Factors influencing the management of chronic non-communicable diseases in cold regions: a qualitative study from Northeast China

Abstract Background and Objectives Non-Communicable Diseases (NCDs) represent a significant public health burden in China, particularly in cold regions where environmental factors further limit access to healthcare. To address this challenge, China has implemented the National Essential Public Health Service Package (NEPHSP) to improve NCD management through primary healthcare services. However, research on the effectiveness of NEPHSP in cold regions is limited. This study aims to identify the key factors influencing the implementation of NCD management services in cold regions, focusing on both barriers and facilitators. Methods This qualitative study was conducted in three purposively selected cold regions in Northeast China (Harbin, Qiqihar, and Jiamusi). Data were collected through semi-structured interviews and focus group discussions, guided by the RE-AIM framework. Participants included local health administrators, primary healthcare workers, and community-dwelling individuals with NCDs. Thematic analysis was employed to code and extract key themes from the data. Results A total of 72 participants (59.7% female, mean age 49.1 ± 6.24 years) took part in the study. Major barriers to NCD management included low health literacy, limited awareness of NCDs, insufficient medical resources, poor public awareness, inadequate multisectoral collaboration, and the absence of effective audit and feedback systems. Key facilitators included the affordability and accessibility of primary healthcare services, strong patient-physician relationships, and the high priority given to NCD management by local governments. Furthermore, harsh environmental conditions and limited healthcare accessibility in cold regions complicated the management of NCDs, highlighting the need for tailored interventions that address the specific challenges of these regions. Conclusions This study identifies significant facilitators and barriers to the implementation of NCD management services under the NEPHSP in cold regions of China. The unique challenges posed by cold climates necessitate the adaptation of healthcare services to local needs, with a focus on improving health literacy, enhancing healthcare infrastructure, and fostering multisectoral collaboration. These findings provide valuable insights for optimizing NCD prevention and management strategies within China's primary healthcare system.