Study On Health Seeking Behavior Based On Ecological Models Of Health Promotion

Research objectives:To review the theories about health seeking behavior at domestic and overseas, to investigate the current status of health seeking behavior among urban and rural residents in China, to analyze the differences in the aspects of perception of disease symptoms, medical services decision-making, and compliance with the health professionals between residents and patients; to explore the predisposing, enabling and reinforcing factors influencing health seeking behavior from the perspective of ecological models of health promotion, to propose the intervention suggestions and strategies about improving health seeking behavior.Methods:1. Data collection methods:Multi-stage stratified random sampling method was used and three provinces in the eastern, central and western regions were sampled.1053patients and residents from medical institutions conducted a questionnaire survey to know their health seeking behavior and related influencing factors.24health professionals and44residents and patients were interviewed to understand residents'medical decision making and compliance behavior and influencing factors.2. Data analysis methods:descriptive statistics such as frequency, proportion was used to depict the current status health seeking behavior among residents and patients and to compare the health seeking behavior characteristics between urban and rural areas and between residents and patients; chi-square analysis and variance analysis and other methods were conducted to analyze the difference of grouped data. Logistic regression analysis was conducted to identify the key factors influencing seeking behavior. Qualitative interview data was analyzed using ANTHROPAC4.0.Key findings:1. Perception of disease symptoms:urban and rural residents' perception of disease symptoms delayed and had low expectations of health, which led to patients to seek health care service only when having significant or severe symptoms. Only7.6%of urban patients and13.8%of rural patients sought medical services when having slight symptoms.2. health care service decision making:2.1The sources of health knowledge among urban and rural residents were mainly individual (doctors) and commercial sources (TV, newspapers), sources channels were relatively simple, and health information and health events disclosed by the government in the media were scarce.2.2Comparative analysis indicated that in rural areas the patients when with disease were more concerned with treatment information than they were without disease (χ2=7.13, P=0.03), while in urban areas, there was no significant differences before and after getting ill.2.3The urban residents with low participation had a significantly different preference to health institutions compared with those with high participation (χ2=9.76, P=0.08), while as for the rural patients there was no different preference in choosing health institutions, which suggested that in rural areas residents had limited choices of medical institutions.3. compliance behavior:3.1The people's overall satisfaction with medical services:rural people'satisfaction was significantly higher than urban people (χ2=17.97, P＜0.001), and compliance of the former were more compliable to the doctor's medical advice than the latter.3.2Compliance with drug prescription:rural respondents were more likely to comply with a doctor's prescription than urban respondents (χ2=24.41, P<0.001).3.3Compliance with behavior control:there was no significant difference between rural and urban groups in terms of control unhealthy lifestyle such as smoking and drinking. In order to cure diseases, both groups reported that they were compliable to medical orders with more than80%compliance rate.4. Seeking behavior predisposing factors:Multiple Logistic regression analysis demonstrated that among the urban individuals the extent of concern about health knowledge and age had impact on seeking behavior. Excluding educational level, occupation and other factors, people concerned with health knowledge sought health services8.33times than people did not concern with health knowledge, and the latter was more likely to choose self-treatment, people aged more than55years were4.35times likely to choose self-treatment than people aged below35years. As for the rural individuals, occupation and income were factor influencing people choice of treatment way.5. seeking behavior enabling factors:The time spent on the way to nearest medical institution, residents' expectation about function of medical institutions, and medical advertisement had impact on medical decision-making, and there was difference between urban and rural areas6. seeking behavior reinforcing factors:Reference groups and family function influenced patients seeking behavior. Social support resources in rural areas were less than urban areas. Once having reference groups, rural residents were more likely to consult reference group before saw a doctor than urban residents, which indicated that the former made use of the resources better than the latter.Conclusions and suggestions1. At individual level:to increase awareness of disease in patients, to renew health notion, to increase the residents expectation to health, advocate residents to early treatment of disease; to expand channels of health knowledge and to enhance patients' information collection ability; to develop good habits in seeking health, convenience more important when facing diseases that did not need patients'high participation, to seek the health professionals' service promptly as for diseases need patients'high participation; to improve the urban patients' compliance with doctor's orders through behavioral intervention.2. At medical institutions level: to strengthen the publicity about the knowledge of health promotion as well as the knowledge of disease; to carry out different disease diagnosis and treatment activities according to different age groups; to strengthen health promotion of the new media; to assist to establish of reference groups and health opinion leaders; to increase patient satisfaction.Innovations:1. From the perspective of ecological theory of health promotion, the patients seeking behavior and related influencing factors that predisposing, enabling and reinforcing behaviors were studied, which was rarely seen at domestic research.2. The study explored the impact of social attribute indicators on seeking behavior, for example, social stratification was used for exploring the influence of the occupation, education, economic factors to seeking behavior. And family function was used to evaluate the influence to the behavior.3. The study combined seeking behavior stage theory and consumer decision-making theory, investigated the whole process of patients seeking health service from perception of disease and medical decision-making to discharge rather than a simple description of the patients'choosing health institutions, which illustrated a comprehensive analysis of health seeking behavior.4. The ecological model of health promotion was served as the intervention strategies. The study put forward suggestions and strategies from environmental changes, behavioral interventions, and policy interventions to help people to make positive health choices in their daily lives. Therefore, this study provided theoretical guidance and practical significance to improve people's health seeking behaviors.5. As for the analysis of qualitative data, ANTHROPAC4.0was conducted to analyze the significance and sorting apart from description.