Analysis of the Effectiveness and Influencing Factors of Rule of Law Propaganda and Education in Tertiary Medical Institutions in Yuzhong District, Chongqing, China ()
1. Introduction
In December 2021, the National Health Commission studied and formulated the Eighth Five-Year Plan for Publicity and Education on the Rule of Law in the Health Care System (2021-2025) (hereinafter referred to as the “Plan”), which puts forward the guiding ideology, main objectives, working principles, key contents, key populations, key tasks and organization and implementation of publicity and education on the rule of law in the health care system in the next five years. Among them, the Plan clearly points out that the main person in charge of various types of medical institutions at all levels should be the first person responsible for the construction of the rule of law, strengthen the rule of law education of medical and health personnel, and effectively improve the awareness and ability of medical and health personnel to practice and act in accordance with the law. Medical and health personnel in the diagnosis and treatment process are often more concerned about the medical means and quality, thus ignoring the relevant legal provisions involved, burying the hidden danger of doctor-patient disputes [1] . With the continuous advancement of the rule of law in China, the people’s rule of law literacy and rule of law thinking continue to improve, more and more patients actively understand and exercise their medical rights, take the initiative to consult doctors, consult relevant laws and regulations, and even protect their rights and interests through legal channels, which puts forward higher requirements for the rule of law for medical and health service practitioners. Doing a good job of publicity and education on the rule of law for health personnel in medical institutions is conducive to comprehensively promoting the rule of law, implementing the “Healthy China Strategy”, improving doctor-patient relations, preventing doctor-patient disputes, and providing high-quality medical services. How to optimize the specific measures to carry out rule-of-law publicity and education activities in medical institutions is a question worthy of deep reflection by policymakers, rule-of-law publicity-related workers and researchers, and it is in this context that this topic is being studied.
2. Research Objects and Methods
2.1. Objects of Study
This study was carried out from July 1 to December 31, 2023, with nine tertiary healthcare institutions in Yuzhong District, Chongqing City. It is located in the center of Chongqing, with the smallest area and the smallest population, Its comprehensive medical and health strength ranks first among all districts and counties in the city. There are 9 tertiary medical institutions in Yuzhong District, accounting for about 20% of the total number of tertiary medical institutions in Chongqing. Tertiary medical institutions bear heavy medical and health tasks, receive a large number of patients, and heavy and complex diagnosis and treatment activities will increase legal risks, have higher legal needs, and put forward higher requirements for the rule of law literacy of tertiary medical institutions personnel.
Therefore, 9 tertiary medical institutions in Yuzhong District were selected as the investigation sites, adopting the whole cluster random sampling method, with all the staff of the healthcare institutions as the sample objects, and the formula for calculating the sample size is:
, where the confidence level is 95%, the corresponding t value is 1.96, p is 0.5, and the permissible error e is 0.05. The sample size is calculated to be about 385 people, and at the same time in the formula multiplied by a “design effect” [2] , set k as the “design effect”, k is set to 1.2, the sample size of 385*1.2 = 462, the actual survey used in the sample size to consider the 20% non-response rate, the final calculation of the sample size of about 540 people. Sixty questionnaires were distributed to each tertiary care institution and all were returned, resulting in 506 valid questionnaires and an effective return rate of 96.6%.
2.2. Survey Instruments
The questionnaire was designed by reviewing the literature and consulting with experts, based on the guidance in the Plan, and in accordance with the requirements of the Plan for publicizing and educating on the rule of law in medical institutions. The questionnaire was divided into three parts: basic personal information, basic participation in rule of law publicity and education, and evaluation questions on the effectiveness of rule of law publicity and education, with a total of 13 entries.
The first part of the basic personal information mainly includes gender, age, job position, years of service, rank, and whether or not to serve in the institution.
The second part of the basic information on participation in public education on the rule of law includes whether or not one participates in learning and the frequency of learning. The frequency of study is categorized as zero to three times a year, four to six times a year, seven to nine times a year, 10 to 12 times a year and more than 12 times a year.
The third part of the evaluation questions on the effect of rule of law publicity and education is based on the requirements of the Plan, Including the key contents of law popularization, the key groups of people, the forms and methods of law popularization, the organization and implementation of law popularization, and examines the effect of the work of medical institutions in carrying out the publicity and education on the rule of law. The third part adopts the Likert 5-level positive scoring method, assigning a value to each entry, with 1 being very non-compliant, 2 being more non-compliant, 3 being average, 4 being more compliant, and 5 being very compliant, and the higher the score represents that the respondents evaluate the effect of rule of law publicity and education under the relevant entry better, and the effect score is the average of scores of each entry. This study was tested by SPSS26.0, which showed that the Cronbach’s alpha coefficient of the questionnaire was 0.871, with good reliability.
