[Medical treatment seeking behaviors and its influencing factors in employed floating population in China]

Health service behaviors of migrants: A conceptual framework

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

Association between ethnicity and health knowledge among the floating population in China

Background

Health equity remains a priority concerns by central government in China. This study aimed to explore ethnic gaps in access to health knowledge categories and sources based on the survey data from a publicly available dataset.

Methods

Data were from 2015 China Migrants Dynamic Survey issued by The National Health Commission in China. Descriptive analyses were performed to reflect geodemographic differences in the floating population of ethnic minority (EMFP) and Han majority (HMFP) with Chi-square test. Ethnic gaps in access to health knowledge categories and sources were explored with Poisson regressions, logistic regressions, and bivariate ordered probit regressions.

Results

In the sample, most of participants had inadequate health information literacy. There were significant differences regarding geodemographic factors between EMFP and HMFP. Illiterate EMFP had likelihood to obtain less health knowledge categories (IRR = 0.80, 95% CI 0.77–0.84) and sources (IRR = 0.83, 95% CI 0.80–0.86) as compared to illiterate HMFP. Most of correlations between health knowledge categories and sources were weak in the samples of EMFP and HMFP.

Conclusion

Ethnic disparities in access to health knowledge categories and sources among the floating population in China were confirmed. Further effective efforts should be provided to reduce ethnic disparities in access to health knowledge under the ethnicity-orientated support of public health resource.

Help-seeking behavior of individuals with schizophrenia in the general population of Hunan, China

This study aims to know the seeking help behavior of individuals with SZ (Schizophrenia) in Hunan province of China. Individuals (age > 15) with schizophrenia were recruited in the study after a two-stage diagnosis procedure (including questionnaire screening and face-to-face SCID interview by psychiatrists) in Hunan province. A self-designed questionnaire was used to investigate their help-seeking behavior. (1) Of the 367 participants, 68.9% (253/367) sought help; of those, 64.6% (n = 163) pursued professional psychiatric services and 30.8% (n = 78) pursued non-medical options (i.e., relatives, praying to Buddha) as the most common first choices. (2) Family history of mental disorders is significantly related to whether or not the individual with SZ seeks help, and the first choice of help is significantly related to education level. (P < 0.05). (3) Frequent reasons behind not seeking help include fear of stigmatization (72.9%), poor mental health literacy (64.5%), concerns over cost (50.6%), and limited access to medical services (47.0%). About one-third of the individuals do not seek help. Individuals with SZ tend to choose psychiatric hospitals and relatives as their first choice. Among the factors we investigated, family history of mental disorders is the most influential factor associated with help-seeking behavior. Individuals with more education tend to seek professional help first. The primary reasons for not seeking help include fear of stigmatization, lack of awareness about mental illness, concerns over cost, etc.

Associations Between Geodemographic Factors and Access to Public Health Services Among Chinese Floating Population

Background: The floating population in urban China is facing multiple barriers to access to comprehensive, affordable, and culturally effective public health services. However, little is known about the role of geodemographic factors. This study aimed to assess the associations between geodemographic factors and access to public health services among the Chinese floating population.

Methods: This study employed the data from the 2015 Migrant Dynamic Monitoring Survey data in China. Descriptive statistical analysis and principal component analysis were used to provide basic characteristics of the main variables. Multiple logistic models were used to analyze how province-level units, economic regions, and economic zones had significant associations with residential health records establishment, social medical insurance, and types and methods of health knowledge attainment in urban China. Using multiple indicator multiple cause models, the association between geodemographic factors and types and methods of health knowledge attainment was studied.

Results: The results indicated that there was regional unbalance in the case of residential health records. Regional differences were significantly associated with social medical insurance. Provincial differences were significantly associated with health knowledge attainment. There were regional differences in the methods of health knowledge attainment. In the most provincial units, geodemographic factors had significant associations with types and methods of health knowledge attainment.

Conclusions: This study confirmed empirical associations between geodemographic factors and access to public health services among Chinese floating population. The relevant suggestion was that provincial units with less-developed public health services should enhance their capabilities to equalize public health services.

What is the impact of rural-to-urban migration on exclusive breastfeeding: a population-based cross-sectional study

Background

In China, less than one third of infants under 6 months of age are being exclusively breastfed. Maternal rural-to-urban migration contributes to these low rates of breastfeeding practices. Therefore, the aim of this study was to assess the prevalence of breastfeeding practices and associated factors among rural-to-urban migrant children and local children with infants aged 0–12 months in China, 2018.

Methods

Data were collected from a population-based cross-sectional survey in 2018 that included 6995 infants from eight urban areas (four metropolis and four medium sized/small cities) in China. The prevalence of breastfeeding practices was calculated using a 24-h recall questionnaire for all infants aged under 12 months. Logistic regression was conducted to examine the association between the prevalence of breastfeeding practices and maternal migrant status, after adjusting for sociodemographic characteristics, mother-infant health information and supportive information. For exclusive breastfeeding, we further analyzed its association with maternal rural-to-urban migration, stratified by maternal education level, maternal resident place and maternal ethnicity, respectively.

Results

The overall prevalence of ever breastfeeding, exclusive breastfeeding, predominant breastfeeding and age-appropriate breastfeeding (exclusive breastfeeding of infants under 6 months of age and complementary feeding from six to 12 months of age) was 97.51, 29.84, 59.89 and 45.07%, respectively. Rural-to-urban migrant children were less likely to be exclusively breastfed compared to local children (AOR 0.81, 95% CI 0.68, 0.95). Stratified by different sociodemographic variables, a negative association between exclusive breastfeeding and rural-to-urban migration was only found in the group with high education level, in the group living in metropolis and in the group of minorities, respectively.

Conclusions

The overall prevalence of breastfeeding practices was low in both rural-to-urban migrant children and local children. Besides common strategies, special approaches should be provided for urban highly educated migrants.

Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China

The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.