The Institute for Global Health and Development
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Item Women’s Experience of Domestic Violence: A Qualitative Study in Hangzhou, China(Springer, 2024-11-30) Yuan, Weiman; Kadetz, Paul; Shen, Xiaohui; Hesketh, TheresePurpose There has been an increasing awareness of Domestic Violence (DV) in China following the announcement of the First Anti-Domestic Violence Law, in 2015 yet, there has been limited in-depth research concerning DV in China -with most focused on prevalence and risk factors. This study aims to capture female DV victims’ experience of violence in China, and identify the perceived causes and impacts of DV. Methods This qualitative research, conducted from June to September 2019 in Hangzhou, China, consisted of in-depth semi-structured interviews with 30 women who had experience of DV. Social cognitive theory served as the theoretical framework and Interpretive Phenomenological Analysis to analyze the data. Results The most common types of physical violence reported included hitting, throwing objects at women, choking, kicking, and slapping. Psychological violence consisted of insults and denigration, physical threats, and enforcement of social isolation. Sexual violence consisted of forced sexual behaviors against women’s willingness. All informants suffered physical or psychological impacts from the violence experienced. Perceived causes of DV included the perpetrator’s personality and childhood experience of violence; victims’ self-blame; conflict between couples that include those concerning raising children and household finances; family conflicts, especially with parents-in-law; social factors including rural-to-urban migration for work, social norms and constraints, and legal constraints to separation. 80% of informants reported that they still cohabit with their abusive partner. Conclusion Our findings provide insights into potential preventative measures for DV from individual, family, and social perspectives, and the need to de-stigmatize and support victims of DV in China.Item ‘You say you are a TB doctor, but actually, you do not have any power’: health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China(BioMed Central, 2022-06-23) Zou, Guanyang; McPake, Barbara; Kielmann, KarinaAbstract: Background: In China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into ‘designated’ public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB ‘designated’ hospitals in Zhejiang province, we explored factors influencing hospital-based health workers’ motivation in the context of integrated TB service delivery. Methods: We conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation. Results: Health workers tasked with TB care in ‘designated’ hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their salaries compared with other clinical staff. In both sites, health workers were concerned about poor infection control and weak risk management assessment systems. Conclusions: Inadequate attention to workforce issues for TB control in China, specifically the professional status, welfare, and development as well as incentivization of infectious disease control workers has contributed to dissatisfaction and consequently poor motivation to serve TB patients within the integrated model of TB care. It is important to address the failure to motivate health workers and maximize public good-oriented TB service provision through improved government funding and attention to the professional welfare of health workers providing TB care in hospitals.Item Health service utilization following systematic upper respiratory tract infections and influencing factors among urban and rural residents in Anhui, China(Cambridge University Press, 2019-12-10) Xu, Shiyu; Dong, Xuemeng; Zhou, Rongyao; Shen, Xingrong; Feng, Rui; Cheng, Jing; Chai, Jing; Kadetz, Paul; Wang, DebinAim: This study seeks to identify healthcare utilization patterns following symptomatic respiratory tract infections (RTIs) and the variables that may influence these patterns. Background: RTIs are responsible for the bulk of the primary healthcare burden worldwide. Yet, the use of health services for RTIs displays great discrepancies between populations. This research examines the influence of social demographics, economic factors, and accessibility on healthcare utilization following RTIs. Methods: Structured interviews were administered by trained physicians at the households of informants selected by cluster randomization. Descriptive and multivariate binary logistic regression analysis was performed to assess healthcare utilization and associated independent variables. Findings: A total of 60 678 informants completed the interviews. Of the 2.9% informants exhibiting upper RTIs, 69.5–73.9% sought clinical care. Healthcare utilization rates for common cold, influenza, nine acute upper RTIs, and overall RTIs demonstrate statistically significant associations with the variables of age, type of residence, employment, medical insurance, annual food expenditure, distance to medical facilities, and others. The odds ratios for healthcare utilization rates varied