With evolving health concepts and changing disease spectra, the importance of proactive health management in disease prevention and health promotion has become increasingly prominent. As the cornerstone of primary health care at the community level, general practitioners play a pivotal role in implementing proactive health management. However, evidence on the current status of community general practitioners' knowledge, attitude, and behaviors regarding proactive health management, as well as the factors influencing these domains, remains limited.

This study aims to assess the current status of knowledge, attitude, and behaviors related to proactive health management among community general practitioners in Shanghai, to analyze the major influencing factors, and to propose targeted strategies for improvement.

From February to May 2023, a questionnaire survey was conducted in two community health service centers in each of the 16 administrative districts of Shanghai, and a total of 691 community general practitioners were enrolled. A self-developed Community General Practitioners' Proactive Health Management Knowledge, Attitude, and Behaviors Questionnaire was used, comprising three dimensions (knowledge, attitude, and behaviors) and demonstrating acceptable reliability and validity. Independent-samples t tests, one-way analysis of variance, and multiple linear regression analyses were performed to examine differences across subgroups and to identify associated influencing factors.

Overall, community general practitioners reported positive beliefs regarding proactive health management (score rate 84.12%), a moderately high level of knowledge (75.90%), and comparatively lower levels of related behaviors (71.98%). Multiple linear regression analysis showed that educational level, professional title, serving as a team leader, and practice region were significant predictors of knowledge scores (P<0.05); educational level, years of working in general practice, and serving as a team leader were significant predictors of attitude scores (P<0.05); and educational level, years of working in general practice, professional title, serving as a team leader, and practice region were significant predictors of behavior scores (P<0.05). The main perceived barriers to implementing proactive, health-oriented management among community general practitioners included lack of policy support (n=473, 68.45%), heavy clinical workload (n=469, 67.87%), insufficient health awareness among residents (n=410, 59.33%), and limited institutional resources (n=383, 55.43%).

Community general practitioners in Shanghai demonstrate generally positive attitudes toward proactive health management; however, their knowledge remains insufficiently systematic and their behaviors are not fully translated into practice. Educational level, professional title, years of general practice experience, team leadership roles, and practice region significantly influence their levels of knowledge, beliefs, and behaviors. Stratified training, optimized policy support, strengthened allocation of digital resources, and enhanced health education for community residents are warranted to promote the effective translation from "knowing" and "believing" to "doing" in proactive health management, thereby improving the quality and effectiveness of proactive health management at the primary care level.

As China enters an aging society, the incidence of Alzheimer's disease (AD) is increasing annually. Concurrently, these patients are susceptible to developing community-acquired pneumonia (CAP), a complication that ultimately leads to adverse outcomes. Therefore, establishing an accurate risk prediction model can assist healthcare professionals in early identification and intervention for high-risk patients, thereby alleviating familial and societal burdens.

To develop a predictive model for the risk of adverse prognosis in AD patients with CAP, analyze the high-risk factors for poor outcomes in this patient population, and provide a basis for formulating targeted treatment measures.

Data retrieval was conducted using the dementia database platform established by Hubei Provincial Hospital of Traditional Chinese Medicine. Hospitalized patients diagnosed with AD and CAP from January 2020 to August 2025 were included as study subjects (n=371). Data collected included demographic and baseline characteristics, comorbidities and behavioral risk factors, assessment scales, and laboratory indicators. The data were randomly split into a training set (n=259) and a validation set (n=112) in a 7∶3 ratio. Subsequently, least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation was employed to screen for optimal predictors. Define the composite outcome of patient death or respiratory failure during hospitalization as an adverse event. Following this screening process, Logistic regression was used to develop the final prediction model, and a nomogram was constructed based on this model. The model performance was evaluated using multiple metrics, including the area under the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

The incidence of adverse outcomes in AD patients with CAP was 27.76% (103/371). Using LASSO regression, four potential predictors were selected from 20 candidate variables: CDR score, CURB-65 score, ADL score, and dysphagia. Subsequent multivariate Logistic regression analysis confirmed that these four factors were independent influencing factors for adverse outcomes (P<0.05), with the following odds ratios: CDR score (OR=2.304, 95%CI=1.486-3.572), CURB-65 score (OR=2.263, 95%CI=1.477-3.468), ADL score (OR=2.337, 95%CI=1.033-5.287), and dysphagia (OR=2.042, 95%CI=1.036-4.023). A clinical prediction model (nomogram) was constructed based on these four predictive variables. The area under the ROC curve for the prediction model was 0.835 (95%CI=0.777-0.892) in the training set and 0.902 (95%CI=0.835-0.968) in the validation set, indicating good discriminative ability. The Hosmer-Lemeshow test results showed χ²=7.046 (P=0.531) for the training set and χ²=7.781 (P=0.455) for the validation set, suggesting good model fit. The Brier scores for the calibration curves were 0.137 and 0.108 for the two datasets, further indicating good consistency between predicted and actual values. DCA results showed that using the nomogram model to predict the risk of adverse outcomes provides clinical benefit when the threshold probability ranges from 0.10 to 0.75.

The nomogram model developed in this study effectively predicts the risk of adverse outcomes in AD patients with CAP. This tool facilitates early identification of high-risk populations by clinicians, thereby enabling the formulation of individualized interventions to improve patient prognosis.

Falls are the leading cause of injury-related death among adults aged 65 years and older in China. In 2018, the U.S. Preventive Services Task Force (USPSTF) released the Recommendation Statement on Fall Prevention in Community-dwelling Older Adults based on a systematic review of the latest evidence and an evaluation of the benefits and harms of interventions for falls in community-dwelling older adults, and this statement was updated in 2024. Drawing on China's 2022 Expert Consensus on the Comprehensive Management of Fall Risk in Older Adults, this article interprets the updated 2024 USPSTF Recommendation Statement, aiming to provide general practitioners in China with the latest evidence and reference for implementing fall prevention measures in older adults.

In the context of population aging, community-dwelling older adults commonly experience insufficient physical activity and difficulty maintaining regular exercise. Zero-time exercise (ZTEx) is lifestyle-based and fragmented, making it easier to integrate into daily life; however, qualitative evidence on older adults' lived experiences and perceptions of ZTEx remains limited.

To explore how community-dwelling older adults understand ZTEx and its practical characteristics in everyday life, and to provide experience-based evidence for health promotion in older populations.

A qualitative research design was adopted. From April to June 2025, 20 older adults from three communities in Nanchang City were selected using purposive sampling. Data were collected through non-participant observation and semi-structured interviews, and analyzed using Colaizzi's seven-step method to identify and summarize themes.

Among the 20 participants, 10 were men (50%) and 10 were women (50%), with a mean age of 66.1±3.4 years. Four themes (adoption drivers, exercise patterns, health perceptions, and sustainability challenges) and 12 subthemes were identified. Participants generally perceived ZTEx as a lifestyle-oriented, low-threshold activity strategy, mainly used to maintain daily functional ability, enhance confidence in mobility, and promote self-health management. Continued practice was influenced by differences in understanding exercise intensity and safety, physical functional limitations, and insufficient professional guidance.

ZTEx demonstrates good acceptability and practical potential among community-dwelling older adults. However, sustained implementation still depends on further improvements in standardized guidance and community support conditions.

Obesity is one of the most modifiable risk factors for type 2 diabetes mellitus (T2DM). Body mass index (BMI) and waist circumference (WC) are widely used metrics for obesity assessment worldwide. Exploring the associations between fasting plasma glucose (FPG) and BMI as well as WC in elderly populations can not only provide accurate, simple and convenient indicators for community physicians in the prevention and management of T2DM among older adults, but also offer novel perspectives for community health education. Furthermore, it can facilitate older adults to conduct self-monitoring and management of FPG via simple, sustainable and non-invasive approaches.

The aim of this study is to investigate the correlation between FPG, BMI, and WC among community-dwelling older adults.

A total of 5 122 older adults (aged≥65 years) undergoing health examinations between January 2022 and December 2024 at Damiao Community Health Service Station, Yinchuan First People's Hospital, Ningxia, were enrolled. Data on demographics, family history, cardiovascular disease history, lifestyle, laboratory tests, electrocardiograms, and medications were collected via the Yinchuan Medical Consortium platform. Participants were stratified into a control group (FPG<7.0 mmol/L, n=4 590) and a study group (FPG≥7.0 mmol/L, n=532). Confounding factors were adjusted via 1∶1 propensity score matching with a caliper value of 0.02. Inverse probability treatment weighting was used as a reference to verify the matching efficiency of propensity score matching. Univariate and multivariate Logistic regression analyses were performed to explore the effects of BMI and WC on elevated FPG among community-dwelling older adults. Restricted cubic spline regression was further applied to examine the potential nonlinear associations of FPG with BMI and WC.

Ultimately, 513 matched pairs were successfully established, with 513 subjects in each group. Both univariate and multivariate Logistic regression analyses demonstrated that WC, BMI, marital status, white blood cell count, serum alanine transaminase, conjugated bilirubin, serum creatinine, blood urea nitrogen, high-density lipoprotein cholesterol, abnormal electrocardiogram results and history of cardiovascular disease were influencing factors for elevated FPG in older adults [OR (95%CI)=1.025 (1.006-1.045), 1.395 (1.224-1.586), 1.012 (1.005-1.019), 1.155 (1.090-1.224), 1.020 (1.010-1.030), 1.058 (1.009-1.108), 0.992 (0.986-0.999), 1.183 (1.112-1.258), 0.625 (0.457-0.836), 1.306 (1.061-1.614), 2.178 (1.592-2.950), all P<0.05]. FPG was positively correlated with BMI and WC before and after matching, with statistically significant differences (P<0.05). Restricted cubic spline analysis indicated significant nonlinear relationships between FPG and BMI as well as WC before and after matching (P<0.05). When BMI exceeded 24 kg/m² and 25 kg/m², and WC exceeded 86 cm and 87 cm respectively, their effects on FPG shifted from protective factors to risk factors.

FPG is positively and nonlinearly correlated with BMI and WC among community-dwelling older adults. A risk transition occurs when BMI is higher than 24 kg/m² and 25 kg/m², and WC exceeds 86 cm and 87 cm.

Artificial intelligence (AI) has substantial potential to improve service quality and health equity in primary healthcare institutions. China has introduced a series of policies to promote the development and application of AI in primary care. However, health data poverty, defined as the inability of individuals or populations to benefit from technological innovation because of insufficiently representative data, may widen service gaps between hospitals and primary healthcare institutions, as well as across primary healthcare institutions. To date, evidence on AI applications in China's primary healthcare institutions and their potential implications for health data poverty has not been systematically mapped.

