The health workers in rural primary care systems are at the increasing risk of job burnout. To explore the prevalence and associated factors of the job burnout among the primary healthcare worker in rural China, a cross-sectional survey was conducted among 15,627 participants in 459 township hospitals from six provinces. A combination of stratified multi-stage sampling and cluster sampling method, and a self-administrated questionnaire with the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS) were used in the investigation. Multilevel regression analyses were used to examine the potential associated factors on both individual and organisational levels. 47.6% of respondents were experiencing moderate burnout, and 3.3% were in severe burnout. Professionals working for over 40 h per week, at young age, with a college degree, and with professional titles at medium or high rank reported a higher degree of job burnout. At the institutional level, the high ratio of performance-based salary was associated with a higher level of depersonalization. Burnout has become prevalent among the primary healthcare workers in rural China, and multiple strategies are needed to reduce the work stress and some high-risk groups’ vulnerability to job burnout.

Background: Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders. Methods: Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household-individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors. Results: In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93-23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21-0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36-0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18-0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09-0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73-48.75) were more likely to self-treat. Conclusion: Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.

Background The internet is one of the most popular health information resources, and the Chinese constitute one-fifth of the online users worldwide. As internet penetration continues to rise, more details on the Chinese population seeking online health information need to be known based on the current literature. Objective This study aims to explore the sociodemographic differences in online health information seeking (OHIS), including the frequency of OHIS and the types of online health information sought among the general Chinese population in mainland China. Methods A cross-sectional study for assessing the residents’ health care needs with self-administered questionnaires was implemented in 4 counties and districts in China from July 2018 to August 2018. Pearson’s chi-square test was used to identify the sociodemographic differences between infrequent and frequent online health information seekers. We also performed binary logistic regression for the 4 types of online health information as the dependent variables and the sociodemographic factors as the independent variables. Results Compared with infrequent online health information seekers, frequent seekers were more likely to be female (infrequent: 1654/3318; 49.85%; frequent: 1015/1831, 55.43%), older (over 60 years old; infrequent: 454/3318, 13.68%; frequent: 282/1831, 15.40%), married (infrequent: 2649/3318, 79.84%; frequent: 1537/1831, 83.94%), and better educated (bachelor’s or above; infrequent: 834/3318, 25.14%; frequent: 566/1831, 30.91%). They were also more likely to earn a higher income (over RMB ¥50k [RMB ¥1=US $0.15641]; infrequent: 1139/3318, 34.33%; frequent: 710/1831, 34.78%), have commercial health insurance (infrequent: 628/3318, 18.93%; frequent: 470/1831, 25.67%), and have reported illness in the past 12 months (infrequent: 659/3318, 19.86%; frequent: 415/1831, 22.67%). Among the 4 health information types, health science popularization was the most searched for information by Chinese online health information seekers (3654/5149, 70.79%), followed by healthy behaviors (3567/5149, 69.28%), traditional Chinese medicine (1931/5149, 37.50%), and medical concerns (1703/5149, 33.07%). The binary logistic regression models showed that males were less likely to seek information on healthy behaviors (adjusted odds ratio [AOR] 0.69, 95% CI 0.61-0.78) and traditional Chinese medicine (AOR 0.64, 95% CI 0.57-0.73), and respondents who had at least 1 chronic disease were more likely to seek information on medical concerns (AOR 1.27, 95% CI 1.07-1.51) and traditional Chinese medicine (AOR 1.26, 95% CI 1.06-1.49). Conclusions Sociodemographic factors were associated with the frequency of OHIS and types of information sought among the general Chinese population. The results remind providers of online health information to consider the needs of specific population groups when tailoring and presenting health information to the target population.

BackgroundChina poverty reduction policy (PRP) addresses two important elements: the targeted poverty reduction (TPA) project since 2015 in line with social assistance policy as national policy; and reducing inequality in health services utilization by making provision of medical financial assistance (MFA). Therefore, this study aims to assess the effects of the PRP in health services utilization (both inpatient and outpatient services) among the central and western rural poor of China.MethodsThe study conducted household survey and applied propensity score matching (PSM) method to assess the effects of the PRP on health services utilization among the rural poor of Central and Western China. A sensitivity test was also performed on the PSM results to test their robustness.ResultsKey findings showed 17.6% of respondents were the beneficial of PRP. The average treatment effects on the treated (ATT) of the PRP on the inpatient visits within one year was found significantly positive (P = 0.026).ConclusionThere has been relationship between PRP with medical financial assistance and reduction of inequality in health services utilization by the poorer, in particular to accessing the inpatient services from the county or township hospitals of China. Policy makers should pay attention for making provision of improving responsiveness of supply, when subsidizing on the demand side.

The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.

