患者就医等候时间、就医便利性和就医感知价值关系研究

文章针对患者就医感知价值中的“看病难”问题,围绕患者就医等候时间、就医便利性和就医感知价值的关系展开理论研究,并结合台州医院的案例进行了实证检验。研究发现,在知名度较高的大型医院里,患者个人时间充裕程度与就医感知便利性无相关性,患者就医感知便利性与就医感知价值呈正相关性;患者个人就医时间充裕程度与就医感知价值无相关性,而患者特征对其时间充裕程度、就医感知便利性有一定影响。     

公立医院患者忠诚度影响因素研究

目的：研究影响公立医院患者忠诚的因素,探索公立医院培养患者忠诚的管理对策。方法：对317名公立医院住院患者和家属进行问卷调查。结果：公立医院患者的态度忠诚主要取决于心理补救、服务价值、沉没成本和产品价值,行为忠诚主要取决于心理补救、服务价值、沉没成本和货币成本。结论：公立医院应重视服务补救,提高患者感知价值和转换成本,来提升患者就医忠诚。     

基于患者类型的医患沟通与患者就医感知价值关系研究

沟通性是患者就医感知价值的重要指标因素。文章通过在台州医院进行的实证研究,对医患沟通与患者就医感知价值的关系进行了深入分析,检验了医患沟通与患者就医感知价值间的正相关性。同时,以学历高低、有无不愉快经历为维度,对患者进行分类,检验了患者类型对两者关系的调节作用,探讨了学历高低、有无不愉快经历对患者就医感知价值评价的影响。     

基于顾客参与的医疗服务管理

在当前服务经济和体验经济环境下,现代医院的管理已经由“以医院为中心的管理”、“以病为中心的管理”向“以服务为中心的管理”和“以顾客为中心的管理”转变。医院的医疗服务是对所有顾客的全方位的服务,有着丰富的顾客内涵。医疗顾客适度和有效地参与医院运营活动,可以增强顾客对医疗服务质量的价值感知、降低对医疗服务质量的感知风险,减少顾客的医疗服务获取成本,可以给顾客带来关系价值、学习价值和心理利益价值,可以提升医疗顾客对感知价值,增加满意度水平,并导致良好的医疗顾客行为意向。因此,医院应积极推进顾客的适度和有效地参与,建立和完善基于顾客参与的医疗服务管理体系,以构建医院的核心竞争优势。     

关联规则在挖掘患者就医行为模式研究中的应用

[目的]探讨数据挖掘中的关联规则在患者就医行为模式研究中的应用价值,为卫生服务研究提供方法学上的借鉴。[方法]利用关联规则中的Apriori算法,通过设置最小支持度和最小置信度对患者就医行为等信息进行挖掘。[结果]不同收入水平、不同报销渠道与疾病不同严重程度等情况的患者就医行为模式存在差异。[结论]关联规则引入到卫生服务研究的资料分析中,可以探讨影响患者就医行为各种因素间潜在的、有价值的关系,较传统的多元回归方法具有独特的优势。     

基于结构方程探索最优竞争模型——患者感知服务态度与服务质量、患者满意及其行为意向间关系

目的应用结构方程模型(SEM)推断患者感知服务态度、服务质量、患者满意及行为意向间的关系,得到最优竞争模型。方法通过6家医院706位门诊和住院患者问卷调查,结合美国顾客满意指数模型及专业文献,建立初始模型,通过SEM拟合,获得患者感知服务态度、服务质量、感知价值、患者满意及行为意向之间的关系。结果通过比较理论模型和3个竞争模型,最终得到最优竞争模型III,即服务态度、服务质量、患者满意与感知价值是患者行为意向的原因变量;服务质量与患者满意、感知价值及行为意向、感知价值与患者满意及行为意向、患者满意与行为意向、服务态度与服务质量、感知价值及患者行为意向均呈正相关;服务态度与患者满意呈间接相关。结论结构方程分析方法证实患者感知服务态度直接影响患者行为意向,服务态度与患者满意之间存在直接或间接效应。     