To characterize AI models developed or validated using data from China's primary healthcare institutions, describe the datasets used in these studies, and assess the severity and distribution of health data poverty in this context.

We searched PubMed, Embase, Web of Science, CNKI and Wanfang Data for studies published between 2009 and 2025 on AI models in China's primary healthcare institutions. Data were extracted and synthesized across three domains: model characteristics, including algorithm type, validation strategy and performance; dataset characteristics, including data source, acquisition method and data content; and metadata distribution, including population coverage and handling of missing data.

57 studies were included. Existing AI models for primary care in China were mainly based on machine learning or deep learning and covered multiple application scenarios, including disease prediction and diagnosis. The most common disease areas were endocrine disorders, mainly diabetes, cardiovascular diseases, mainly hypertension, and mental health conditions. Datasets used to develop or validate these models showed limited accessibility, with no fully open dataset identified. Reporting quality was suboptimal, with a mean score of 6.53 out of 10; nearly one-third of studies did not report inclusion and exclusion criteria or methods for handling missing data. Dataset representativeness was also limited, with people younger than 45 years accounting for only 13.5% of reported study populations (5/37), and studies were predominantly conducted in more developed regions.

AI research in China's primary healthcare institutions is constrained by health data poverty, including limited data accessibility, suboptimal reporting quality and insufficient representativeness. Strengthening data linkage, developing high-quality research-ready datasets and establishing end-to-end governance may help build a stronger data foundation for primary healthcare.

The hierarchical medical system in China aims to guide patients toward primary healthcare institutions for first-contact care. Nevertheless, the proportion of visits at the primary level has continued to decline. The system's actual effectiveness and the mechanisms underlying changes in primary care service volume remain insufficiently understood.

To examine trends in primary care service volume and identify key driving factors after implementation of the hierarchical medical system, thereby providing empirical evidence for policy optimization.

Data were drawn from the China Health Statistical Yearbook series spanning 2005 to 2023. Interrupted time series (ITS) analysis was used to evaluate policy effects, and the logarithmic mean divisia index (LMDI) method was employed to decompose and quantify the contribution of each driving factor.

The ITS model showed that total primary care visits increased at an annual rate of 196 million (P=0.005), yet the proportion declined by 0.67 percentage points per year (P<0.001). At the point of policy intervention (2016), primary care visits fell abruptly by approximately 435 million (P<0.001), with the proportion dropping by 2.14 percentage points (P<0.001). After policy implementation, growth slowed markedly; the annual increase was 168 million fewer than in the pre-intervention period (P<0.001). LMDI results indicated a cumulative change of 2 351 million in primary care visits from 2005 to 2023. The per capita investment effect (EP) and institutional scale effect (SI) were the main positive drivers, while the capital intensity effect (IE, -12 409 million) and physician service productivity effect (PD, -1 551 million) posed major impediments to growth. In the post-implementation period, PD shifted from positive to negative, reflecting weakened growth momentum.

Primary care growth in China exhibits characteristics of an extensive model marked by high input and low efficiency. Resource and workforce productivity have not kept pace with investment increases, which may constrain the patient-diversion capacity of the hierarchical medical system.

Primary healthcare institutions commonly experience a "post-examination gap" in health checkup services, where high-risk populations lack unified risk stratification and proactive management pathways, thereby undermining the full value of health checkups. As potential strategies to enhance the continuity of post-examination care, color-coded management and active recall have not yet been systematically evaluated.

To evaluate the effectiveness of a post-examination service model centered on color-coded management and active recall in primary healthcare institutions.

Using the implementation of a post-examination service process reengineering at Jingshan Town Community Health Service Center, Yuhang District, Hangzhou as a natural boundary, 862 residents who underwent health checkups before the reengineering were assigned to the control group, and 712 residents who underwent checkups after the reengineering were assigned to the intervention group. The intervention group received color-coded management and active recall services. A self-designed questionnaire (Cronbach's α=0.89, KMO=0.87, Bartlett's test P<0.001) was used to assess service quality, process satisfaction, and post-examination management experience in both groups. Multivariate linear regression was used to analyze the independent effect of the intervention.

The intervention group scored significantly higher than the control group in all dimensions of service quality and process satisfaction (P<0.001). Multivariate linear regression showed that, after adjusting for confounders, the overall satisfaction score in the intervention group was 0.319 points higher than that in the control group (95%CI=0.278-0.360, P<0.001). In the intervention group, 98.0% (698/712) of respondents expressed overall satisfaction or had no specific suggestions, which was significantly higher than the 85.0% (733/862) in the control group (P<0.001). The coverage rate of color-coded management advice was 88.8% (632/712), that of active recall was 62.8% (447/712), and that of health intervention services was 74.3% (529/712); the median satisfaction scores for these services were all 4.00 (out of 4.00).

The post-examination service model centered on color-coded management and active recall significantly improved satisfaction and service experience among residents undergoing health examinations in primary healthcare institutions, effectively bridging the continuity gap in post-examination care. This model is worthy of promotion in primary care settings.

As the focus of chronic non-communicable diseases (hereinafter referred to as chronic diseases) prevention and control shifts toward communities, primary healthcare institutions are playing an increasingly prominent role in nutrition health promotion and early intervention of chronic diseases. However, the current capacity for building nutrition clinics and providing multidisciplinary services at the primary level remains generally weak, underscoring the urgent need to explore practical new paths for the integration of clinical care and public health. Based on literature reviews and expert discussions, this consensus employed the modified Delphi method and the Joanna Briggs Institute (JBI) evidence pre-grading system to systematically construct a precision nutrition health management system centered on the N-RCSP (nutrition, rehabilitation, chinese medicine, sports, psychology) "five-in-one" integrated intervention strategy. It specifies the construction principles, personnel and equipment allocation, and informatization standards for primary nutrition clinics, and outlines a digital closed-loop service process covering "screening-assessment-intervention-monitoring-follow-up". The N-RCSP precision nutrition health management model serves as an effective tool for implementing the integration of clinical care and public health, and can comprehensively enhance the non-pharmacological intervention capacity for chronic diseases and health management levels in primary healthcare institutions. Promoting this model helps lower the technical threshold for primary general practitioners to deliver professional nutritional interventions and facilitates multidisciplinary collaboration.

Exploring a cancer management plan suitable for our national conditions by utilizing the convenience of community services is an urgent need to ensure the out-of-hospital management for patients with cancer.

To analyze the current status, needs, and challenges in community-based cancer patient management, providing information for the development of innovative models for cancer patient management in Chinese communities.

A total of 35 cancer patients and 23 community healthcare professionals were recruited for in-depth interviews on the current status and needs of community cancer patient management from September to November 2023. Thematic framework analysis was used for data analysis. While 14 key decision-makers were selected for focus group interviews on the implementation factors of community-led cancer patient management models in December 2023, and data analysis was carried out based on grounded theory research methods.

Cancer patients in the community rehabilitation stage not only faced various physical discomforts caused by the disease and treatment, but also suffer from psychological distress and social isolation. However, they held a negative attitude towards the existing community management. Primary healthcare institutions had already implemented various cancer management practices in their daily work, but the content is fragmented and lacked integration. A community-led, personalized, and proactive cancer patient management model was expected by stakeholders, and the "burdens" and "benefits" brought by its implementation were concerns of key decision-makers.

Currently, the management of cancer patients in the community has not yet formed a complete system, and the health needs of cancer patients in the community have not been fully met. Community-led personalized and proactive cancer patient management can be the direction for further exploration.

Primary-level traditional Chinese medicine (TCM)personnel serve as the cornerstone of China's TCM development. Strengthening this workforce is crucial for advancing the inheritance and innovation of TCM and safeguarding public health.

This study analyzes the formulation characteristics and implementation outcomes of China's primary-level TCM talent policies (2012-2024), reveals policy instrument preferences, and assesses workforce development status to optimize TCM service capacity at the grassroots.

Based on a three-dimensional "theme-instrument-evaluation" framework, we employed LDA topic modeling to analyze 47 policy documents publicly available on Chinese government websites, used NVivo coding to examine policy tool distribution, and evaluated policy implementation effectiveness using data from official sources including the National Administration of Traditional Chinese Medicine.

reveal that policy themes predominantly focus on talent utilization and cultivation (combined >65%). Instrument usage exhibits a capacity-building-dominated structure (47.0%)> regulatory (23.5%)> incentive (20.2%)> informational/persuasive (9.3%), yet demonstrates structural imbalances: economic incentives constitute merely 5%, while information provision and promotion tools each account for <5%. By 2023, China's primary-level TCM workforce reached 277 000 personnel, with rural doctors proficient in TCM or TCM-Western integrated practices surging to 128 000 (significant growth since 2012). Structural challenges persist: TCM practitioners comprise only 22.6% of health personnel in corresponding institutions (below the 25% target), per-capita allocation remains inadequate, and shortages of high-caliber professionals endure despite expanded service coverage.

Thematic analysis confirms policy prioritizes talent utilization and cultivation. Instrument deployment reveals a "capacity-building-led, regulation-supported, incentive-supplemented" framework, with training programs, standard-setting, and non-financial incentives as dominant sub-tools. However, insufficient economic incentives and underutilized informational constrain policy effectiveness. Implementation challenges persist: imbalanced talent distribution, regional disparities, and shortages of high-caliber professionals. While systemic policy architecture exists, optimizing instrument combinations and resource allocation remains crucial to enhance the accessibility and sustainability of grassroots TCM services.

Although the overall prevalence of chronic kidney disease (CKD) in China has decreased, patients with hypertension and type 2 diabetes mellitus (hereinafter referred to as "the two diseases") have a relatively high risk of developing CKD, and the status of their standardized management in primary medical institutions remains unclear.

To conduct a cross-sectional survey of patients with "the two diseases" in community health service centers regarding the prevalence and management status of CKD, so as to provide data support for optimizing the management of chronic kidney disease at the primary level.

From January to December 2024, a two-stage random sampling method was adopted. Taking 12 community health service centers in Wuhou District, Chengdu as the sampling frame, 6 institutions were randomly selected, and then 600 eligible patients with "the two diseases" were randomly extracted from these selected institutions (including 205 cases of isolated hypertension, 213 cases of isolated type 2 diabetes mellitus, and 182 cases of comorbidity of the two diseases). The prevalence and management status of CKD in these patients were calculated, covering outpatient management, metabolic intervention, pharmacotherapy, and comprehensive intervention. Data were entered using EpiData 3.1 software, and statistical analysis was performed with SPSS 21.0 software.

