BMC HEALTH SERVICES RESEARCH 是一本开放获取、同行评议的期刊，考虑有关卫生服务研究各个方面的文章，包括提供护理、卫生服务管理、医疗保健需求评估、结果测量、医疗资源分配、评估不同的卫生市场和卫生服务组织、卫生系统的国际比较分析、卫生经济学以及卫生政策和法规的影响。

BMC Health Services Research is an open access, peer-reviewed journal that considers articles on all aspects of health services research. This includes studies on the provision of care, health service management, healthcare needs assessment, outcome measurement, allocation of healthcare resources, evaluation of different health markets and health service organizations, international comparative analysis of health systems, health economics, and the impact of health policies and regulations.

BMC Health Services Research 是一本开放获取、同行评审的期刊，涵盖卫生服务研究的各个方面。该期刊接受关于护理提供、卫生服务管理、医疗需求评估、结果测量、医疗资源分配、不同卫生市场和卫生服务组织的评估、卫生系统的国际比较分析、卫生经济学，以及卫生政策和法规影响的研究文章。

BMC Health Services Research

Internet medical care has been advancing steadily, especially during the coronavirus disease 2019 pandemic, the development momentum of Internet medical care in China is more vigorous. This study aimed to explore the factors associated with using the Internet for medical information, to examine the popularisation and implementation of Internet medical treatment and feasible strategies, and promote the further development of Internet medical treatment.
A cross-sectional study was conducted on 408 medical patients who had used online medical services. The one-way analysis of variance or independent samples t-test was used to compare the differences in the influence of demographic characteristics on behavioural intentions of different people seeking medical care. Pearson’s correlation was used to evaluate the correlation between different measurement variables. A mediation regression analysis was used to explore the mediating role of trust in Internet medical care.
The difference in the influence of Internet medical use frequency on the behavioural intention of different participants was statistically significant (F = 3.311,P= 0.038). Among the influencing factors, personal trust propensity (r= 0.387,P< 0.01), website credibility (r= 0.662,P< 0.01), hospital credibility (r= 0.629,P< 0.01), doctor’s credibility (r= 0.746,P< 0.01), and online patient trust (r= 0.874,P< 0.01) were positively correlated with patients’ behavioural intentions. In the analysis of intermediary factors, the total effect of the credibility of the diagnosis and treatment website on the behavioural intention of patients was 0.344. The total effect of the credibility of the diagnosis and treatment hospital on the behavioural intention of patients was 0.312; the total effect of the service doctor’s credibility on the patient’s behavioural intention was 0.385; the total effect of the personal trust tendency on the patient’s behavioural intention was 0.296.
This study found defects in various factors that produce distrust in Internet medical treatment. It also reveals the positive effect of trust factors on the development and implementation of Internet medical treatment and provides some ideas for improving the use of Internet medical treatment by the masses.

Yang Fu

Tianwei Tang

Junhao Long

Bohuai Lin

Jiayue Li

Guohong Quan

Hanwen Yang

Chongbang Zhao

Mei Yin

Lei Shi

BMC Health Serv Res

Factors associated with using the internet for medical information based on the doctor-patient trust model: a cross-sectional study

基于医患信任模型的互联网医疗信息使用相关因素：一项横断面研究

Abstract Background The present study has been undertaken with the aim to evaluate performance and ranking of various universities of medical sciences that are responsible for providing public health services and primary health care in Iran. Methods Four models; Weighted Factor Analysis (WFA), Equal Weighting (EW), Stochastic Frontier Analysis (SFA), and Data Envelopment Analysis (DEA) have been applied for evaluating the performance of universities of medical sciences. This study was commenced based on the statistical reports of the Ministry of Health and Medical Education (MOHME), census data from the Statistical Center of Iran, indicators of Vital Statistics, results of Multiple Indicator of Demographic and Health Survey 2010, and results of the National Survey of Risk Factors of non-communicable diseases. Results The average performance scores in WFA, EW, SFA, and DEA methods for the universities were 0.611, 0.663, 0.736 and 0.838, respectively. In all 4 models, the performance scores of universities were different (range from 0.56–1, 0.53–1, 0.73–1 and 0.83–1 in WFA, EW, SFA and DEA models, respectively). Gilan and Rafsanjan universities with the average ranking score of 4.75 and 41 had the highest and lowest rank among universities, respectively. The universities of Gilan, Ardabil and Bojnourd in all four models had the highest performance among the top 15 universities, while the universities of Rafsanjan, Ahvaz, Kerman and Jiroft showed poor performance in all models. Conclusions The average performance scores have varied based on different measurement methods, so judging the performance of universities based solely on the results of a model can be misleading. In all models, the performance of universities has been different, which indicates the need for planning to balance the performance improvement of universities based on learning from the experiences of well-performing universities.

