Social Determinants Of Usefulness And Utilization Wishes Of Community Health Services: A Population-based Survey In Wuhan City, China

ObjectiveTo investigate the distribution characteristics of urban residents’ utilization ofcommunity health services in Wuhan, and to analyse the social determination ofusefulness and utilization wishes of community health services(CHS), and to providescientific data and policy recommendations in order to promote the sustainabledevelopment of CHS.MethodsStratified random sampling method was taken in selecting10urban communities in5districts of Wuhan, from May2010to August2011. The respondents were residents aged15years and older.665households were surveyed and the actual sample investigated was1134. The survey included demographic characteristics, physical health status, socialfactors, and usefulness and utilization wishes of community health services. Social factorsincluded Community-dwelling time, The number of the health staff known, Previoustreatment experience and Family income and Health insurance. All analyses wereperformed using SAS version9.2. The analysis methods included descriptive analysis,χ~2test and multivariable logistic regression.Results1.26.10%of participants felt that CHS was "Relatively useless or Completelyuseless";37.74%of participants considered that their utilization wishes of CHS were "lowor very low". Among the five social factors,31.39%of participants used the CHS;67.99%had been living in their community for more than10years;64.02%of participants knewnone of the health staff;22.18%of participants had no health insurance.2. The results of multivariable logistic regression analysis:"Having previoustreatment experience" and "The number of the health staff known" were significantlyassociated with the "Usefulness of CHS". There was a decreased odds of "Usefulness of CHS" among participants "Having previous treatment experience" relative to participants"Having no treatment experience"(OR=0.53;95%CI=0.41-0.70); Compared withparticipants who knew0health staff, there were also decreased odds of "Usefulness ofCHS" among participants who knew1-2health staff and who knew3and above healthstaff (OR=0.44;95%CI=0.32-0.59and OR=0.30;95%CI=0.20-0.46). The other socialfactors (Residence time, Family income, Health insurance) had no effect on the usefulnessof CHS. Education level and two-week prevalence were protective factors for the"Usefulness of CHS".3."Having previous treatment experience" and "The number of the health staffknown" were significantly associated with the "Utilization Wishes of CHS". Comparedwith participants having no treatment experience, there was a decreased odds of"Utilization Wishes of CHS" among participants having previous treatment experience(OR=0.17;95%CI=0.13-0.24); Compared with participants who knew0health staff, therewere also decreased odds of "Utilization Wishes of CHS" among participants who knew1-2health staff and who knew3and above health staff (OR=0.32;95%CI=0.23-0.45andOR=0.24;95%CI=0.15-0.38). The other social factors (Residence time, Family income,Health insurance) had no effect on the usefulness of CHS. Age and two-week prevalencewere protective factors for the "Utilization Wishes of CHS".Conclusions1. The usefulness and utilization wishes of CHS of urban residents in Wuhan were allnot high."Minor ailments to the community” need a long way to go.2. Social factors impacting on usefulness and utilization wishes of community healthservices are "Having previous treatment experience" and "The number of the health staffknown". These suggest the importance of training general practitioners for CHS.3. It can regard old people and high education residents as focus groups and throughtheir exemplary role to drive more people to use CHS.4. Health insurance had no significant impact on "The usefulness and utilizationwishes of CHS". It shows that health insurance policy aiming at seeing a minor illness intothe CHS need still further study.