Among the included population with "the two diseases", 173 cases (28.8%) were diagnosed with CKD. Of these CKD patients, 55 cases (26.8%) were from the isolated hypertension group, 52 cases (24.4%) were from the isolated type 2 diabetes mellitus group, and 66 cases (36.3%) were from the comorbidity group of the two diseases. Among all the CKD patients, 39 cases (22.5%) were at CKD stage 3, 5 cases (2.9%) at CKD stage 4, and 1 case (0.6%) at CKD stage 5. However, only 9 cases (5.2%) were registered for the special outpatient service for chronic kidney disease, 70 cases (59.3%) achieved the target of blood glucose control, 112 cases (92.6%) reached the standard of blood pressure control, 64 cases (37.0%) took SGLT-2i/GLP-1RA drugs, and 90 cases (52.0%) administered ACEI/ARB drugs.

At present, the prevalence of CKD in patients with the two diseases (diabetes/hypertension) in community health service centers of Wuhou District of Chengdu City is relatively high, and the standardized management of CKD patients remains inadequate. These findings indicate that primary medical institutions should improve the capacity for early screening and intervention of CKD, strengthen the standardized management of CKD patients, and enhance the control of patients' metabolic indicators, which is of great significance for effectively preventing and delaying disease progression.

Chronic pruritus (CP) is prevalent in the elderly population and its prevalence increases with age, seriously affecting their physical and mental health.

To explore pruritus symptoms and intensity of elderly patients with CP in community outpatient clinics in Beijing and analyze the factors affecting it, in order to provide a reference for improving the prevention and treatment in the community.

A multi-stage sampling method was employed to conduct a questionnaire survey among elderly patients with CP meeting the study criteria who visited outpatient clinics at 14 community health service centers in Beijing's urban districts from September to December 2024. The numerical rating scale (NRS) was used to assess patients' pruritus intensity, while the Chinese version of the ItchyQoL questionnaire evaluated pruritus related quality of life. A multinomial Logistic regression model was used to analyze factors influencing pruritus intensity, while Spearman's rank correlation analysis examined the relationship between pruritus intensity and pruritus-related quality of life.

A total of 631 questionnaires were distributed, with 623 valid responses collected, resulting in a response rate of 98.7%. The duration of illness in elderly CP patients predominantly was 5 years and above (327, 52.5%), the intensity of pruritus was moderate and above (434, 69.6%), and the pruritus-related quality of life was mildly impaired (569, 91.3%). The results of multifactorial Logistic regression analysis showed that pruritus intensity was higher in patients with aged between 70 and 80 years (compared to those aged 60 to 70, OR=1.459, P=0.028), junior high school education and below (compared to those college degree or higher, OR=1.661, P=0.010), and strong tea drinking habit (OR=1.411, P=0.046). Conversely, patients with a disease duration of 5 years or more (compared to those duration of CP less than 1 year, OR=0.590, P=0.016) exhibited lower pruritus intensity. Patients with higher pruritus intensity experience more severe impairment in pruritus-related quality of life (r_s=0.278, P<0.01). The more severe the pruritus intensity, the more severe the impairment in symptoms (r_s=0.325, P<0.01), functional activities (r_s=0.283, P<0.01), and emotional well-being (r_s=0.243, P<0.01).

Strengthening the attention to the problem of chronic pruritus in the community, focusing on patients with education level of junior high school or below, strong tea drinking habit and shorter duration of the disease, and adopting targeted prevention and treatment measures to improve their skin health and quality of life are of great significance in promoting the physical and mental health of the elderly population.

The establishment of a primary care-oriented healthcare system is crucial to enhancing the performance and sustainability of China's healthcare system. However, the relatively low utilization of primary care services remains a central barrier to the implementation of a tiered healthcare system.

Identify the institutional operational and environmental characteristics associated with the level of primary care service utilization, thereby providing policy recommendations for optimizing primary care.

A search of CNKI, Wanfang, VIP, Web of Science, and PubMed databases up to December 2022 yielded 245 Chinese and English empirical studies. These literatures were included to sort out influencing factors by referencing the WHO's six-building-block health system framework and the Andersen Behavioral Model of Health Services Use. Partial least squares structural equation modeling was used to analyze cross-sectional data from 153 primary care institutions in a case city in Shandong Province in 2021, sourced from financial reports, statistical yearbooks, and institutional questionnaires, to examine the correlations between institutional operational and environmental characteristics and the utilization of primary care services.

The review showed that primary care service utilization is influenced by four categories of factors: supply-side, demand-side, health system, and social environment. The structural equation modeling analysis showed that the model had an explanatory power (R²) of 0.489 and a predictive relevance (Q²) of 0.158. Healthcare service capacity (β=0.471, P<0.001), public health service quality (β=0.266, P=0.037), residents' health literacy (β=0.328, P<0.001), residents' health status (β=0.187, P=0.041), and geographical accessibility of primary care services (β=0.270, P=0.003) were significantly positively correlated with the utilization of primary care services, while participation in a regional medical alliance was significantly negatively correlated (β=-0.468, P=0.023).

To promote primary care utilization, rational resource allocation and improved geographical accessibility should form the foundation. Service delivery must prioritize strengthening clinical capacity for managing common diseases and advance the integration of medical and preventive care. The development of medical alliances requires the establishment of mechanisms for shared benefits and risks across institutional levels to promote the utilization of primary healthcare services. Concurrently, continuous efforts are needed to elevate residents' health literacy and overall health status.

With the growing public awareness of health, residents' demand for medical and health services has increased dramatically, which in turn raises higher requirements for the service capacity of primary healthcare institutions. Strengthening the deployment of general practice talents in primary health facilities serves as an effective way to meet the basic health needs of residents.

Based on the iceberg model, this study analyzes the current status and interrelationship between the explicit and implicit competencies of primary care doctors in China, and identifies existing problems.

In August 2020, a multistage stratified cluster sampling method combined with typical sampling was adopted. First, the country was divided into eastern, central, and western regions according to the gradient distribution of socioeconomic development levels. Sample provinces and prefecture-level cities were selected from each region, and one district and one county (or county-level city) were chosen from each sample city as urban and rural survey sites. An online questionnaire survey was conducted among 8 537 primary care doctors. Differences in explicit and implicit competency levels between urban and rural areas, as well as across the eastern, central, and western regions, were compared. A negative binomial regression model was used to analyze the association between implicit and explicit competency levels.

A total of 8 469 valid questionnaires were collected, yielding an effective response rate of 99.2%. Among the respondents, 2 863 (33.8%) were urban primary care doctors, and 5 606 (66.2%) were rural ones. In terms of regional distribution, 2 953 (34.9%) were from the eastern region, 3 200 (37.8%) from the central region, and 2 316 (27.3%) from the western region. Regarding explicit competencies, five areas with the lowest proficiency levels among primary care doctors include use of simple medical devices (4 589/8 469, 54.2%), medical coordination (4 800/8 469, 56.7%), community rehabilitation guidance (5 166/8 469, 61.0%), traditional Chinese medicine service capacity (5 613/8 469, 66.3%), and diagnosis and treatment of common diseases (6 497/8 469, 76.7%). In terms of implicit competencies, 8 167 out of 8 469 physicians (96.4%) possessed humanistic literacy, and 5 768 (68.1%) possessed learning ability. Rural primary care doctors showed higher proficiency rates in most health service competencies than their urban counterparts (P<0.05). The overall competency level of physicians in the western region was relatively low. Furthermore, implicit competencies (humanistic literacy and learning ability) were significantly and positively associated with the comprehensive level of explicit competencies (P<0.001).

The overall level of health service competencies among primary care doctors in China is not high and exhibits regional disparities. Notable weaknesses exist in medical services and learning capacity. Implicit competency is found to be a potential key factor in enhancing the comprehensive level of explicit competency. Therefore, it is recommended that the government strengthen the construction of the primary care workforce in the western region, promote the sharing and flow of medical resources in rural areas, accumulate practical experience, provide targeted skills training, and simultaneously focus on cultivating the intrinsic qualities of primary care doctors, thus improving the overall service capacity.

People with dementia typically require ongoing care and comprehensive management following diagnosis. However, current long-term management strategies exhibit significant shortcomings, and the importance of family caregivers in their long-term care is often overlooked.

This study aims to develop a post-diagnostic management program tailored to the community context in Beijing, encompassing both patients with dementia and their family caregivers.

The research team constructed a draft of the management program using literature analysis and stakeholder interviews, and conducted an expert meeting in June 2025 to validate the draft. A total of 10 experts were invited to attend the meeting, and their basic information and authority levels were collected via the meeting invitation letter. Within three days after the meeting, the modified management program was sent back to the experts for verification, and they were asked to rate the importance of each item.

The expert authority coefficient was 0.86. The mean importance scores for all items ranged from 4.3 to 5.0, with coefficients of variation ranging from 0 to 0.22. The Kendall's coefficient of concordance for the importance scores of all items were 0.140 (P<0.05). The final program comprises five domains: follow-up assessment, medication management, non-pharmacological interventions, management of coexisting health problems, and caregiver support, as well as the corresponding division of responsibilities, and the corresponding management process has been formulated.

The program is scientifically sound, reliable, comprehensive, and considers practical implementation within primary care settings. It provides a feasible and evidence-informed framework for care of people with dementia and their caregivers in Beijing.

The assessment of work motivation among community health service providers is crucial for improving service quality. However, there is still a lack of tools to evaluate their work motivation, and a corresponding scale urgently needs to be developed.

To develop an assessment tool for the work motivation of community health service providers in order to boost their enthusiasm and proactivity at work.

Based on grounded theory, an interview outline was constructed using a literature review. From February to July 2022, in-depth interviews were conducted with personnel from community health service centers (n=40) in Heilongjiang, Hubei, Gansu, and Guangdong provinces, selected through theoretical sampling. Grounded theory was used to extract concepts and categories to form an initial scale, which, after expert review, resulted in 42 items. From August to December 2022, questionnaires were distributed online in two phases, yielding two independent samples for exploratory factor analysis (n=314) and confirmatory factor analysis (n=327). SPSS 25.0 and AMOS 17.0 were used for reliability and validity testing, assessing the scale's internal consistency, structural validity, and model fit.

A total of 800 questionnaires were distributed, and 641 valid responses were collected, with an overall effective response rate of 80.1%. The final work motivation scale for community health service providers consisted of six dimensions, including compensation and benefits, job content, work climate, working environment, career development, and work support, with a total of 29 items. The Cronbach's α coefficient for the total scale was 0.966, and the Cronbach's α coefficients for the six dimensions were 0.864, 0.878, 0.937, 0.934, 0.940, and 0.902, respectively.

The work motivation scale for community health service providers developed in this study demonstrates good reliability and validity in measuring their work motivation. It provides a measurement tool for in-depth investigation of work motivation among community health service providers and offers a reference for organizations to assess and improve employee incentive strategies.

