Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A Cross-Sectional Study

Decomposition analysis on the equity of health examination utilization for the middle-aged and elderly people in China: based on longitudinal CHARLS data from 2011 to 2018

BACKGROUND

This study aimed to investigate the utilization rate and equity of health examination service among the middle-aged and elderly population in China from 2011 to 2018. The contribution of various determinants to the inequity in health examination service utilization was also examined.

METHODS

Data from the China Health and Retirement Longitudinal Survey (CHARLS) were analyzed to assess the health examination service utilization rate among the middle-aged and elderly population. A concentration curve and concentration index were employed to measure the equity of health examination service utilization and decomposed into its determining factors. Horizontal inequity index was applied to evaluate the trends in equity of health examination service.

RESULTS

The health examination service utilization rates among the middle-aged and elderly population were 29.45%, 20.69%, 25.40%, and 32.05% in 2011, 2013, 2015, and 2018, respectively. The concentration indexes for health examination service utilization were 0.0080 (95% CI: - 0.0084, 0.0244), 0.0155 (95% CI: - 0.0054, 0.0363), 0.0095 (95% CI: - 0.0088, 0.0277), and - 0.0100 (95% CI: - 0.0254, 0.0054) from 2011 to 2018, respectively. The horizontal inequity index was positive from 2011 to 2018, evidencing a pro-rich inequity trend. Age, residence, education, region, and economic status were the major identified contributors influencing the equity of health examination service utilization.

CONCLUSIONS

A pro-rich inequity existed in health examination service utilization among the middle-aged and elderly population in China. Reducing the wealth and regional gap, providing equal educational opportunities, and strengthening the capacity for chronic disease prevention and control are crucial for reducing the inequity in health examination service utilization.

Knowledge and Attitude of Patients Attending Primary Health Care (PHC) or Family Medicine Clinics About Periodic Health Assessment

Background This study assesses the awareness and perceptions of periodic health assessments (PHA) among patients at primary health care (PHC) and family medicine clinics. Despite PHC's importance in preventive health, previous research indicates a significant gap in the public's knowledge and routine practice of PHA, potentially affected by various demographic factors. Materials & methods A cross-sectional approach was employed in Riyadh, Saudi Arabia, with data gathered via self-administered questionnaires from 382 participants. The survey focused on socio-demographic information, knowledge about PHA, and attitudes towards it. Statistical analysis explored the influence of demographic and clinical factors on individuals' knowledge and attitudes. Results Findings showed that 300 (78.5%) participants had engaged in routine medical examinations, displaying substantial knowledge of PHA. Nevertheless, issues like healthcare accessibility and provider availability were identified as the major barriers, affecting 125 (32.7%) and 84 (22%) participants, respectively. The overall attitude towards PHA was positive, especially among individuals with chronic conditions, emphasizing its perceived benefits in health management. Conclusion The research underscores a generally positive attitude and fair knowledge level regarding PHA among the studied population, alongside significant barriers to participation. Targeted interventions that address these barriers and capitalize on the positive attitudes may enhance PHA uptake, promoting better health outcomes. This study contributes to the understanding of public engagement with PHA, offering insights for improving health promotion and disease prevention strategies.

Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model

BACKGROUND

Existing global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.

METHODS

Data were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less.

RESULTS

The results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530)  had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (β = 0.054, IRR = 1.056, 95% CI = [1.041-1.071]), cues to action (β = 0.076, IRR = 1.079, 95% CI = [1.044-1.114]), self-efficacy (β = 0.042, IRR = 1.043, 95% CI = [1.013-1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (β= - 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (β= - 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (β= - 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults.

CONCLUSION

The findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.

Trends in the availability of community-based psychological counselling services for oldest-old in China, 2005 to 2018

BACKGROUND

Community-based psychological counselling services (CPCS) is crucial for the oldest-old who often faces challenges or are reluctant to seek care at the healthcare settings. This study aims to examine trends in availability of CPCS over time and rural-urban disparities in service availability among nationwide oldest-old in China.

METHODS

Multiple cross-sectional data were derived from the 2005-2018 Chinese Longitudinal Health Longevity Survey. Service availability was reported by each oldest-old participant or their next-of-kins as having CPCS in one's neighborhood. We used Cochran-Armitage tests to estimate service availability trends and applied sample-weighted logistic regression models to examine its rural-urban disparities.

RESULTS

Of 38,032 oldest-old, CPCS availability decreased from 6.7 % in 2005 to 4.8 % in 2008/2009, followed by continual increases to 13.6 % in 2017/2018. In 2017/2018, rural oldest-old's neighborhoods had no greater service availability. Oldest-old residing in the Central (6.7 %), Western (13.4 %) and Northeast China (8.1 %) were less likely to report having services locally than their Eastern counterparts (17.8 %). Oldest-old having any disability or living in the nursing homes reported having greater service availability than those without disability or living at home.