2.3. Questionnaire Quality Control
During the questionnaire design phase, the survey was completed with expert consultation and several revisions, and during the questionnaire distribution phase, all investigators were educated in sociomedical and managerial sciences, as well as trained in statistics. Prior to conducting the survey, all investigators received uniform training and possessed the appropriate professional knowledge and skills. We actively coordinated and communicated with the medical institutions to obtain informed consent from their staff; in the survey, complete anonymity was used, and the purpose and content of the occasion were explained to those surveyed, so as to effectively safeguard the privacy of the respondents. If any missed or defective questionnaires were found, the investigators recorded them on the spot. In the data entry session, a two-person team was used to enter the data, with one person entering the data and the other acting as a supervisor to oversee the data entry process.
2.4. Statistical Treatment
Epidata 3.1 was used to establish the database, and two people were taken to enter the questionnaire at the same time and space to guarantee the accuracy of the data. SPSS26.0 software was used to statistically analyze the data, and the count data were expressed as frequency and percentage, and the measurement data conforming to normal distribution were described by (
) to describe. The total score of employees’ evaluation of the effect of rule of law publicity and education was used as the dependent variable, and different genders, ages, work positions, years of work, ranks, whether they hold positions, whether they participate in missionary learning, and the frequency of participation in missionary activities were used as independent variables. Analysis of variance (ANOVA) and multiple linear regression analysis was used to compare the differences in the evaluation of the effectiveness of rule of law publicity and education by different variables and to explore the influencing factors affecting the effectiveness of rule of law publicity and education.
3. Results
3.1. Basic Personal Information
Of the 506 questionnaires collected in this survey, women accounted for the majority of the total number of respondents, accounting for 66.4%, and men accounted for 33.6%. The age group of the surveyed population is 20 - 30 accounting for 32%, 31 - 40 accounting for 29.1%, 41 - 50 accounting for 21.1%, and 51 - 60 accounting for 17.4%, which is mainly middle-aged and young people work group, and they bear heavier workloads. According to the respondents’ work positions, doctors accounted for 23.9%, medical technicians 13.4%, nursing staff 32.4%, and administrative staff 30.2%. The proportion of staff is in line with the medical organization. Years of working experience are 0 - 10 accounting for 32.0%, 11 - 20 accounting for 29.1%, 21 - 30 accounting for 21.1%, and more than 30 years accounting for 17.8%. The highest percentage of ranked staff was primary at 31.4%, intermediate at 26.5%, associate senior at 14.0%, senior title at 4.9%, and unranked staff at 23.1%. The percentage of employees holding a position in the institution or department was 18.0%, and the percentage of those without a position was 82% (Table 1).
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Table 1. Basic information on survey respondents (N = 506).
3.2. Basic Information on Participation in Rule of Law Awareness-Raising and Education
Among the 506 surveyed medical institution staff, 503 employees, or 99.4%, have participated in rule of law publicity and education studies, indicating that the situation of rule of law construction and rule of law education in the three-level medical institutions in Yuzhong District, Chongqing City, is better, and the participation of employees is more desirable. The number of employees who participated in legal education for 0 - 3 times in a year was 177, accounting for 35.5%, 185 for 4 - 6 times, accounting for 36.6%, 105 for 7 - 9 times, accounting for 20.8%, 35 for 10 - 12 times, accounting for 6.9%, and 4 for more than 12 times, accounting for 0.8% (Table 2).
3.3. Evaluation of the Effectiveness of Rule of Law Public Education
Through the statistical software SPSS26.0 the mean of the sum of the actual scores of the five effects evaluation single items is 3.18 points, this score is the total effect score of the staff on the evaluation of rule of law publicity and education work in the hospital. In this survey, the staff of the rule of law publicity and education effect of the ratings of the individual items, personal rule of law literacy and awareness of the rule of law has been improved, the content of the law is full and perfect, comprehensive and accurate ratings of the object of the law is higher than the average score. However, the ratings for the flexibility and effectiveness of the forms of publicizing the law and the scientific and accurate evaluation of publicizing the law were low and did not reach the median score of 3 (Table 3).
3.4. Analysis of Factors Affecting the Effectiveness of Rule of Law Publicity and Education
3.4.1. One-Way Analysis of Variance (ANOVA) Affecting the Effectiveness of Rule of Law Awareness Education
The survey examined the relationship between the demographic characteristics of the respondents, their participation in missionary learning and their assessment of the effectiveness of rule of law publicity and education, and used a
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Table 2. Basic information on publicizing and educating on the rule of law in hospitals (N = 506).