Building a strong and healthy nation through grassroots public health services has been established as a fundamental national strategy in China. Enhancing the job performance of community health service personnel is therefore of critical importance.

This study aimed to analyze the driving factors and improvement pathways for the job performance of community health service personnel, providing insights for strengthening the capacity of primary health services.

A questionnaire survey was conducted from July to September 2023 using purposive sampling. Participants included 4 000 community health service personnel from northern (Heilongjiang Province), central (Hubei Province), western (Gansu Province), and southern (Guangdong Province) China. The questionnaire comprised the following sections: a General Information Questionnaire, Job Motivation Measurement Scale, Job Content Questionnaire, the Minnesota Satisfaction Questionnaire, the Social Support Rating Scale, the WHO-5 Well-being Index, and Job Performance Measurement Scale. Data were analyzed using fuzzy-set qualitative comparative analysis (fsQCA) .

A total of 3 854 valid questionnaires were collected, with an effective response rate of 98.2%. The fsQCA results indicated that no single factor constituted a necessary condition for high job performance. Five distinct causal configurations were found to enhance job performance, with an overall solution consistency of 0.933 5 (exceeding the 0.800 0 threshold), indicating strong explanatory power for the model. Work climate motivation, work environment motivation, and job support motivation emerged as core conditions across solutions. Compensation and benefits motivation, job satisfaction, and social support played important roles in specific pathways. Job content motivation, career development motivation, and occupational stress acted as peripheral conditions in certain configurations.

The three motivational factors of work environment motivation, work climate motivation and job support motivation are the core influencing factors to enhance the job performance of community health service workers. Job performance should be improved by optimising and improving the working environment, creating a good working atmosphere and strengthening the job support system.

At present, community health service personnel in China are facing many practical problems, which seriously affect their work enthusiasm and motivation. At the same time, the research on the relationship between work motivation and work performance of community health service personnel is still in its infancy, and there is no systematic research.

To identify potential subgroups of job performance among community health service personnel using a person-centered approach and to examine the predictive effect of work motivation on different job performance subgroups.

This study was conducted from July to September 2023, surveying 50 randomly selected community health centers or service stations in Heilongjiang, Hubei, Gansu, and Guangdong provinces. Within each community service center or station, 20 staff members were randomly selected to complete work motivation and work performance scales. A total of 4 000 staff members were surveyed, with 3 925 questionnaires returned and 3 854 valid questionnaires, resulting in an effective response rate of 98.2%. Latent profile analysis was used to determine the latent classification of community health service personnel's work performance. Multivariate linear regression analysis was employed to assess the relationship between different work performance subcategories and work motivation, while controlling for demographic variables such as gender and age.

The latent profile analysis (LPA) identified three distinct classes of job performance among community health service personnel, namely low, moderate, and high job performance groups, accounting for 14.71%, 46.16%, and 39.13% of the sample, respectively. The three-class model demonstrated good classification quality, with average posterior probabilities ranging from 93.8% to 96.6% across classes. Significant differences were observed among the three performance classes in task performance, contextual (relational) performance, and learning performance scores (all P<0.001). The low-, moderate-, and high-performance groups also differed significantly with respect to age, marital status, educational attainment, years of work experience, professional title, employment status, and average monthly income (all P<0.001). Multiple linear regression analyses indicated that, after controlling for relevant demographic characteristics, work motivation was a significant positive predictor of job performance in the low-, moderate-, and high-performance groups (β=0.264, 0.207, and 0.340, respectively; all P<0.001).

The work motivation of community health service personnel is effectively improved through corresponding incentive measures, which will directly promote the improvement and improvement of their work performance.

The training of rural order-oriented medical students is an important initiative to alleviate the shortage of medical human resources in rural areas. As of October 2023, three batches of order-oriented medical graduates have completed their required service obligations. However, there is still a lack of systematic research and definitive conclusions regarding their career development and whether they will continue to serve in rural areas after fulfilling their service commitments.

Based on eight years of panel data from a cohort of rural order-oriented medical students, this study aims to analyze their early career development characteristics and identify key factors influencing their retention in primary healthcare institutions. The findings are intended to provide policy recommendations for the training and management of order-oriented medical graduates in China.

Since 2010, a dynamic follow-up cohort has been established, involving order-oriented medical graduates from Qinghai University, Guangxi Medical University, Jiujiang University, and Gannan Medical University. This study utilized data from 2 041 graduates from the 2015-2019 cohorts, collected through annual online surveys conducted over eight years. The surveys tracked their career development, including professional title promotion, administrative role acquisition, average monthly income, and the proportion of performance-based pay. Descriptive analysis was used to summarize the characteristics of career development, while Logistic regression models were employed to explore factors influencing retention in primary healthcare institutions after the contractual period.

Among the 2 041 order-oriented medical graduates included, 1 068 (52.3%) were male and 973 (47.7%) were female. By the eighth year after graduation, 92.0% (69/75) of graduates had obtained the title of attending physician, and 24.0% (18/75) held administrative positions. The median monthly income was 5 214.0 yuan, with median performance-based pay accounting for 42.5% of the total. As of December 2023, with 232 graduates remaining in their positions after contract completion, resulting in a 37.5% retention rate in primary healthcare settings. Among the 386 graduates who left primary healthcare settings, 136 (35.2%) transitioned to hospitals above the county level, representing the largest proportion, followed by 107 (27.7%) moving to county-level hospitals, and 29.0 (7.5%) pursuing graduate studies. Multivariate Logistic regression analysis revealed that contract placement in home county/city (OR=2.74, 95%CI=1.57-4.78, P=0.001) and holding administrative positions (OR=2.02, 95%CI=1.14-3.59, P=0.016) were significant facilitators of retention in primary healthcare settings post-contract completion among order-oriented medical graduates. Conversely, passing the national medical licensing exam within two years of graduation (OR=0.37, 95%CI=0.15-0.94, P=0.036) emerged as a barrier to retention.

Order-oriented medical graduates show rapid career progression, with over half choosing to remain in county-level or lower primary healthcare institutions after fulfilling their contracts. This strengthens human resource capacity and improves care quality in primary healthcare settings. Notably, order-oriented medical graduates who obtained physician qualification within two years post-graduation exhibited significantly higher occupational mobility in primary healthcare settings.

Currently, the incidence of breast cancer remains high. The "Cancer Screening Program in Urban China" program, initiated by the National Health Commission, aims to promote early diagnosis and treatment among high-risk populations. However, survey results indicate that the current status of screening among high-risk women is still suboptimal.

To explore the barriers and facilitators of screening implementation among the high-risk population for breast cancer, and to provide a basis for formulating targeted implementation strategies.

From September to November 2024, six community health service centers and the sole designated screening hospital in Nanjing, Jiangsu Province, were selected as study sites using convenience sampling. Semi-structured interviews were conducted with medical staff involved in screening work and high-risk women for breast cancer, following the principle of maximum variation sampling. Researchers constructed interview outlines based on the five dimensions and 48 constructs of the Consolidated Framework for Implementation Research (CFIR). And the interview data were analyzed using the content analysis method combined with the top-down approach.

A total of 16 high-risk women for breast cancer, 12 medical personnel from community health service centers, and 10 medical personnel from the designated screening hospital were interviewed. At the screening provider level, barriers included long waiting times for examination and report issuance, limited capacity in interpreting risk assessment results, insufficient information transmission to screening demanders, and unmet human resource and time needs of providers. Facilitators included smooth internal collaboration and adequate reflective work. At the screening recipient level, barriers included digital exclusion, limited information accessibility, insufficient capacity, and weak motivation. Facilitators included perceived risk and benefits, and adequate social support.

There are multi-level barriers and facilitators in screening implementation for high-risk populations of breast cancer. Future efforts should focus on developing targeted implementation strategies to promote the smooth conduct of breast cancer screening, while also providing insights for the overall advancement of the "Cancer Screening Program in Urban China" program.

The number of persons living with Alzheimer's disease (AD) will increase dramatically in China. Community physicians play an increasingly critical role in its early screening and management. However, the structure and applicability of the Alzheimer's Disease Knowledge Scale (ADKS) within this population remain unclear.

To explore the factor structure of ADKS in Chinese community physicians.

A cross-sectional online survey was conducted from December 1, 2021, to January 7, 2022, using convenience sampling. Demographic information and ADKS scores were collected from participating community physicians. Exploratory factor analysis (EFA) using principal component analysis with varimax rotation was performed to identify the underlying factor structure. Confirmatory factor analysis (CFA) was subsequently carried out in R 4.3.0 with the Lavaan package to evaluate model fit, and the final model was visualized using semPlot.

A total of 5 313 persons viewed at the online survey, with 1 288 community physicians completing the questionnaire. Among the 1 288 participants, 389 (30.2%) were male and 899 (69.8%) were female, with an average age of (38.5±9.2) years. A total of 419 (32.5%) participants held below-bachelor qualifications, while 869 (67.5%) had a bachelor's degree or higher. EFA extracted eight factors with eigenvalues of 2.58, 1.73, 3.22, 1.11, 1.43, 1.37, 1.64, and 1.35, collectively explaining 48.13% of the total variance. These factors were labeled as knowledge about disease causes, symptoms, patient experience, comorbidity, differential diagnosis, treatment and rehabilitation, care needs, and life impact. CFA indicated acceptable model fit (GFI=0.929, χ²/df=3.71, RMSEA =0.046). All items showed factor loadings above 0.3, and moderate correlations were observed among the eight factors.

The ADKS demonstrated a clear and clinically interpretable 8-factor structure when applied to community physicians. This model comprehensively covers key domains of AD knowledge from a clinical practice perspective, supporting the use of the scale as a reliable instrument for systematically assessing AD-related knowledge in community physicians.

Functional fitness represents a composite measure of multi-dimension of physical capacity. However, it remains unclear whether the multiple dimensions of functional fitness exhibit consistent patterns or heterogeneous characteristics across different elderly individuals., whether distinct population subgroups demonstrate similar or divergent categorical traits.

To analyze the latent categorical characteristics of functional fitness levels among community-dwelling older adults and identify their associated influencing factors.

From March to November 2021, multi-stage stratified sampling was conducted in Suzhou to collect senior fitness test (SFT) data from 1 122 community-dwelling older adults. Integrating data on general demographic characteristics and health status indicators, latent profile analysis (LPA) was employed to identify latent categories of functional fitness, followed by multivariate Logistic regression to explore influencing factors.

