Investigating Factors Influencing Medical Practitioners' Resistance to and Adoption of Internet Hospitals in China: Mixed Methods Study.

BACKGROUND: The swift shift toward internet hospitals has relied on the willingness of medical practitioners to embrace new systems and workflows. Low engagement or acceptance by medical practitioners leads to difficulties in patient access. However, few investigations have focused on barriers and facilitators of adoption of internet hospitals from the perspective of medical practitioners. OBJECTIVE: This study aims to identify both enabling and inhibiting predictors associated with resistance and behavioral intentions of medical practitioners to use internet hospitals by combining the conservation of resources theory with the Unified Theory of Acceptance and Use of Technology and technostress framework. METHODS: A mixed methods research design was conducted to qualitatively identify the factors that enable and inhibit resistance and behavioral intention to use internet hospitals, followed by a quantitative survey-based study that empirically tested the effects of the identified factors. The qualitative phase involved conducting in-depth interviews with 16 experts in China from June to August 2022. Thematic analysis was performed using the qualitative data analysis software NVivo version 10 (QSR International). On the basis of the findings and conceptual framework gained from the qualitative interviews, a cross-sectional, anonymous, web-based survey of 593 medical practitioners in 28 provincial administrative regions of China was conducted. The data collected were analyzed using the partial least squares method, with the assistance of SPSS 27.0 (IBM Corp) and Mplus 7.0 (Muthen and Muthen), to measure and validate the proposed model. RESULTS: On the basis of qualitative results, this study identified 4 facilitators and inhibitors, namely performance expectancy, social influence, work overload, and role ambiguity. Of the 593 medical practitioners surveyed in the quantitative research, most were female (n=364, 61.4%), had a middle title (n=211, 35.6%) or primary title (n=212, 35.8%), and had an average use experience of 6 months every year. By conducting structural equation modeling, we found that performance expectancy (ß=-.55; P<.001) and work overload (ß=.16; P=.005) had the most significant impact on resistance to change. Resistance to change fully mediated the influence of performance expectancy and partially mediated the influences of social influence (variance accounted for [VAF]=43.3%; P=.002), work overload (VAF=37.2%; P=.03), and role ambiguity (VAF=12.2%; P<.001) on behavioral intentions to use internet hospitals. In addition, this study found that the sex, age, professional title, and use experience of medical practitioners significantly moderated the aforementioned influencing mechanisms. CONCLUSIONS: This study investigated the factors that facilitate or hinder medical practitioners' resistance to change and their behavioral intentions to use internet hospitals. The findings suggest that policy makers avoid the resistance and further promote the adoption of internet hospitals by ensuring performance expectancy and social influence and eliminating work overload and role ambiguity.

How organizational support can help employees mitigate the effects of distributive injustice: a hierarchical moderated mediation model.

Objectives. At present, the mechanism of distributive justice leading to presenteeism is still unclear. We aim to explore the relationship among distributive justice, organization-based self-esteem, presenteeism and organizational support among Chinese medical workers by building a moderated mediation model. Methods. We employed a cross-level research design that aggregated organizational support to the organizational level. Medical staff from 50 different hospitals in China were invited to participate in the survey, and 1122 valid data questionnaires were obtained. We used hierarchical linear modelling to test this cross-level moderated mediation model. Results. Our results suggest that, at the individual level, organization-based self-esteem partially mediates the distributive justice-presenteeism relationship, and at the individual level, organizational support moderates the relationship between distributive justice and organization-based self-esteem. Conclusions. Distributive justice enhances individuals' organization-based self-esteem, which is associated with a reduction in presenteeism, and underscores the importance of organizations shaping an organizational support climate.

Conceptual Framework for Smart Health: A Multi-Dimensional Model Using IPO Logic to Link Drivers and Outcomes.

Smart health is considered to be a new phase in the application of information and communication technologies (ICT) in healthcare that can improve its efficiency and sustainability. However, based on our literature review on the concept of smart health, there is a lack of a comprehensive perspective on the concept of smart health and a framework for how to link the drivers and outcomes of smart health. This paper aims to interweave the drivers and outcomes in a multi-dimensional framework under the input-process-output (IPO) logic of the "system view" so as to promote a deeper understanding of the model of smart health. In addition to the collection of studies, we used the modified Delphi method (MDM) to invite 10 experts from different fields, and the views of the panelists were analyzed and integrated through a three-round iterative process to reach a consensus on the elements included in the conceptual framework. The study revealed that smart health contains five drivers (community, technology, policy, service, and management) and eight outcomes (efficient, smart, sustainable, planned, trustworthy, safe, equitable, health-beneficial, and economic). They all represent a unique aspect of smart health. This paper expands the research horizon of smart health, shifting from a single technology to multiple perspectives, such as community and management, to guide the development of policies and plans in order to promote smart health.

