Social Capital And Influence Of Health Service Utilization In Disease-causing Poverty Population

BackgroundChina is implementing poverty alleviation policies.Among all the causes,poverty caused by diseases accounted for the largest proportion.In order to achieve the goal of China's poverty alleviation policy,the government needs to take effective measures to assist disease-causing poverty population,in which the key point is to understand the characteristics and influencing factors of the disease treatment behaviors of this population.Existing studies have found that the main characters of this population are poor health condition,high demand of health services but low level of actual utilization Therefore,enhancing the health service utilization of this population to improve the disease treatment effect can be an effective measure.Attentions have been paid to the influence of social capital to health,and close relationship has been found between social capital,health and poverty,in which social capital could be the mediating variable.Apart from that,social capital could positively affect the health service utilization.However,researches in disease-causing poverty population are still limited,with inconsistent conclusionsObjectivesTaking Shandong province as the example,this paper aims to test the reliability and validity of Chinese social capital measurement scale(translated from Onyx&Bullen social capital scale)in disease-causing poverty population,to measure social capital in this population and to analyze impact of social capital as well as its factors to health service utilization.This study will provide data support for improving the utilization level of health services from the perspective of social capital,being of important theoretical and practical significance to improve disease treatment effect,reduce economic burden and alleviate poverty.MethodsIn this study,a multi-stage stratified random sampling was used to conduct a sampling survey in all disease-causing poverty families in Shandong province.Firstly,English version of Onyx&Bullen social capital measurement scale was translated into Chinese and conducted cultural adaption.Secondly,face-to-face interviews were made using electronic questionnaire in tablet personal computers.Thirdly,data was collected and analyzed.SPSS21.0 and Statal5 were used for data analysis.Statistical analysis methods including descriptive analysis of variables,exploratory factor analysis and internal consistency reliability test of Chinese social capital scale,logistic regression analysis was used for influencing factor analysis of health service utilization,in which dependent and independent variables were selected according to Andersen's behavioral model of health care utilization.ResultsAll the 652 samples of this study were the elderly rural residents with low level of education and one or more chronic disease that lead to heavy economic burden on their families.Analysis of social capital scale showed that all the 29 items could be classified into 7 factors,totally interpreting 56.76%of all the variation.Internal consistency reliability coefficient(Cronbach's alpha)was 0.88 with Cronbach's alpha of all factors were larger than 0.50,indicating the good reliability and validity of Chinese social capital scale.The characteristics of social capital in disease-causing poverty population are high level in Feelings of Safety and familiarity and low level in Participation in the Local Community.Among all the factors of social capital,Feelings of Trust and Self-value(p<0.1)was a risk factor of unmet hospitalization demand because of self-rated health condition.Neighborhoods and Friends Connections(OR=0.75 1,p<0.01)and Feelings of Safety and familiarity could positively affect health service utilization as well as decrease unmet needs for health care.Tolerance of Diversity(?=0.463,p<0.01;?=0.356,p<0.01)and Voluntariness(?=-0.354,p<0.01;?=-0.193,p<0.01)affected patients' choice of medical institutions differently.Other factors such as the female,being old and having low level of education also had negative impacts on health service utilization.Conclusion and policy recommendationChinese social capital scale showed a good reliability and validity in disease-causing poverty population.Different factors of social capital had different impact on health service utilization of this special population.Suggestions aimed at improving the health service utilization and treatment effect of disease-causing poverty population includes increasing and developing social activities as well as strengthening people's participation under the organization of community;improving the awareness of seeking medical treatment and the ability of disease management of the disease-causing poverty population by educating health knowledge and incentive methods;enhancing inter-personal communication and relationship as well as the security sense of the community,to maximze health outcome and reduce disease burden,contributing to poverty alleviation of this population.