Among the 1 122 participants, 458 were male (40.8%) and 664 were female (59.2%), with a mean age of (69.34±6.54) years. LPA supported a three-category model, classifying the participants into high (n=431, 38.4%), moderate (n=582, 51.9%), and low (n=109, 9.7%) functional fitness groups respectively. All test indicators showed parallel trends across the three groups, suggesting that the structure of functional fitness is characterized by overall consistency rather than multi-dimensional heterogeneity. Notably, the timed up and go test (TUGT) exhibited the largest difference among the three groups, while inter-group differences in flexibility indicators were relatively small. Multivariate Logistic regression results revealed that, compared with the high functional fitness group: older adults with advanced age (OR=1.298), male sex (OR=2.399), low educational level (primary school or below) (OR=6.748, 19.052), and chronic diseases (OR=3.475) had a significantly higher risk having low functional fitness (P<0.05); older adults with advanced age (OR=1.109), male sex (OR=1.448), low educational attainment (OR=1.596, 2.204, 2.465), chronic diseases (OR=1.588), and self-paid medical expenses (OR=2.200) were more likely to be in the moderate functional fitness group (P<0.05). The participants with low educational level had the highest risk of having low physical fitness level (OR=6.748-19.052).

The multi-dimensional functional fitness levels of community-dwelling older adults can be categorized into high, moderate, and low tiers based on overall performance. TUGT is recommended as a preferred indicator for screening functional fitness in this population. Targeted health education, early screening, and functional fitness interventions should be prioritized for older adults with advanced age, male sex, chronic diseases, and particularly those with low educational attainment.

Metabolic associated fatty liver disease (MAFLD) and hypertension are prevalent chronic conditions in older adults, with accumulating evidence linking both to metabolic dysfunction. The cardiometabolic index (CMI) is a composite parameter that evaluates visceral adipose distribution and metabolic status, yet its association with incident hypertension among elderly MAFLD patients remains to be elucidated.

To investigate the association of CMI with incident hypertension in elderly patients with MAFLD, and to evaluate the predictive value of CMI for hypertension development in this population.

Elderly non-hypertensive patients diagnosed with MAFLD during health check-ups at Yingzhong and Zijin Community Health Centers affiliated with Changzhi People's Hospital between January and December 2021 were enrolled. Follow-up investigations were conducted from January 2022 to December 2024, and 426 elderly MAFLD patients who completed follow-up were ultimately included in this study. Baseline characteristics and relevant clinical data were collected, and CMI was calculated. Participants were stratified into three tertile groups based on CMI: T1 (CMI<0.467, n=141), T2 (0.467≤CMI<0.758, n=142), and T3 (CMI≥0.758, n=143). They were further categorized into non-hypertension (n=355) and hypertension (n=71) groups based on incident hypertension during follow-up. Kaplan-Meier survival analysis was performed to estimate the cumulative incidence of hypertension across CMI groups, with between-group differences assessed using the Log-rank test. Multivariate Cox proportional hazards regression and restricted cubic spline (RCS) analysis were used to evaluate the association between CMI and incident hypertension. Sex-stratified analysis and sensitivity analysis were performed to examine the robustness of this association.Furthermore, time-dependent receiver operating characteristic (ROC) curves were constructed to assess the predictive performance of CMI for hypertension development in elderly MAFLD patients.

During a median follow-up period of 36.00 (27.75, 38.00) months, 71 patients (16.7%) developed incident hypertension. There were statistically significant differences between the non-hypertension and hypertension groups in age, waist circumference, BMI, CMI, TC, TG, LDL-C, and HDL-C (P<0.05). Log-rank test demonstrated that the cumulative incidence of hypertension increased significantly across T1 to T3 groups with elevated CMI levels (χ²=26.468, P<0.001). Multivariate Cox proportional hazards regression analysis revealed that when analyzed as a continuous variable, CMI was significantly and positively associated with incident hypertension in elderly MAFLD patients after adjusting for relevant confounders (HR=1.927, 95%CI=1.381-2.689, P<0.001). When CMI was analyzed as a categorical variable with the T1 group as the reference, the risk of developing hypertension was significantly higher in the T3 group after adjusting for confounders (HR=5.453, 95%CI=2.268-13.109, P<0.001). Interaction analysis showed no statistically significant interaction between CMI and gender (P_interaction=0.557). Sensitivity analysis demonstrated that the association between CMI and hypertension remained significant after excluding participants with MAFLD remission. RCS analysis showed a non-linear dose-response relationship between CMI and the risk of hypertension in elderly MAFLD patients (P_{non-linearity}=0.005). The risk of hypertension exhibited a continuous upward trend with increasing CMI levels, which plateaued when CMI exceeded 1.185. Time-dependent ROC curve analysis showed that CMI demonstrated optimal predictive performance for hypertension at 24 months of follow-up, with an AUC of 0.722 (95%CI=0.618-0.827). Over time, the AUC decreased to 0.648 (95%CI=0.537-0.759) and 0.652 (95%CI=0.542-0.763) at 30 and 36 months, respectively.

CMI is significantly positively associated with incident hypertension in elderly MAFLD patients, and its measurement can be used to assess the short-term (24-month) risk of hypertension development in this population.

With the increasing burden of chronic diseases, promoting health behaviors among residents has become a key public health priority. Although health literacy and awareness of health management have gradually improved, a significant gap remains between knowledge and actual behavioral change. The Behavior Change Wheel (BCW) theory, as a systematic framework for identifying behavioral determinants and designing targeted interventions, has been widely applied internationally. However, empirical research applying this model to the health behaviors of community residents in China remains limited.

To assess the current status of health behaviors among community residents in Shanghai, identify their influencing factors, and propose optimization strategies to improve health behaviors based on the BCW framework.

From February to May 2023, a stratified sampling method was employed. Based on the permanent population and the number of community health service centers (CHSCs) in each administrative district of Shanghai, 1 to 4 CHSCs were randomly selected from each district, resulting in a total of 28 centers. At each site, 50 community residents attending outpatient services were invited to complete a structured questionnaire assessing their health behaviors. The questionnaire was developed based on the BCW framework. Health literacy was assessed using the Health Literacy Management Scale (HeLMS) , while health management behaviors, health management beliefs, and participation in health management programs were evaluated using self-designed items. To control for confounding, propensity score matching (PSM) based on general individual characteristics was applied to balance baseline variables, and key influencing factors of health behaviors were subsequently analyzed.

A total of 1 436 community residents were included in the study. Among the four dimensions evaluated, the highest score rate was observed in health management beliefs (mean score: 2.58±0.63; score rate: 86.0%) , followed by health literacy (mean score: 95.40±16.28; score rate: 79.5%) . In contrast, health management behaviors showed a lower score (mean score: 4.24±1.73; score rate: 60.6%), and participation in health management programs was the lowest (mean score: 4.00±2.67; score rate: 33.3%) . Based on health management behavior scores, residents scoring ≥5 were categorized as the good behavior group (n=412) , and those scoring ≤4 as the poor behavior group (n=1 024) . PCM (1∶1) was applied to control for potential confounding variables including gender, age, education level, residential area, source of medical payment, monthly income, and marital/childbearing status. After matching, significant differences remained between the two groups in health literacy and health management belief scores (P<0.05) . Targeted optimization strategies were subsequently proposed based on the BCW framework: improving residents' health literacy and health management beliefs.

Community residents in Shanghai demonstrated relatively strong health management beliefs and health literacy. However, the execution of health-related behaviors and participation in health management programs remain suboptimal. Guided by the BCW framework, this study proposed a set of multi-dimensional intervention strategies encompassing health education, capacity building, incentive mechanisms, and environmental support. These strategies target core behavioral determinants such as capability and motivation, aiming to enhance residents' health behavior performance and provide theoretical and practical guidance for systematic community health management interventions.

Primary health institutions serve as the frontline defense against hypertension and diabetes. Their capabilities are critical to China's ability to effectively prevent and control these two chronic conditions.

To analyze the current situation of health management and treatment services provided by community hospitals in China for patients with hypertension and diabetes to identify problems and make suggestions.

The "Quality Service Grassroots Activities Application System" collected information on hypertension and diabetes prevention and treatment capacity and service provision in 3 718 community hospitals. Descriptive statistical analysis and multiple linear regression analysis were carried out based on Stata15.0.

There were statistically significant differences in the allocation of electrocardiogram machines and peripheral blood glucose meters among primary health institutions across different regions (P<0.001). Similarly, significant regional disparities were observed in the availability of essential antihypertensive and hypoglycemic medications (P<0.001). The annual number of hypertension and diabetes diagnoses and treatments per institution also varied significantly by region (P<0.001). Additionally, significant differences were found in the renewal rates of hypertensive and diabetic patients across regions(P<0.001). Furthermore, significant variations were observed among regions in the standardized management rates of hypertensive and diabetic patients, as well as in blood pressure and blood glucose control rates (P<0.001). Multiple linear regression analysis revealed that factors such as region, institution type, the number of essential antihypertensive drugs available, the number of registered general practitioners, the proportion of medical income to total income, the proportion of medical insurance income to medical income, and the contract renewal rate significantly influenced the annual number of diagnosed and treated hypertensive patients (P<0.05). Similarly, region, institution type, the number of practicing (assistant) physicians, the proportion of medical income to total income, and the renewal rate were found to affect the standardized management rate of hypertensive patients (P<0.05). Moreover, region, institution type, the number of electrocardiogram machines, the number of practicing (assistant) physicians, and the proportion of medical income to total income had statistically significant effects on blood pressure control.

The hardware conditions of community hospitals in the western region are better, but the medical service capacity is not as good as that in the east, and the soft power still needs to be improved. The ECG machine is the best, but the peripheral blood glucose meter, drug equipment, diagnosis and treatment times and other indicators that reflect the ability of medical services are not as good as those in the east. The integration of medical prevention of hypertension and diabetes still needs to be implemented, and public health indicators such as standardized management rate and blood pressure and blood glucose control rate are "decoupled" from the medical service capacity of community hospitals, and the indicators related to medical services and public health services are "inverted", with the former being high in the east and the latter in the west, and the quality and service connotation of public health data need to be improved.

The integration of medical and preventive care has emerged as an essential strategy to address the increasing healthcare demands of the population and effectively enhance public health outcomes. Primary care doctors play a pivotal role in implementing the integration of medical and preventive services, making the assessment of their competencies essential for advancing this integration. However, the indicators for evaluating the primary care doctors' service capabilities in the integration of medical and preventive care have not yet been comprehensively explored and established.

This study aims to develop an indicator system for assessing the service capability of primary care doctors in the integration of medical and preventive care, providing a reference framework for evaluating and improving their competencies.

From June to August 2023, purposive sampling was employed to select consulting experts specializing in theoretical research, practical implementation, and administrative management related to the integration of medical and preventive services. A two-round Delphi method was conducted following informed consent, with questionnaires distributed via WeChat or email. The proposed competency evaluation framework was discussed, refined, and finalized. Analytic hierarchy process (AHP) was subsequently utilized to determine the weight of each indicator.