Arash Rashidian

Nader Jahanmehr

Farshad Farzadfar

Ardeshir Khosravi

Mohammad Shariati

Ali Akbari Sari

Soheila Damiri

Reza Majdzadeh

Performance evaluation and ranking of regional primary health care and public health Systems in Iran

伊朗地区初级卫生保健和公共卫生系统的绩效评估与排名

Migrants are the unique production of China's urbanization process. They are often excluded from social welfare and security systems of cities, and often exposed to high health risk related closely to their health problems. This research sought to unveil and explore the influencing factors on health services utilization of migrants in Beijing.A sample of 2014 inter-provincial migrants and 4578 residents with Beijing "Hukou" who were 15 years old and above was chosen by three-stage stratified cluster sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Anderson health service utilization model was used to demonstrate the effects of the explanatory variables on health seeking behavior from predisposing, enabling and need variables.The study reveals that the rate of 'having symptoms' of migrants was lower than that of residents with "Hukou" only in the group of 25 to 34 years old in the past month. 503 migrants (25.0%) and 1441 (31.5%) residents with "Hukou" reported at least one episode of discomfort in the past month, and the rate of health service seeking behavior among migrants (46.8%) was lower than residents with "Hukou" (62.6%) (P < 0.0001). Chi-square independence test shows that age, ethnicity, employment status, having chronic disease and the degree of symptom were the major determinants affecting migrants to receive health services. The binary logistic regression indicates that the degree of symptom as the need variable and ethnicity as the predisposing variable were the strong and consistent determinants of health services seeking behavior. The migrants with moderate degree and severe degree of symptom in the past month were at 1.623-times (OR = 1.623) and 5.035-times (OR = 5.035) higher chances of seeking health services respectively, comparing to mild degree of symptom. Minority migrants were less likely to seek health services than Han migrants (OR = 0.282).The results indicate that the current health delivery system is not conducive for migrants to seek appropriate health services. Relevant policies and feasible measures, including increasing the coverage of health insurance and improving the health perception of migrants should be vigorously implemented to provide affordable health services and change health service utilization behaviors for migrants.

Shuang Shao

Meirong Wang

Guanghui Jin

Yali Zhao

Xiaoqin Lu

Juan Du

Analysis of health service utilization of migrants in Beijing using Anderson health service utilization model

Shenzhen has rapidly grown into a megacity in the recent decades. It is a challenging task for the Shenzhen government to provide sufficient healthcare services. The spatial configuration of healthcare services can influence the convenience for the consumers to obtain healthcare services. Spatial accessibility has been widely adopted as a scientific measurement for evaluating the rationality of the spatial configuration of healthcare services. The multi-modal two-step floating catchment area (2SFCA) method is an important advance in the field of healthcare accessibility modelling, which enables the simultaneous assessment of spatial accessibility via multiple transport modes. This study further develops the multi-modal 2SFCA method by introducing online map APIs to improve the estimation of travel time by public transit or by car respectively. As the results show, the distribution of healthcare accessibility by multi-modal 2SFCA shows significant spatial disparity. Moreover, by dividing the multi-modal accessibility into car-mode and transit-mode accessibility, this study discovers that the transit-mode subgroup is disadvantaged in the competition for healthcare services with the car-mode subgroup. The disparity in transit-mode accessibility is the main reason of the uneven pattern of healthcare accessibility in Shenzhen. The findings suggest improving the public transit conditions for accessing healthcare services to reduce the disparity of healthcare accessibility. More healthcare services should be allocated in the eastern and western Shenzhen, especially sub-districts in Dapeng District and western Bao'an District. As these findings cannot be drawn by the traditional single-modal 2SFCA method, the advantage of the multi-modal 2SFCA method is significant to both healthcare studies and healthcare system planning.

