What affects how Chinese patients wish to be involved in health care delivery? Perspectives of the Chinese policy and institutional contexts

Introduction The benefits of involving patients and carers include improving health outcomes and safety, reducing costs and enhancing an open, accountable and equitable relationship between service providers and users. However, the willingness for involvement and participation is largely affected by a range of factors, including those at the micro, meso and macro levels. As the previous studies have given much attention to the factors at the individual level, it is worthwhile to explore the factors at the broader levels of the policy and institutional contexts. The objective of the research is to understand how the policy and institutional contexts in China affect how patients wish to be involved in their health care delivery. Methods An abductive research strategy was used to generate emergent hypotheses in the first stage of data construction. In the second stage of fieldwork, hypotheses were tested using the deductive approach. Three local hospitals in Shandong Province, China, were selected. The case study method was designed with qualitative methods of policy documents and interviews. Interviews included health professionals, health board managers, local administrators and service users. Thematic analysis and framework analysis were conducted. Results Four policy and institutional contexts were identified: insufficient policy support, the current institutional design of involving users, the heterogeneity of organisational autonomy and resources, as well as the demography of the population of service users. Conclusions As a policy strategy at the state level, there is a lack of policy support for patient involvement and participation in the Chinese health system. The heterogeneity of the institutional context of health facilities plays a key role in affecting how patients wish to be involved in health care delivery. Highlights The main purpose of the research was to explore the policy and institutional contexts, that affected users' willingness of involving in their health care in Chinese local hospitals. The policy and institutional contexts significantly affected how patients wish to be involved in their health care, in terms of the policy support, the institutional design, the organisation autonomy and resources and the demography of service users. The insufficient policy support became the barrier to involving users in the Chinese health system. Different institutional designs between tertiary and secondary hospitals led to the differences in promo