Key Motivators and Framework for Integrated Care by Family Physician Team Members in Urban China

Background: This study aimed to develop an analytical framework to investigate the key motivators influencing family physician team members (FPTMs) in delivering integrated care at the primary healthcare (PHC) level within urban China. The objective was to identify critical factors based on cause and effect relationships, with the ultimate aim of enhancing the integration of primary care and public health services. Methods: A mixed-methods design was implemented, integrating thematic analysis and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method. Data were gathered from semi-structured interviews with 24 participants, comprising FPTMs and administrators from Wuhan, Shenzhen, and Shanghai, collected between January and July 2022. The thematic analysis facilitated the construction of an initial framework of motivators, while the DEMATEL method was employed to examine and map the interdependent relationships among these motivators. Results: The analysis distilled 64 first-order concepts into 15 second-order themes, which were then categorized into four broader dimensions: government agencies, primary healthcare institutions, family physician teams, and residents. Motivators at the government level, such as resource allocation and the development of IT infrastructure, were identified as proactive forces driving change. In contrast, resident-level factors, including trust and adherence, were more reactive, shaped by external conditions and responsive rather than initiators of change. Conclusion: The findings emphasize the pivotal role of government leadership in fostering the adoption of integrated care. Key strategies include enhancing interdisciplinary team collaboration, optimizing performance evaluations, and refining incentive structures to boost FPTMs' motivation. Equally important is the need to encourage residents to engage in proactive health management, promoting a collaborative care model that integrates both FPTMs and the communities they serve.