LIMITATION

Service availability might have disrupted during the COVID-19 pandemic.

CONCLUSIONS

Despite the increasing service availability, as of 2017/2018, only 13.6 % oldest-old in China had reported CPCS availability. It raises concerns on the disproportionate access to and continuity of mental health care, especially for those living the Central, Western China and those living at home. Policy efforts are needed to incentivize service expansion and eliminate disparities in the service availability.

Role of Perception, Health Beliefs, and Health Knowledge in Intentions to Receive Health Checkups among Young Adults in Korea

Regular health checkups allow early treatment when problems occur and prevent disease progression, but the rate of health checkups among young adults is low. This study aimed to investigate the factors affecting the intentions to receive health checkups among young adults in their 20s in Korea. The study design was a descriptive cross-sectional study and examined their intentions to receive health checkups, their health beliefs (perceived sensitivity, perceived severity, perceived benefit, perceived barrier, cue to action, self-efficacy), their attitude toward health checkups, and their knowledge of health checkups. The participants were 252 adults in their 20s in South Korea who were eligible for national health checkups. The intentions to receive check-ups model identified five variables, including sex, perceived sensitivity, cue to action, self-efficacy, and attitudes toward health checkups, were as significant influencing factors for the intentions to receive health checkups with 51.0% explanatory power (F = 53.18, p < 0.001). Different approaches must be adopted according to past experiences with health checkups when attempting to improve the intentions to receive health checkups in young adults.

Barriers to routine checkups use among Saudis from the perspective of primary care providers: A qualitative study

OBJECTIVES

To explore the perspectives of primary care providers (PCPs) on the low use of and barriers to routine checkups among Saudi adults.

METHODS

A qualitative phenomenological study design was used. Interviews were carried out between (December 2020 and February 2021) with 19 PCPs working at 5 primary healthcare centers (PHCs) operated by the Ministry of Health (MOH) in Makkah, Saudi Arabia. Descriptive statistics were performed to characterize participants, and a directed content analysis was carried out to examine major themes.

RESULTS

Primary care providers identified a number of barriers that contributed to a low uptake of routine checkup among Saudis. These barriers to routine checkups were classified into 3 main themes: patient-related barriers, provider-related barriers, and healthcare system-related barriers. Lack of knowledge of patients, crowdedness at PHCs, and busy staff at PHCs were the most frequently mentioned barriers that hamper the use of routine checkups.

CONCLUSION

This study presented new insight into the low use of routine checkups by obtaining the perspective of PCPs. Although results point to potential targets for interventions to increase routine checkups, additional research is recommended with a representative sample of PCPs randomly selected from the healthcare system to inform future policy and decision making related to improving use of routine care available through the Saudi Healthcare System.

Middle-aged and elderly users' continuous usage intention of health maintenance-oriented WeChat official accounts: empirical study based on a hybrid model in China

Background

Although middle-aged and elderly users are the main group targeted by health maintenance-oriented WeChat official accounts (HM-WOAs), few studies have explored the relationship of these accounts and their users. Exploring the factors that influence the continuous adoption of WOAs is helpful to strengthen the health education of middle-aged and elderly individuals.

Objective

We developed a new theoretical model and explored the factors that influence middle-aged and elderly individuals' continuous usage intention for HM-WOA. Performance expectancy mediated the effects of the model in explaining continuous usage intention and introduced health literacy into the model.

Methods

We established a hybrid theoretical model on the basis of the unified theory of acceptance and use of technology 2 model (UTAUT2), the health belief model (BHM), protection motivation theory (PMT), and health literacy. We collected valid responses from 396 middle-aged and elderly users aged ≥ 45 years in China. To verify our hypotheses, we analyzed the data using structural equation modeling.

Results

Performance expectancy (β = 0.383, P < 0.001), hedonic motivation (β = 0.502, P < 0.001), social influence (β = 0.134, P = 0.049), and threat appraisal (β = 0.136, P < 0.001) positively influenced middle-aged and elderly users' continuous usage intention. Perceived health threat (β =  − 0.065, P = 0.053) did not have a significant effect on continuous usage intention. Both threat appraisal (β = 0.579, P < 0.001) and health literacy (β = 0.579, P < 0.001) positively affected performance expectancy. Threat appraisal indirectly affected continuous usage intention through performance expectancy mediation.

Conclusions

Our new theoretical model is useful for understanding middle-aged and elderly users' continuous usage intention for HM-WOA. Performance expectancy plays a mediation role between threat appraisal and continuous usage intention, and health literacy positively affects performance expectancy.