基于扎根理论的执行突发公共卫生事件社区防控政策的影响因素研究  

Influencing factors of the implementation of community-based public health emergency prevention and control policies:based on Grounded Theory

作　　者：黄震 陈敏玚 段庭山 陈星宇 胡婉慈 朱应如 张皓[1] Huang Zhen;Chen Minyang;Duan Tingshan;Chen Xingyu;Hu Wanci;Zhang Hao;Zhu Yingru(College of Medicine,Hangzhou Normal University,Hangzhou 311121,Zhejiang Province,China;Changxing Campus,The Second Affiliated Hospital of Medical College of Zhejiang University,Hangzhou,Zhejiang Province,China)

机构地区：[1]杭州师范大学医学部,311121 [2]浙江大学医学院附属第二医院长兴院区

出　　处：《中国医疗管理科学》2021年第2期7-16,共10页Chinese Journal Of Medical Management Sciences

基　　金：国家自然科学基金(72004051);浙江省自然科学基金项目(LQ19G30010);教育部人文社会科学项目(18YJCZH232);杭州师范大学本科生创新能力提升工程(CX2020168)。

摘　　要：目的探讨执行突发公共卫生事件社区防控政策的影响因素及其作用机制,并提出相应对策。方法于2020年2-9月按照目的、理论和滚雪球抽样结合扎根理论研究方法对我国7个省(市)的122名社区管理人员、基层医疗机构医务人员、志愿者和社区居民进行半结构化访谈,经开放编码、主轴编码和选择性编码构建执行突发公共卫生事件社区防控政策的影响因素及其作用机制理论框架。结果经过三级编码,最终梳理出与突发公共卫生事件应急防控政策执行相关的146个概念、22个范畴、5个主范畴和1个核心范畴,归纳出执行突发公共卫生事件社区防控政策的影响因素主要包括政策属性、内部管理、外部支持和居民的配合与参与。结论在执行突发公共卫生事件社区防控政策过程中,政策属性对政策执行产生前置驱动作用,内部管理发挥引力作用,外部支撑形成支持力作用,居民配合与参与起到推力作用,最终产生政策正常执行和偏差执行等不同执行行为。因此,需完善社区工作者绩效激励机制与素质提升机制;优化政策执行监督制度;创新政策宣传方式和营造良好政策氛围。Objective To investigate the influencing factors,mechanisms,and countermeasures of the implementation of public health emergency prevention and control policies in communities.Methods Semi-structured interviews were conducted with 122 community managers,medical staff at primary care institutions,volunteers,and community residents in seven provinces(municipalities)in China from February 2020 to September 2020 with a Grounded Theory(GT)approach(including the use of snowball sampling).The influencing factors of community-based implementation of public health emergency prevention and control policies and their mechanisms of action were analyzed by using the three data analysis steps in the GT method:open coding,axial coding,and selective coding.Results After the three-level coding,146 concepts,22 categories,5 primary categories and 1 core category related to the implementation of public health emergency prevention and control policies were identified,which yielded that the main influencing factors for the implementation of community prevention and control policies for public health emergencies were policy attributes,internal management,external support,and residents'cooperation and participation.Conclusions In the implementation of communitybased prevention and control policies for public health emergencies,“policy attributes”is an antecedent to policy implementation,“internal management”plays a gravitational role,“external support”has a supportive role,and“residents'cooperation and participation”plays a“thrust”role.All of these factors ultimately produce different implementation behaviors such as normal and deviant policy implementation.Therefore,it is important to improve the performance incentive mechanism and quality improvement mechanism of community workers,optimize the supervision of policy implementation,and innovate the ways of policy publicity to create a good environment for policy implementation.

关 键 词：突发公共卫生事件 社区防控 政策执行 扎根理论 

分 类 号：R197[医药卫生—卫生事业管理] R184[医药卫生—公共卫生与预防医学]