<p>The Influencing Factors of Health-Seeking Preference and Community Health Service Utilization Among Patients in Primary Care Reform in Xiamen, China</p>

Abstract

Introduction: Patients often seek healthcare at general hospitals rather than at community healthcare centres (CHCs) which leads to inefficiency of health services. The primary healthcare reform developed by Xiamen has proven to break through the barriers of hierarchical diagnosis and treatment. The influencing factors of health-seeking behaviours of patients in the Xiamen reform, however, are unclear.Objective: This study aimed to assess patients' healthcare-seeking preferences and CHCs utilization, and identify influencing factors among patients affected by the Xiamen reform. Methods: A cross-sectional study composed of 2200 individuals with hypertension or diabetes was conducted in association with Xiamen's reform. The choice of health institutions was used to measure health-seeking preference. The probability and frequency of outpatient service use were used to measure CHC utilization. The social ecological model and two-part model were employed to examine influencing factors. Results: As high as 72.5% of the subjects, including those who were under 60 years old, had low education level, with long disease duration, good self-report health and low household income expressed a preference for CHC (P<0.05). Also, participants who had good-condition CHCs (χ 2 =6.736, P=0.010), joined in three-in-one chronic disease management (χ 2 =81.615, P<0.01) and were insured by medical insurance (χ 2 =21.142, P<0.01) significantly preferred to visit CHCs for treatment. In addition, patients who had a preference for CHC utilized many more CHCs (P<0.01). Analysis of influencing factors found that education, selfreported health, smoking, household income, condition of the CHC, whether the patient had joined the healthcare reform and whether the patient had medical insurance were important factors affecting health-seeking preference and CHC utilization (P<0.05). Conclusion:The Xiamen healthcare reform made some achievements in improving CHC utilization. However, certain challenges remain. The government should further strengthen CHCs, deepen and expand healthcare reform, and make efforts to guide reasonable healthcare-seeking behaviour and improve the efficiency of primary health systems.

Health-seeking Behavior of Undergraduate Nursing Students and Associated Factors: A Cross-sectional Study

“…This is consistent with another study showing that students with higher monthly income show more favorable attitudes towards healthcare than those with lower income [18]. Research about primary care also found out that patients with higher household incomes are more willing to use community healthcare centers [17]. Income, as well as education and occupation, as important components of socioeconomic status, are all in uencing factors of health-seeking behavior [19,20].…”

“…Smoking is considered one of the health risk behaviors which are linked to physical and psychological problems. Since smoking exposes individuals to greater health problems, it should increase health-seeking behavior [17]. However, this study nds the opposite effect among nursing students.…”

The Influential factors of Adherence to Physical Activity and Exercise among Community-Dwelling Stroke Survivors: A Path Analysis

“…Another study by Ovbiagele et al (43) found that nearly 70% of 144 stroke survivors maintained regular exercise upon being discharged from hospital, which was similar to but slightly higher than our ndings. Despite differences in research design, cultural background, and economical level, lack of conventional management(44), not ideal health care seeking behavior (45) have been main barriers for adherence behavior, and it is likely to present an even greater in uence on Chinese community-dwelling stroke survivors' long-term outcomes over the next few decades.…”

Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data

“…Recent studies have evaluated the effects of public hospital reform by comparing the proportion of patients at each level, of both hospital pre-reform and post-reform, with large-scale statistical data, or by surveying the change of patient attitudes toward primary care use after the reform [30,31]. For instance, Wu et al, (2017) examined public views toward the choice of first-contact care in the hierarchical medical system of China [7].…”