s thyroiditis, a prevalence that was not significantly lower than that reported in industrialized countries.ConclusionsAlthough a study of this nature cannot definitively support or refute the hygiene hypothesis, it does provide a novel snapshot of disease prevalence in rural Andean villages of central Peru. The study could serve as a basis to implement basic public health interventions and prepare for future missions to the same or comparable regions.Electronic supplementary materialThe online version of this article (doi:10.1007/s13317-016-0076-z) contains supplementary material, which is available to authorized users.

Ebola and Its Control in Liberia, 2014-2015.

The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June-July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems.

Asking the Right Questions About the Future of Shale Gas

This Article argues that the questions that have guided U.S. energy policy for decades — about how to assure cheap, plentiful, and secure energy with basic environmental and public health protection — are no longer the only relevant questions. This is particularly true after the December 2015 Paris Agreement on climate change Shale, in which countries unanimously agreed to progressively reduce their greenhouse gas emissions until there are net zero greenhouse gas emissions in the second half of this century. Shale gas is used as a case in point. Shale gas development is justified on the basis that it contributes to some reduction in greenhouse gas emissions, that it produces needed energy, and that it has economic, social, and security benefits. This Article criticizes these questions as inadequate to address the Paris agreement and foster sustainable development, and describes and explains better questions.

An Experimental Research on the Equalization of Basic Public Services in Huizhou City

In April 2012, the government of Guangdong Province selected Huizhou City as the first pilot city of this province to further promote comprehensive reform on the equalization of basic public services. Under the policy background, this paper selects pilot city, namely Huizhou, as an experimental research object, and selects three core indicators of the foundational education, social insurances and medical and health services to analyze. Specifically, this paper introduces governmental policies and security standards, and uses statistical analysis and coefficient of variation method to calculate and compare the index data for each county (district) of Huizhou City from 2008 to 2014. Overall, by studying current situation of the equalization of basic public services, we know the government of Huizhou has innovatively established a series of policies and measures and made considerable achievements in the process of implementation. Many coefficients of variation of indicators have declined after pilot project. But among the basic public services, the medical and health service develops slowly and it is serious unequal. The construction of medical and health service has become the bottleneck of the equalization of basic public services. Finally, according to the medical problem, the corresponding countermeasures are put forward.

Non Communicable Diseases in urban India: The challenges and opportunity for the physiotherapist

Introduction and background The Global burden of Disease (GBD) study mentions how India has been a huge contributor to the GBD. India is facing challenges to strengthen basic public health infrastructure and health care delivery system. The health systems are unprepared to address the sudden manic due to the change in the disease distribution. NCDs act as a public health burden of both the rural and urban India. India was become the diabetic capital of the world with 50 million diabetics and an estimated 77 million pre-diabetics. There is high presence of associated risk factors for NCDs in the urban areas. Physiotherapist form an integral part of the health system and this study explores if the training of physiotherapist meets the essential requirements for NCDs prevention and control. The scope of their work can be increased by investigating the increase in NCDs and the lack of health care human resource in the country. Methodology The study involves a review of literature on NCDs prevention and control and the need of training of Physiotherapist. The methodology involves selection of university curriculum of both the private and government universities offering graduate physiotherapy education (BPT). The latest curriculum was assessed of 22 universities and colleges. A policy analysis of NCDs prevention and control was done for National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) along with Health Systems review. Findings The findings of the study are congruent with the earlier findings of O’Donoghue et al. (2014). The physiotherapy curriculum in INDIA does not meet the essential requirements to address the associated risk factors for NCDs. The policy analysis of NPCDS and Health Systems highlights the role of physiotherapist in India is considered as a health promotive and rehabilitative professional. A recommendation of World Health Professional Alliance (WHPA) and World Confederation of Physical Therapist (WCPT) mentions the important role of Physiotherapist in combating NCDs by prevention of the risk factors and the necessary role to combat NCDs. Interpretation There is a need for policy/program/curriculum adaptation required to provide physiotherapist with necessary skills required to address the NCDs.

Determinants of basic public health services provision by village doctors in China: using non-communicable diseases management as an example.