What Drives the Influence of Health Science Communication Accounts on TikTok? A Fuzzy-Set Qualitative Comparative Analysis.

Medical institutions face a variety of challenges as they seek to enhance their reputation and increase the influence of their social media accounts. Becoming a social media influencer in the health field in today's complex online environment requires integrated social and technical systems. However, rather than holistically investigating the mechanism of account influence, studies have focused on a narrow subset of social and technical conditions that drive online influence. We attribute this to the mismatch between complex causality problems and traditional symmetric regression methods. In this study, we adopted an asymmetric configurational perspective that allowed us to test a causally complex model of the conditions that create strong and not-strong account influence. We used fuzzy-set qualitative comparative analysis (fsQCA) to detect the effects of varying configurations of three social system characteristics (i.e., an oncology-related attribute, a public attribute, and comment interaction) and two technical system characteristics (i.e., telepresence and video collection) on the TikTok accounts of 63 elderly Chinese doctors (60 to 92 years old). Our results revealed two pathways associated with distinct sociotechnical configurations to strong account influence and three pathways associated with distinct sociotechnical configurations to not-strong account influence. Furthermore, the results confirmed that a single antecedent condition cannot, on its own, produce an outcome, i.e., account influence. Multiple inter-related conditions are required to produce an influential account. These results offer a more holistic picture of how health science communication accounts operate and reconcile the scattered results in the literature. We also demonstrate how configurational theory and methods can be used to analyze the complexities of social media platforms.

Comparison of health-oriented cross-regional allocation strategies for the COVID-19 vaccine: a mathematical modelling study.

BACKGROUND: Controlling the epidemic spread and establishing the immune barrier in a short time through accurate vaccine demand prediction and optimised vaccine allocation strategy are still urgent problems to be solved under the condition of frequent virus mutations. METHODS: A cross-regional Susceptible-Exposed-Infected-Removed dynamic model was used for scenario simulation to systematically elaborate and compare the effects of different cross-regional vaccine allocation strategies on the future development of the epidemic in regions with different population sizes, prevention and control capabilities, and initial risk levels. Furthermore, the trajectory of the cross-regional vaccine allocation strategy, calculated using a particle swarm optimisation algorithm, was compared with the trajectories of other strategies. RESULTS: By visualising the final effect of the particle swarm optimisation vaccine allocation strategy, this study revealed the important role of prevention and control (including the level of social distancing control, the speed of tracking and isolating exposed and infected individuals, and the initial frequency of mask-wearing) in determining the allocation of vaccine resources. Most importantly, it supported the idea of prioritising control in regions with a large population and low initial risk level, which broke the general view that high initial risk needs to be given priority and proposed that outbreak risk should be firstly considered instead. CONCLUSIONS: This is the first study to use a particle swarm optimisation algorithm to study the cross-regional allocation of COVID-19 vaccines. These data provide a theoretical basis for countries and regions to develop more targeted and sustainable vaccination strategies.KEY MESSAGEThe innovative combination of particle swarm optimisation and cross-regional SEIR model to simulate the pandemic trajectory and predict the vaccine demand helped to speed up and stabilise the construction of the immune barrier, especially faced with new virus mutations.We proposed that priority should be given to regions where it is possible to prevent more infections rather than regions where it is at high initial risk, thus regional outbreak risk should be considered when making vaccine allocation decisions.An optimal health-oriented strategy for vaccine allocation in the COVID-19 pandemic is determined considering both pharmaceutical and non-pharmaceutical policy interventions, including speed of isolation, degree of social distancing control, and frequency of mask-wearing.

Effect of Job Stressors on Presenteeism among Aging Workers: A Longitudinal Moderated Mediation Model.

Objectives: With the rapid global increase in the age of workforces, companies are increasingly concerned with improving the working conditions of older workers. Anxiety is an important psychological variable in sociological studies but has attracted less attention in studies of occupational health and management. In this study, we explored the mediating effect of anxiety on the relationship between job stressors and presenteeism, and the moderating effect of pessimism. Methods: We collected longitudinal data from 892 respondents who participated in the 2008 and 2012 waves of the Health and Retirement Study in the United States. We tested the proposed moderated mediation model using structural equation modeling. Results: Job stressors were positively related to anxiety and presenteeism. Anxiety was positively related to presenteeism and mediated the relationship between job stressors and presenteeism. Pessimism had a statistically significant negative effect on the relationship between anxiety and presenteeism. Conclusions: These results make theoretical and practical contributions to the literature on the influencing mechanisms of presenteeism. The use of longitudinal data ensured that the research conclusions were reliable; we suggest ways to improve the productivity of aging workers.