This study aims to identify the characteristics and trajectories of outpatient service utilisation for hypertensive patients in tertiary hospitals. This study also attempts to investigate the determinants of the trajectories of outpatient service utilisation. A total of 9822 patients with hypertension and hypertension-related medical utilisation were recruited in Yichang, China from January 1 to December 31 in 2016. The latent trajectories of outpatient service utilisation were identified through latent class growth analysis. Differences in the demographic characteristics and medical utilisation among patients in different trajectories were tested by one-way ANOVA and chi-square analysis. The predictors of the trajectory groups of outpatient service utilisation were identified through multinomial logistic regression. Four trajectory groups were determined as stable-low (34.7%), low-fluctuating (13.4%), high-fluctuating (22.5%), and stable-high (29.4%). Significant differences were observed in all demographic characteristics (p < 0.001) and medical service utilisation variables (p < 0.001) among the four trajectories except for inpatient cost (p = 0.072). Determinants for outpatient service utilisation patterns include the place of residence, education level, outpatient visit times, inpatient service utilisation, and outpatient cost. Overall, hypertensive patients visiting outpatient units in the tertiary hospital were middle-aged, elderly, and well-educated, and they received poor follow-up services. The four identified latent trajectories have different characteristics and medical utilisation patterns. Trajectory group-based measurements are necessary for hypertension management and economic burden reduction.

Background Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in the current rural China remain unclear. This study aims to explore the determinants of self-treatment among elders in rural China, focusing on context-specific and multi-dimensional factors. Methods Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, Guizhou Province in western China. Data were collected through a self-administered questionnaire on the healthcare needs of residents. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 338 (individuals). Pearson’s chi-squared test and binary logistic regression analysis were performed among the whole sample group and four subgroups. Results Approximately 25.94% of the 1303 elders reported illness within the last 2 weeks, of whom 34.4% indicated self-treatment. The variables independently associated with a greater probability of self-treatment in the whole sample group were better health status, no recent alcohol consumption and no utilisation of family practice services; the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (TCM) and drinking alcohol recently were less likely to self-treat. Non-empty-nest elders who were no less than 75 years old and at better health status were more likely to self-treat. Conclusion Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Advanced age and self-care habits in TCM also play roles in some subgroups. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for developing improvement strategies of the family practice system in China.

BACKGROUND The internet is one of the most popular health information resources, and the Chinese constitute one-fifth of the online users worldwide. As internet penetration continues to rise, more details on the Chinese population seeking online health information need to be known based on the current literature. OBJECTIVE This study aims to explore the sociodemographic differences in online health information seeking (OHIS), including the frequency of OHIS and the types of online health information sought among the general Chinese population in mainland China. METHODS A cross-sectional study for assessing the residents’ health care needs with self-administered questionnaires was implemented in 4 counties and districts in China from July 2018 to August 2018. Pearson’s chi-square test was used to identify the sociodemographic differences between infrequent and frequent online health information seekers. We also performed binary logistic regression for the 4 types of online health information as the dependent variables and the sociodemographic factors as the independent variables. RESULTS Compared with infrequent online health information seekers, frequent seekers were more likely to be female (infrequent: 1654/3318; 49.85%; frequent: 1015/1831, 55.43%), older (over 60 years old; infrequent: 454/3318, 13.68%; frequent: 282/1831, 15.40%), married (infrequent: 2649/3318, 79.84%; frequent: 1537/1831, 83.94%), and better educated (bachelor’s or above; infrequent: 834/3318, 25.14%; frequent: 566/1831, 30.91%). They were also more likely to earn a higher income (over RMB ¥50k [RMB ¥1=US $0.15641]; infrequent: 1139/3318, 34.33%; frequent: 710/1831, 34.78%), have commercial health insurance (infrequent: 628/3318, 18.93%; frequent: 470/1831, 25.67%), and have reported illness in the past 12 months (infrequent: 659/3318, 19.86%; frequent: 415/1831, 22.67%). Among the 4 health information types, health science popularization was the most searched for information by Chinese online health information seekers (3654/5149, 70.79%), followed by healthy behaviors (3567/5149, 69.28%), traditional Chinese medicine (1931/5149, 37.50%), and medical concerns (1703/5149, 33.07%). The binary logistic regression models showed that males were less likely to seek information on healthy behaviors (adjusted odds ratio [AOR] 0.69, 95% CI 0.61-0.78) and traditional Chinese medicine (AOR 0.64, 95% CI 0.57-0.73), and respondents who had at least 1 chronic disease were more likely to seek information on medical concerns (AOR 1.27, 95% CI 1.07-1.51) and traditional Chinese medicine (AOR 1.26, 95% CI 1.06-1.49). CONCLUSIONS Sociodemographic factors were associated with the frequency of OHIS and types of information sought among the general Chinese population. The results remind providers of online health information to consider the needs of specific population groups when tailoring and presenting health information to the target population.