Juntian Shen, a Global Health major from Duke Kunshan University’s Class of 2025, is one of the student leaders of the CSCC Faculty-Student Collaborative Project titled “Management of Multimorbidity among Community Residents with Hypertension and Diabetes in China”. Under the guidance of Prof. Lijing Yan, Juntian is dedicated to addressing critical health issues in China. This project employs a community empowerment approach, as recommended by WHO, to better understand and address issues of chronic disease management in urban populations.
In addition to her research involvement, Juntian was a key contributor to the CSCC’s Community Service Project “The Medical English Project,” aiding in the capacity-building of local hospital’s healthcare professionals by enhancing their English proficiency. Her active role in both research and community service reflects her commitment to practical health solutions and underscores the role of student leadership in advancing public health objectives. Our recent conversation with Juntian provided insightful reflections on her path in Global Health, the tangible impact of her work, and the individual growth she has experienced through her multifaceted role as a student-researcher and community health advocate.
What drew you to the “Management of Multimorbidity among Community Residents with Hypertension and Diabetes in China” project?
What initially drew me to this project was a personal connection. My grandmother suffers from coronary heart disease, hypertension, rheumatoid arthritis, and dry eye syndrome. She developed rheumatoid arthritis at a young age, but no one ever explicitly informed her that dry eye syndrome is a common comorbidity of rheumatoid arthritis. She was unaware of the potential coexisting conditions or how to prevent them. Additionally, managing multiple chronic diseases posed far greater challenges for her compared to patients with a single condition, such as medication conflicts between treatments for different diseases and the need to visit various healthcare facilities to access prescriptions for each condition. Her experience inspired me to explore the factors that influence multimorbidity and potential intervention methods. Fortunately, Professor Yan offered the research opportunity and the platform for me to explore this topic.
On a broader scale, multimorbidity is becoming an increasingly prominent public health issue both in China and globally. Multimorbidity, defined as the presence of two or more co-existing conditions in an individual, leads to adverse health outcomes and healthcare challenges such as frailty, polypharmacy, reduced quality of life, and fragmented care. Recognizing its urgency, China’s 14th Five-Year Plan has included the co-management of multimorbidity as part of its health agenda. However, there is still a significant research gap, as only a limited number of studies consider multimorbidity as a dependent variable and evaluate its associated factors. This is where our research team aims to contribute and provide insights for future multimorbidity management at the community level.
As you dive into the ongoing phase of the research project this summer, could you share any initial findings or patterns you’ve observed related to multimorbidity that have emerged from the recent data analysis?
As our research progresses, some interesting phenomena and preliminary findings have emerged. On the quantitative side, our data analysis has shown that socioeconomic status and individual behaviors, such as smoking and vegetable intake, have a significant impact on the number of multimorbid conditions an individual may develop. These factors appear to be critical in understanding the prevalence and severity of multimorbidity in the population.
On the qualitative side, we have observed that patients who engage in better self-management practices tend to achieve more favorable outcomes. Specifically, those who follow a bland diet, maintain regular exercise routines, and demonstrate good medication adherence often show improved control over conditions such as blood pressure and blood sugar levels. This suggests that effective self-management strategies could be key to better multimorbidity management. These early findings will help inform future stages of our research, particularly in developing targeted management and interventions for patients with multimorbidity.
You have been involved in both quantitative and qualitative aspects of the project. How do you balance these two different research approaches, and what have you learned from each?
Working with both quantitative and qualitative methods has been one of the most enriching aspects of this project. For the quantitative part, we focus on identifying the prevalence of multimorbidity and understanding the relevant factors, such as age, gender, and lifestyle habits, that contribute to its rise. This data is essential for creating generalizable conclusions that can be applied across populations. However, numbers alone don’t tell the whole story, which is why qualitative research is just as crucial. Through interviews and focus groups, we are able to gather insights that structured surveys cannot capture, such as the personal challenges patients face in managing their conditions, or the emotional struggle chronic diseases take on both patients and their families. This blend of approaches facilitates our research project as statistics provide a broad framework encompassing correlations and trends, while qualitative data adds depth and nuance to capture a more holistic picture of the health issue.
Given the dynamic nature of your research, what are some of the challenges you are anticipating or currently facing in collecting and analyzing data on multimorbidity?
One of the key challenges we anticipate in the quantitative phase of our research involves the questionnaire, which asks residents to assess the quantity and quality of medications they receive, as well as the services provided by the community health center where the fieldwork is conducted. We foresee that some residents may hesitate to provide honest feedback, possibly due to fear of the community doctors being present. To address this, we plan to conduct the surveys in a room separate from the community health workers’ offices, ensuring a more private environment for genuine responses.