医疗卫生领域安德森模型的发展、应用及启示

安德森模型自1968年创建以来,在倾向特征、促进资源和需要三个初始组成部分基础上,通过增加模型测量指标、调整结构、扩充路径关系、转变分析路径等方式历经5次修正和完善,实现了其作为理论模型的完整性及实证研究的可行性,最终获得了国际学术界的广泛认可。在欧美各国广泛应用于医疗卫生服务研究领域,作为分析影响个体就医选择、医疗花费、疾病筛查、药物使用等医疗卫生服务利用行为主要因素的理论模型。梳理并借鉴安德森模型的发展演变、国外应用研究进展,不但有助于我国医疗卫生服务领域的学术研究,亦对优化我国医疗卫生政策、国家卫生服务调查中问卷的指标设计具有现实指导意义。     

患者就医感知价值及其应用策略研究

患者就医感知价值研究为把握患者就医感受,建立以患者为中心的新型医疗服务体系提供了理论依据和实践方法。患者就医感知价值由一系列关键指标构成,通过分析患者感知价值的各个构成指标及其对患者感知价值的影响作用,可以将患者感知价值指标按照敏感度和易感性分为两个维度,分别找出其中的强感知指标、中等感知指标、弱感知指标、显性指标、隐性指标。结合实际的案例,对这些指标进行归类分析后,可以为提升医疗服务水平提供具有实践指导意义的管理策略。     

影响新老患者就医感知价值因素的实证研究——以台州医院为例

新老患者就医时的价值感知存在一定差异，医疗机构需要针对这种差异采取不同的服务策略，才能有效提升医疗服务质量。文章采用理论研究结合实证调研的方法，调查了新老患者在就医感知价值上的差异，分析了产生这些差异的影响因素，在基础上，给出了医疗机构有效提升服务质量的策略建议。     

台州医院——浙江大学医院管理研究基地

自2005年开始，浙江省台州医院与浙江大学的研究人员展开医院管理领域的研究合作，共同探索在中国医疗情境下提升医院管理水平的理论和实践方式方法。研究学科带头人为浙江省台州医院陈海啸教授和浙江大学张大亮教授，研究范围涉及到医疗质量改进、临床路径应用、患者满意度评价、患者就医感知价值、医患关系、医院知识管理、医院发展战略等领域。     

The Revised Health Hardiness Inventory (RRHI-24): psychometric properties and relationship with self-reported health and health behavior in two Dutch samples.

Our objective was to examine the psychometric properties of a Dutch translation of the Health Hardiness Inventory (HHI), and to determine relationships between health hardiness scales and self-reported health and preventive health behavior. Data from a cross-sectional study with two samples [a general population sample (n = 205) and a student sample (n = 286)] were analyzed. The Revised Health Hardiness Inventory (RHHI-24) was found to consist of four stable and reliable scales: (1) Health Value, (2) Internal Health Locus of Control, (3) External Health Locus of Control and (4) Perceived Health Competence. Women valued their health more than men, older individuals (> 45 years) valued their health more than younger individuals (< or = 45 years) and elderly people (> 65 years) were more externally orientated with respect to health locus of control. Preventive health behavior was related to a higher value placed on health, a lower external health locus of control and a higher perceived health competence. Better self-reported health was related to a higher perceived health competence and a more internally orientated health locus of control. We conclude that the RHHI-24 is a theoretically sound instrument for the measurement of health cognitions.     

Assessment of Stigma Towards Homosexuality in China: A Study of Men Who Have Sex with Men

Previous research has documented the deleterious impact of homosexuality stigma on HIV sexual risk behavior among men who have sex with men (MSM) and the vulnerability of this group in China for HIV acquisition. Factor analysis of 10 survey items from 477 MSM from Shanghai yielded two factors: Perceived stigma assessed participants' impressions of the degree of societal stigmatization of homosexuals whereas enacted stigma measured direct personal experiences of stigmatizing behaviors. Enacted stigma exhibited satisfactory internal reliability and was associated with HIV sexual risk behavior. Further research is needed to refine perceived and other stigma constructs for Chinese MSM.     

