Abstract / Summary
Background: With the advancement of the tiered healthcare system, primary care facilities are transitioning toward a service model that integrates general and specialized care. The General Practitioner with Extended Role(GPwER) model has been validated by multiple studies as an effective approach to integrating general practice with specialty care. In Henan Province, research on general practitioners’ willingness to adopt this model and their decision-making mechanisms remains unexplored. Objective: To systematically investigate the willingness of urban general practitioners(GPs) in Henan Province to adopt the GPwER model, with the aim of providing references for relevant policy design. Methods: A mixed-methods research design was employed. During the qualitative study section, 17 GPs from urban community health service centers in Henan Province were selected using purposive sampling for one-on-one semi-structured interviews. Framework analysis was used to identify the factors influencing adoption intentions. During the quantitative study section, a questionnaire was developed based on the findings of the qualitative study and the UTAUT2 theory. A stratified quota cluster sampling method was used to distribute a total of 426 questionnaires across 17 cities in Henan Province. The study compared the adoption intention scores of GPs with different characteristics and employed structural equation modeling to analyze the factors influencing GPs’ adoption of the GPwER model. Results: The qualitative study findings suggest that the surveyed GPs generally recognize the many potential benefits of the GPwER model. Institutional safeguards, resource support, and the alignment of GPwER training with primary care practice were identified as factors influencing their willingness to adopt the model. A total of 303 valid questionnaires were collected in the quantitative study section, with a response rate of 71.12%. GPs’ willingness to adopt the GPwER model scored (3.56±1.07) points. Monthly income was the relevant factor influencing willingness to adopt ( P = 0.002), with the low-income group (≤5000 CNY) scoring higher on willingness to adopt than the higher-income group (>5000 CNY). Structural equation modeling (SEM) path analysis indicated that effort expectancy ( β =−0.561, P < 0.001) was a negative relevant factors of willingness to adopt; price value ( β = 0.465, P < 0.001), facilitating conditions ( β = 0.232, P = 0.031), and performance expectancy ( β = 0.130, P = 0.009) exerted significant positive influences; social influence ( P = 0.536) did not significantly affect adoption intention. Conclusion: GPs in urban areas of Henan Province generally exhibit a cautious yet positive willingness to adopt, with lower-income groups demonstrating a stronger willingness to adopt. The primary factors influencing willingness to adopt include effort expectancy, price value, facilitating conditions, performance expectancy and monthly income level. The findings suggest that when developing policies and training programs related to the GPwER model, consideration should be given to both the learning burden and expected benefits for GPs, and a thorough assessment should be conducted of the resource capacity and staffing capabilities of primary care facilities to enhance the model’s acceptability and feasibility in such settings.