Do indicators for the proportion of pharmaceutical spending alleviate the burden of medical expenditure? Evidence from provincial panel-data in China, 2010-2019.

BACKGROUND: The current study aims to empirically evaluate the direct relationship between the proportion of pharmaceutical spending and total medical expenditure in China in a recent decade period. METHODS: A two-way fixed-effect model was established to estimate the relationship between the proportion of pharmaceutical spending and total medical expenditure using the balanced panel data for thirty provincial-level administrative regions in mainland China from 2010 to 2019. RESULTS: The proportion of pharmaceutical spending was significantly positively related to inpatient and outpatient expenditure, with coefficients of 0.30 (p = 0.014) and 0.58 (p = 0.002), respectively. This positive correlation was not significant in the eastern regions, likely due to the unexpected supply-side coping behaviors brought about by the compulsory control of the proportion of pharmaceutical spending. We investigated the improvement of service efficiency could significantly alleviate the burden of medical expenses. CONCLUSION: Our research provided empirical evidence for the necessity of using the proportion of pharmaceutical spending as a cost control indicator and showed the factors that may affect the amount of medical expenditure, emphasizing the significance of improving the efficiency of resource utilization to compensate for the unintended behaviors and effects caused by single index assessment.

Redefinition and Measurement Dimensions of Sustainable Employability Based on the swAge-Model.

OBJECTIVES: To solve the labour shortage, we clarify the definition and dimensions of sustainable employability, and make it possible to develop sustainable employability scales in the future and lay the foundation for subsequent quantitative research. Finally, people's sustainable employability can be improved. Highly sustainable employability employees can continue to work in the labour market and their working lives can be prolonged. Labour market supply will increase and labour shortage will be partly solved. METHODS: We discuss the concept of sustainable employability based on some previous studies. Our conclusion is that the existing definitions and measurement dimensions are problematic. The swAge-model, a tool that helps us understand how to make working life more sustainable and healthier for all ages, can be the basis of sustainable employability. RESULTS: We develop a discussion paper concerning the definition and measurement dimensions of sustainable employability using the swAge-model with an added factor of intrinsic work value and the dynamic chain. CONCLUSIONS: Our definition of sustainable employability takes environmental factors into consideration and makes it clear that it is not a solely personal characteristic, but the result of an interaction between individuals and the environment, thus distinguishing employability from work ability. We use the swAge-model as a basis to make the composition of our definition more logical and informed. Our measurement dimensions are clearly described to facilitate the future development of a scale, and our concept may ultimately help to extend the working lives of older and retired workers and thus solve the future labour shortage problem.

Occupational stress, distributive justice and turnover intention among public hospital nurses in China: A cross-sectional study.

AIM: To examine the mediating role of distributive justice on the relation between occupational stress and turnover intention, and the regional role in moderating the relationship between distributive justice and turnover intention. BACKGROUND: Turnover intention is an effective indicator of job departure and has been widely studied. Identification of methods to reduce turnover intention among nurses is a focus of the new round of medical and health system reform in China and in the realization of the "Healthy China 2030" policy. However, few studies have examined the present situation of Chinese nurse's turnover intention and corresponding influencing factors. METHODS: Data were collected on-site by using questionnaires designed by anonymous researchers. A total of 718 effective questionnaires were allocated from representative public hospitals. Data were collected for the "Challenge and Hindrance-Related Self-Reported Stress Scale", "Distributive Justice Scale" and "Turnover Intention Scale". RESULTS: Challenge stress was significantly inversely correlated with turnover intention, while hindrance stress was significantly positively correlated with turnover intention. Moreover, there was a significant inverse correlation between the two types of occupational stress and distributive justice and an inverse correlation between distributive justice and turnover intention. Regional role had a moderating effect on the correlation between distributive justice and turnover intention. CONCLUSIONS: Chinese nurses' turnover intention is directly or indirectly influenced by occupational stress and distributive justice. Managers should set reasonable goals to cope with challenging stress. Proper intervention measures should be designed such as reducing barrier pressure, increasing remuneration, and promoting the matching between workload and job value to reduce the turnover intention. Finally, balancing the treatment towards nurses in different regions may help achieve relative fairness.

