Healthcare Providers’ Knowledge, Perceptions, and Expectations of Healthier SG: A Cross-Sectional Survey

Abstract

AbstractIntroduction: The Healthier SG initiative marks a significant shift away from Singapore's focus on curative medicine toward preventive and household-focused care. This intervention, linked to the increasingly aging population and the rise in the prevalence of chronic illnesses, has clear objectives, but its implementation depends on the preparedness of healthcare providers. This study assesses the knowledge, perceptions, and expectations of staff members of SingHealth, the largest of Singapore's three public healthcare clusters, regarding Healthier SG and its implementation. Methods: A quantitative cross-sectional survey was conducted among 449 healthcare providers, such as nurses (n=258), allied health professionals (n=143), administrators (n=12), physicians (n=8), and other cadres (n=28) working at SingHealth. A structured questionnaire targeting the three constructs of the Theory of Planned Behavior (attitude, subjective norms, perceived behavioral control) was adopted for the data collection process, and questions focused on awareness levels for HSG, formal training, perceptions on preventive care, capitation-based healthcare financing models, doctor-patient relationships, and the long-term impact of proactive care on patient outcomes. The data were analyzed using descriptive statistics, categorical associations were examined through Fisher’s exact tests, and the effect of formal training on HSG familiarity was assessed via the Welch two-sample t-test. Results: While more nurses responded to the survey questions than other healthcare providers, the data analyzed reveal that Healthier SG's awareness level was high (94.8% (n=422)), and most professionals were positive about the intervention's impact. However, only a few healthcare providers (27.8% (n=121)) had received formal training to better prepare for the change, and significant differences (p<0.001) were observed between the trained mean familiarity score = 2.57) and the untrained participants (Mean familiarity score =1.95). While perceptions of the shift to preventive care were positive (72.2%), some respondents were unsure about the impact of the capitation-based healthcare financing model on healthcare delivery (54.7%). The perceptions towards the new funding approach changed depending on the profession. More nurses reported the model as more beneficial than other groups, specifically doctors. Also, no strong predictors were identified for positive and negative stakeholder perceptions of the new funding model. Additionally, the survey participants expected challenges related to enrollment, information technology applications, limited resources, and adapting to preventive care models. Discussion: These results confirm that the high level of uncertainty towards capitation-based healthcare financing means that awareness of Healthier SG does not translate into capacity for its successful implementation. The SingHealth staff are not fully prepared, with only a few of them formally trained for the reform. The uncertainty towards the capitation model reflects unaddressed barriers and an imbalance between attitude and perceived behavioral control, causing the professionals to resist the change. The government must involve all stakeholders and provide sufficient resources, among other recommendations, to support these professionals in maximizing desirable health outcomes. Conclusion: The study provides adequate evidence on the impact of unpreparedness on the implementation of interventions through the experiences of SingHealth staff. The Singaporean government has an important part to play in enhancing communication related to Healthier SG, offering training opportunities, and addressing systemic barriers to ensure they transform Healthier SG from a theory to an actual program for a wider population in Singapore.