Structural factors influencing the adoption and adaption of foreign innovations in health service delivery in the Chinese context: a qualitative study

Many Global Health initiatives aim to disseminate best practices to developing countries to improve access and quality of care. However, current concepts of successful innovation are primarily based on studies conducted in developed, Western countries. Little is known about the structural factors influencing the uptake of these innovations in non-Western developing countries. This gap motivated our study on the introduction of ‘best international practices in health service delivery’ in China. We conducted semi-structured online interviews with 20 participants, consisting of 10 Chinese, 9 Dutch, and 1 German, to advance scientific understanding of this topic. Four themes of structural factors that influence the adoption and adaption of health service delivery innovations originating from abroad in China emerged. These four themes include: Alignment with governmental policies and regulations, Leadership engagement on multiple levels, Alignment between internal stakeholders, and Matching incentives with both organizational and personal interests. While adoption is always top-down, adaption often follows a bottom-up approach in the Chinese context. Resource scarcity in primary care institutions adds extra difficulties to bottom-up innovations. Health professionals’ motivations to adopt and adapt foreign innovations are primarily controlled (externally) instead of autonomous (internally), which can diminish sustainability. Reducing workload and increasing salaries can facilitate resolving motivation challenges. Our findings indicate that differences exist in the adoption and adaptation of foreign innovations in developing countries with tight government control and a centralized health system such as China, compared to developed countries with decentralized health systems.