Does Co-worker Presenteeism Increase Innovative Behavior? Evidence From IT Professionals Under the 996 Work Regime in China.

Drawing on the event system and regulatory focus theory, this study constructed an impact mechanism model to investigate the relationship between the event strength of co-worker presenteeism and innovative behavior among IT professionals under the 996 work regime. In addition to test the direct effect, we examined the indirect effect of promotion focus and the moderating effect of event time in this relationship. Data were collected through an online survey administered to 374 IT professionals in China. The results showed a positive relationship between the criticality of co-worker presenteeism events and innovative behavior. An indirect effect of promotion focus was also found in this relationship. The timing of co-worker presenteeism events moderated the relationship between the criticality of co-worker presenteeism events and promotion focus. Specifically, the effect was more significant when co-worker presenteeism events occurred during project delays.

How does social support affect public service motivation of healthcare workers in China: the mediating effect of job stress.

BACKGROUND: This study aimed to examine relations between social support, job stress, and public service motivation (PSM), also assessed how social support and job stress affect PSM in China based on the job demands-resources (JD-R) theory. METHODS: The survey investigated a sample of 973 healthcare workers employed in public hospitals in Beijing, Xiamen, and Guangzhou in 2017 (including doctors, nurses, medical technicians, and administrators). Correlation analysis and Structural equation modeling (SEM) were used. RESULTS: Challenge stress and hindrance stress were directly negatively associated with PSM. Supervisor support was significantly positively associated with PSM, and the path from coworker support to PSM was significant. Supervisor support was significantly negatively associated with hindrance stress, and coworker support was significantly negatively associated with challenge stress. Hindrance stress and challenge stress significantly mediated the relations between supervisor support and PSM, and between coworker support and PSM respectively. PSM might be raised by increasing supervisor support and coworker support and by limiting hindrance stress and challenge stress. CONCLUSION: Our study suggests that administrators of public hospitals should be mindful of the intense job stress of healthcare workers and undertake interventions targeting challenge stress and hindrance stress. Also, public hospital administrators should encourage and assist supervisors in their leadership functions. Besides, administrators of public hospitals should emphasize coworker support and good employee relationships.

Lessons Learnt from China: National Multidisciplinary Healthcare Assistance.

PURPOSE: In response to the transmission of COVID-19, China adopted the "national multidisciplinary healthcare assistance". This commentary evaluates whether it is effective and sustainable to contain the COVID-19. METHODS: We adopted the "Difference-in-difference Method" to investigate whether the national multidisciplinary healthcare assistance policy could provide significant benefits in areas affected by COVID-19 by increasing their recovery rates. A total of 578 panel data samples were taken from the Ministry of Health in China. RESULTS: We observed that the number of recovered cases per day increased by 39.36 as a result of this policy. GDP per capita and land area were significantly negatively correlated with the number of recovered cases while the resident population was significantly positively correlated with it. CONCLUSION: The national multidisciplinary healthcare assistance was an effective intervention to reduce the burden of COVID-19 and ease pressure on the healthcare system in Hubei and China. To quickly formulate and promulgate effective response policies for emergent public health crises, the national government should introduce the concept of emergency management into policy agendas and highlight the importance of "problem streams".

Moderated Mediation Model from Stress to Burnout among Health Professionals.

Objectives: It is unclear whether poor health is a contributing factor or a consequence of burn-out. We aimed to explore the relationship among job stress, physical health, mental health, burnout, and coping strategies among health professionals using a moderated mediation model. Methods: Health professionals in Taiwan were invited using a stratified and probability proportional to size sampling. A structure equation model (SEM) was used to examine relationships among job stress, burnout, and physical/mental health. The bootstrapping approach for moderated mediation analysis was then used to explore the role of coping strategies. Results: Totally 935 health professionals participated. The SEM model revealed that job stress was inversely associated with physical and mental health. The direct association between job stress and burn-out was insignificant. Moderated mediation analysis revealed that job stress influenced burnout through physical health and mental health, and that the coping strategy of support-seeking moderated the indirect effect only through mental health. Conclusions: Support-seeking is a good coping strategy for health professionals to buffer the harmful effects of job stress on mental health.

SARS-Cov-2 trajectory predictions and scenario simulations from a global perspective: a modelling study.

