{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T15:24:03Z","timestamp":1784993043549,"version":"3.55.0"},"reference-count":57,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,8,19]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To determine the prevalence of physical violence and threats against health workers and the aftermath in tertiary, secondary and primary care facilities in China.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A cross-sectional questionnaire study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>5 tertiary hospitals, 8 secondary hospitals and 32 primary care facilities located in both urban and rural areas of Zhejiang Province, China, were chosen as the study sites.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A total of 4862 health workers who have contact with patients completed a survey from July 2016 to July 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>The prevalence of physical violence, threats and Yi Nao, specific forms of physical violence and their aftermath were measured by a self-designed and verified questionnaire. Multivariable logistic regression models were used to examine the association between perceived organisational encouragement of reporting workplace violence (WPV) and physical violence, threats and Yi Nao after controlling for age, sex, level of facility, professional ranking and type of health worker.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among all respondents, 224 (4.6%) were physically attacked and 848 (17.4%) experienced threats in the past year. Respondents in secondary hospitals were more likely to experience physical violence (AOR=3.29, 95%\u2009CI 2.21 to 4.89), threats (AOR=1.61, 95%\u2009CI 1.32 to 1.98) and Yi Nao (AOR=2.47, 95%\u2009CI 2.10 to 2.91), compared with primary care providers. Lack of organisational policies to report WPV was associated with higher likelihood of physical violence (AOR=3.64, 95%\u2009CI 2.57 to 5.18) and threats (AOR=2.21, 95%\u2009CI 1.76 to 2.78). Among physical violence cases, only 29.1% reported the attack to police mainly because most felt it useless to do so (58.8%). Only 25.7% were investigated and 72.4% of attackers received no punishment. Of all those attacked or threatened, 59.4% wanted to quit current post and 76.0% were fearful of dealing with urgent or severe cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Proper management of the aftermath of violence against health workers is inadequate. Formal guidelines for reporting and managing WPV are urgently needed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-031513","type":"journal-article","created":{"date-parts":[[2019,9,21]],"date-time":"2019-09-21T07:05:32Z","timestamp":1569049532000},"page":"e031513","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Workplace violence and its aftermath in China\u2019s health sector: implications from a cross-sectional survey across three tiers of the health system"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7912-7415","authenticated-orcid":false,"given":"Sheng Zhi","family":"Yang","sequence":"first","affiliation":[{"name":"Institute for Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Wu","sequence":"additional","affiliation":[{"name":"Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute for Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese","family":"Hesketh","sequence":"additional","affiliation":[{"name":"Center for Global Health, School of Medicine, Zhejiang University, Hangzhou, China"},{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai Sing","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Li","sequence":"additional","affiliation":[{"name":"Institute for Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xudong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Institute for Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,9,20]]},"reference":[{"key":"2025101811014899000_9.9.e031513.1","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0140-6736(14)60658-9","article-title":"Tackling violence against health-care workers","volume":"383","author":"Nelson","year":"2014","journal-title":"The Lancet"},{"key":"2025101811014899000_9.9.e031513.2","unstructured":"Martino D . 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White paper on the career condition of Chinese licensed physicians, 2015. Available: http:\/\/www.cmda.net\/zlwqgzdt\/596.jhtml [Accessed 29 Jul 2019]."},{"key":"2025101811014899000_9.9.e031513.10","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.4103\/0366-6999.209888","article-title":"Origin and prevention of workplace violence in health care in China: legal and ethical considerations","volume":"130","author":"Guan","year":"2017","journal-title":"Chin Med J"},{"key":"2025101811014899000_9.9.e031513.11","doi-asserted-by":"crossref","first-page":"01","DOI":"10.20529\/IJME.2019.006","article-title":"Workplace violence against healthcare professionals in China: a content analysis of media reports","volume":"4","author":"Teoh","year":"2019","journal-title":"Indian J Med Ethics"},{"key":"2025101811014899000_9.9.e031513.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-019373","article-title":"Impact of workplace violence and compassionate behaviour in hospitals on stress, sleep quality and subjective health status among Chinese nurses: a cross-sectional survey","volume":"8","author":"Zhang","year":"2018","journal-title":"BMJ Open"},{"key":"2025101811014899000_9.9.e031513.