Study On Behaviors And Factors Associated With Signing A Health Service Contract With The Family Doctor In Community-dwelling Residents In Hangzhou

ObjectiveUnder the policy circumstance of family doctor system implemented in Hangzhou,this study,based on the theory of planned behavior and information-motivation-behavioral skills model aims to investigate community-dwelling residents' behaviors of registering with a family doctor,explore associated factors which may affect registering behaviors and put forward targeted intervention measures for the sustainable development of family doctor system.MethodsThe model of community-dwelling residents' behaviors in registering with a family doctor was built on the basis of literature review,910 eommunity-dwelling residents who are 18 and older were selected through multistage sampling in 3 community health centers in Hangzhou,and their konwledge about family doctor contracted services,attitudes,subjective norms,and perveived behavioral control towards registering with a family doctor were surveyed by a self-made scale which was directed by the theory of planned behavior and the information-motivation-behavioral skills model.The chi-square test and the binary logistic regression analysis were used to explore the social demographie factors affecting community-dwelling residents' registering behaviors,and the structural equation model was applied to verify the validation of the model of community-dwelling residents' behaviors in registering with a family doctor.ResultsThere existed 343 respondents who have registered with a family doctor and the registering rate was 37.7%.In the aspect of service utilization,72.3%of the respondents mentioned that they have received health related knowledge by their family doctor in the form of oral or text messages,and it was the highest utilization rate;33.8%of the respondents illustrated that they have utilized the follow-up service provided by their family doctor,and it was the lowest utilization rate.In the aspect of service satisfaction,registered residents showed the highest satisfaction in doctor's service attitude,and the satisfaction rate was 85.31%,as to the medical equipment in community health service center,registered residents showed the lowest satisfaction,the rate was 76.85%.Binary logistic regression analysis showed that residents' socio-demographic characteristics which affected their registering behaviors were:attendance of primary medical insurance(OR=3.593?95%CI:1.674?7.713),the prevalence of chronic disease(OR=2.347?95%CI:1.706?.229),self-reported health status was poor(OR=2.262?95%CI:1.322?3.872),walking time of residence community to the nearest health service center is less than 15 minutes(OR=1.652?95%CI:1.229?2.222),the first contact choice was community health center when occurred with common disease or frequently-occurring disease(OR=3.034?95%CI:2.231?4.125).Structural equation model analysis indicated that the fitness of the model in explaining community-dwelling residents' registering behaviors with the family doctor was good,and 52.7%of the behavioral intention of total variance and 48.5%of the behavior of total variance could be explained.Obeying intentions,positive attitude and normative beliefs directly predicted behavioral intentions and also positively predicted the registering behaviors through behavioral intention,the direct effect value was 0.429?0.237?0.208 respectively and the indirect effect value was 0.081,0.045 and 0.039 respectively;information,behavioral intention and perceived behavioral control positively predicted the registering behavior directly,and the effect value was 0.505,0.188 and 0.185 respectively.ConclusionCommunity-dwelling residents have strong intentions to register with a family doctor,but few have turned it into actions.Registered residents showed middle-level utilization in health services as well as fair satisfaction in family doctor contracted services.The model of community-dwelling residents' registering behaviors with the family doctor which constructed on the basis of the theory of planned behavior and information-motivation-behavioral skills model can well explain community-dwelling residents' registering behaviors,the information about family doctor contracted services learned by residents had the greatest influence on registering behaviors.For the better development of family doctor contracted services,some related deparments are supposed to innovate propagation approaches,culitivate characteristics of community health centers,improve services-related systems and activate the channel of referral.