The coronavirus SARS-CoV-2 emerging from Wuhan, China has developed into a global epidemic. Here, we combine both human mobility and non-pharmaceutical interventions (social-distancing and suspected-cases isolation) into SEIR transmission model to understand how coronavirus transmits in a global environment. Dynamic trends of region-specific time-variant reproduction number, social-distancing rate, work-resumption rate, and suspected-cases isolation rate have been estimated and plotted for each region by fitting stochastic transmission processes to the real total confirmed cases reported of each region. We find after shutdown in Wuhan, the reproduction number in Wuhan greatly declined from 6·982 (95% CI 2·558-14·668) on January 23rd, 2020 to 1.130 (95% CI 0.289-3.279) on February 7th, 2020, and there was a higher intervention level in terms of social-distancing and suspected-cases isolation in Wuhan than the Chinese average and Western average, for the period from the shutdown in Wuhan to mid-March. Future epidemic trajectories of Western countries up to October 10th, 2020, have been predicted with 95% confidence intervals. Through the scenario simulation, we discover the benefits of earlier international travel ban and rigorous intervention strategies, and the significance of non-pharmaceutical interventions. From a global perspective, it is vital for each country to control the risks of imported cases, and execute rigorous non-pharmaceutical interventions before successful vaccination development.

Association between ambient air pollution and laryngeal neoplasms incidence in twelve major Chinese cities, 2006-2013.

Epidemiological evidence has suggested that ambient air pollution is an increasingly important risk factor for respiratory diseases without assessing its influence on laryngeal neoplasms incidence in China. We constructed two-way fixed effect models and Poisson regression models to explore the effects of ambient air pollutants including nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter less than or equal to 10 µm in aerodynamic diameter (PM10) on incidence of laryngeal neoplasms in twelve major cities in China over the period 2006-2013. The annual average concentration for PM10, SO2, and NO2 was 107.22 µg/m3, 44.07 µg/m3, and 46.71 µg/m3 with standard deviations of 24.84 µg/m3, 13.68 µg/m3, and 9.19 µg/m3, respectively. We observed that ambient air pollutants were significantly positively correlated with the incidence of laryngeal neoplasms, especially for NO2. The relative risks of overall incidence of laryngeal neoplasms in the current period were 1.20, 1.04, and 1.00 for NO2, SO2, and PM10, with 95% confidence intervals (CIs) of 1.01-1.43, 0.93-1.16, and 0.96-1.05, respectively. Moreover, this deleterious impact was stronger in the male than in the female, likely due to genetic predisposition caused by longer exposure to more serious air pollution for men. Our findings complement the epidemiological evidence of laryngeal neoplasms due to ambient air pollution and reinforce the necessity of policy efforts to control the noxious air pollution emissions.

Association of Ambient Air Pollution with Nasopharyngeal Carcinoma Incidence in Ten Large Chinese Cities, 2006-2013.

Large cities in China are experiencing severe ambient air pollution. Although China accounts for more than 45% of new cases of nasopharyngeal carcinoma worldwide in 2018, few studies have examined the association between ambient air pollution and the high nasopharyngeal carcinoma (NPC) incidence in China. Thus, we aim to investigate whether exposure to ambient air pollution (including nitrogen dioxide, sulfur dioxide, and PM10) would significantly affect NPC incidence in large Chinese cities. We collected panel data of ten Chinese provincial cities about local NPC incidence, air pollution level, meteorology, and city profiles during 2006 to 2013 to construct a two-way fixed-effects model to explore the association between ambient air pollution and NPC incidence, as well as possible regional and gender differences behind the association. We found that NO2 had the strongest association with NPC incidence, and the relative risks were 2.2995 (95% CI, 1.2567-4.2075) for males and 1.3010 (95% CI, 0.8212-2.0620) for females, respectively. Under cumulative exposure, it was still NO2 that had the strongest association with NPC incidence, with a relative risk of 1.8836 (95% CI, 1.2416-2.8577), compared to 1.0857 (95% CI, 0.9474-1.2450) and 1.0547 (95% CI, 0.8790-1.2663) for SO2 and PM10, respectively. In addition, males were found more sensitive to ambient air pollution than females. We also found that southern Chinese cities were more sensitive to NO2 than northern cities, which might be related to a higher humidity there. Our study reveals that exposure to ambient air pollutants like SO2, PM10, and particularly NO2, is significantly positively associated with NPC incidence in China.

Effect of Discrimination on Presenteeism among Aging Workers in the United States: Moderated Mediation Effect of Positive and Negative Affect.

