Self-reported illnesses and service utilisation among migrants working in small-to medium sized enterprises in Guangdong, China

Impact of digital infrastructure construction on the migrants' utilization of basic public health services in China

BACKGROUND

Global digitalization significantly impacts public health by improving healthcare access for marginalized populations. In China, socioeconomic disparities and the Hukou system create significant barriers for the migrant population to access basic public health services (BPHS). This study aimed to assess how digital infrastructure construction (DIC) affects BPHS utilization among China's migrant populations, filling a gap in the literature regarding the relationship between digital advancements and health service accessibility.

METHODS

This research used micro-level data from the 2018 China Migrants Dynamic Survey and incorporated variables aligned with the Broadband China policy to employ a comprehensive empirical strategy. It included baseline regressions, robustness checks through propensity score matching and machine learning techniques, and heterogeneity analysis to explore the differential impacts of DIC based on gender, age, education level, and Hukou status.

RESULTS

The findings revealed that DIC significantly enhances the likelihood of migrants establishing health records and registering with family doctors, demonstrating quantifiable improvements in health service utilization. Heterogeneity analysis further indicated that the beneficial impacts of DIC were more pronounced among female migrants, those with higher education levels, younger populations, and urban Hukou holders.

CONCLUSIONS

DIC plays a crucial role in bridging the accessibility gap to BPHS for migrant populations in China, contributing to narrowing health disparities and advancing social equity. These results emphasize the significance of digital infrastructure in public health strategies and offer valuable insights for policymakers, healthcare providers, and researchers. Future research should prioritize longitudinal studies on the sustained effects of DIC and tailor digital health initiatives to meet the unique needs of migrant populations, promoting inclusive health policy planning and implementation.

Analysis of road traffic accidents and casualties associated with electric bikes and bicycles in Guangzhou, China: A retrospective descriptive analysis

Introduction

Electric bicycles (e-bikes) and bicycles in large Chinese cities have recently witnessed substantial growth in ridership. According to related accident trends, this study analyzed characteristics and spatial distribution in the period when e-bike-related accidents rapidly increased to propose priority measures to reduce accident casualties.

Methods

For e-bike- and bicycle-related accident data from the Guangzhou Public Security Traffic Management Integrated System, linear regression was used to examine the trends in the number of accidents and age-adjusted road traffic casualties from 2011 to 2021. Then, for the period when e-bike-related accidents rapidly increased, descriptive statistics were computed regarding rider characteristics, illegal behaviors, road types, collision objects and their accident liability. One-way analysis of variance (ANOVA) followed by Bonferroni's multiple comparison test. P < 0.05 was considered statistically significant. Finally, the density distribution of accidents was presented, and Moran's I (MI) was used for assessing spatial autocorrelation. Hotspots were identified based on an optimized hotspot analysis tool.

Results

Between 2011 and 2021, the number of accidents and casualty rate (per 100,000 population) increased for e-bikes but decreased for bicycles. After 2018, e-bike-related accidents increased rapidly, and bicycle-related accidents plateaued. Accident hotspots were concentrated in central city areas and suburban areas close to the former. Three-quarters of accidents occurred in motorized vehicle lanes. Most occurred on roads without physically segregated nonmotorized vehicle lanes. More than three-fifths of the accidents involved motor vehicles with at least four wheels. The prevalence (per 100 people) of casualties among e-bike rider victims and cyclist victims accounted for 92.0 % and 96.5 %, respectively. A total of 71.6 % of e-bike-related accidents involved migrant workers. Riding in motorized vehicle lanes was the most common illegal behavior.

Conclusions

Although e-bike-related and bicycle-related accidents presented similar characteristics, the sharp increase in e-bike-related accidents requires attention. To improve e-bike safety, governments should develop appropriate countermeasures to prevent riders from riding on motorways, such as improving road infrastructure, adjusting the driver's license system and addressing priority control areas.

The prevalence of preterm and low birth weight infants among migrant women in the Pearl River Delta region, China: a population-based birth cohort study

BACKGROUND

The existing literature evaluating the association between neonatal morbidity and migrant status presents contradictory results. The purpose of this study was to compare the risk of preterm birth (PTB) and low birth weight (LBW) among newborns from local and migrant women in China's Pearl River Delta (PRD) region.