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12955-019-1164-3","article-title":"The impact of workplace violence on job satisfaction, job burnout, and turnover intention: the mediating role of social support","volume":"17","author":"Duan","year":"2019","journal-title":"Health Qual Life Outcomes"},{"key":"2025101811014899000_9.9.e031513.14","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000012501","article-title":"Analysis of current situation and influencing factor of medical disputes among different levels of medical institutions based on the game theory in Xiamen of China: a cross-sectional survey","volume":"97","author":"Zeng","year":"2018","journal-title":"Medicine"},{"key":"2025101811014899000_9.9.e031513.15","doi-asserted-by":"crossref","unstructured":"Lu L , Dong M , Wang S-B , et al . 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Impact of patients violence in public hospital on job burnout of nurses. Chinese Hospital Management 2016."},{"key":"2025101811014899000_9.9.e031513.29","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.apnr.2018.01.003","article-title":"Incidence and risk factors of workplace violence against nurses in a Chinese top-level teaching hospital: a cross-sectional study","volume":"40","author":"Chen","year":"2018","journal-title":"Appl Nurs Res"},{"key":"2025101811014899000_9.9.e031513.30","doi-asserted-by":"publisher","DOI":"10.1891\/0886-6708.15.1.41"},{"key":"2025101811014899000_9.9.e031513.31","doi-asserted-by":"publisher","DOI":"10.1177\/0886260513487987"},{"key":"2025101811014899000_9.9.e031513.32","unstructured":"Zhejiang Provincial Bureau of Statistics . Statistics of Zhejiang population in 2017 Zhejiang: Zhejiang provincial Bureau of statistics, 2018. Available: http:\/\/tjj.zj.gov.cn\/tjgb\/rkcydcgb\/201801\/t20180131_204500.html [Accessed 29 Dec 2018]."},{"key":"2025101811014899000_9.9.e031513.33","unstructured":"Health and Family Planning Commission of Zhejiang Province . Quantity of health facilities, hospital beds, and health personnel in Zhejiang Province 2017. 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Analysis on the Direct Causes and Solutions to \"Occupational Medical Quarreler\". Journal of North Sichuan Medical College 2011."},{"key":"2025101811014899000_9.9.e031513.48","unstructured":"Zheng X , Wei L , Zhang B , et al . Medical dispute survey in China and medical dispute solution overseas. Chinese Hospitals 2007."},{"key":"2025101811014899000_9.9.e031513.49","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2011.01336.x"},{"key":"2025101811014899000_9.9.e031513.50","first-page":"188","article-title":"The Five \u201cImportant and Light\u201dConstruction Analysis of Public Hospital Management Culture- from the Perspectives of Social Field and Habituation","volume":"18","author":"Yuan","year":"2018","journal-title":"Modern Hospital"},{"key":"2025101811014899000_9.9.e031513.51","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1998.00167.x"},{"key":"2025101811014899000_9.9.e031513.52","unstructured":"American Medical Association . Taking steps to prevent violence in health care workplace Chicago: American Medical association, 2016. Available: https:\/\/wire.ama-assn.org\/ama-news\/taking-steps-prevent-violence-health-care-workplace [Accessed 29 Dec 2018]."},{"key":"2025101811014899000_9.9.e031513.53","unstructured":"Richards J . ILO\/ICN\/WHO\/PSI workplace violence in the health sector Cross-Cutting theme study: management of workplace violence victims. Geneva International Labour Office, International Council of Nurses, World Health Organisation, Public Services International; 2003."},{"key":"2025101811014899000_9.9.e031513.54","unstructured":"American Federation of State CaME . Preventing workplace violence: a Union representative's Guidebook, 2006. Available: https:\/\/www.afscme.org\/news\/publications\/for-leaders\/preventing-workplace-violence-a-union-representatives-guidebook [Accessed 29 Dec 2018]."},{"key":"2025101811014899000_9.9.e031513.55","unstructured":"UNISON . Violence at work, a guide to risk prevention. London UNISON; 1997."},{"key":"2025101811014899000_9.9.e031513.56","unstructured":"UNISON . It's not part of the job: a health and safety guide on tackling violence at work. London UNISON; 2013."},{"key":"2025101811014899000_9.9.e031513.57","unstructured":"Chinese Medical Doctor Association . A joint call for zero tolerance to workplace violence against health workers by Chinese medical doctor association, Chinese medical association, Chinese Hospital association, and China health law Society (Chinese). Otorhinolaryngology 2013;28."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-031513","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:02:05Z","timestamp":1760810525000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-031513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":57,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9,20]]},"published-print":{"date-parts":[[2019,9]]}},"alternative-id":["10.1136\/bmjopen-2019-031513"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-031513","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}