ABSTRACT
Background Grassroots center for disease control and prevention (CDC) staff undertake intensive work of disease prevention and control, and may be susceptible to occupational stress, anxiety, depression, and other health problems. Objective To understand the current situation of occupational stress, anxiety, and depression among grassroots CDC staff, and to identify potential risk factor configurations for occupational stress, anxiety, and depression using fuzzy set qualitative comparative analysis (fsQCA), so as to provide a basis for effective intervention. Methods The staff working in county/district-level CDCs in Hebei Province were the target population of the current study. Stratified random cluster sampling method was used to select 1860 staff members of the target population. A questionnaire of general situation, Job Content Scale, 7-item Generalized Anxiety Disorder Scale, and Patient Health Questionnaire-9 were used. Risk factor configurations associated with health outcomes of interest were identified by fsQCA3.0 software. Results The positive rates of occupational stress, anxiety, and depression were 42.69%, 44.25%, and 47.96%, respectively. Marital status was a necessary condition for occupational stress, anxiety, and depression in the grassroots CDC staff (the necessity values were 0.911, 0.939, and 0.933, respectively). There were two types of risk factor configurations for occupational stress: "self-improvement" and "disease burden"; the risk factor configurations for anxiety were "disease burden" and "economic-disease burden"; while the risk factor configurations for depression were "disease burden", "economic-disease burden", and "self-improvement". The overall consistency scores of occupational stress, anxiety, and depression were 0.941, 0.820, and 0.774, respectively. Regarding outstanding components, "self-improvement" included pressure of job requirements and promotion, "disease burden" included impact of chronic illness on psychological state, and "economic-disease burden" included not only impact of chronic illness but also financial support for CDC staff. Conclusion All positive rates of occupational stress, anxiety, and depression are high among grassroots CDC staff in Hebei Province. Occupational stress, anxiety, and depression of grassroots CDC staff are the results of multiple influencing factors, so targeted intervention measures should be formulated.
ABSTRACT
Background: India recently launched Ayushman Bharat – National Health Protection Mission – an upgraded version of Rashtriya Swasthya Bima Yojna (RSBY), which is projected as world's largest public insurance scheme by numbers. The new scheme can certainly draw learning from the former (RSBY) to ensure better reach and success. RSBY has been extensively analyzed for supply-side barriers but sparsely for demand and supply-side barriers simultaneously. Objectives: Through this study, authors intend to determine causality as well as configurations (pathways) of demand and supply barriers that make beneficiary vulnerable even under the scheme. The study explores the interaction of barriers that lead to patient dis/satisfaction, overcharging for a medical procedure and high disease severity among beneficiaries. Methods: The study uses RSBY insurance claim records from 2013 to 2015 backed up by posthospitalization survey of the state of Chhattisgarh, India. It employs a fuzzy set qualitative comparative analysis to determine causality and configuration (path-way) of parameters leading to the outcome. Results: Provision of medicine emerges as a necessary condition for patient satisfaction. Waiting time did not appear as a necessary parameter of satisfaction. Overcharging the cashless card in case of minor surgical procedures is observed irrespective of beneficiaries' education and occupation status. Urban male and rural female appear to bear high disease severity. Conclusions: Results have implication for policymakers and implementors to recognize the segment that remains vulnerable under the scheme and gain insights on the parameters of patient satisfaction.
ABSTRACT
This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country.