Factors influencing the management of chronic non-communicable diseases in cold regions: a qualitative study from Northeast China

Rui Jiang; Yuhan Zhou; Min Yang; Lu Yue; Lyuzhuang Huang; Yongchen Wang

doi:10.1515/fzm-2025-0001

Factors influencing the management of chronic non-communicable diseases in cold regions: a qualitative study from Northeast China

doi: 10.1515/fzm-2025-0001

Department of General Practice, the Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China

Funds: Not applicable

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Corresponding author: Yongchen Wang, E-mail: yongchenwang@hrbmu.edu.cn

摘要

Abstract: Background and Objectives Non-Communicable Diseases (NCDs) represent a significant public health burden in China, particularly in cold regions where environmental factors further limit access to healthcare. To address this challenge, China has implemented the National Essential Public Health Service Package (NEPHSP) to improve NCD management through primary healthcare services. However, research on the effectiveness of NEPHSP in cold regions is limited. This study aims to identify the key factors influencing the implementation of NCD management services in cold regions, focusing on both barriers and facilitators. Methods This qualitative study was conducted in three purposively selected cold regions in Northeast China (Harbin, Qiqihar, and Jiamusi). Data were collected through semi-structured interviews and focus group discussions, guided by the RE-AIM framework. Participants included local health administrators, primary healthcare workers, and community-dwelling individuals with NCDs. Thematic analysis was employed to code and extract key themes from the data. Results A total of 72 participants (59.7% female, mean age 49.1 ± 6.24 years) took part in the study. Major barriers to NCD management included low health literacy, limited awareness of NCDs, insufficient medical resources, poor public awareness, inadequate multisectoral collaboration, and the absence of effective audit and feedback systems. Key facilitators included the affordability and accessibility of primary healthcare services, strong patient-physician relationships, and the high priority given to NCD management by local governments. Furthermore, harsh environmental conditions and limited healthcare accessibility in cold regions complicated the management of NCDs, highlighting the need for tailored interventions that address the specific challenges of these regions. Conclusions This study identifies significant facilitators and barriers to the implementation of NCD management services under the NEPHSP in cold regions of China. The unique challenges posed by cold climates necessitate the adaptation of healthcare services to local needs, with a focus on improving health literacy, enhancing healthcare infrastructure, and fostering multisectoral collaboration. These findings provide valuable insights for optimizing NCD prevention and management strategies within China's primary healthcare system.
- non-communicable diseases /
- National Essential Public Health Service Package /
- RE-AIM framework /
- qualitative study /
- primary health care

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Table 1. RE-AIM framework dimensions and example interview questions

Dimension	Example interview questions
Reach	In your view, are the current measures for NCD management sufficient to meet the actual demand for healthcare services? How extensive is the coverage of these policies or initiatives?
Effectiveness	What factors do you believe contribute to regional variations in policy development and implementation?
	How effective have these policies been in practice? What factors influence their effectiveness?
Adoption	How well are the NCD management measures being adopted at the local level?
	What strategies does your department use to ensure that health service providers and NCD patients, along with their families, accept and adopt these policies?
Implementation	What are the key facilitating and hindering factors in the implementation process?
	Is your current role involved in the management of NCDs? If so, how?
Maintenance	What steps are being taken to ensure the sustainability of these interventions and their long-term impact?
	How is the ongoing performance of these policies or interventions evaluated over time?

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Table 2. Participant Characteristics

Demographic characteristic	In-depth interview		Focus group discussion
	Policy makers (N = 4)	Leaders of primary health institutions (N = 12)	Healthcare providers (N = 24)	NCDs Patients (N = 32)
Gender
Male (N = 29)	3(75.00%)	9(75.00%)	6(25.00%)	11(34.38%)
Female (N = 43)	1(25.00%)	3(25.00%)	18(75.00%)	21(65.63%)
Age, mean(SD), y	43.00 ± 2.71	46.33 ± 6.11	40.83 ± 7.83	66.22 ± 8.30
Education
College and above (N = 56)	4(100.00%)	10(83.33%)	20(83.33%)	22(68.75%)
High school and middle school (N = 14)	0	2(16.67%)	4(16.67%)	8(25.00%)
Primary school or below (N = 2)	0	0	0	2(6.25%)
Years of working
5 y or below (N = 6)	0	1(8.33%)	5(20.83%)	NA
5y to 10y (N = 7)	2(50.00%)	1(8.33%)	4(16.67%)	NA
10y and above (N = 27)	2(50.00%)	10(83.33%)	15(62.50%)	NA
Years of NCD
5 y or below (N = 11)	NA	NA	NA	11(34.38%)
5y to 10y (N = 5)	NA	NA	NA	5(15.63%)
10y and above (N = 16)	NA	NA	NA	16(50.00%)
Abbreviation: NA, not applicable

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Table 3. Identified themes, barriers, and facilitators under the RE-AIM framework

Domain	Facilitators(8)	Barriers(12)
Reach	Primary healthcare services offer easy access, competitive pricing, and favorable reimbursement rates	The service content and forms of chronic disease management are singular. Severe population loss in cold regions
		Patients, particularly those aged 35-64, exhibit low awareness of health management, with minimal knowledge and acceptance
Effectiveness	Doctors and patients both acknowledge improvements in health conditions	Inadequate infrastructure and medicines in primary healthcare facilities
	Rigorous quality control and performance appraisal of health records	The characteristics of cold regions limit the forms of health promotion activities to be monotonous
Adoption	Doctors and patients generally agree that accepting chronic disease management services from family doctors is essential	Inadequate publicity and regulation of policies by the government and media Lack of guidance and incentives (performance appraisal, talent development)
	Implement regular community health promotion and manage highrisk populations effectively
Implementation	Medical personnel establish good doctor-patient relationships Collaborate with community boards and grid workers	Insufficient medical staff and inadequate capacity in primary healthcare facilities, including general practitioners and public health personnel
	The health administration agency directs primary medical facilities and arranges training for healthcare personnel	Lack of attention and cooperation from departments outside of the health administration
		Health system service information management requires enhancement
Maintenance		Insufficient multi-dimensional assessment and evaluation indicators
		Inadequate salaries and high turnover rates among medical personnel

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