Compliance to health recommendations: a theoretical overview of message framing

Health care professionals have become increasingly interestedin motivating individuals to comply with health recommendations.One approach to this issue has been to evaluate the impact ofmessage framing on behavior change processes. Three types offraming are described: gain, loss and fear. Theoretical considerationsfrom such theories as the Health Belief Model, Prospect Theory,and Protection Motivation reveal the significance of two dimensions,the perceived value and perceived threat of an outcome. Theperceived value dimension focuses on the importance of definingmessages on the basis of whether or not a valued outcome isacquired, and the perceived threat dimension stresses the importanceof negative outcomes. Perceived value is critical to a manipulationof gain and loss framing, while perceived threat is criticalto a manipulation of fear framing. The assumptions underlyingthe theories relevant to these distinctions are considered,followed by a review of the literature, and speculations aboutthe possible mechanisms which may mediate framing effects.     

Perceived racial discrimination and nonadherence to screening mammography guidelines: results from the race differences in the screening mammography process study

The study objective was to determine whether perceived racial discrimination influenced nonadherence to screening mammography guidelines. Enrolled in this prospective study were 1,451 women aged 40-79 years who obtained an "index" screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998. This logistic regression analysis included 1,229 women (484 African American (39%), 745 White (61%)) who completed telephone interviews at baseline and follow-up (on average 29 months later). Perceived racial discrimination was measured as lifetime experience in seven possible situations. Approximately 42% of African-American women and 10% of White women reported lifetime racial discrimination. Perceived racial discrimination was not associated with nonadherence to age-specific mammography screening guidelines in unadjusted or multivariate-adjusted analyses. Although these negative findings may reflect the well-recognized problems associated with measurement of perceived discrimination, it is possible that women who recognize and report racial discrimination develop compensatory characteristics that enable positive health prevention behavior, in spite of their past experiences.     

The relationships among constructs in the health belief model and the transtheoretical model among African-American college women for physical activity

PURPOSE: Health Belief Model (HBM) and Transtheoretical Model concepts were used to investigate possible differences in perceptions of physical activity among African-American college women categorized by their stage of physical activity behavior METHODS: A survey was administered to 233 participants to assess their stage of physical activity behavior and HBM perceptions. Analysis of variance was used to investigate possible differences among HBM constructs for each behavior stage. RESULTS: Perceived barriers were significantly higher (p < .05), and perceived severity, cues to action, and self-efficacy were significantly lower in the inactive group than in the active group. For example, perceived barriers were significantly higher in the inactive (mean = 2.3) stage than in the preparation (mean = 2.1), action (mean = 1.9), and maintenance (mean = 1.7) stages of physical activity behavior. DISCUSSION: The results suggest that many perceptions of physical activity differ significantly among stages of behavior in this sample of African-American college women. A limitation was that some scales were modified specifically for this population and were not validated.     

Towards patient-centered health services in India--a scale to measure patient perceptions of quality.

OBJECTIVE: . (i) To develop a reliable and valid scale to measure in-patient and outpatient perceptions of quality in India and (ii) to identify aspects of perceived quality which have large effects on patient satisfaction. DESIGN: Cross-sectional survey of health facilities and patients at clinics. SETTING: Primary health centers, community health centers, district hospitals, and female district hospitals in the state of Uttar Pradesh in north India. MAIN OUTCOME MEASURES: Internal consistency, validity, and factor structure of the scale are evaluated. The association between patient satisfaction and perceived quality dimensions is examined. RESULTS: A 16-item scale having good reliability and validity is developed. Five dimensions of perceived quality are identified-medicine availability, medical information, staff behavior, doctor behavior, and hospital infrastructure. Patient perceptions of quality at public health facilities are slightly better than neutral. Multivariate regression analysis results indicate that for outpatients, doctor behavior has the largest effect on general patient satisfaction followed by medicine availability, hospital infrastructure, staff behavior, and medical information. For in-patients, staff behavior has the largest effect followed by doctor behavior, medicine availability, medical information, and hospital infrastructure. CONCLUSIONS: The scale developed can be used to measure perceived quality at a range of facility types for outpatients and in-patients. Perceived quality at public facilities is only marginally favorable, leaving much scope for improvement. Better staff and physician interpersonal skills, facility infrastructure, and availability of drugs have the largest effect in improving patient satisfaction at public health facilities.     

