Micro-model Study On The Rural Public Health System

BackgroundRural public health services are the essential basis for disease prevention and safeguard for health in rural population. The "three-level" prevention strategy has once played a major role in rural areas. However, with the reconstruction of the socio-economic system, the former prevention strategy can barely should the responsibility to provide sufficient services in rural areas. It is, therefore, an challenging task for the prevention in rural areas.If the goal of rural public health services is not achievable, the key points lies in the system of rural public health services. The recent research has been striving to underscore the responsibility of the government from the theoretical perspective, and also focused on the development of rural public health systems. The underlying rationale presumes that the goal of rural public health services will be achieved automatically if the system was reconstructed and the function was articulated. However, practically, the deviation between the configuration and operation of the system made us realize that we should endeavour to research on the interrelationships between the parts that constitutes the rural public health system, i.e. the supply, the demand and the provider.ObjectiveTo test the micro-model for the rural public health system using empirical data. On the basis of rational choice, the macro- and micro-model will be constructed for the rural public health system. Use Structural Equation Modeling (SEM) to conduct the evidence-based research. The goal is to test the hypothesis that the behaviour of rural residents are helpful to achieve the goal of rural public health services, and therefore, the right and the duty of rural residents should be emphasized in the process of designing the rural health system.MethodsTo specify the model for rural public health system based on the literature. Based on evidence of the rural residents' demands and the goal of services in Zhejiang Province, the hypothesis on the rural public health system was tested. (1) Study population. Rural residents in Zhejiang Province with a sample size of 1100. (2) Sampling method. Multistage stratified random sampling was used. Firstly, HangZhou and QuZhou was randomly selected based on the geographic and economic status. Secondly, two counties from HangZhou and three counties from QuZhou were selected also based on the geographic and economic status. Finally, 300 residents were chosen and interviewed. (3) Data Collecting. Self-filling questionnaires were used. The questionnaires included the demographics as well as the concepts of health status, health belief, disease prevention and access to health care and need for health services. (4) Statistical analysis. The raw data was input by Epidata 3.0. SPSS 12.0 package was used to conduct statistical analysis, which includes Cronbach a parameter and factor analysis. Descriptive statistics were reported for demographics, health belief, disease prevention, needs from rural residents and the goal of rural public health services. ANOVA was used for continuous variable and Wilcoxon rank sum test was used for categorical variables.Multiple regression was used for the relationship between the goal of health services and need for public health care in rural residents.Structural Equation Modeling (1) Model Specification. Model was specified based on literature. Path diagram was plotted to illustrate the relationships. (2) Model Identification. Preliminary estimation was conducted to identify whether the unique solution was derived. (3) Model Estimation. Parameters were estimated by Maximum Likelihood Estimation. (4) Model Evaluation. The model fitting indices were evaluated to report how the data fit the hypothesized the model. Model modification was considered if the model-fit indicates that the improvement could be obtained by specifying an alternative model.Results1500 questionnaires were sent, and 1378 returned (response rate 91.8%). 1312(95.2%) questions were completed.1. Tests of reliability and validity: The Cronbach's alpha coefficients and split-half reliability were calculate to be 0.824 and 0.790 respectively for the health belief questionnaire, Factor analysis identified only one principal components that explained 50.586% of the variances.2. Descriptive statistics for public health need in rural residents and the realization of the goal of public health services. This survey included 11 services provided in rural public health care. Generally, most of the residents believed that rural public health provided "timely access to health care", "vaccine for children", and "availabilities of clean sources of food". However, other services were viewed as "mediocre" and "poor". Most of interviewees expressed a strong desire for public health care.3. Factors influencing the need for public health care and realization of public health services. Age, marital status, education, living areas, occupation andhousehold income per capita in the last year are significant factors (p<0.01) for the realization of public health services. It's statistically different (p<0.05) for the public health care needs for the population with different age, marital status, education, living areas and household income per capita. Analysis by multiple regression showed that household income per capita, prevention behaviour and belief, need, living areas, occupation 6, education #1, education 2, occupation 3, occupation 2 and occupation 4 are significant factors in the model for the realization of public health care. In predicting the difference of public health care needs, the statistical significant factors are health belief, disease prevention, living areas, age, household income, occupation 3, education 3.4. Analysis of rural public health micro-model by structure equation modeling. After several runs of estimation and modification, resources-belief-realization ('latent contract') model was fitted well (GFI = 0.8571, RMR=0.1747) and also have a meaningful interpretation.ResourcesHealth Belief0.41NormPrevention BeliefConclusionsThis study confirms our original hypothesis that the rural residents were 'rational' in public health system. Needs of rural residents are accomplished by rational guidance, and their resources, health belief and prevention conception areall contributed to the accomplishment of the final goal. This, therefore, indicated that rural residents play a pivotal role in the realization of the goal of the rural public health services. Put it in another way, in the development of rural public health system, both the responsibilities and rights of rural residents should be articulated. The realization of the goal of public health care should not only take count of the demand side, but also emphasize the interactive relationships between the providers and the demand side. These micro-models matched well with our original hypotheses and provide the basis to facilitate the macro-model.