Factors Influencing the Implementing Readiness of Shared Medical Appointments in China's Primary Healthcare Institutions: A Mixed-Method Study Utilizing Qualitative Comparative Analysis

Abstract

Background and Objective Diabetes mellitus (DM) is a mounting public health concern in China, home to the largest number of patients with diabetes globally. A primary challenge has been the integration of high-quality chronic disease services, with poor outcomes and inefficient health management intensifying the disease burden. Shared Medical Appointments (SMAs) offer a promising solution, yet evidence of their practical application in resource-limited settings like China's primary healthcare institutions is scant. This study aims to evaluate the organizational readiness for change (ORC) in implementing SMA services in Guizhou province's primary healthcare institutions and to identify determinants of high-level ORC to foster implementation success. Methods This study employed a mixed-method approach. The validated Chinese version of the Workplace Readiness Questionnaire (WRQ-CN) was used to assess the ORC status across 12 institutions participating in the SMART pilot trial. A Normalization Process Theory (NPT) -guided qualitative interview and quantitative survey were used to collect the conditions. Data analysis encompassed standardized descriptive statistics, Spearman correlation analysis, and qualitative comparative analysis (QCA) to discern condition variables and configurations that are favorable to high-level ORC. Results The study engaged 70 institutional participants, including administrators, clinicians, and public health workers. The median ORC score was 105.20 (101.23-107.33). We identified 12 condition variables through the interview and survey. The Spearman correlation analysis highlighted a moderate correlation between Specific tasks and responsibilities (r=0.393, p=0.206) and Key participants (r=0.316, p=0.317) with ORC. QCA also revealed these condition configurations and pathways that collectively align with heightened ORC, accentuating the pivotal role of key participants. Conclusions This study unveiled a spectrum of dynamic conditions and pathways affecting ORC, which are consistent with the NPT-based theoretical steps. They were essential for attaining high-level ORC in rolling out health service innovations like the SMART study, especially in resource-limited settings.