For the qualitative part, conducting semi-structured interviews presents its own challenges. Some interviewees may provide limited or irrelevant information, deviating from the data we aim to collect. To mitigate this, we will thoroughly train our student interviewers to guide the conversations effectively, ensuring that they can steer discussions back to the topics of interest while allowing the interviewees to share their insights freely.
During the upcoming qualitative fieldwork, what insights do you hope to gain from the community residents and healthcare providers that will inform your understanding of multimorbidity management at the primary care level?
The upcoming qualitative fieldwork marks an exciting phase of our project, as the semi-structured interviews offer valuable insights that structured questionnaires in the quantitative phase may not be able to cover.
From the residents, we hope to learn more about how they manage their conditions on a daily basis, including the barriers they face in accessing care, dietary control, physical activity and adherence to treatment regimens. This will give us a clearer picture of the real-world challenges of managing multimorbidity. From healthcare providers, we aim to understand their current strategies for addressing multimorbidity at the primary care level, as well as the challenges they encounter, such as resource constraints or patient adherence issues. Additionally, we are eager to assess the acceptability and feasibility of new interventions we’ve proposed, such as integrated care models or digital health tools. This fieldwork will provide us with crucial data to inform the next steps of our research or potential intervention design.
How do you aim to investigate the impact of gender and socioeconomic disparities on multimorbidity during this research phase, and what methodology do you intend to use to analyze these disparities?
Gender and socioeconomic disparities play a significant role in health outcomes, particularly in the context of multimorbidity. To investigate these disparities, we plan to conduct a subgroup quantitative analysis, dividing participants by key demographic factors such as gender, age, residence, education, occupation, and household income. We will use regression models to compare the rates of multimorbidity across these groups, which will help us identify which populations are most at risk. By analyzing these disparities, we hope to provide insights for future targeted interventions that address the specific needs of these vulnerable groups and reduce health inequities in multimorbidity management.
How has participating in the “Medical English Program” influenced your approach to community health, and what skills have you gained that benefit your research endeavors?
In the “Medical English Program”, I realized the crucial role that doctors play in facilitating community health outcomes. I was responsible for teaching medical English to a doctor from the outpatient department of Kunshan No.3 Hospital. One notable experience occurred when, after a morning lesson on medical vocabulary related to physical check-ups, the doctor was able to use what she had learned later that afternoon to effectively communicate with one of our international students, helping them navigate the hospital. This demonstrated to me the tangible benefits of empowering doctors to improve community health.
This insight is also manifested in our multimorbidity project, where we have incorporated qualitative interviews with general practitioners at community health centers. These interviews aim to understand their processes, challenges, and the support they need in managing patients with multimorbidity. Understanding their perspective is critical for designing future interventions that empower community doctors and improve multimorbidity management in the community setting.
As a student leader/researcher, what advice would you give to other undergraduates who are interested in getting involved in research, especially in a field as demanding as global health?
My advice for undergraduates interested in global health research is to develop a strong sense of observation and remain aware of the complex factors that influence health outcomes, including cultural, environmental, and socioeconomic dynamics. Global health is highly interdisciplinary, so it’s essential to keep an open mind and engage with a wide range of perspectives, from individual behaviors to systemic healthcare issues.
Equally important is the willingness to experiment and embrace failure. Setbacks are inevitable in research, but they provide valuable learning opportunities. For example, at the start of this summer, my first data analysis project did not yield statistically significant results despite a month of work. However, throughout the process, I learned advanced techniques like restricted cubic spline, Kaplan-Meier survival estimates, and Cox regression, which became instrumental in my subsequent analysis. Being bold enough to try new ideas and adapt when things don’t go as planned is crucial not only for innovation but also for personal growth. My advice for undergraduates interested in global health research is to cultivate a keen sense of observation and be mindful of the sophisticated factors influencing health outcomes, such as cultural, environmental, and socioeconomic dynamics. Global health is an interdisciplinary field, so having an open mind and willingness to engage with a variety of perspectives—from individual behaviors to systemic healthcare issues—is essential.
With the culmination of your project potentially contributing to your final signature work, can you give us a glimpse into the themes or conclusions you’re hoping to explore or confirm through your continued research?
In my signature work, I would like to focus on the individual, family, and community factors that affect the multimorbidity outcomes. Chronic disease management is a long-term process that involves not only the patient but also their family and understanding how family function affects multimorbidity outcomes is crucial. Furthermore, since community health centers also play a vital role in delivering primary health services and manage chronic diseases among community-dwelling elderly, I also plan to examine how these centers can be leveraged to improve multimorbidity care.
Through this research, I hope to provide a systematic analysis of the key determinants of multimorbidity and promote a more holistic understanding of how different factors at the individual, family, and community levels shape health outcomes in middle-aged and older adults with multimorbidity.