Predictors of perceived breast cancer risk and the relation between perceived risk and breast cancer screening: a meta-analytic review

BACKGROUND: Perceived risk is a principal variable in theoretical models that attempt to predict the adoption of health-protective behaviors. METHODS: This meta-analysis synthesizes findings from 42 studies, identified in PubMed and PsycInfo from 1985 onward. Studies examined demographic and psychological variables as predictors of perceived breast cancer risk and the relationship between perceived risk and breast cancer screening. Statistical relationships, weighted for sample size, were transformed to effect sizes and 95% CIs. RESULTS: Women do not have accurate perceptions of their breast cancer risk (N = 5561, g = 1.10). Overall, they have an optimistic bias about their personal risk (g = 0.99). However, having a positive family history (N = 70660, g = 0.88), recruitment site, and measurement error confounded these results. Perceived risk is weakly influenced by age (N = 38000, g = 0.13) and education (N = 1979, g = 0.16), and is moderately affected by race/culture (N = 2192, g = 0.38) and worry (N = 6090, g = 0.49). There is an association between perceived risk and mammography screening (N = 52766, g = 0.19). It is not clear whether perceived risk influences adherence to breast self-examination. Women who perceived a higher breast cancer risk were more likely to pursue genetic testing or undergo prophylactic mastectomy. CONCLUSION: Perceived breast cancer risk depends on psychological and cognitive variables and influences adherence to mammography screening guidelines.     

基于微信平台的中老年用户群体食品安全信息采纳意愿研究

目的 探讨中老年用户群体对微信食品安全信息的采纳意愿。方法 在整合式技术接受模型（UTAUT2）基础上,引入感知风险和信息特性2个因素,从主客观角度构建中老年用户群体对微信食品安全信息采纳意愿的影响因素模型。采用问卷调查,收集401份有效数据,用AMOS21.0对模型进行检验及修正。结果 结构方程模型拟合较好,各因素对行为意愿的影响系数由高到低依次为享乐动机（β = 0.351）、信息特性（β = 0.259）、便利条件（β = 0.234）、绩效期望（β = 0.123）、价格价值（β = 0.081）、感知风险（β = 0.068）;行为意愿对使用行为的影响系数β 值为0.957。结论 绩效期望、享乐动机、便利条件、信息特性对行为意愿产生正向影响（P＜0.05）;感知风险、价格价值对行为意愿影响不显著（P＞0.05）;行为意愿对使用行为产生正向影响（P＜0.05）。面向中老年的食品安全信息服务时,应加强信息的审核力度,扩宽信息内容的适用性,提供可靠的信息服务以满足用户需要。     

Pesticide safety among farmworkers: perceived risk and perceived control as factors reflecting environmental justice

Farmworkers in the United States constitute a population at risk for serious environmental and occupational illness and injury as well as health disparities typically associated with poverty. Pesticides are a major source of occupational injury and illness to which farmworkers are exposed. Efforts to provide safety training for farmworkers have not been fully evaluated. Based on the Health Belief Model, this analysis examines how safety information affects perceived pesticide safety risk and control among farmworkers and how perceived risk and control affect farmworker knowledge and safety behavior. Data are based on interviews conducted in 1999 with 293 farmworkers in eastern North Carolina as part of the Preventing Agricultural Chemical Exposure in North Carolina Farmworkers' Project. Perceived pesticide risk and perceived pesticide control scales were developed from interview items. Analysis of the items and scales showed that farmworkers had fairly high levels of perceived risk from pesticides and perceived control of pesticide safety. Receiving information about pesticide safety (e.g., warning signs) reduced perceived risk and increased perceived control. Pesticide exposure knowledge was strongly related to perceived risk. However, perceived risk had a limited relationship to safety knowledge and was not related to safety behavior. Perceived control was not related to pesticide exposure knowledge, but was strongly related to safety knowledge and safety behavior. A key tenet of environmental justice is that communities must have control over their environment. These results argue that for pesticide safety education to be effective, it must address issues of farmworker control in implementing workplace pesticide safety.