substantially, ranging from 0.026 to 9.364. More than 69% of informants with RTIs sought clinical interventions. These findings signify a marked issue with the large amount of healthcare for self-limited RTIs.Item Teachers’ perceptions of student mental health in eastern China: A qualitative study(MDPI, 2021-07-07) Yao, Min; Kadetz, Paul; Sidibe, Aissata Mahamadou; Wu, Yedong; Li, Jiameng; Lyu, Jinping; Ma, Cuiling; Hesketh, ThereseIn China, primary and secondary school teachers, known as ban zhu ren, have pastoral responsibility for the students in their class. The aim of this preliminary study is to identify how ban zhu ren perceive the mental health of their students, and how they have acted on these perceptions. Content analysis was used to organize the data and distinguish categories or themes derived from in-depth semi-structured interviews conducted with 27 ban zhu ren from Zhejiang and Anhui provinces. Frequencies of informant responses were used to identify the areas of agreement and disagreement across identified categories and themes among the informants. The results illustrate that the informants consider issues, such as not paying attention in class (n = 14), not getting along well with classmates (n = 12), and excessive gaming (n = 11) to be indicative of mental illness, although these would commonly be considered normal adolescent behaviors. Fifteen informants admitted that they found it difficult to work with student mental health issues, and 18 felt they had inadequate or non-existent training. However, all informants stated that they had intervened with what they perceived to be students’ mental health issues, although only 9 informants had referred students for professional help. The informants reported that they were reluctant to provide referrals, due to the stigmatization they believed students would experience if given a diagnosis of mental illness. We conclude that among our informants there is a lack of agreement on what behavioral and mental health issues are, and that informants may be confusing what are, in actuality, non-conformist or non-compliant (yet often normal), adolescent behaviors with mental illness due to insufficient mental health training.Item About face: How the People’s Republic of China harnessed health to leverage soft power on the world stage(Frontiers, 2022-02-03) Kadetz, Paul; Stanley-Baker, Michael; Wang, MeiIn the fifteen year period from 1964–1979, The People’s Republic of China engaged in an unprecedented number of domestic and international health campaigns that were utilized for China’s entrance onto the world stage. From Mao Zedong’s vision of a new form of medicine via the unification of Chinese medicines and biomedicine to the adoption of a Chinese model of healthcare integration and primary healthcare by the World Health Organization in the Declaration of Alma Ata, the PRC entered the world stage through its health exports and its distinctive adaptation of modernity to serve domestic, and often foreign policy goals. These exports include Sino-African health diplomacy; the globalization of Traditional Chinese Medicine, and in particular the global utilization and scientific recognition of the antimalarial artemisinin derived from the Chinese herb Qinghao; and a model of primary and rural universal healthcare utilizing community health workers that garnered multilateral support. However, the face of benevolence displayed on the world stage was often contradicted by what was occurring domestically, behind the scenes, with the marked state enforcement of many of these same health campaigns in front of the backdrop of the cultural revolution. This paper examines if, and how, the West may have orientalized and romanticized China’s healthcare exports. Furthermore, we analyze the World Health Organization’s adoption and global promotion of a model for universal healthcare using healthcare integration that was only able to be achieved through the often brutal enforcement of the state, whilst rejecting grass-roots movements enacted during the same period, such as the practitioner-led integration of Ayurvedic medicine in India.Item Perceived challenges in delivering comprehensive care for patients following stroke: A qualitative study of stroke care providers in Guangdong Province, China(Taylor & Francis, 2020-04-28) Wu, Chanchan; Zou, Guanyang; Chen, Minjie; Wan, Lihong; Kielmann, Karina; McCormack, BrendanPurpose: To understand the challenges in delivering comprehensive care for patients recovering from stroke.Item Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study(BMJ Publishing Group, 2018-01-13) Peng, Bo-li; Zou, Guanyang; Chen, Wen; Lin, Yan-wei; Ling, LiObjectives To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation. Design Cross-sectional survey between April and May 2016. Setting Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. Participants We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. Main outcome measures The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups). Results In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. Conclusions Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.