BackgroundTo ensure equity and accessibility of public health care in rural areas, the Chinese central government has launched a series of policies to motivate village doctors to provide basic public health services. Using chronic disease management and prevention as an example, this study aims to identify factors associated with village doctors’ basic public health services provision and to formulate targeted interventions in rural China.MethodsData was obtained from a survey of village doctors in three provinces in China in 2014. Using a multistage sampling process, data was collected through the self-administered questionnaire. The data was then analyzed using multilevel logistic regression models.ResultsThe high-level basic public health services for chronic diseases (BPHS) provision rate was 85.2 % among the 1149 village doctors whom were included in the analysis. Among individual level variables, more education, more training opportunities, receiving more public health care subsidy (OR = 3.856, 95 % CI: 1.937–7.678, and OR = 4.027, 95 % CI: 1.722–9.420), being under integrated management (OR = 1.978, 95 % CI: 1.132–3.458), and being a New Cooperative Medical Scheme insurance program-contracted provider (OR = 2.099, 95 % CI: 1.187–3.712) were associated with the higher BPHS provision by village doctors. Among county level factors, Foreign Direct Investment Index showed a significant negative correlation with BPHS provision, while the government funding for BPHS showed no correlation (P > 0.100).ConclusionIncreasing public health care subsidies received by individual village doctors, availability and attendance of training opportunities, and integrated management and NCMS contracting of village clinics are important factors in increasing BPHS provision in rural areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1276-y) contains supplementary material, which is available to authorized users.

Systematic medical assessment, referral and treatment for diabetes care in China using lay family health promoters: protocol for the SMARTDiabetes cluster randomised controlled trial.

BackgroundType 2 diabetes (T2DM) affects 113.9 million people in China, the largest number of any country in the world (JAMA 310:948–59, 2013). T2DM prevalence has risen dramatically from around 1 % in the 1980s to now over 10 % and is expected to continue rising. Despite the growing disease burden, few people with T2DM are achieving adequate management targets to prevent complications. Health system infrastructure in China is struggling to meet these gaps in care, and innovative, cost-effective and affordable solutions are needed. One promising strategy that may be particularly relevant to the Chinese context is improving support for lay family members to care for their relatives with T2DM.MethodsWe hypothesise that an interactive mobile health management system can support lay family health promoters (FHP) and healthcare staff to improve clinical outcomes for family members with T2DM through medical assessment, regular monitoring, lifestyle advice and the prescribing of guidelines recommended medications. This intervention will be implemented as a cluster randomised controlled trial involving 80 communities (40 communities in Beijing and 40 rural villages in Hebei province) and 2000 people with T2DM. Outcome analyses will be conducted blinded to intervention allocation.The primary outcome is the proportion of patients achieving ≥2 “ABC” goals (HbA1c <7.0 %, blood pressure (BP) <140/80 mmHg and LDL cholesterol <100 mg/dl or 2.6 mmol/L) at the end of follow-up (Diabetes Care 36(Supplement 1):S11-S66, 2013). Secondary outcomes include the proportion of patients achieving individual ABC targets; mean changes in HbA1c, BP, LDL, renal function (serum creatinine and urinary albumin), body mass index, quality of life (QOL, EQ-5D), and healthcare utilisation from baseline; and cost-effectiveness/utility of intervention. Trial outcomes will be accompanied by detailed process and economic evaluations.DiscussionThe Chinese government has prioritised prevention and treatment of diabetes as 1 of 11 National Basic Public Health Services. Despite great promise for mHealth interventions to improve access to effective health care, there remains uncertainty about how this can be successfully achieved. The findings are likely to inform policy on a scalable strategy to overcome sub-optimal access to effective health care in China.Trial registrationClinicaltrials.gov NCT02726100

Exploration and practice of general practitioner responsibility system in an urban community of Shanghai

<h3>Objective</h3> The Minhang district of Shanghai was selected as the subject and its public health management model was investigated. <h3>Methods</h3> Minhang became a pilot location for the implementation of the general practitioner responsibility system (GPRS) in 2011. Since then, the management model of public health services in the district has gradually merged with the GPRS through a series of actions: the adjustment of organizations and the coordination mechanism in community public health services, the integration of basic public health services and clinic practice, the establishment of an informationized Internet service platform, comprehensive budgeting management of public health service programs, and performance assessment management of health workers. <h3>Results</h3> By the end of 2014, the number of residents who had a contractual relationship with a general practitioner (GP) in Minhang had reached 1.4367 million and all of them had family health records. Compared with 2010, both the rate of maternal management and the rate of children management stayed at high level (≥96%), the rate of hypertension management increased (40.73% vs. 28.70%), the rate of blood pressure control increased (82.13% vs. 77.51%), the incidence of diabetes decreased (21.93% vs. 37.85%), the rate of effective control of blood glucose for diabetic patients increased (82.43% vs. 62.77%), and the rate of child health management increased (99.79% vs. 91.54%). <h3>Conclusion</h3> The GPRS has helped to create a better community health environment. However, the development of this system is limited by several factors, including the following: the shortage of GPs, most GPs do not have good public health service skills and a correct public health concept, unclear division of different services, and imperfect department coordination.

