| ObjectiveDue to transformation of age and living environment,policy restrictions,lack of attention,the elderly migrants face more health management problems than the local elderly and the general migrants,which is not conducive to maintaining their own health.How to improve the community health management level of the elderly migrants is a difficult point in community work and is closely related to the daily work of community nurses.This study intends to understand the current development of community health management services and the real needs for elderly migrants,explore the influencing factors and mechanism of the community health management behavior,in order to provide a basis for constructing an intervention strategy to improve their community health management utilization behavior,improve the quality of community care related to elderly migrants as a whole.Methods:On the basic of analyzing the literature and theory study,the research framework was developed.And then two small researches were followed accordingly.(1)Research on the health management utilization and demand : A convenience sample of 277 elderly migrants and 272 other elderly form Hangzhou to compare and analyze the differences in the utilization of community health management services.(2)Research on the influencing factors: Initially constructed a influencing factors model of the community health management utilization behavior of the elderly migrants which is based on Anderson model and the Theory of Planned behavior,and relevant questionnaires were designed and prepared through Delphi expert consultation.A convenience sample of 636 older was recruited from HangZhou.Structural equation modeling were used to verifie the initial model and analyze the influencing factors of community health management utilization behavior.Finally,semi-structured interviews were carried out in11 community staff and 10 elderly migrants to supplement and revalidate the model.Than,based on the research results,combined with the concept of health empowerment,the recommendations ofcommunity nurses to improve the health management and utilization of mobile elderly communities are proposed from the perspectives of the state,community,family and individual.Results:(1)Health status: In the case of similar chronic diseases,the self-rated health of the elderly was significantly better than that of the non-flowing elderly,and the difference was statistically significant when there was no or one or two chronic diseases.The flow of the elderly felt the body has obviously deteriorated trend in the past year was significantly higher in non-current elderly(67.1% vs 52.2%),and the difference was statistically significant(P<0.01).(2)Community health management utilization shows:(1)In terms of project awareness,except daily medical treatment,routine dispensing,assessment measurement and health checkups,the elderly migrants can reach 85%,while the remaining projects are only 40%-70%,significantly lower than non-current elderly(>90%).And the difference was statistically significant(P<0.01).(2)In terms of project utilization,elderly migrants are only half of the non-current(10%-40% vs 50%-90%),and there is a significant gap in the community’s first choice rate(28.2% vs 57%).The difference was statistically significant(P<0.05).The elderly migrants also has great differences in the utilization of various projects.For example,family doctors signing,the Chinese medicine health management utilization rate is less than 20%,and the high projects utilization rate is mostly about 40%.The reasons for the non-utilization of two elderly are different,elderly migrants’ mainly subjective need are no time,cost problems and inability to obtain.(3)Community health management needs: 70.04% of elderly migrants want community health management services scheduled for the weekend,and the top four demand acquisition methods are SMS,oral education/consultation,understanding between friends and family,and access to Internet information technology.The demand items are mainly focused on prevention related(health examination,),intervention-related(dispensing,treatment),and social/cultural health-related(community cultural activities,Clansmen Association).(4)Use behavioral factors: The univariate analysis showed that there were significant differences in the scores of community health management behavior among the elderly migrants with different ages,education levels,occupations,household registration,residence status,current residence,monthly income,monthly income of children,and insurance type(P<0.01).The regression analysis and SME showed that the effect of various influencing factors on the community health management utilization behavior of the elderly migrants is Requires(0.51)>Policy Impact(-0.45)>Environmental Accessibility(-0.35)>Utilization willingness(0.31)>Social Support(0.26)>Health Belief(0.16)> Child Monthly Income(0.14)>Environmental Impact(-0.08).Health beliefs,social support and environmental impact have only indirect effects.The results of semi-structured interviews show that the community health management utilization behavior of elderly migrants is mainly affected by four factors,namely,policy influencing,community health management resource supply and accessibility,family friend support,and elderly migrants.Conclusions:(1)Mobile elderly people have a weak health concept and their health fragility increase with time.(2)The elderly migrants are very lacking in the knowledge and utilization of community health management,the imbalance between projects,and the utilization of emerging projects is poor.(3)The overall situation of the demand for community health management by elderly migrants is general,but there are obvious differences in demand between different projects.Compared with the needs of basic projects,the channels and time of demand need special attention.(4)Different types of elderly migrants community health management and utilization behaviors are different,there should be differences in improvement.The need in this study is the primary factor affecting the health management and utilization behavior of the elderly migrants community.However,factors such as policy and environmental accessibility have greatly hindered the occurrence of utilization behavior,which indicates that community health management may have inequalitiesin the mobile elderly. |
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