The response rates for the first and second rounds of consultation were 96.7% and 100.0%, respectively. The expert authority coefficient was 0.885. Kendall's coefficients of concordance for the two rounds were 0.181 (P<0.001) and 0.371 (P<0.001) , indicating significant consensus among experts. The finalized framework comprises three primary indicators, nine secondary indicators, and 26 tertiary indicators.

The constructed indicator system is scientifically rigorous and reliable, identifying the core elements required to assess the service capabilities of primary care doctors in the integration of medical and preventive care. This framework provides a valuable reference for accurately evaluating and enhancing the capacity of primary care doctors to integrate medical and preventive services.

Primary care doctors are the main providers of medical and preventive services. Understanding their current service capacity is crucial for guiding and optimizing relevant practices. However, systematic evaluations and comprehensive analyses of primary care doctors' capabilities to integrate medicine and prevention services remain limited.

This study aimed to assess the current capacity of primary care doctors in Shandong Province for delivering integrated medical and preventive services and to analyze the factors influencing this capacity, providing a reference for improvement strategies.

In August 2023, a multi-stage stratified random sampling method was used to conduct a questionnaire survey of 477 rural and community physicians in Shandong Province. The questionnaire included demographic characteristics and an evaluation of integrated service capacity. Scores for overall and dimension-specific capacities were categorized into high (≥80%) , medium (≥60% and <80%) , and low (<60%) groups. Ordinal Logistic regression was used to identify factors influencing integrated service capacity.

Among the respondents, 273 doctors (57.2%) demonstrated high overall capacity for integrated services. The number of doctors in the low-score group for professional knowledge and skills and for comprehensive service ability were 67 (14.0%) and 40 (8.4%) , respectively. Higher capacity was associated with having a bachelor's degree or above (OR=3.470, 95%CI=1.802-6.680) , awareness of policies on medical and preventive integration (OR=4.211, 95%CI=2.742-6.468) , perceived organizational emphasis on integration services (OR=2.36, 95%CI=1.347-4.138), and participation in at least two training sessions on integration (OR=2.557, 95%CI=1.228-5.324) (P<0.05) .

The overall capacity of primary care physicians in Shandong Province to deliver integrated medical and preventive services is satisfactory. However, there is a need to strengthen professional knowledge, skills, and comprehensive service abilities. Efforts should focus on raising awareness of medical-preventive integration, implementing targeted training programs, and establishing innovative assessment and incentive mechanisms to further enhance the capacity of primary care doctors in this area.

Community health education is widely recognized as an effective health promotion strategy with low costs and high benefits. Nevertheless, existing research on health education needs lacks an analytical framework based on various community types, making it difficult to fully explain the differentiated and diverse health education needs under the complex population composition of urban communities.

To investigate the health education needs of residents in different types of communities and whether there are significant differences, thereby providing support for community health medical science popularization efforts.

This study was conducted in Hangzhou from April to June 2024, employing a mixed-methods research approach. The qualitative research phase involved purposive sampling to select open-ended interviews from heterogeneous, transformed, homogeneous and system-based community types, aiming to understand residents' perceptions of health education needs. A total of 14 residents were included, along with 21 policy texts to understand the knowledge system residents should possess in health education. Nvivo 12.0 software was utilized to perform a three-level coding of the text data, categorizing health education content needs based on resident perspectives and policy document analysis. Based on the identified themes, a questionnaire was designed. In the quantitative research phase, residents from four community types were selected as survey subjects, and the Likert 5-point scale was used to quantify the needs for health education content. Then, descriptive statistics, nonparametric tests, and multivariate Logistic regression models were employed to investigate the degree of these needs and differences in health education content among different community types.

The qualitative research synthesized eight primary themes of health education: major disease prevention and control, healthy lifestyles, maternal and child health, mental health, environmental health, medication health, emergency and safety, and sex education, encompassing 23 specific educational topics. A total of 299 valid questionnaires were collected in the quantitative research, with a response rate of 94.03%. The results highlighted that the highest need is first aid knowledge [5 (4, 5)], followed by cancer prevention and treatment [4 (4, 5)]. Kruskal-Wallis H test results indicated that residents' educational level, income level, and different types of communities had a significant impact on the health education needs (P<0.05). Further multivariate Logistic regression analysis showed that different educational levels significantly influenced the needs for diabetes prevention (P<0.05) and life safety education, different income levels significantly affected the needs for cardiovascular and cerebrovascular disease prevention and infectious disease prevention (P<0.05), and different types of communities had significant differences in the needs for natural environmental pollution prevention, infectious disease prevention, diabetes prevention, cardiovascular and cerebrovascular disease prevention, first aid knowledge, and life safety education (P<0.05).

Residents' perceptions of community health education needs are diverse, influenced by multiple factors such as educational level, income level, and community health resources. Different types of communities should closely align with residents' perceptions of health education needs for precise targeting, while ensuring the effectiveness and equity of educational resources.

Early detection of atrial fibrillation is important for timely initiation of anticoagulation. Hand-held single-lead electrocardiogram devices are recommended for atrial fibrillation screening, but limited evidence is available for its use in Chinese population.

To investigate the diagnostic performance of a hand-held single-lead ECG device (MyDiagnostick) in atrial fibrillation screening and its potential in the opportunistic screening of atrial fibrillation in the community.

Diagnostic performance of the MyDiagnostick was examined among 296 hospitalized patients with atrial fibrillation, using 12-lead electrocardiograms as the gold standard. Sensitivity, specificity, and kappa value were calculated. A single-time point opportunistic screening for atrial fibrillation was conducted using the MyDiagnostick in 1 577 community dwellings. Detection rate of atrial fibrillation was calculated.

The sensitivity and specificity of the MyDiagnostick for diagnosing atrial fibrillation were 0.945 and 0.947, respectively. The Kappa value was 0.892. Among 1 577 community dwellings, 60 cases of atrial fibrillation were detected (3.80%), among which 33 cases were new-onset atrial fibrillation (2.13%). Male gender (OR=2.553, 95%CI=1.504-4.333) and a history of stroke/transient ischemic attack/thrombosis (OR=2.840, 95%CI=1.330-6.064) were risk factors for atrial fibrillation in the community population.

The handheld single-lead electrocardiogram device of MyDiagnostick has a high accuracy in atrial fibrillation diagnosis and shows the potential to be used in atrial fibrillation screening in the community.

Pre-frailty represents a transitional risk status between health and frailty. Early identification and intervention during this stage can delay or even reverse the frailty development. However, there is a lack of standardized pre-frailty assessment tool tailored for community-dwelling older adults.

To compare the effectiveness of Fried's Frailty Phenotype (FP) and FRAIL Scale in assessing pre-frailty among community-dwelling older adults undergoing health examinations, thereby providing evidence for the selection of appropriate assessment tools.

A cross-sectional study was conducted using convenience sampling to recruit older adults aged 60 years and above undergoing health examinations at five community health centres in Beijing from December 1, 2024, to March 20, 2025. Demographic data were collected, and frailty status was assessed using the FP and the FRAIL scale. Activities of daily living (ADL) were evaluated using the Modified Barthel Index (MBI), and quality of life was assessed using the 36-Item Short Form Survey (SF-36). Spearman rank correlation and Kappa statistics were used to analyze the consistency and correlation between the two scales. Using MBI and SF-36 scores as validity criteria, the validity of both tools was evaluated via Spearman rank correlation, receiver operating characteristic (ROC) curve analysis, and Bayes discriminant analysis.

The prevalence of pre-frailty detected by the FP was higher than that by the FRAIL scale (36.3% vs. 25.3%). The two scales showed a moderate positive correlation (r_s=0.713, P<0.001) and moderate agreement (Kappa=0.606, P<0.001), with consistent classification in 81.2% of participants. Frailty severity assessed by both scales was positively correlated with ADL decline and negatively correlated with SF-36 total, Physical Component Summary (PCS), and Mental Component Summary (MCS) scores. Both scales demonstrated associations with ADL decline, with ROC curve areas under the curve (AUC) of 0.736 and 0.735, respectively (P<0.001). Bayes discriminant analysis indicated that the cross-validation accuracy for ADL decline was higher for the FP (86.3%) than the FRAIL scale (85.1%). ROC analysis revealed that the FP had higher sensitivity (74.0% vs. 64.4%), while the FRAIL scale had superior specificity (80.1% vs. 65.8%) for predicting ADL decline. The optimal cutoff value for both scales in predicting ADL decline was 0.5.

The FP and FRAIL scale demonstrate moderate correlation and consistency, and both are negatively associated with quality of life. Both tools possess moderate validity in verifying ADL decline and are suitable for assessing pre-frailty in community-dwelling older adults. The FP, with its higher sensitivity and inclusion of objective indicators, is more suitable for pre-frailty screening in health examination settings aiming for "early detection and intervention". Conversely, the FRAIL scale, due to its simplicity and high specificity, serves as a viable alternative for rapidly identifying high-risk individuals in resource-limited settings. These findings suggest practical value in integrating frailty screening into routine community health examinations and initiating interventions based on a 0.5 cutoff value.

The actual capacity of community health service institutions in Shanghai for the diagnosis and treatment of depressive disorders has not been systematically evaluated, and there is a lack of empirical research on the urban-suburban differences.

To assess the current capacity of community health service institutions in Shanghai in the screening, diagnosis, treatment and management of depressive disorders, investigate the knowledge mastery and practical difficulties of community general practitioners, focus on analyzing urban-suburban differences, and provide evidence for optimizing the primary mental health service system.

A cross-sectional questionnaire survey was conducted among 244 community health service centers across 16 administrative districts in Shanghai from July to August 2025. A total of 2 222 valid questionnaires were collected from institutional managers and general practitioners (244 and 1 978 questionnaires from institutions and doctors, respectively). The institutional survey mainly covered: screening tools for depressive disorders, relevant laboratory/examination items, drug allocation, psychotherapy, related management, and the establishment of specialized clinics in medical institutions. The survey for community general practitioners mainly focused on: knowledge of diagnosis and treatment of depressive disorders, cognition of screening tools for depressive disorders, cognition of differential diagnosis between depressive disorders and bipolar disorder, cognition of follow-up for depressive disorders, and difficulties in the diagnosis, treatment and management of depressive disorders.

