How does health literacy affect the utilization of basic public health services in Chinese migrants?

Unveiling spatial disparities in basic medical and health services: insights from China's provincial analysis

Based on the panel data of 31 provinces (municipalities and autonomous regions) in China from 2012 to 2019, this paper constructs the evaluation index system of basic medical and health services in China from seven dimensions: medical and health facilities, health expenditure, medical services, traditional Chinese medicine hospital services, maternal and child health care, people's health and medical security, disease control and public health. The entropy method was used to measure the level of basic medical and health services in China, and its spatial differences and convergence characteristics were further investigated. In this study, we employ the entropy weight method, σ convergence, and β convergence as our primary methodologies. The entropy weight method is used to evaluate the variability of each indicator, determine the weights of indicators, and quantify the information content of the data. σ convergence illustrates the process by which the variance of a sample decreases over time. β convergence refers to the gradual approach of variables within an economic system towards their long-term equilibrium level over time. The results show that: (1) The scores of basic medical and health services in China's four major regions (including Northeast, East, Central and West) remain in a relatively stable state, with small fluctuations and great room for improvement; (2) There are significant regional differences in the level of basic medical and health services in China, and the intra-regional differences are much greater than the inter-regional differences; (3) There is no significant σ convergence observed in China and its four major regions; however, there is a notable presence of β convergence.

Effect of health rights accessibility on the urban integration of minority rural migrants in China: a cross-sectional study

BACKGROUND

Accessing health rights is an integral component of people's aspirations for a better life. Existing discussions and evaluations regarding the accessibility of health rights for minority rural migrants are insufficient. In comparison to objective health conditions, inequalities in health rights lead to chronic and long-term depletion of human capital among minority rural migrants. This study aimed to assess the overall impact, heterogeneity effects, and mechanisms of health rights accessibility on the urban integration of minority rural migrants.

METHODS

Based on the 2017 China Migrants Dynamic Survey Data (CMDS), this study employs OLS models, 2SLS models, conditional mixed process (CMP) methods, and omitted variable tests to estimate the impact of health rights accessibility on the urban integration of minority rural migrants. Additionally, from the perspectives of migration scope and illness experience, this study explored the heterogeneity in the relationship between health rights accessibility and urban integration. Finally, using the Karlson-Holm-Breen (KHB) model, this study dissects the mechanisms through which health rights accessibility influences the urban integration of minority rural migrants.

RESULTS

Health rights accessibility significantly enhances the urban integration of minority rural migrants. Moreover, compared to minority rural migrants who move across provinces and who have no history of illness, those who migrate within the same province and who have experienced illness are more sensitive to the positive impact of health rights accessibility. However, the enhancing effect of health rights accessibility does not significantly differ between the new and old generations of minority rural migrants. Furthermore, health rights accessibility can indirectly improve the urban integration of minority rural migrants by elevating health levels, improving health habits, and reinforcing health behaviors. Among these, the indirect effects mediated by health habits are more pronounced.

CONCLUSION

The research conclusions underscore the issue of health accessibility and urban integration among minority rural migrants, providing a reexamination and clarification of the policy effects of health rights in promoting the urban integration of minority rural migrants. Relevant policy design should commence with improving the health rights of minority rural migrants, enhancing their health integration capabilities, and effectively boosting their ability to integrate into urban life.

Correlation between health literacy and health‐related quality of life in patients with diabetic peripheral neuropathy: The mediating role of self‐management

AIM

The aims of the study were to analyse the current situation of health literacy (HL), self-management and health-related quality of life (HRQOL) in patients with diabetic peripheral neuropathy (DPN), to explore the correlation between the three and to verify the mediating role of self-management in HL and HRQOL.

DESIGN

A cross-sectional survey.

METHODS

The convenience sampling method was used to select 401 DPN patients attending the First Hospital of Jinzhou Medical University in Liaoning Province, China, from December 2020 to December 2021 as the study population. The research instrument included socio-demographic characteristics questionnaire, Health Literacy Management Scale (HeLMS), Summary of Diabetes Self-Care Activities (SDSCA) and Short-Form 12-item Health Survey (SF-12). SPSS 25.0 was applied to the data for descriptive analysis, Pearson correlation analysis and stratified multiple regression analysis. Mediating effects were tested using SPSS PROCESS macro 4.0 software.

RESULTS

HL and self-management of DPN patients correlated positively with HRQOL. The mediation role of self-management was significant in the relationship between HL and physical and mental HRQOL (physical component summary: β = 0.26, P < 0.01; mental component summary: β = 0.18, P < 0.01), with mediating effects accounting for 35.62% and 34.62% of the total effect.