Implementation of the International Health Regulations (2005) Through Cooperative Bioengagement.

Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency’s Cooperative Biological Engagement Program, the State Department’s Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public health capacities. This article examines the extent to which cooperative bioengagement projects address public health capacity building under the revised International Health Regulations and alignment with the Global Health Security Agenda action packages.

Concurrent control of blood glucose, pressure, lipids, and body mass in patients with type 2 diabetes and comparison with the 2013 Chinese guidelines: a cross-sectional study

BackgroundDiabetes has rapidly become an epidemic in recent decades, and in 2008, the prevalence of type 2 diabetes was reported to be 9·7% in China. According to the China National Basic Public Health Services implemented in 2009, local public health services should take charge of management of patients with chronic diseases, including diabetes. The 2013 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes has set comprehensive goals for control of the disease. The aim of this study was to assess concurrent control of blood glucose, pressure, lipid, and body mass in patients with diabetes in comparison with the 2013 Chinese Guidelines. MethodsA cross-sectional study with stratified cluster sampling was conducted in Changshu county and Huai'an City of Jiangsu Province. According to criteria by America Diabetes Association, 39 564 patients diagnosed with type 2 diabetes have registered and received management of the National Basic Public Health Services in 2012. 23 240 patients with type 2 diabetes in 44 public health service centers within 65 townships were sampled, and 20 340 individuals agreed to participant in the survey, which consisted of a structured epidemiological questionnaire and physical examination between December, 2013, and January, 2014. Fasting blood samples were collected to measure glycated haemoglobin A1c (HbA1c), fasting blood glucose, and lipid profiles. Blood pressure, weight, height, and body-mass index (BMI) were also measured and calculated. This study was approved by the ethic committe of Jiangsu Provincial Center for Disease Control and Prevention (2013026), and informed consent was obtained from each participant. Findings20 053 patients with type 2 diabetes were included in the study. The mean age of the participants was 62·8 years (SD 9·9), and 12190 (60·8%) patients were female. 8370 (42%) patients had controlled HbA1c concentration below 7·0%, and 6291 (31%) patients had fasting blood glucose concentration below 7·0 mmol/L. 15 406 (77%) patients had hypertension, and 4876 (24%) patients had controlled blood pressure (systolic blood pressure <140 mm Hg and diastolic blood pressure <80 mm Hg). The prevalence of dyslipidemia was 48% (9715 of 20 053 patients); 11 119 (55%) patients had controlled triglyceride concentrations (<1·7 mmol/L), 4774 (24%) patients had controlled total cholesterol (<4·5 mmol/L), 4439 (22%) patients had controlled LDL-cholesterol concentration (<1·8 mmol/L with cornary heart disease and <2·6 mmol/L without the disease), and 15 115 (75%) patients had controlled HDL-cholesterol concentration (>1·0 mmol/L in men and >1·3 mmol/L in women). 7186 (36%) participants had BMI less than 24·0 kg/m2. InterpretationThe glycaemic control is quite low in the present study, and even fewer patients had gained control of blood pressure and body mass. Nearly half of the participants had dyslipidemia. More intensive management of diabetes and comorbidities is warranted in the Chinese population. FundingJiangsu Provincial Health Department (K201105).

Rising to the Challenge: The Ebola Outbreak in Sierra Leone and How Insights Into One Nongovernmental Organization's Response Can Inform Future Core Competencies.

Nongovernmental organizations (NGOs) play a critical humanitarian role in the developing world. Over 100 NGOs currently operate in Sierra Leone, a country in West Africa that ranks 183 out of 187 in the United Nation's Human Development Index. Following a brutal 11-year war that ended in January 2002, the country has been unsuccessful at building a sufficiently resourced, robust, and anticipatory public health and medical care infrastructure. Consequently, Sierra Leone suffers from high levels of poverty, infant mortality, and limited access to safe drinking water, as well as morbidity from malnutrition, diarrheal diseases, hepatitis A, cholera, and typhoid fever. Large international NGOs such as Doctors Without Borders have attempted to fill the void left by fragile and fragmented government health services but have been overwhelmed and saturated by the continual spread of Ebola virus disease and growing numbers of cases and deaths. Smaller NGOs endeavored to assist during this crisis as well. One of them, Caritas, has actively sought public health knowledge and has applied public health principles to reduce and contain Ebola virus disease transmission. The Ebola outbreak illuminates the importance of building basic public health capabilities within the core competences of NGOs.