Among the 244 community health service institutions in 16 districts of Shanghai, 80 (32.8%) and 164 (67.2%) subjects were urban and suburban institutions, respectively; among 1 978 general practitioners, 505 (25.5%) and 1 473 (74.5%) subjects were urban and suburban practitioners, respectively. Regarding screening tools for depressive disorders, the allocation rate of Self-rating Depression Scale (SDS), Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) in urban institutions was 47.5%, 43.8% and 12.5%, respectively, compared with 44.5%, 38.4% and 7.3% in suburban institutions. In terms of examinations, the availability rate of electroencephalography and echocardiography in urban and suburban community health service centers was 17.5% vs 4.3% and 70.0% vs 51.8%, respectively; the proportion of electroencephalography and echocardiography was higher in urban areas than in suburban areas (P<0.05). In terms of therapeutic drugs, the allocation rate of benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) in urban and suburban community health service centers was 95.0% vs 91.5% and 38.8% vs 33.5%, respectively. In terms of specialized clinics, the availability rates of psychosomatic disease clinics and psychological counseling clinics in urban and suburban community health service centers were 17.5% vs 4.3% and 15.0% vs 28.0%, respectively; the rate of psychosomatic disease clinics was higher in urban areas, while the rate of psychological counseling clinics was lower in urban centers than in suburban centers (P<0.05). The main difficulties in the management of depressive disorders in community health service centers included: limited medical resources, limited dedicated managerial staff and time (95.1%), lack of therapeutic drugs and psychotherapy skills (87.7%), and poor patient compliance with distrust in community medical staff (60.2%). The awareness rate of the diagnostic duration of depressive symptoms (minimum duration of depressive symptoms for diagnostic significance) among urban and suburban general practitioners was 52.3% and 57.6%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rates of PHQ-9 and SDS among urban and suburban general practitioners were 64.0% vs 57.8% and 65.9% vs 59.5% respectively, indicating the urban community general practitioners were higher than the suburban community general practitioners (P<0.05). The awareness rates of decreased sleep need, distractibility and inflated self-esteem were 61.2% vs 67.3%, 41.2% vs 49.6% and 57.2% vs 64.3%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rate of monthly follow-up was 73.9% in urban areas and 82.1% in suburban areas, indicating that the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The suburban general practitioners reported the higher rates of difficulties in diagnosis and treatment (including insufficient suicide risk assessment ability, insufficient non-pharmacological treatment ability and insufficient post-treatment efficacy evaluation ability) than the urban general practitioners (P<0.05). In management difficulties, suburban practitioners also reported the higher rates of insufficient health education capacity on depressive disorders, lack of expert guidance in communities, and lack of two-way referral channels with higher-level hospitals (P<0.05).

Community health service institutions in Shanghai, especially those in suburban areas, should strengthen the allocation of screening tools, relevant examinations and medications. It is necessary to improve general practitioners' mastery of depressive disorder knowledge, health education ability and psychotherapy skills. Institutional construction, resource allocation and capacity improvement should be strengthened to promote an integrated management system and enhance the efficiency of primary mental health services.

With the continuous advancement of contracted family doctor services, improving service quality has become increasingly challenging. There is an urgent need for cost-effective, operationally feasible, and readily implementable strategies to enhance service delivery.

To evaluate whether a WeChat-based enhanced service package "developed using existing community resources without additional costs" can improve the efficiency and effectiveness of contracted family doctor services.

From May 29 to June 9, 2023, a total of 131 participants were recruited from a family doctor studio at Kangjian Community Health Service Center in Xuhui District, Shanghai. Participants who had WeChat contact with the family doctor were invited to join a dedicated WeChat service group. The enhanced intervention package was delivered via WeChat for 6 months. Before and after the intervention, data were collected on health management service utilization, physician trust (assessed using the revised Wake Forest Physician Trust Scale), and family doctor service cohesion. Multiple linear regression was employed to identify individual-level factors associated with changes in these outcomes.

(1) Health management service utilization and outcomes: after the intervention, the proportions of participants receiving physician/nurse health follow-ups, health record establishment, integrated specialist consultations, and health education services significantly increased; evaluation scores for all these services also improved (P<0.05). (2) Physician trust: total physician trust scores significantly improved after the intervention (P<0.05); among the 10 items, 9 showed significant improvement (P<0.05), with only the item "The physician's skill level did not meet my expectations" showing no significant change (P>0.05). (3) Family doctor service cohesion: Monthly per capita visits to the family doctor increased from 0.43 to 0.62, and the proportion of visits to family doctors rose from 32.30% to 61.01%, while total monthly outpatient visits to the community health center significantly decreased (P<0.05). Regression analysis revealed that the number of chronic diseases and education level were significantly associated with total physician trust scores (P<0.05), while the number of chronic diseases was the primary predictor of changes in monthly family doctor visits (P<0.05).

The "micro" -integration enhanced medical-preventive services package improved contracted residents' evaluation of family doctor services and ultimately increased both the frequency and proportion of visits to family doctors. This preliminary exploration demonstrates the feasibility of a strategy in which family doctors systematically integrate existing service content and deliver structured services in a visualized and intensified manner through an online platform.

The rapid development of digital technologies such as the Internet of Things (IoT), big data, and artificial intelligence (AI) offers new opportunities for empowering the health management of the elderly in communities. However, the integrated effects, implementation barriers, and health benefits of these technologies require systematic evaluation.

This scoping review aims to systematically summarize the current research status of digital health management platforms in empowering the health management of the elderly in communities, providing a basis for future research, policy-making, and platform optimization.

This study followed the scoping review framework by Arksey & O'Malley, and established inclusion and exclusion criteria based on the PCC (Population-Concept-Context) model. Systematic searches were conducted in CNKI, Wanfang Data, PubMed, and Web of Science databases between May and June 2025 to identify literature related to digital-intelligent health management platforms empowering health services for community-dwelling older adults. The search period was set from June 1, 2015 to June 1, 2025.

A total of 50 relevant literature were retrieved and screened, including 13 Chinese and 37 English publications. The technical architecture of the included platforms generally follows the "perception layer-transmission layer-processing layer-application layer" model. The core functions focus on real-time health monitoring and early warning, multi-source data fusion and intelligent decision-making, personalized intervention, as well as collaborative integration of medical, nursing and care resources. Empirical studies show that it can effectively improve the health behaviors of the elderly, enhance the efficiency of chronic disease management, and optimize the speed of service response.

Digital-intelligent health management platforms demonstrate significant potential in empowering health services for community-dwelling older adults. However, current research is limited by a lack of high-quality empirical evidence. Future efforts should focus on conducting localized, multi-dimensional effectiveness studies in real-world settings.

Traditional Chinese medicine (TCM) plays a preventive healthcare role and is valuable for chronic disease management and active aging. Community health service centers (CHCs) are key places for promoting TCM preventive healthcare services, yet elderly utilization remains unsatisfactory.

To examine the factors influencing the elderly's utilization of TCM preventive healthcare services in CHCs and evaluate their importance.

A face-to-face questionnaire survey was conducted from July to September 2022 using a multi-stage stratified cluster random sampling method in a total of 12 communities of older adults in six cities selected from Zhejiang and Guangxi Provinces. The questionnaire was designed based on an integrated framework of Andersen and Social Cognitive Theory (SCT) dual models, aiming to comprehensively collect data on the utilization of TCM preventive healthcare services and their influencing factors among the elderly. A binary Logistic regression model was used to analyze the factors influencing the utilization of TCM preventive healthcare services used by older adults, and Logistic dominance analysis was applied to determine the importance of these factors.

A total of 2 081 (94.33%) valid questionnaires were retrieved, among them, only 369 (17.73%) indicated that they had participated in TCM preventive healthcare services in the past year, and the frequency of utilization was mainly concentrated in 1-2 times per year [196 cases (53.11%)]. The results of binary Logistic regression model analysis showed that: the educational level in predisposing characteristics, the situation of suffering from chronic diseases and the situation of pain/discomfort in need factors, the score of perceived service environment in enabling resources, as well as the scores of cognitive status and self-control in individual factors are the influencing factors for the utilization of primary-level traditional Chinese medicine preventive and health care services (P<0.05). Further Logistic dominance analysis showed that the weights of the importance of the influencing factors, in descending order, were: individual factors (belief and knowledge, self-regulation) > enabling resources (perceived environment) > predisposing characteristics (educational level) > need factors (chronic disease, pain, or discomfort).

Individual factors play a crucial role in the decision-making process of elderly individuals regarding the use of primary care TCM preventive healthcare services. Enhancing the health literacy and self-control abilities of the elderly, along with improving the TCM service environment in CHCs, is expected to promote the widespread adoption of TCM preventive health services among the elderly population.

Currently, the health management of diabetic patients in the community is still facing many challenges, and it is difficult to effectively improve the glycemic control rate, so exploring the factors affecting glycemic control to delay or reverse the development of complications in diabetic patients is important.

Exploring the characteristics of specific categories of glycemic control in community diabetic patients, the influencing factors, and the association with common complications to provide a scientific basis for the management of community diabetic patients.

A questionnaire survey conducted from March 2023 to April 2024 was used to collect demographic characteristics, health education, diseases, and health management of 417 community diabetes patients in three county-level regions of Qintong Town in Jiangyan District, Taizhou City, Jishi Town in Jingjiang City, and Chenbao Town in Xinghua City. The patients' glycemic control was categorized by potential category analysis, and the prevalence of diabetic complications and their influencing factors under different glycemic control categories were investigated by multiple Logistic regression analysis.

Based on the latent class analysis results, the 417 diabetic patients were categorized into three groups: Class 1: the older-age/low-health-literacy group (n=181, 43.40%); Class 2: the middle-age/moderate-health-literacy group (n=158, 37.89%); and Class 3: the younger-age/high-health-literacy group (n=78, 18.71%). Significant differences were observed among the three groups in the prevalence of hypertension, stroke, and neuropathic complications (P<0.05). Specifically, the older-age/low-health-literacy group and the middle-age/moderate-health-literacy group exhibited higher rates of comorbid hypertension, stroke, and neuropathy compared to the younger-age/high-health-literacy group (all P<0.01). Multiple Logistic regression analysis revealed that, compared to the younger-age/high-health-literacy group, having a junior high school education or above (OR=0.256, 95%CI=0.129-0.510, P<0.001; OR=0.355, 95%CI=0.181-0.696, P=0.003) and implementing more than three blood glucose control measures (OR=0.272, 95%CI=0.148-0.499, P<0.001; OR=0.542, 95%CI=0.298-0.986, P=0.045) were protective factors for blood glucose control in the older-age/low-health-literacy group and the middle-age/moderate-health-literacy group, respectively. Conversely, being unmarried/divorced/widowed (OR=3.303, 95%CI=1.208-9.035, P=0.020) was identified as a risk factor for blood glucose control in the middle-age/moderate-health-literacy group.

Glycemic control of diabetic patients in the Taizhou community has obvious categorical characteristics. The distribution of hypertension, stroke, and neurological complications is different among different potential categories, and the influencing factors are education level, marital status, glycemic control measures, etc. Categorical interventions should be carried out according to the characteristics of the different categories of the population.

