| Objective:In this study,Andersen health service utilization behavior model was used to study the health seeking behavior of infertility patients in Longyang District of Baoshan City and Huize County of Qujing City in Yunnan Province,and to explore the current situation and influencing factors of this population,in order to provide a basis for the provision and use of infertility diagnosis and treatment services.Methods:The study uses a cross-sectional study design,combining quantitative and qualitative research methods.The quantitative research uses a self-made questionnaire to conduct a face-to-face survey of selected infertility patients.Infertility patients are contacted by the rural maternity and child specialists after finding out the number of infertility patients.The patients who meet the eligibility criteria for the study will be contacted by phone.After obtaining the patient's consent,they will arrange an appointment with the local township hospital to participate in the survey.The qualitative research mainly uses personal in-depth interviews to interview patients,their families,and infertility clinicians to understand relevant information about patient medical treatment.The frequency/composition ratio,chi-square test,t/F test and other analysis to use to describe the patient's health seeking behaviors.The binary Logistic and multinomial logistic regression analysis were used to analyze the influencing factors of health seeking behavior.Results:(1)Basic situation of patients:A total of 345 infertile patients were investigated,there are 204 patients come from Huize County,including the average age is 34.79 ± 7.18 years old and 37.90±7.29 years old in their spouse;there are 141 patients come from Longyang District,including the average age is 28.03± 6.08 years old and 29.91±5.28 years old in their spouse.In Huize County,140(68.63%)had primary infertility and 64(31.37%)had secondary infertility;in Longyang District,83(58.87%)had primary infertility and 58(41.13%)had secondary infertility.(2)The health service utilization of patients:There are 339 patients(98.26%)had sought medical services in 345 patients,in these patients:?So far,the number of patients who have visited 2-3 medical institutions is 168(49.56%),and 81(23.89%)who have visited more than 3 medical institutions..There are 73 people(21.53%)who had a normal sexual life and did not take any contraceptives and went to a medical institution for a medical treatment less than 6 months before consciously failing to get pregnant,113 people(33.33%)went to the medical institution for 6-11 months,95 people(28.02%)went to the medical institution for 1?2 years and 58 people(17.11%)went to the medical institution for more than 2 years,238 people(70.21%)who have undergone systematic infertility tests on both sides.The largest proportion of patients obtained medical institution information from relatives and friends,accounting for 71.68%.89.09%of the patients are most concerned about the technical level of the medical institution when choosing a medical institution.?At the first visit,74.63%of patients chose public hospitals above county level,46.64%of them chose high-level technology;10.03%of patients chose private hospitals,of which 47.06%were recommended by relatives or friends.25.33%were very dissatisfied with the first consultation experience,while 3.33%patients were very satisfied with it.47(23.50%)of the patients who went to the public hospitals that can systematically diagnose and treat infertility were not satisfied with their medical experience,106(53.00%)said they feel general,and 6(3.00%)said they were very satisfied.? At the time of the most recent visit,83.33%of the patients chose public hospitals above county level,of which 52.22%of them chose a high level of technology;8.33%of patients chose a private hospital,of which 62.96%were recommended by relatives and friends,51.85%are due to advertising media recommendations.?Medical treatment situation of secondary infertility:Among them,20.97%of the patients with children went to medical institutions to see a doctor when they were conscious of not being pregnant without any contraceptive measures,30.65%of the patients with 6?11 months,25.81%of the patients with 1?2 years and 22.58%of the patients with more than 2 years;In the case of patients with secondary infertility who do not have children,during normal sex life and without any contraceptive measures,the interval between going to the medical institution and consciously unable to get pregnant is 28.57%,and 6?11 months is 39.29%,accounting for 25.00%in 1?2 years and 7.14%in more than 2 years.55.23%of the patients with infertility who had a child who had undergone a systemic examination at the time of medical treatment,and 66.07%without a child.The first medical institution for infertility patients with children is public hospital that can systematically treat infertility,accounting for 66.13%;the first medical institution for patients without children is a public hospital that can systematically treat infertility It accounts for 35.71%,which is lower than the proportion of secondary infertility patients with children(?2=10.900,P=0.002).The number of hospitals where patients with children recently visited was the public hospitals that systematically diagnose and treat infertility,accounting for 62.90%;patients without children chose this type of medical institutions less than patients with children,accounting for 28.57%(?2=13.936,P<0.001).?180 people(82.19%)who were still not pregnant after seeking medical services said they would continue to seek medical services.(3)The factors influencing patients' health seeking behavior:? The factors of affecting Patients Visit Time:The results of multinomial logistic regression showed that when compared with the group of timely medical treatment,patients under the age of 30 are more likely to have the interval of more than two years from having normal sexual life without any contraceptive measures to consciously not being pregnant and seeking medical services(B=-1.732,OR=0.177,95%CI:0.032?0.985,P=0.048),which is delayed medical treatment;Taking the family without fixed income as a reference item,the patients with fixed income in the family were more likely to occur when the interval from normal sexual life without any contraceptive measures to the conscious inability to become pregnant and to seek medical services is less than 12 months(B=0.876,OR=2.402,95%CI:0.032-0.985,P=0.048),which seeking medical service too early.?The influencing factors of whether the first medical institution is public hospital that can systematically diagnose and treat infertility:The results of binary logistic regression showed that the patients with higher education level(B=0.305,OR=1.356,95%CI:1.047?1.756,P=0.021)and higher family annual income(B=0.365,OR=1.441,95%CI:1.006?2.062,P=0.046)are more likely to choose a public hospital that can systematically diagnose and treat infertility when they first visit;The patients with shorter marriageable age(B=-0.454,OR=0.635,95%CI:0.417?0.967,P=0.034)and the shorter infertility years(B=-0.341,OR=0.711,95%CI:0.541?0.934,P=0.014)are more likely to choose a public hospital that cannot systematically diagnose and treat infertility at the first visit.Conclusions:About half of the patients with infertility have visited 2?3 medical institutions,and they pay most attention to the professional level of the medical institution during the consultation.Therefore,most patients chose public hospitals at or above the county level during the first and most recent visits.However,some patients chose medical institutions that could not treat infertility systematically during the first consultation.At the same time,the timing of the patient to seek medical treatment is too early or too late.The factors that affect the patient's medical timing are mainly age and whether the family has a fixed income.The main factors of public medical institutions that systematically treat infertility are the education level of the patient,the family's annual income,the age of marriage,and the infertility duration.Therefore,we propose to take corresponding measures based on the Andersen Model of Health Services Use from three aspects of medical service system,health policy,and capability resources to guide patients to establish correct and effective health seeking behaviors. |
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