METHODS

In this observational population-based study, we included all live singleton deliveries from PRD region local women and migrant women. Data were sourced from the Guangdong Medical Birth Registry Information System between Jan 1, 2014, and Dec 31, 2020. Women were categorized into three groups by maternal migrant status: local women from PRD region, migrant women from Guangdong province or from other provinces. The outcome variables that were examined included two adverse birth outcomes: PTB and LBW. The association between the risk of PTB and LBW and maternal migrant status was assessed using logistic regression.

RESULTS

During 2014-2020, 5,219,133 single live deliveries were recorded, corresponding 13.22% to local women and the rest to migrant women coming from Guangdong (53.51%) and other provinces (33.26%). PTB prevalence was highest among local women (5.79%), followed by migrant women from Guangdong (5.29%), and the lowest among migrants from other provinces (4.95%). This association did not change after including maternal age, infant sex, delivery mode, and birth season in the models. Compared to local women, migrant women from other provinces had a lower risk of LBW (4.00% vs. 4.98%, P < 0.001). The prevalence of PTB and LBW was higher among local women than migrants. The odds of delivery PTB and LBW were higher for women who were age ≥ 35. Among the three maternal migration groups, the age-LBW association displayed a typical U-shaped pattern, with those in the youngest (16-24 years) and oldest (≥ 35) age categories exhibiting the higher odds of delivering a LBW neonate. With respect to infant sex, the prevalence of PTB was significantly higher in males than females among the three maternal migration groups. An opposite trend was found for LBW, and the prevalence of LBW was higher in females among the three maternal migration groups.

CONCLUSION

The findings of this study contribute to the understanding of the epidemiology of PTB and LBW among migrant women. Our study suggests that it is the health and robust nature of migrant mothers that predisposes them to better birth outcomes. It is important to recognize that the results of this study, while supportive of the healthy migrant effect, cannot be considered definitive without some exploration of motivation for moving and changes in lifestyle postmigration.

Diagnostic delay, treatment duration and outcomes since the implementation of integrated model of tuberculosis control and their associated factors in a county in East China

OBJECTIVE

This study assesses the diagnostic delay, treatment duration and treatment outcomes of tuberculosis (TB) patients since the implementation of the integrated model of TB control in a county in eastern China. It further identifies factors associated with diagnostic delay and treatment duration in the integrated model.

METHODS

We collected data through the Chinese Tuberculosis Information Management System (TBIMS) for Cangnan County in Zhejiang Province. Chi-square and Mann-Whitney tests were adopted to identify factors associated with duration of treatment and treatment delay for TB patients within the integrated model. Multiple regression analysis was subsequently performed to confirm the identified factors.

RESULTS

In the integrated model from 2012 to 2018, the median health system delay was maintained at 1 day, and the median patient delay decreased from 14 to 9 days and the median total delay decreased from 15 to 11 days. In addition, the proportion of patients who experienced patient delay > 14 days and total delay > 28 days decreased from 49% to 35% and from 32% to 29% respectively. However, the proportion of patients who had health system delay > 14 days increased from 0.2% to 13% from 2012 to 2018. The median treatment duration increased from 199 to 366 days and the number of TB patients lost to follow-up showed an overall upward trend from 2012 to 2018. The multivariable regression analysis indicated that migrant TB patients and TB patients initially diagnosed in hospitals at the prefectural level and above tended to experience total delay > 28 days (p < 0.001). Linear regression analysis confirmed that new TB patients>60 years tended to have longer treatment duration (p < 0.05).

CONCLUSIONS

While our study may suggest the potential of the integrated model in early detection and diagnosis of TB, it also suggests the importance of strengthening supervision and management of designated hospitals to optimize the treatment duration and improve retention of patients in TB care. Enhancing health education for TB patients, especially amongst migrant patients, and training in TB identification and referral for non-TB doctors are also key for early TB detection and diagnosis in the integrated model.