Zhuolin Tao

Zaoxing Yao

Hui Kong

Fei Duan

Guicai Li

Spatial accessibility to healthcare services in Shenzhen, China: improving the multi-modal two-step floating catchment area method by estimating travel time via online map APIs

Abstract Background Recruiting and retaining staff are standing challenges in eldercare. Low pay, difficult working conditions, and social relations at the workplace impact on turnover intentions. Few studies have used quantitative data for estimating the role of recognition by the wider society for staff instability. This study examines how perceived lack of recognition at the societal level affects Nordic eldercare workers’ considerations of leaving their jobs. Methods The 2015 Nordcare survey among frontline eldercare workers in Denmark, Finland, Norway, and Sweden ( N = 3,677) is analysed. Issues such as working conditions, financial strain, work-life balance, and appreciation by care recipients and colleagues, were covered. Recognition at the societal level was measured by perceptions of being valued by top municipal leaders, mass media, and the general public. Analyses are made with cross-tabulations and multivariate linear probability regression models. Results In the total sample, 41.1 % had “seriously considered to quit during the last 12 months”. About one third felt “not at all valued” by top municipal leaders, while one fourth felt “not at all valued” by mass media. In bivariate analyses, perceptions of recognition were strongly associated with considerations to quit. These associations were reduced, but remained sizeable and highly significant in multivariate analyses adjusted for age, gender, health, working conditions, financial stress, workplace relations, and other known turnover predictors. Conclusions Lack of recognition by societal agents such as top municipal leaders, mass media, and the general public, is widely felt by Nordic eldercare workers. Feeling poorly valued by such sources is associated with frequent considerations to leave one’s employment. Perceived lack of recognition by the wider society has a significant and independent impact on staff instability in the eldercare sector. Societies’ recognition order is embedded in social structures which are resistant to change, but policies which succeed in raising the societal recognition of eldercare work may contribute to reduced retention difficulties in eldercare.

Jon Ivar Elstad

Mia Vabø

Lack of recognition at the societal level heightens turnover considerations among Nordic eldercare workers: a quantitative analysis of survey data

Abstract Background The transfer of innovations into healthcare is laden with challenges. Although healthcare professionals are expected to adopt and fulfil new policies, a more person-centered healthcare with conditions for preference-based patient participation is anticipated. Methods The aim of the study was to evaluate two implementation strategies for person-centered patient participation in kidney care, including dissemination of a clinical toolkit, and additional training and support of internal facilitators. Nine Swedish kidney care units joined the study (August 2019–September 2021), strategically organized into: a control group (three sites, no support); a standard dissemination group (three sites, with a tool for patient participation and guidance disseminated to the site managers); and a facilitated implementation group (three sites, with the tool and guidance disseminated as above, plus a six-month support program for designated internal facilitators). This process evaluation was comprised of repeat interviews with managers ( n = 10), internal facilitators ( n = 5), recordings, and notes from the interventions, and Alberta Context Tool survey data ( n = 78). Hybrid analyses comprised mixed methods: descriptive and comparative statistics, and qualitative descriptive analysis. Results None of the control group sites addressed patient participation. While the standard dissemination sites’ managers received and appreciated the toolkit, they made no attempts to make further use of it. In the facilitated implementation group, five internal facilitators from three sites engaged in the support program. They welcomed the opportunity to learn about preference-based patient participation, and about implementation, including potentially enhanced opportunities for preference-based patient participation via the tool. Each site’s facilitators developed a separate strategy for the dissemination of the tool: the tool was used with a few patients in each site, and only some staff were involved. Although noting a general interest in improving patient participation, the internal facilitators described limited local support. Rather, they suggested a longer support program and more local backing and engagement. Conclusions Facilitating person-centered patient participation is complex, given the need to address attitudes, beliefs, and behaviors. This study indicates slow uptake and change, and more efficient strategies are needed to ensure the fundamentals of care remain accessible to all.

Liselott Årestedt

Fredrik Uhlin

Ann Catrine Eldh

Facilitating person-centered patient participation in kidney care—a process evaluation of a quasi-experimental study incorporating a tool and training of local implementation teams

促进以患者为中心的肾病护理参与——一项准实验研究的流程评估，结合了工具和本地实施团队的培训

The use of welfare technology is gaining ground in municipal eldercare and is increasingly being integrated into everyday routines. However, the meanings that eldercare personnel attach to welfare technology in the care of older recipients, and thus the domestication of welfare technology, remain largely underexplored. This study explores how eldercare personnel understand and ascribe meanings to welfare technologies in their daily work, with the aim of understanding their domestication.

