| BackgroundThe decline in the birth rate and the increase in the average life expectancy due to the improvement of living standards have made the aging process of the Chinese population much faster than most other countries.It is expected that by 2050,China will have the world’s largest population of this most elderly age group.At the same time,one of the major problems associated with the aging of the population is the increasing burden of chronic diseases.It is predicted that by 2030,China’s rapidly aging population is expected to be linked to at least a 40%increase in the burden of chronic noncommunicable disease.The World Health Organization’s Global Burden of Disease estimate Provided further evidence,nearly 45%of disability-adjusted life years(DALYs)in China are attributable to the health conditions among adults aged 60 years and over.The occurrence,development and disability of chronic diseases are the result of long-term effects of chronic disease on the body,and human behavior is the main contributing factor.In China,most elderly people live in rural areas.However,the disability-free life expectancy of elderly people living in rural China is lower than that of urban residents.According to the 2010 Chronic Disease Risk Factor Surveillance Survey,the disparity was striking in the distribution of risk factors among rural and urban adults,with the total prevalence of chronic disease being higher among rural adults than urban.Moreover,in rural China,the rural households were proven to be more likely to suffer catastrophic health expenditure,and greater risk of poverty due to illness.Implementation of clinical preventive services is the basic measure for chronic disease to reduce the occurrence and development of chronic diseases,at the same time,it is also the main work contents for family practitioners under the prevention-oriented service concept.Many studies have shown that the use of clinical preventive services in China is still at a relatively low level compared to other countries.At the same time,compared with the urban population,rural residents have more health care needs,but they have a lower usage of clinical preventive services obviously.Michelle M.Casey’s study in 2001 confirmed that rural residents used clinical prevention services less frequently than urban residents.All these indicate that we should pay more attention to the health prevention and disease treatment of the older in rural China.Many studies had shown that the.proportion of elderly people in rural China who use recommended clinical prevention services was relatively low.Therefore,it is necessary to explore the factors that affect the use of clinical prevention services in the elderly in rural areas in conjunction with the psychological factors,and make policy recommendations for further follow-up investigations and effective interventions.ObjectivesThe main purpose of this study is to investigate the elderly people aged 60 or over in rural areas in Shandong Province to explore the current status of behavioral intentions of rural seniors in using clinical prevention services,and to use the eight-dimensional health belief model to explore influencing factors from the perspective of demographic characteristics and model eight dimensions.Meanwhile,we will give suggestions for improving the clinical prevention service using rate of rural elders in Shandong Province,and provide reference for the promotion of the health system in other places.MethodsWith a stratified random sampling,a structured cross-sectional face-to-face questionnaire survey was conducted of 509 elderly from 27 rural areas of 3 couties in Shandong Province between March to September 2017.Demographic characteristics,behavioral intention and eight dimensions of extended health belief model were measured.Data was processed by Microsoft Access and analyzed by SPSS 22.0.Descriptive statistics were used to identify demographic characteristics,influencing factors,and the eight constructs of the extended health belief model(HBM).A no pair tests or analysis of variance was employed to compare the demographic information,influencing factors,and eight constructs of the extended HBM.Behavioral intention and eight dimensions of the health belief model were scored.And thus Pearson’s correlation analysis was conducted between extended HBM constructs and behavioral intention.Multiple linear regression methods were used to identify the determinants of behavioral intention.Finally,Multiple linear regression method was used to determine whether demographic characteristics constructs of extended HBM are predictors of clinical prevention service preference.All p values reported are two-sided,and p values below 0.05 are considered statistically.Main results and conclusions(1)Behavioral intention scored(4.43 ± 0.80)points,each dimension of health belief model scored,respectively,Self-efficacy scored(8.53 ± 1.27)points,health knowledge(9.14±2.36)scored points,social support scored(23.35 ± 6.54)points,perceived susceptibility scored(7.15 ± 2.05)points,perceived severity scored(5.61 ±1.84)points,perceived benefits scored(12.12 ± 2.90)points,perceived barriers scored(5.45 ± 2.64)points,cues to action scored(11.89±2.84)points;(2)Multivariate linear regression analysis showed that participants who were male,drinking,smoking,aged 70 years and over,with lower social support,perceived lower self-efficacy,less benefits and more barriers had poor BIE.Among them,barriers were found to be the most important determinant.Policy SuggestionsThis study showed that the participation rate of clinical prevention services for older people aged 60 years and over in rural areas was low.This indicate that it is necessary to carry out health interventions,especially in rural areas.Meanwhile,during the health intervention,we should firstly start with the target population.We should remove their perceptual obstacles through intervention for those who perceive more obstacles,less self-efficacy,less benefits,less social support,and men,those who ages 70 and above,who have smoking habits,and who have drinking habits.As doctors have largely determined the use of existing medical services.General practitioners should be encouraged to actively intervene in the health of older people on the basis of assessing the health status of different older people and the existing health risk factors of different individuals,and to promptly remind them to receive services from designated institutions before the expiration of the time set for the next clinical prevention services.Meanwhile,rural medical institutions can take various types of health education through bulletin boards,TV/broadcasting and other health communication channels to help the rural elderly form the habit of using clinical prevention services.In addition,Government should play the leading role of increasing the using rate of clinical prevention services through funding and policy measures to give priority to supporting the development of rural health institutions such as township(town)health centers and village clinics.we should improve the basic health literacy of the rural elderly and promote their enthusiasm for prevention and treatment.Strengthen and improve the construction of rural health service system and increase the trust of rural seniors. |
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