Health service behaviors of migrants: A conceptual framework

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

Air pollution and refraining from visiting health facilities: a cross-sectional study of domestic migrants in China

BACKGROUND

Local environmental factors are associated with health and healthcare-seeking behaviors. However, there is a paucity in the literature documenting the link between air pollution and healthcare-seeking behaviors. This study aimed to address the gap in the literature through a cross-sectional study of domestic migrants in China.

METHODS

Data were extracted from the 2017 China Migrants Dynamic Survey (n = 10,051) and linked to the official air pollution indicators measured by particulate matter (PM_2.5 and PM₁₀) and air quality index (AQI) in the residential municipalities (n = 310) of the study participants over the survey period. Probit regression models were established to determine the association between air pollution and refraining from visiting health facilities after adjustment for variations in the predisposing, enabling and needs factors. Thermal inversion intensity was adopted as an instrumental variable to overcome potential endogeneity.

RESULTS

One unit (µg/m³) increase in monthly average PM_2.5 was associated with 1.8% increase in the probability of refraining from visiting health facilities. The direction and significance of the link remained unchanged when PM_2.5 was replaced by AQI or PM₁₀. Higher probability of refraining from visiting health facilities was also associated with overwork (β = 0.066, p = 0.041) and good self-related health (β = 0.171, p = 0.006); whereas, lower probability of refraining from visiting health facilities was associated with short-distance (inter-county) migration (β=-0.085, p = 0.048), exposure to health education (β=-0.142, p < 0.001), a high sense of local belonging (β=-0.082, p = 0.018), and having hypertension/diabetes (β=-0.169, p = 0.005).

CONCLUSION

Air pollution is a significant predictor of refraining from visiting health facilities in domestic migrants in China.

Psychological Distress and Homesickness Among Sudanese Migrants in the United Arab Emirates

Migration is a global phenomenon growing in scope, and it can be associated with negative emotions such as sense of impending loss, fear of the unknown, and anxiety about those left at home. The objective of this exploratory study was to examine psychological distress and homesickness among Sudanese migrants in the United Arab Emirates (UAE). Participants were 1444 Sudanese migrants (M_age = 40.20; SD = 10.98). The Second Version of the Dundee Relocation Inventory was used to assess homesickness, and the 28-item General Health Questionnaire was used to measure psychological distress, depressive and anxiety symptoms, somatic symptoms, and social dysfunction. The results showed that older age and longer duration of residence in the UAE were associated with lower levels of homesickness, psychological distress, and depressive and anxiety symptoms. Further, homesickness was associated with higher psychological distress, somatic symptoms, and depressive and anxiety symptoms. Women and unemployed migrants had higher psychological distress, somatic symptoms, and depressive and anxiety symptoms compared with men and those employed, respectively. Being unmarried was associated with higher levels of depressive symptoms and homesickness, while those married or divorced/widowed showed lower levels of depressive symptoms and homesickness. It was concluded that there is a need to tackle unemployment among migrants in the UAE and address family reunion issues.

Comparison of Delay in Tuberculosis Diagnosis Between Migrants and Local Residents in an Eastern County of China: An Analysis of the Electronic Data Between 2015 and 2019

Introduction: China continues to rank among one of the countries with the highest number of tuberculosis (TB) cases globally. Migrants are a particularly at-risk subgroup for TB and pose a challenge for case management in contemporary China. The early diagnosis and treatment of patients with TB are pivotal for effective TB control. This study investigates the delay in the TB diagnosis of migrants as compared with residents, to provide an evidence base for improved case detection and the better management of migrant patients with TB. Materials and Methods: The data was collected from the Tuberculosis Information Management System (TBIMS) (2015-2019) in an eastern county of China. The total diagnostic delay, consisting of patient delay and health system delay, is defined as the interval between the onset of TB symptoms and the confirmation of TB diagnosis in the designated TB hospital. The comparison of the delay in the TB diagnosis between migrants and residents was conducted using a Mann-Whitney U-test and chi-square test. The difference in the delay curves between these two groups was examined using a log-rank test. Results: Of 2,487 patients with TB, 539 (22%) were migrants. The migrants tended to be younger, presented with less severe conditions, received an initial diagnosis at prefectural and above-level hospitals. Compared with the local patients with TB, the migrant patients with TB had a longer median total diagnostic delay (30 vs. 9, P = 0.000) and a higher proportion of patients with this delay >28 days (52 vs. 13%, P = 0.000). Similarly, the migrant patients with TB also had a longer median patient delay (13 vs. 9, P = 0.000) and a higher proportion of patients with this delay >14 days (47 vs. 30%, P = 0.000), longer median health system delay (9 vs. 0, P = 0.000), and a higher proportion of patients with this delay >14 days (42 vs. 0.5%, P = 0.000) than the local patients with TB. The survival curves of delay showed that the longer the time interval was, the more likely the migrant patients with TB were to be diagnosed (P < 0.05). Conclusions: Diagnosis is significantly delayed among migrant patients with TB. Our study highlights the importance of early screening and diagnosis for TB especially among migrants, to improve access and ensure better management for all patients with TB.

Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China

Background

Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay.

Methods

Data was collected from China’s Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system’s respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM.

Results

Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008–11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582–36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days.

Conclusions

Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.

Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China

BACKGROUND

Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.

METHODS

The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level.

RESULTS

Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively.

CONCLUSION

This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: a systematic review and policy gap analysis

BACKGROUND

More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China's total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China.

METHODS

A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed.

RESULTS

(1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers.

CONCLUSION

It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW's characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW's job stability.

Factors influencing the implementation of a pilot smoking cessation intervention among migrant workers in Chinese factories: a qualitative study

Background

Tobacco control intervention with Chinese internal migrants, especially those working in factories has rarely been investigated. This study aims to identify aids and barriers to implementing a comprehensive pilot intervention aimed at reducing smoking among migrant workers working in factories in China.

Method

Twenty in-depth interviews were conducted 3 months into the intervention, with managers, migrant workers and team leaders in two factories, where the pilot intervention was implemented, in Zhongshan city in Guangdong, a southern Chinese province. Data analysis was based on the thematic approach.

Results

This study identifies the societal, individual and programmatic factors that could influence the implementation of a pilot smoking cessation intervention among migrant workers in the two Chinese factories. At the societal level, social customs and relationships where smoking is seen as essential in social communications was the most important barrier to the implementation of smoking cessation intervention. At the individual level, migrant-related features such as low education, high mobility and poor integration with local residents, together with poor health beliefs and attitudes added to the challenges of implementing smoking cessation intervention. At the programmatic level, the role of small-team leaders was generally positive, although limited due to their busy work patterns and poor powers of enforcement.

Conclusion

Achieving successful smoking cessation intervention in factories could be challenging with many migrants, as multi-level factors including social context, intervention delivery, individual and migrants’ characteristics play an important role in shaping the implementation of the intervention. Our study suggests the importance of tailoring interventions for the migrant factory workers.

Trial registration

ChiCTR-OPC-17011637 at Chinese Clinical Trial Registry. Retrospectively registered on 12th June 2017.

Health Service Seeking Behavior among Migrant Workers in Small and Medium-Sized Enterprises in Guangdong, China: Does Family Migration Matter?

Objective

This study aims to understand the health service seeking behavior of migrant workers and explore its association with their living status (i.e., living with family members or not), in Guangdong, China.

Methods

This was a cross-sectional survey conducted with 912 migrant workers in 2012 using a structured questionnaire adapted from the National Health Service Survey. Data were analyzed using the multivariable logistic regression.

Results

Of all migrant workers, 58% lived with at least one family member in the host city. Most of the respondents rated their health status being “very good or good” (58%). Fifty-four percent of the respondents reported having at least one disease in the past 12 months. Sixty-two percent of those who reported at least one disease visited doctors in the past 12 months. Of these, 22% returned to their hometown for medical treatment. Logistic regression showed that migrant workers living with families rated themselves as having better health status (P<0.05) but had more diseases (P>0.05) and had higher doctor visitation rate than those living with alone (58% vs. 66%, P<0.05).

Conclusion

The Andersen health service utilization model helps to understand the health seeking behavior of the migrant workers in the host cities. Migrant workers living with family members were positively associated with self-rated health status and health service seeking behavior in small and medium-sized enterprises. Our findings suggest the importance of the assistance programs and social support to improve seeking of healthcare services among migrant groups, especially those who live alone in the host cities.