The key and difficulty in building a compact county medical community lies in grassroots medical and health institutions. Currently, research on grassroots medical and health institutions under the compact county medical community mainly uses discontinuous time series models and DEA models to analyze their operational efficiency. There is a lack of comprehensive evaluation of the service performance of grassroots medical and health institutions from multiple dimensions, Therefore, it is of great significance to conduct research on the service performance of grassroots medical and health institutions under the tight county medical community.

Evaluate the service performance of grassroots medical and health institutions in 39 pilot counties (cities, districts) of Guangxi's tightly knit county-level medical communities, in order to provide a basis for deepening the high-quality development of Guangxi and nationwide tightly knit county-level medical communities.

Collect operational data of grassroots medical and health institutions in 39 pilot counties (cities, districts) from 2018 to 2021, and evaluate them using descriptive analysis, entropy weighted TOPSIS and RSR.

From 2018 to 2021, the C_i values of the service performance of grassroots medical and health institutions were 0.311 2, 0.363 2, 0.579 1, and 0.674 2, respectively. Ranked first in 2021 and last in 2018; In 2021, a total of 7 pilot counties (cities, districts) were evaluated as "excellent" in the service performance of grassroots medical and health institutions, accounting for 17.95%. A total of 6 individuals were rated as "poor", accounting for 15.38%. The remaining 26 were rated as "medium", accounting for 66.67%.

The sinking of resources has been improved, capacity building has been further strengthened, access to health equity has increased, the efficiency of medical insurance fund utilization has improved, and overall service performance is showing an upward trend. However, the two-way referral system needs to be strengthened, resource utilization efficiency needs to be strengthened, and the benefit sharing mechanism needs to be further improved. There are significant differences in the service performance of grassroots medical and health institutions among pilot counties (cities, districts). We need to improve and leverage the role of the county-level medical community management committee, improve the annual total budget system of the medical community, establish a comprehensive benefit distribution mechanism, and focus on supporting pilot counties (cities, districts) with relatively poor economic development.

Primary medical first consultation plays an important role in the rational utilization of medical services and alleviating the contradiction between supply and demand of medical resources. However, the rate of primary medical first consultation in China is lower than the policy expectations, and it is very important to guide patients to primary care. Therefore, it is of great significance to conduct an in-depth exploration of the driving mechanism of patients' willingness for primary medical first consultation.

Based on the family doctor contract service scenario, a theoretical model of "expectation confirmation-patient trust-sustained willingness to first visit at the grassroots level" was constructed based on the expectation confirmation theory. Through empirical research, this paper verifies the social psychological mechanism of patients' willingness to continue grassroots first diagnosis, reveals the path of patient trust, and provides theoretical basis and practical enlightenment for improving patients' willingness to continue grassroots first diagnosis.

Taking a community health service center in Chengdu as the research site, a questionnaire survey was conducted on the patients served by the center in March 2024, including four parts: general information questionnaire, expectation confirmation, patient trust, and medical seeking willingness at the grassroots level. Independent sample t-test and one-way analysis of variance were used to study the differences in patients' trust between groups, and the structural equation model was used to verify the theoretical hypothesis and mediating effect.

A total of 318 questionnaires were collected for the survey, of which 288 (90.6%) were valid. The average expection confirmation score for patients was (3.99±0.74) points, with 208 cases (72.2%) exhibiting high expected confirmation. The average patient trust score was (4.13±0.61) points, with the three dimensions of technical trust, service trust, and emotional trust averaging (4.18±0.65), (3.60±1.02), and (4.35±0.64) points respectively. Patients who were adults, aged 60 years or older, had hypertension/diabetes, had signed up with a family doctor, and had high expectations demonstrated higher trust in primary care (P<0.05). Patients who did not have a designated doctor showed lower trust in primary care (P<0.05). Patient trust had a complete mediating effect between expectation confirmation and the willingness to seek initial treatment at primary care facilities (P<0.05).

Patient trust has a significant full mediating effect between expectation confirmation and willingness to continue primary care. It is the starting point to cultivate patients' trust by providing patients with super-expected experience through targeted demand satisfaction, so as to improve patients' expectation confirmation. Taking public health services as an opportunity to establish emotional trust, relying on the improvement of diagnosis and treatment ability and the optimization of referral services to establish technical trust and service trust may be the key path to enhance the first diagnosis of patients' willingness at the grassroots level.

Primary healthcare workers' work motivation is closely related to the quality and accessibility of health services. Autonomous motivation represents a higher-quality form of motivation, yet it is not fixed and may change with factors such as career experience and the institutional context, thereby exerting potential effects on work-related outcomes.

Drawing on Self-determination Theory (SDT), this study compared primary healthcare workers' initial (entry) motivation for practicing medicine with their current work motivation to describe changes in autonomous motivation (i.e., engaging in an activity based on full willingness and autonomous choice) and to examine the reasons for such changes and their associations with key work outcomes.

A mixed-methods design was adopted. Using multistage cluster sampling, we selected three cities in Shandong Province, China (Yantai in the east, Zibo in the central region, and Liaocheng in the west). In each city, three districts/counties were selected, and four primary healthcare institutions were sampled within each district/county, yielding 36 survey sites. On the survey day, all on-duty healthcare workers (including physicians, nurses, public health workers, and medical technicians) were invited to complete a questionnaire. Of 1 271 questionnaires distributed, 1 113 were valid (effective response rate: 87.6%). In addition, 107 participants were purposively sampled for in-depth interviews. Initial motivation for practicing medicine was measured using a self-developed questionnaire, while current work motivation was assessed with a revised Work Motivation Scale. Based on SDT, both initial and current motivations were classified into two types: autonomous motivation and non-autonomous motivation. By comparing the dominant type of initial and current motivation, a "motivation change" variable was constructed, yielding four categories. Four key indicators of work attitudes and behaviors were assessed: turnover intention, job burnout, job satisfaction, and job performance. Questionnaire data were analyzed using descriptive statistics, analysis of variance (ANOVA), and multiple linear regression. Interview data were analyzed using the thematic framework approach.

For initial motivation, 545 (49.0%) participants were classified as having autonomous motivation and 568 (51.0%) as having non-autonomous motivation. For current work motivation, 713 (64.0%) participants had autonomous motivation and 400 (36.0%) had non-autonomous motivation. The 2×2 "motivation change" variable produced four categories: stable autonomous motivation (n=403, 36.2%), stable non-autonomous motivation (n=258, 23.2%), autonomization (n=310, 27.8%), and de-autonomization (n=142, 12.8%). Scores for turnover intention, job burnout, job satisfaction, and job performance differed significantly across the four categories (all P<0.05). Specifically, compared with the stable autonomous motivation group and the autonomization group, the stable non-autonomous motivation group and the de-autonomization group reported higher turnover intention and job burnout (P<0.05) and lower job satisfaction and job performance (P<0.05). In addition, the autonomization group had higher turnover intention and job burnout (P<0.05) and lower job satisfaction and job performance (P<0.05) than the stable autonomous motivation group. Multiple linear regression indicated that, relative to the stable autonomous motivation group, the other three groups had higher regression coefficients in the models for turnover intention and job burnout (P<0.05) and lower regression coefficients in the models for job satisfaction and job performance (P<0.05). Interview findings suggested that changes in motivation were mainly influenced by the needs for meaning, competence, and relatedness.

Autonomous motivation is associated with better work performance among primary healthcare workers. Greater resource investment and institutional improvements are needed to foster a more supportive organizational context—such as strengthening health information systems, improving training mechanisms, and innovating doctor-patient communication-to satisfy primary healthcare workers' basic psychological needs and thereby enhance autonomous motivation.

Osteoarthritis (OA) is a chronic, disabling disease and one of the most common comorbidities in older adults. Community health centres are the optimal setting for delivering long-term, personalized health management to OA patients and those with multiple comorbidities. Conducting surveys within these centres can determine the current state of health management and treatment for individuals with OA. Currently, research on the comorbidity characteristics and diagnostic and therapeutic status of OA patients remains inadequate.

To describe the comorbidity patterns and current treatment status of patients with OA in community health centres in Beijing, for informing future strategies for managing OA in the context of multimorbidity.

A purposive sampling method was used in this cross-sectional study used to select four community health centres in Beijing, each provided over 50 000 consultations per year. Electronic medical records of patients diagnosed with OA between June 2020 and June 2024 were retrieved. Patient data were merged using unique patient identifiers. Key variables included gender, age, occupation, diagnoses, number of visits, and treatments. Patients were grouped by comorbidity status, and the differences in clinical characteristics and treatment status between patients with single disease and comorbidities were analyzed.

A total of 10 552 OA patients were included, representing 31.1% of all outpatients. The average age was (65.1±14.2) years, 4 293 patients (40.7%) were males and 6 259 patients (59.3%) were females. On average, patients had (10.5±13.1) visits during the study period and (3.9±2.1) diagnoses. In total, 860 patients (8.2%) had OA only, while 4 320 (40.9%) had 1-2 other chronic conditions. The most frequent comorbidities were cardiovascular diseases (52.4%), endocrine and metabolic conditions (35.6%), respiratory diseases (35.2%), musculoskeletal conditions (34.1%), and digestive system disorders (27.3%). Hypertension (24.4%), coronary heart disease (20.8%), dyslipidemia (15.2%), osteoporosis (11.9%), and type 2 diabetes (11.7%)were the most prevalent diagnoses. A total of 5 013 patients (47.5%) received OA-related treatment, with an average of (3.92±2.31 ) treatment types. Treatment patterns included oral medications (73.2%), topical agents (24.6%), and external traditional Chinese therapies (2.3%). The most frequently used oral medications were Chinese herbal medicines or prepared Chinese medicines (43.2%), followed by anti-inflammatory drugs (18.7%), anti-osteoporotic agents (6.3%), and anxiolytics (5.0%). Older patients had a higher prevalence of comorbidities (93.0%), comparing with younger patient (88.7%), and the proportion with more than 10 comorbidities rose from 1.0 % of younger patients to 2.1 % of older patient. Patients had other chronic conditions had significantly more visits (P<0.01) and received more treatment approaches (P<0.001). Regression analysis identified age, comorbidity status, and number of visits as independent predictors of treatment diversity (P<0.01).

Over 90 % of OA patients in Beijing community health centres present with at least one chronic comorbidity, most commonly cardiovascular diseases (hypertension, coronary heart disease) and metabolic diseases (dyslipidemia, osteoporosis and type 2 diabetes). Compared to patients with OA only, those had other chronic conditions require more frequent visits and more complex treatment. Community-based OA management predominantly involves oral medications, particularly Chinese traditional and anti-inflammatory drugs.