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Table 5 Barriers in implementation of HE

From: Progress of equalizing basic public health services in Southwest China--- health education delivery in primary healthcare sectors

Core PRISM domains Themes Results Example quotations
Interventions –HE program design Content/materials for HE The materials for HE cannot meet needs: The materials for HE provided by CDC cannot meet needs of HE, and so HCWs in PHC have to look for the content on health issues for each topic. They were not sure the credibility of the content identified by them based on their knowledge. On the other hand, they felt difficult to find enough content because they are required to change the content every two months.
HCWs lacked of hard copy and video materials to hand out for residents when they carry out “Provision of health education materials”.
Content of lecture could not meet needs of residents too.
We have difficulty in HL. Our CHC is not teaching hospital, we had not many teaching PPT for HL. Though CDC often give us some materials for HL, it is not enough. We just get some materials for HL from websites, or prepared the PPT by ourselves. But those materials were limited and are not enough for 12 HL per year. And so the residents would not like to participate in our HL when we repeated HL. This is a big difficulty (HCWs in CHC).
Some materials for HE are not available in our PHC sector and we were required to look for by ourselves. But we had no adequate knowledge to prepare the materials based on the needs of residents. CDC often gave some materials for some health issues, but not all of these materials were needed by residents because they were not based on resident’s health needs (HCWs in CHC).
Funds Almost all HCWs mentioned lack of enough funds for HE materials preparation and activities because PHC sectors needed prepare gifts for participants which were not covered by funds from BPHS Actually, the funds are not enough. We paid for materials for HE by our CHC. And we often bought gifts for residents in order to attract them to participate in HE activities. (HCWs in THC).
Recipients PHC sectors PHCs lack of professional HCWs for HE: Almost all HCWs reported they did not work on HE full-time and undertake more than one item of BPHS and they lacked of health knowledge. Particularly HCWs reported they had little skills to provide health counseling and personalized health education. Majorities of interviewers were not satisfied with their salary and the opportunity of self-development.
Lower authority of PHC among residents results low participation of residents in HE activities
The biggest difficulty is lack of professional HCWs for HE. We are part-time working for HE (HCWs in CHC)..
We felt difficult to provide PHE for residents which required providers with highly professional knowledge. We are not GP who has knowledge of both internal medicine and surgery. So we cannot provide PHE of high quality. We lacked of human resource (HCWs in CHC).
We lacked of knowledge of public health, we are nurses. We don’t know lots of professional health knowledge (HCWs in CHC)..
Our salary is very low. I am Contract worker, income is very low (HCWs in THC)..
My major is Family planning and I cannot see good prospect of myself development (HCWs in CHC).
Residents Residents had no correct recognition of HE activities and would not like to participate in HE: most of HCWs reported that residents were reluctant to participate in HL, utilize HC, get and read the materials because residents had no correct recognition of HE or they cannot discern the actual HE from advertisement by drug dealers. PHCs often used gifts to attract residents to participate in HL.
Some HCWs reported some residents cannot understand HE content due to lower education, particularly the elderly.
If we invite many doctors to join our HE activities and give gifts to residents, residents would like to participate in our activities, and otherwise they have no interesting in HE activities (HCWs in THC).
They (residents) thought we are drug dealers to give advertisement to sell medicine. They would not like to participate. Some residents thought it waste time to listen half hour lectures which is not addressing their health problems (HCWs in CHC).
We had PCHE in our THC, but many residents don’t know it is PCHE or never pay attention to it. Because most of the residents who use health service in THC were the elderly (HCWs in THC).
External environment Venue for HE Lack appropriate venue for health lectures
It is difficult to have the venue where is appropriate for health lectures and playing video materials on health knowledge and are accessible for residents though there is a small meeting room in PHCs
We often have difficult to find an appropriate venue for HE activities outside of our CHC (HCWs in CHC).
Multi-sector cooperation Several HCWs also complained multi-sectors cooperation was not so good. For example, the city management personnel often prohibited HCWs from having a site for HC or PHEM in the street because they thought those activities had impact on clean and tidy of street. HE needs cooperation of multi-sectors. It is difficult to carry out HE activities only by CHS. We need organize residents, we need look for venue, and we need prepare HE materials for residents (HCWs in THC).
It is difficult to have a venue for HE activities, the city management is strict. We want to have a banner for HC (in order to attract residents to come) in street, but the city management personnel would prohibit (HCWs in CHC).
Implementation infrastructure Transportation tools Some HCWs complained they lack of transportation tools to carry out health education in remote mountain area in many PHC sectors We have no transportation tools for HE. We carry out HE activities in remote rural mountain area, but is not convenient, we had no car t to take materials (HCWs in CHC).
  1. Notes: HE refers to health education, PHC refers to primary health care, HCWs refers to health care workers, HL refers to health lectures, PHE refers to personalized health education, HC refers to health counseling, PCHE refers to propagandizing column of health education