Comparing the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016

BACKGROUND

With a large population of internal migrants from all over the world, China has the largest number of internal floating migrants, and most of them (up to 169 million in 2016) are rural-to-urban migrants. Those migrants have difficulty accessing essential health care services because of Hukou, leading to disparities in health needs and utilization between rural-to-urban migrants and residents. To compare the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016.

METHOD

We used longitudinal data from the Chinese Labor Dynamic Survey (CLDS) with three waves in 2012, 2014 and 2016. Descriptive analysis was employed to show self-reported illnesses and health services utilization among locals and migrants in the most recent 2 weeks in China. Chi-square tests and log binomial regression models were constructed to explore factors influencing health care needs and utilization.

RESULT

A total of 19.97% of respondents were rural-to-urban migrants, with an upward trend from 2012 to 2016. Rural-to-urban migrants (11.99%) had higher needs for health services than urban residents (10.47%) in general, while urban residents and migrants had no differences in needs in 2012. Besides, there was no difference in the utilization of health services between residents and migrants in 2012, 2014 or 2016. In addition, increased age, male sex, poor medical insurance coverage and dissatisfaction with income were found to have negative effects on health care needs.

CONCLUSION

This study has shown that the rural-to-urban migrants had higher health care needs but the same health care utilization compared with urban residents in China. Health policies focusing on equitable health outcomes should pay more attention to rural-to-urban migrants in China's health care system reform.

Status and determinants of health services utilization among elderly migrants in China

Background

The household registration system in China places migrants in a vulnerable status regarding access to local public services, including limited access to health services. Most studies on migrants’ health services utilization targeted on working-age migrants, and there has been a paucity of studies conducted among elderly migrants. This study aims to investigate the status of health services utilization and its influential factors among elderly migrants.

Methods

Data (13,043 participants, 52.4% male, mean age 66.22 ± 6.20) were derived from the 2015 Migrant Dynamics Monitoring Survey. The outcome variable in the study was health services utilization, consisting of doctor visits, hospitalization and local inpatient care. The Behavioral Model of Health Service Use was applied to categorize the influential factors into three components, including predisposing, enabling and need factors. Multivariate logistic regression analysis was used to investigate the influential factors of the three components of health services utilization.

Results

Of the total sample, 45.5% would visit a doctor when they were ill, 81.8% would prefer to be hospitalized when recommended by doctors, and 71.6% (those who were hospitalized) would choose to receive local inpatient care rather than going back to their hometown. Age, marital status, household income, years of residence, migration range, reasons for migration, size of friend network, health insurance type, local health insurance status and chronic disease status were significantly associated with health services utilization.

Conclusion

A low level of local health services utilization was observed among elderly migrants. Enabling factors played important roles in promoting health services utilization among elderly migrants. Policy and decision makers may consider improving the capability for elderly migrants to access health services, such as increasing income and providing local health insurance.

Factors that influence planning for physical activity among workers in small- and medium-sized enterprises

Physical activity (PA) is necessary for improving the health of workers in small- to medium-sized enterprises (SMEs). However, behavioral changes conducive to PA are often difficult to achieve despite intentions. Because intention to perform PA does not always translate to action, proper planning may be critical for achieving PA. In this study, we aimed to identify factors related to planning for PA among workers in SMEs because this is one population that has been identified as being at higher risk for lifestyle-related diseases in Japan. Participants completed a series of validated questionnaires. Of 353 valid responses, 226 individuals (149 men; aged 47.5 ± 8.7 years) stated their intention to perform PA. Multiple regression analysis indicated that a higher PA planning score was significantly associated with higher self-efficacy for PA (p < 0.001), higher risk perception regarding inactivity (p = 0.012), and greater knowledge of information about PA community services (p = 0.019). Therefore, we recommend that self-efficacy, risk perception, and information regarding PA community services are enhanced in the daily working lives of workers at their workplaces. In this manner, they can promote their planning of health behavioral changes in a supportive environment, drawing upon available services, supports, and other resources.

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Physical activity (PA) action is essential for the health of middle-aged workers.

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Planning for PA is the key skill that lies between intention and action for PA.

