Status Of Participation Of The Public And Its Influencing Factors In Basic Public Health Services

Background and purposeBackground Promotion of the equalization of basic public health services is one important goal of Chinese government to reform of the national healthcare system and materialize primary health care. Since the equalization of basic public health services officially started in 2009, it continually took new progress in 7 years. However, from the findings of some existing researches throughout China, there are often some significant differences of policy effects between different regions. Therefore, it is necessary to understand how the basic public health service is running and what factors are influencing the implementation of this policy. Only by this way can we pertinently take measure to improve the policy and its results.As an important public policy, basic public health services not only need the government-led work, but also require the residents’ participation, which includes their utilization, feedback and supervision of the very policy. From some researches we found that in some areas, residents’knowledge about basic public health services is poor although the allocation of health resources has been improved. We believe it is because the participation was lacking. In order to test this hypothesis, we conducted this study.Purpose This study aimed to understand residents’ knowledge rate and access situation of basic public health services by conducting a field investigation and a systematic review. The understandings of the status quo and influence factors of residents’participation of basic public health services will be help to improve the implementation basic public health services and provide evidence for the promotion of equalization of basic public health services and health care system reform.Methods1. Study designs:We employed a cross-sectional study and an evidence-based medicine research (systematic review) in this paper.2. A systematic review was conducted on domestic researches that study residents’ access to basic public health services. This review retrieved four domestic databases:CNKI database, VIP database, Wanfang database and SinoMed database, and we also retrieved the global database of PubMed. The retrieved data started from January 1st 2009 to April 1st 2016. Quality of studies included was assessed using AHRQ and MINORS indices.3. Questionnaire design:We designed the questionnaire base on literature research. The questionnaire contained 12 questions, which included 5 questions on demographic data,1 question on health insurance,5 questions on knowledge of basic public health services and 1 question on the acceptance of basic public health service (health care education, health records, chronic disease management).4.Subjects:Local resident aged 16 and above who are from 4 streets and 6 towns in Shunde District, Foshan City, Guangdong Province. The sampling survey was conducted by means of a chance encounter method.5. Statistical analysis:After sorted the collected questionnaires, we input data into Excel 2013. We cleaned false data and checked variables by deleting abnormal data and illogical data. Then we removed cases do not meet the quality requirements of entry criteria, such as:①local living time less than 6 months; ② ≤15 years; ③ missing items≥2. Then we import the processed data into SPSS17.0 where the data will be statistically analyzed. We used descriptive method to analysis demographic data of residents, awareness and acceptance rates about basic public health services. Chi-square test was used for univariate analysis of influencing factors. Those factors were statistically significant (P<0.05) in univariate analysis were then put in multivariate analysis.Results1. Results of the systematic review:There were only 40 articles included in the literature analysis. Of which,37 articles were epidemiological studies and 3 articles were opinion discussion. The quality of these 37 epidemiological studies was assessed as medium basis on the AHRQ and MINORS indices. The results showed that the degrees of equalization of basic public health were low and the studies about public participation and basic public health service should be enhanced.2. Basic characteristics of subjects:we collected 1935 questionnaires out of 2000 residents, with the response rate 96.75%. Forty-eight questionnaires were removed for their meeting the quality requirements. Final valid questionnaires for analysis were 1887, which effective rate was 94.35%(1887/2000). Participants were distributed in the region’s 4 streets and 6 towns, and valid response averages 188 people each town. The youngest subject was 16 years and the oldest aged 83 years, average age was (33.4 ± 11.7) years. There were 966 male (51.2%) and 921 female (48.8%).3. Knowledge about the public health services in residents:there were 52.12% (973/1867) of respondents said they had heard this service before, it is not related to age, but males that knows are more than females (56.31% vs.46.58, χ2=20.79, P <0.01). The ones who lives in local for longer time has a greater proportion of knowledge about "basic public health services" (χ2= 37.16, P<0.01). There was no difference between occupations. However, health insurance types and income were related with Knowledge about the public health services. People who did not have medical insurance had lowest percentage of 36.2% on awareness, while the rate in people who had medical insurance for urban workers (including public health) was 58.2%. In addition, the higher the income was, the greater the proportion was (P <0.001).4. Access of the basic public health services:of the 1887 participants,94.64% had received at least one of the above services, only 5.35% of the respondents answered that they had not received these services. The ones received guidance services accounted for a healthy lifestyle had the highest proportion of 43.67%, followed by disease prevention knowledge popularization of 38.47%. There were 30.26% of respondents answered that they had established a resident personal health records. There were only 25.23% of residents said had ever received follow-up services.5. Factors that influenced the residents’ access and knowledge to public health services:there wer no significant differences of access rates of public health services between age, occupations. However, female, short local residence time, no medical insurance, low monthly income were influencing factors. Long local residence time, work in state-owned enterprises and public institutions, medical insurance for urban workers (including public health), were positive factors to the access knowledge rate about basic public health services.6. The influencing factors on receiving one of four of health services in participants:gender and Income do not have influence on acceptance of these services. The main factors were age, occupation (work unit properties), local living time, medical insurance types. Long live time, job in state-owned enterprises and public institutions, medical insurance for urban workers (including public health), were positive factors that influenced the access rate to health services in residentsConclusions1. Chinese Residents’ awareness and knowledge rate about basic public health services are still not high enough. We need to mobilize the enthusiasm of residents to participate in the basic public health services2. There are significant differences of access rates to different basic public health services. We need to promote the publicity of basic public health services.3. The main negative factors influenced the awareness rate of basic public health services for residents include:gender (female), period of living (short) time, medical insurance (none), monthly income (low). These people should be the main targets for the propaganda of basic public health services.4. The main positive factors influenced the residents’ access to basic public health services include:period of living time (long), occupation (jobs at State owned unit), and medical insurance (State paid medical care). We should be learned and summed up the positive experiences.5. It needs to strengthen studies on public participation in the public health service in our country. Current studies were mainly descriptive study designs and the contents of researches were not wide and deep enough. Relevant research should be strengthened, especially for the macroscopic investigation.