CONCLUSIONS

There was a positive correlation between HL, self-management and HRQOL in patients with DPN. Self-management plays a partially mediating role in the relationship between HL and HRQOL in DPN patients. It means that HRQOL in this population can be improved by increasing HL and thus self-management in DPN patients.

PATIENT OR PUBLIC CONTRIBUTION

None.

The Impact of Public Health Education on Migrant Workers' Medical Service Utilization

Based on the dynamic monitoring survey data of China's migrant population (CMDS) in 2017, this study analyzes the impact of public health education on migrant workers' medical service utilization. The study found that public health education can significantly promote the utilization of migrant workers' medical services and has a greater effect on the older generation groups, those who received secondary and higher education, and those working in first-tier cities. By distinguishing different types of public health education, it is found that smoking control education has the most obvious effect. Further differentiating disease types, the study found that the promotion effect of receiving occupational disease education is the highest, while the effect of receiving STD/AIDS education is relatively low. The mechanism test indicates that public health education has significantly improved migrant workers' utilization of medical services by influencing their health literacy, social network, and psychological integration.

Emergency medical service utilization among acute ischemic stroke patients in Beijing: An observational study

Objective

To investigate emergency medical service (EMS) utilization and its associated factors in patients with acute ischemic stroke (AIS), and further explore the urban-rural differences.

Methods

Medical records for AIS in all emergency departments in Beijing were obtained from the Beijing Emergency Care Database from January 2018 to December 2021. EMS utilization was described and factors associated with EMS use were examined by multivariable logistic regression models with the generalized estimating equations. Results were compared between urban and rural districts.

Results

A total of 24,296 AIS patients were included in the analysis, and 11,190 (46.1%) were transported to hospitals by EMS. The percentage of EMS usage in urban areas was significantly higher than that in rural areas (53.6 vs. 34.4%, P < 0.001). From 2018 to 2021, EMS utilization was on the increase (P-value for trend <0.001) with a higher average annual growth rate in rural areas (12.6%) than in urban (6.4%). Factors associated with EMS utilization were age (OR: 1.20 per 10-year increase, 95% CI: 1.17–1.23), NIHSS scores, off-hour arrival (OR: 1.32, 95% CI: 1.23–1.37), treatment in tertiary hospitals (OR: 1.75, 95% CI: 1.60–1.92), and possessing comorbidities such as coronary artery disease (OR: 1.15, 95% CI: 1.17–1.24), atrial fibrillation (OR: 1.56, 95% CI: 1.41–1.73), prior stroke (OR: 0.84, 95% CI: 0.78-0.90) or dyslipidemia (OR: 0.78, 95% CI: 0.71–0.85).

Conclusion

This study demonstrated an inadequate use of EMS among AIS patients in Beijing, especially in rural areas, and revealed several associated factors. Enhanced education programs and EMS accessibility are necessary particularly for high-risk individuals and regions.

Awareness, Utilization and Health Outcomes of National Essential Public Health Service Among Migrants in China

Background

The national essential public health service (NEPHS) has been in operation for more than a decade. Numerous studies examined the utilization of NEPHS by migrants and the factors that influence it, but few examined the effect of NEPHS awareness and utilization on the health of inhabitants, particularly migrants. The purpose of this study is to ascertain the level of awareness and utilization of NEPHS, as well as to examine their health-improving effects on migrants.

Methods

Based on the data from the 2017 China Migrants Dynamic Survey, linear probability model, ordered logit model and the propensity score matching methods were employed to investigate impact of awareness and utilization of NEPHS on the health among Chinese migrants. Mediating effect model were used to identify the mechanism of the impact of NEPHS on health.

Results

The findings indicated that migrants' awareness and utilization of NEPHS are still insufficient. After adjusting for other factors, the study discovered that increased awareness and use of NEPHS had a beneficial influence on migrants' self-rated health. Further heterogeneity analysis revealed significant disparities in the health consequences of NEPHS awareness and utilization across subgroups. The effect of increased awareness and usage of NEPHS on health is stronger for middle-aged and elderly people, women, and low-educated migrants with urban household registration. The estimated results of the mediating effect model supported the mechanism that increased NEPHS awareness among the floating population could encourage its utilization and further improve the floating population's health.

Conclusions

Given that migrants' NEPHS utilization is still low and that NEPHS utilization has a positive effect on health, some targeted strategies, such as a variety of new media communication methods, health education related to occupational disease and tuberculosis prevention, and targeted NEPHS projects for specific groups, such as men, young and middle-aged groups, those with a high level of education, and rural migrants, should be conducted to improve the health of migrants.