Factors Influencing Chinese Voluntary Premarital Medical Examination:Synthesizing The Health Belief Model And The Theory Of Reasoned Action

Premarital medical examination (PME) used to be compulsory by the marriage law in China. Its main purpose was to screen for genetic disorders, sexually transmitted diseases, hepatitis B and conditions that may jeopardize parenting abilities, such as psychiatric problems. China introduced the new regulations on marriage registration in2003, and put an start to the voluntary PME. Since then the number of couples undergoing PME has dropped drastically nationwide, in spite of the policy of free of charge in some provinces. PME is a circumscribed preventive action on individual level, namely participation in a special screening test. The Health Belief Model(HBM) and the Theory of Reasoned Action(TRA) were among the most widely used individual-level theories in the literature for studying participation in medical screening.This paper developed a new model representing the synthesis of two models as the theoretic framework for an investigation of the factors affecting participation PME. Instrument development was approached by content and construct validity test. Multiple logistic multilevel analysis and Structural equation modeling(SEM) were the main statistical method. Data were collected from the self-designed instrument to2572newly married respondents, selected by a stratified randomized sampling at Marriage Registration Office in12counties in Zhejiang Province. The initial sample included148respondents for the item test of the instrument and598respondents for the instrument validity and reliability test. After a598sample pretest,the new model was evaluated with2572respondents using SEM. Cross validation was applied within two groups of Marlowe—Crowne Social Desirability Scale(MCSDS) with a cut-point7using SEM.The mail results were from people whose MCSDC froml to6(n=777).Here are the main results of this paper.1.The relationship between intention and action. Of those who intended to receive PME,75%eventually received it, While19.4%of them didn't do. Those, who didn't intent to participate and actually didn't accept the PME, accounted for2.6%among the2572respondents. The SEM revealed that earlier intention to PME was vigorously correlated to their actual participation in PME(r=0.75, p<0.01).2.The correlation from attitude,subjective norm and perceived threat to earlier intention to PME. The SEM revealed that the correlation from attitude to intention is0.48(T=8.81, p<0.01).The total correlation from subjective norm to intention to PME was0.36including the direct path(r=0.22, p<0.01) and the indirect path(r=0.14, p<0.01).The correlation from perceived threat to intention was0.08minus.3.The correlation from perceived benefits and perceived barriers to attitude of PME. The standard correlation effect was-0.16(T=4.45, p<0.01) from perceived barriers to intention and0.52(T=11.98, p<0.01) from perceived benefits to attitude.4. The spurious association from perceived benefits to action of PME. The SEM revealed that perceived benefits was not correlated with action of statistically significance(r=-0.02, p=0.284). the spurious direct path(r=-0.16, p<0.01) was confounded by the social desirability.5. The correlation from perceived susceptibility and perceived seriousness to perceived threat. The standard correlation effect was0.89(T=37.74, p<0.01) from perceived susceptibility to perceived threat and0.52(T=33.59, p<0.01) from perceived seriousness to perceived threat.6. The correlation from normative belief and motivation to comply to subjective norm. The SEM revealed that the standard correlation effect was0.64 (T=30.59, p<0.01) from normative belief to subjective norm, and0.46(T=28.08, p<0.01) from motivation to comply to subjective norm.7. Influence from geographical environment to action. Multiple logistic multilevel analysis revealed that premarital medical examination behavior showed a clustering trait on the county level(P=0.018)and variance partition coefficient (VPC) of each variables was15.40%to17.58%.8. The role of external variable, such as demographic variables, in influencing behavior. There was no statistical significance in PME rates among different respondents of gender, age, Household Register, education, income, health insurance and history of premarital medical examination, despite the significant correlation with occupation. The PME rate of the respondents who haven't attended medical examination during the last six moths was1.31times (95%confidence intervals,1.05-1.65) than those who have attended. OR(Odds ratio) was1.51(95%CI:1.14-2.00) for the firstly-married pregnant respondents and0.35(95%CI:0.23-0.51) for remarried respondents, compared with firstly-married unpregnant ones.It was concluded that the influence of attitude, subjective norm and perceived threats on PME were mediated through their effect on behavioral intention. Geographical environment explained16%of the variance in PME acceptance. Occupation, medical examination history during the last6months and type of marriage registration were influential to PME acceptance, while gender, age, Household Register, education, income, health insurance and history of premarital medical examination were not.As for the suggestion to PME acceptance in order of priority, this paper proposed that social norm and key figure's recommendation such as physician, family members, head of the village women's federation was an effective means to promote PME acceptance. Recommended strategies reducing perceived barriers, such as efforts to make PME as convenient as possible, free policy, process optimization, informed consent and privacy, may be quite effective in increasing couples'motivations to attend PME. Providing information about the benefits of PME will probably not be useful for recruiting couples, promotion should be based upon individualized and classified guidance such as different occupation, medical examination history.