The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective This study focuses on Hangzhou, a Chinese city with a population of nine million urban and rural residents, to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then disseminate the findings through international third parties. Methods Measures such as data analysis, study of documents and regulations, fieldwork, and expert discussions were used to systematically investigate primary health care in Hangzhou. The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs. Results Community health services in Hangzhou are characterized as follows: They are government led; they are guaranteed with enough financing, personnel, facilities, and regulation; supported by the unified information platform; general practitioners have been assigned the key role of health ‘gatekeepers’; they provide primary care combined with basic public health services; there are integrated urban and rural health services and insurance coverage; and there is health care–pension–nursing integration and general practitioner – contracted ‘smart’ services. Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole, and some health indicators in Hangzhou are comparable to those in Western developed countries. Conclusion It is reasonable to believe that the primary health care level in China, including Hangzhou, will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

Health allowance for improving the nutritional status and development of 3-5-year-old left-behind children in poor rural areas of China: study protocol for a cluster randomised trial.

BackgroundLeft-behind children (LBC) are recognised as a new social group in China. LBC are young children who are abandoned in rural villages whilst their parents travel to distant urban centres for employment (a new generation of migrant workers). Following the rapid growth in the number of migrant workers, the LBC population is also rapidly increasing. These children are usually left to be raised by elderly grandparents, a single parent, or sometimes distant relatives or neighbours who have limited resources, tend to have a poor education and sometimes are in frail health. Over 40 % of the 61 million LBC in China who are under 5 years old are undernourished, which affects their long-term health and abilities. An intervention that combines a conditional cash transfer (CCT) with nutrition education offers a potential solution.Methods/DesignA cluster randomised controlled trial design will be used to allocate 40 villages to the intervention arm (20 villages) or control arm (20 villages). The caregivers and all of the 3–5-year-old LBC will be the target population. Caregivers in the intervention arm will receive a cash allowance conditional on attending nutrition education sessions, ensuring that the LBC will use basic public health services over a 12-month period. At the baseline, midterm (month 6) and end (month 12) of the intervention period, evaluations will be conducted in all 40 villages. Multilevel generalised linear models will be used to analyse the impact of the intervention on nutrition status and other outcomes, adjusting for baseline levels using an analysis of covariance approach. The cost of the intervention will also be estimated.DiscussionIf found to be cost-effective, the findings will inform the development of a sustainable model to improve nutrition status among LBC in rural areas of China.Trial registrationChinese Trial Register (ChiCTR) identifier: CTXY-140003-2. Registered on 19 Aug 2014.

Web-based training for primary healthcare workers in rural China: a qualitative exploration of stakeholders' perceptions.

BackgroundEquitable access to basic public health services is a priority in China. However, primary healthcare workers’ competence to deliver public health services is relatively poor because they lack professional training. Since the availability of web-based training has increased in China, the current study explored stakeholders’ perceptions of a web-based training program on basic public health services to understand their thoughts, experiences, and attitudes about it.MethodsSix focus group discussions with primary healthcare workers and three with directors of township hospitals, county-level Health Bureaus, and county-level Centers for Disease Control and Prevention were conducted in Yichang City during 2013. Semi-structured topic guides were used to facilitate qualitative data collection. Audio recordings of the sessions were transcribed verbatim and theme analysis was performed.ResultsMost of the study’s participants, especially the village doctors, had insufficient knowledge of basic public health services. The existing training program for primary healthcare workers consisted of ineffective traditional face-to-face sessions and often posed accessibility problems for the trainees. Most of the study’s participants had a positive attitude about web-based learning and expressed a strong desire to receive this novel training approach because of its flexibility and convenience. The perceived barriers to utilizing the web-based training method included poor computer literacy, lack of personal interaction, inadequate infrastructure, and lack of time and motivation. The facilitators of this approach included the training content applicability, the user-friendly and interactive learning format, and policy support.ConclusionsWeb-based training on basic public health services is a promising option in rural China. The findings of the study will contribute knowledge to implementation of web-based training in similar settings.