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Table 3. Staff rating on the effectiveness of rule of law publicity and education.
one-way ANOVA to analyze whether different genders, ages, job positions, years of working, rank, whether or not they held a position, whether or not they participated in education activities, and the frequency of their participation in education activities affected the staff’s assessment of the effectiveness of rule of law publicity and education in the hospital.
Here are different evaluations of the staff on the rule of law publicity and education effect with different ages, job positions, years of working, rank, whether or not they held a position, frequency of participation in education activities, the difference is statistically significant (P < 0.05), the older the staff of the effect of the higher evaluation, 51 - 60 years of age of the staff of the total score in 18.64, 20 - 30 years of age of the staff of the evaluation of the lowest, the total score of 13.19. medical and nursing technology jobs evaluation of the staff of the evaluation of the staff of significantly better than the administrative management, the administrative administrators had a total effectiveness score of 11.59, while staff in medical and nursing technology jobs all had a total score of 17.00 or higher. The number of years of working experience is positively proportional to the effect evaluation, and the staff with more than 30 years of working experience has the highest trust evaluation, which is 18.59 points. The higher the rank, the better the effect evaluation of the staff and the effect evaluation score of the senior title staff reached 23.76, which was significantly higher than that of the staff without rank (12.07 ± 4.80). The effect evaluation of staff holding positions in the institution (21.42 ± 3.16) was better than that of staff without positions (14.71 ± 4.42). The higher the number of simultaneous participation in rule of law awareness and education activities, the better the evaluation of effectiveness (Table 4).
3.4.2. Multiple Linear Regression Analysis of the Effects of Publicizing and Educating on the Rule of Law
Taking the total mean score of the employees’ evaluation of the effectiveness of the rule of law publicity and education in medical institutions as the dependent variable, the data variables with P < 0.05 in the one-way ANOVA, different ages, job positions, years of experience, grades, whether or not they hold a position, and the frequency of participation in publicity and education activities as the independent variables, we conducted multivariate linear regression analyses to explore the influence of the independent variables on the dependent variables. The results of the analysis showed that age, job position, rank, whether or not to hold a position, and frequency of participation in educational activities were the factors influencing the effectiveness of rule of law publicity and education, and the difference was statistically significant (P < 0.05) (Table 5).
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Table 4. Single-factor analysis of the total score of the effectiveness of rule of law publicity.
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Table 5. Multiple linear regression analysis of the effects of publicizing and educating on the rule of law.
4. Discussion
With the deepening reform of China’s health care system, the modern hospital management system of tertiary medical institutions is basically formed, the establishment of the internal rule of law rules and regulations of the hospital [3] , the hospital’s day-to-day work is standardized, institutionalized, and in the provision of health and health services to do so in accordance with the law, rules and regulations to follow, and at the same time, pay attention to the staff of the rule of law publicity and education efforts have been carried out to carry out various types of learning activities, and most of the employees have received different Degree, the number of education and training, the rule of law education work gradually normalized, covering all genders, age groups, grades, jobs, the rule of law publicity and education environment was initially formed [4] .
4.1. Overall Effectiveness of Awareness-Raising and Education on the Rule of Law Is Poor
From the results of the survey, the effect of the rule of law publicity and education in the three-level medical institutions in Yuzhong District has further room for improvement, the overall educational effect of the subjective evaluation of the staff of the medical institutions is at a general level, the average score is only (3.18 ± 0.99), slightly above the median value of 3 points, less than 4 points, the staff’s overall rule of law literacy is low, and the concept of the rule of law needs to be strengthened, This is consistent with the research results of Liu Yanping and other scholars in Yubei District, Chongqing [5] . This may be one of the important reasons for the frequent occurrence of doctor-patient disputes in recent years.
The low evaluation score on the form and method of popularization of the law shows that the means of preaching is not flexible and interesting enough and does not take into account the nature of the staff’s work of heavy medical tasks and time constraints, and the staff lack flexible time and place to study [6] , which causes a contradiction between work and study, resulting in the ineffectiveness of the rule of law preaching.
4.2. Factors Affecting the Effectiveness of Rule of Law Awareness Education
The results of the multiple linear regression analysis showed that the age, job position, rank, whether or not they held a position and Participation frequency were statistically significant factors influencing the effectiveness of rule of law publicity and education among the staff of medical institutions (P < 0.05).