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Self-efficacy, risk perception, and services information promote planning for PA.

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It is recommended that workplaces enhance the planning of health behavioral modifications.

Association between social health insurance and choice of hospitals among internal migrants in China: a national cross-sectional study

OBJECTIVES

There is a tendency to pursue higher-level hospitalisation services in China, especially for internal migrants. This study aims to investigate the choices of hospitalisation services among internal migrants, and evaluate the association between social health insurance and hospitalisation choices.

METHODS

Data were from a 2014 nationally representative cross-sectional sample of internal migrants aged 15-59 years in China. Descriptive analyses were used to perform the distribution of healthcare facility levels for hospitalisation services, and multinomial logistic regression was applied to examine the association between social health insurance and hospitalisation choices.

RESULTS

Of the 6121 inpatient care users, only 11.50% chose the primary healthcare facilities for hospitalisation services, 44.91% chose the secondary hospitals and 43.59% preferred the tertiary hospitals. The choices presented large regional variations across the country. Compared with the uninsured, social health insurance had no statistically significant effect on patient choices of healthcare facility levels among internal migrants in China, whereas socioeconomic status was positively associated with the choices.

CONCLUSIONS

Social health insurance had little influence on the hospital choice among the internal migrants. Thus, social health insurance should be consolidated and portable to enhance the proper incentive of health insurance on healthcare seeking behaviours.

Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study

OBJECTIVES

To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation.

DESIGN

Cross-sectional survey between April and May 2016.

SETTING

Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China.

PARTICIPANTS

We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year.

MAIN OUTCOME MEASURES

The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups).

RESULTS

In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status.

CONCLUSIONS

Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.

A qualitative study of two management models of community health centres in two Chinese megacities

Two common public models of community health centres (CHCs) exist in China, i.e. the 'government-owned and government-managed' CHCs (G-CHCs) and the 'government-owned and hospital-managed' CHCs (H-CHCs). Shanghai and Shenzhen are two Chinese megacities that lead the primary care development on the G-CHC and H-CHC models, respectively. Using a qualitative case study design, this study compares the management of the G-CHC model in Shanghai and H-CHC model in Shenzhen, through perspectives of a range of health providers. In each city, we randomly selected four CHCs and in total conducted 31 interviews with officers from the municipal health authorities, directors, GPs, nurses and public health doctors of the CHCs. When comparing with the H-CHC model in Shenzhen, the G-CHC model in Shanghai, a model with more simplified but accountable structure tended to present better management conditions, in terms of financial transparency, recruitment autonomy, community health workforce development (CHC staffing and family medicine training), funding and priority for public health. However, regardless of the models, staff retention remained a challenge. While our study tends to suggest that the G-CHC model in Shanghai presents better management conditions, future study can test whether and to what extent the model itself can lead to such differences.

Health service utilisation of rural-to-urban migrants in Guangzhou, China: does employment status matter?

OBJECTIVE

To describe the self-reported health status and service utilisation of employed, retired and unemployed migrants in Guangzhou, a megacity in southern China.

METHODS

A cross-sectional study adapted from the National Health Service Survey was conducted between September and December in 2014. Based on the distribution of occupation of migrants, multistage sampling was used to recruit individuals. Logistic regression was applied to explore the factors influencing their service utilisation.

RESULTS

Of 2906 respondents, 76.6% were employed, 9.2% retired and 14.2% unemployed. Only 8.1% reported having an illness in the previous 2 weeks, and 6.5% reported having been hospitalised in the previous year. Employed migrants had the lowest recent physician consultation rate (3.4%) and the lowest annual hospitalisation rate (4.5%) (P < 0.05); unemployed migrants had the highest rates (6.8% and 14.5% respectively, P < 0.05). Retired migrants were more likely to return to their hometown for health care (8.6%) than employed (1.5%) and unemployed migrants (3.4%) (P < 0.05). After adjusting for age and gender, employment status remained significant in explaining the recent two-week treatment-seeking behaviour of migrants (P < 0.05).

CONCLUSION

Disparity of service utilisation continues to be a problem for migrants due to the poor health awareness, lack of time and inconvenience of medical insurance reimbursement. Employed migrants make the least use of health services.