Susanne Frennert

Katrin Skagert

Anna Williamsson

It is a matter of convenience: why welfare technologies have become domesticated in Swedish eldercare

方便问题：为何福利技术在瑞典老年护理中变得普及

Abstract Background In Swedish care for older adults, the use of welfare technology − for example, medicine-dispensing robots and GPS alarms − stimulates ongoing evaluations and negotiations. National policy documents, as well as previous research, indicate that these technologies are expected to improve the quality and efficiency of care but also involve potential or experienced challenges in providing high-quality care and the conditions for care workers − often portrayed as a conflict between political and caring organizational values. More research is thus needed on how the use of welfare technology is justified at central and municipal government levels as well as within care-providing organizations. This article aims to identify how the introduction and use of welfare technology is justified by employees and in policy documents pertaining to welfare technology in Swedish care for older people. Methods Qualitative interview data involving 37 individuals were collected in municipalities in southern Sweden. The interviewees were managers, administrative staff, and licensed practical nurses working in home care services or special housing for older adults, offering care 24/7. Policy documents and agreements of significance for Swedish welfare technology policy were analysed. The analysis focused on values promoted as significant for the provision of care and related to the use of welfare technology. Justifications and values were analysed as belonging to different ‘worlds of worth’, as either shared or conflicting, and contextually situated. Results The documents reflect values regarding, for instance, efficiency , independence , good working conditions , optimised use of human resources , and time to tend to relationships . The employees justified the use of welfare technologies with reference to optimisation and efficiency , activation and participation , dignity and freedom , social relationships , and good working conditions. These values represent three different worlds of worth − the industrial world, the civic world, and the domestic world − and are situated in employees’ everyday work practices. Conclusions Values presented by employees and in policy documents are shared rather than conflicting. However, employees emphasise values associated with the domestic world, downplaying industrial values. We argue that politicians and civil servants should consider the situated judgements made by employees and develop more bottom-up strategies. This requires an acknowledgement of the existing values hierarchy, where values of optimisation and efficiency are held in high esteem but to accommodate higher values rather than as end goals.

Doris Lydahl

Anna Davidsson

Values of welfare technologies: a qualitative study of how employees in Swedish care for older adults understand and justify the use of new technology

福利技术的价值：一项关于瑞典老年人护理员工如何理解和证明新技术使用的定性研究

Maarit Wirkkala

Katarina Wijk

Agneta C. Larsson

Maria Engström

Technology frustration in healthcare – does it matter in staff ratings of stress, emotional exhaustion, and satisfaction with care? A cross-sectional correlational study using the job demands-resources theory

医疗技术挫败感——它对员工压力、情绪耗竭和护理满意度评分有影响吗？基于工作需求-资源理论的横断面相关性研究

Changing public health and hospital protocols during the height of the COVID-19 pandemic shaped the provision of inpatient mental health care. While a growing body of research explores the challenges of restrictions on adult psychiatric wards, the impact on clinical teams and epidemiological trends in youth mental health, no research has explored inpatient psychiatric hospital services for child and adolescent psychiatry during the pandemic. This study seeks to understand how clinicians in Canada working in child and adolescent mental health wards experienced caring for their patients while navigating pandemic hospital restrictions. Following a qualitative descriptive methodology and also drawing on institutional ethnography we generated data using two methods: 1) an online survey of clinicians across the country asking about experiences providing care and COVID restrictions and 2) in-depth, semi-structured interviews with clinicians. Data from 54 surveys and 14 interviews were analyzed using thematic analysis yielding two major themes. First, clinicians felt that clinical care was compromised with likely impact on patient outcomes. Second, respondents reported that the context of the pandemic provoked tensions and resistance within the clinical teams and the institution. Our findings have important implications not only for future public health crises, but also for rethinking how psychiatric care is provided and prioritized. This study points to the need for 1) mechanisms which support collaborative decision making at the institutional level, to ensure regulations are more flexible and can adapt to the needs of child mental health patients; and 2) that child psychiatry prioritize generating spaces of ethical reflection for clinical teams and institutional decision-makers so that paternalism does not trump principles of primum non-nocere (first, do no harm), autonomy and reciprocity.

Rachel Kronick

Isabella Kakish

Ana Gomèz-Carrillo

‘We tried our best... it wasn’t great’: a qualitative study of clinician experiences on child psychiatry wards at the height of COVID-19

“我们尽力了……但情况并不理想”：一项关于新冠疫情高峰期儿童精神科病房临床医生经历的定性研究

Abbreviation	BMC Health Serv Res
Journal Impact	2.70
Quartiles(Global)	HEALTH CARE SCIENCES & SERVICES(Q2)

ISSN	1472-6963
h-index	146

Publication Information	Publisher: BioMed Central Ltd，Publishing cycle: Irregular，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2001，Proportion of original research papers: 93.65%，Self Citation Rate:7.40%， Gold OA Rate: 99.91%
Journal Fees	$3190Details
Average review cycle	网友分享经验：平均6月
Average recruitment ratio	网友分享经验：容易

BMC Health Services Research

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