The comparative study found that the evaluation of the effectiveness of young staff was lower than that of older staff; the evaluation of medical and nursing technicians was better than that of staff in administrative positions; the higher the level of the title, the higher the evaluation of the effectiveness of rule of law publicity and education; the evaluation of staff holding positions was better than that of those who did not hold a position; and the evaluation of staff who had participated in the study more often was better.
The poor evaluation of the effect of young employees may be due to the lack of work experience of young employees, less involvement in the need to use the law to resolve doctor-patient disputes, the subjective willingness to learn is not strong [7] . The better evaluation of the effect of education is the doctor, medical technology and nursing positions, this is due to the heavy responsibility of medical staff, the slightest omission in the diagnosis and treatment process may cause serious consequences to the life and health of the patient, and stimulate the contradiction between doctors and patients [8] , so it is necessary to focus on the education of this part of the position. The administrative position personnel need to face fewer legal problems, and the demand for receiving rule of law education is not high. The lower the rank and the staff of medical institutions who do not hold positions have poor educational effects, the total effect of employees without titles and primary titles is (12.07 ± 4.80) and (14.32 ± 3.72), and the total effect of staff without a post is (14.71 ± 4.42), the score is lower than that of high-ranking staff and employees who hold administrative positions. This is due to the fact that staff with higher titles and positions face more complex diagnostic and therapeutic activities in their work, have more legal needs, and are more willing to learn, which suggests that we need to strengthen the efforts of staff in grassroots positions. At the same time, 71.6% of the staff participated in the rule of law publicity and education in the past year 6 times or less, with a monthly average of less than 1 time. The total score of the trust evaluation of the staff with fewer participation is significantly lower than that of the staff with more participation, which is in line with the results of the research of other scholars [9] . This leads to the poor educational effect of rule of law publicity and education.
5. Countermeasures
5.1. Increase Publicity and Education on the Rule of Law in Medical Institutions
The health administrative department, as the regulator of medical institutions, should strengthen its external supervision of medical institutions. It has further strengthened its efforts to combat overdiagnosis and treatment in medical institutions, illegal fees, fraud and insurance fraud, improper handling of medical waste and other illegal practices, while improving the assessment system for the construction of the rule of law in medical institutions, and providing appropriate incentives to hospitals that have achieved significant results in the construction of the rule of law by way of incentives.
Medical institutions in Yuzhong District should continue to establish and improve the rule of law system for hospitals to govern and practice in accordance with the law, enhance the awareness of the rule of law among the staff of medical institutions as the cornerstone for promoting the construction of the rule of law, improve the working mechanism and regulations for publicizing and educating the rule of law in their hospitals, and equip them with specialized personnel and funds to provide support. Updating the forms of publicity and education on the rule of law, and utilizing more interactive forms of publicity and education, such as legal knowledge quizzes, case studies, and rule of law performances, to strengthen the effect of education. The establishment of a sound assessment system for the rule of law literacy of the staff of the institution, the establishment of a scientific reward and punishment mechanism, the effectiveness of education and individual rewards and punishments linked to the active participation in the activities of the staff, the results of the assessment of the excellent, the use of the rule of law means of flexible staff to be appropriate incentives; at the same time, we also need to be less effective in the education of the individual for a certain amount of punishment, to provide the staff with their own efforts to learn the enthusiasm of the staff.
5.2. Carry out Accurate Legal Education for Different Positions and Levels of Employees
In order to enhance the effectiveness of rule of law publicity and education in the three levels of medical institutions in Yuzhong District, medical institutions should carry out rule of law publicity and education studies in a hierarchical and categorized manner, and carry out targeted education in conjunction with the relevant laws for personnel in different positions, grades, and positions, and increase the frequency of rule of law publicity and education activities.
It pays close attention to publicizing and educating grass-roots front-line staff, young staff and staff at lower grades on the rule of law, and incorporates publicizing and educating on the rule of law into the pre-service training and annual inspection of new staff. Continue to deepen the rule of law publicity and education of clinical staff such as doctors, medical technicians and nursing staff, and strengthen the education of health profession-related laws according to the characteristics of their positions. At the same time, we should pay attention to the missionary education of administrative managers, and carry out regular training and assessment for them. Administrative managers are both the organizers and should be trained in the rule of law missionary education and included in the rule of law publicity and education.
The formation of the rule of law thinking is a long and protracted process that requires the concerted efforts of the state, the government, various medical institutions and staff in order to ultimately and continuously promote the rule of law process in China’s health care industry, and to promote the orderly development of medical and health care.