This study aimed to examine how perceived everyday discrimination influences presenteeism and how conscientiousness moderates the relationship between discrimination and positive affect among older workers. Structural equation modeling (SEM) was used to examine the mediating effect. The moderated mediation model was examined by PROCESS. The results of the final SEM model showed that discrimination was directly positively associated with presenteeism. Furthermore, positive affect was significantly inversely correlated with discrimination and presenteeism. In addition, negative affect was significantly positively correlated with discrimination and presenteeism. The significant indirect effect between perceived everyday discrimination and positive affect was significantly mediated by positive and negative affect. In addition, the results of the moderated mediation model indicate that positive affect was more likely to be influenced by perceived everyday discrimination among older workers with less conscientiousness, as compared with those with greater conscientiousness. To enhance work outcomes of aging workers in the United States, managers should foster highly conscientious aging workers, award those who are hardworking and goal-oriented, and combine personal goals and organizational goals through bonuses, holidays, and benefits. Policymakers should be mindful of the negative impact of discrimination on presenteeism and should target lowly conscientious older workers.

Do job stress, health, and presenteeism differ between Chinese healthcare workers in public and private hospitals: a cross sectional study.

To determine if job stress, health, and presenteeism differ between healthcare workers at Chinese public and private hospitals. This cross-sectional study analyzed the records of 1080 healthcare workers in eastern, central, and western China for the period from January2015 through November2015. Data on challenge stress, hindrance stress, health, and presenteeism were collected. Using univariate and multivariate regression and SPSS, we investigated differences between Chinese public and private hospitals in China. Challenge stress, hindrance stress, and presenteeism, but not health status, significantly differed between healthcare workers at public and private hospitals in China. Challenge stress and hindrance stress were significantly higher in public hospitals, while presenteeism was significantly lower in private hospitals. The significant differences between public and private hospitals are attributable to differences in the business practices and management of public and private hospitals. To achieve successful long-term medical reform in China, the adverse effects of psychosocial factors should be considered in future research plans and policies. Chinese hospitals urgently require improvements in management and leadership. Reform efforts should encompass fields such as management science, psychology, and the behavioral sciences.

Status of healthcare workers after comprehensive reform of urban public hospitals in Beijing, China: sustainable supply, psychological perception, and work outcomes.

BACKGROUND: Healthcare reform in China has attracted worldwide interest and reached a new juncture. In an attempt to improve healthcare quality and patient satisfaction, the government of Beijing introduced comprehensive reform of urban public hospitals in 2016 and implemented new policies on personnel, compensation, management, and diagnosis and treatment. As the agents of healthcare service, and a target of reform measures, healthcare workers were greatly affected by these reforms but have not been carefully studied. METHODS: This study used mean value analysis, variance analysis, and qualitative content analysis to investigate the status of healthcare workers after comprehensive reform of urban public hospitals in Beijing. RESULTS: We found a gradual but constant increase in the number of healthcare workers in poor health in Beijing public hospitals. After the reforms, this population reported high challenge stress, public service motivation, job satisfaction, job performance and quality of healthcare, moderate presenteeism, and low hindrance stress and turnover intention. The status of healthcare workers differed by subgroup and changed during the reform process. CONCLUSIONS: Our study provides data useful for policy recommendations regarding the implementation and extension of future reforms and offers important lessons for developing and developed countries that are reforming public hospitals to improve efficiency and reduce costs.

Perceived social support and presenteeism among healthcare workers in China: the mediating role of organizational commitment.

OBJECTIVES: We assessed the role of social support in presenteeism by examining organizational commitment among Chinese healthcare workers. METHODS: One thousand four hundred thirty-four healthcare workers from 6 hospitals in 4 Chinese cities completed a questionnaire measuring presenteeism, social support, and organizational commitment. With organizational commitment as the mediator, regression analyses and structural equation modeling were used to test the model. RESULTS: Organizational commitment was directly inversely associated with presenteeism (ß = - 0.42, p < 0.001). Coworker support was moderately but significantly inversely associated with presenteeism (ß = - 0.15, p < 0.001), but the path from supervisor support to presenteeism was not significant (ß = 0.05, p > 0.05). The correlation between supervisor support and coworker support was significant (ß = 0.71, p <0.001). Supervisor support and coworker support were significantly positively associated with organizational commitment (ß = 0.41, p < 0.001, and ß = 0.14, p < 0.001, respectively). CONCLUSIONS: Supervisor support was more important in promoting organizational commitment, while coworker support was more effective in reducing presenteeism. The mediating effect of organizational commitment was significant.