关键词: 公共卫生, 社区卫生服务, 焦点访谈, 扎根理论, 实施效果, 影响因素分析, 天津

Abstract: Background　In general，the implementation of the national essential public health services project in China has achieved relatively good results at the national level，but the practical effect is still the focus of the government and society. Reasonable evaluation of the implementation effect and identification of the associated factors are the prerequisite and foundation for improving the implementation of the services. Objective　To evaluate the implementation effects and influencing factors of the national essential public health services，analyze the existing problems and discuss the rationality of project planning，to provide support for further development of such services. Methods　Using purposive sampling，a total of 26 resident representatives and public health professionals were selected from Heping District，Tianjin. Regarding the implementation effect，evaluation and influencing factors of national essential public health service projects，focus interviews were conducted to collect data in April 2017，and grounded theory coding was used for analysis. Results　The coding of the interview results yielded 53 open codes，16 axial codes and 4 selective codes. The selective codes included project lead，project traction，implementation guarantee and project results. The first three were interrelated and influenced each other，and collaboratively affected project results. Project results covered 4 axial codes：recognized project，problematic project，medical workers' satisfaction with the project and residents' satisfaction with the project. "Demand-oriented-well-matched supply and demand"（21 times），"service delivery mode-team mode"（3 times），"management experience-solid foundation formed by years of development"（5 times） and "fund management-appropriate fund for each service item"（5 times） were main reasons for good healthcare management of elderly people and women and children. "Demand-oriented-well-matched supply and demand" and "project evaluation mechanism" were obstacles to health records management，health education，severe mental illness management and tuberculosis management. "Project evaluation mechanism-high requirements for quantification of indicators"（26 times），"fund management-relatively sufficient funds but insufficient in actual practice"（22 times），"service delivery mode-different delivery patterns for medical and public health services" （10 times） and "project planning"（9 times） were main factors associated with medical workers' satisfaction with the project. "Policy interpretation"（7 times），"satisfaction with medical care"（7 times），"equipment accuracy"（5 times） and "professional level of medical workers"（4 times） were main factors associated with residents' satisfaction with the project. Conclusion　Project lead，project traction，and implementation guarantee are prerequisites and guarantees for effective implementation of the national essential public health service projects. Relevant departments should optimize the project setting based on demand，optimize the project evaluation based on the performance indices，and support the implementation of the related policies to ensure the implementation of the project，and overcome the difficulties of insufficient amount and unsatisfied quality of community health resources，to promote and improve the national essential public health service projects.

Key words: Public health, Community health services, Focused interview, Grounded theory, Practice effect, Root cause analysis, Tianjin