Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A Cross-Sectional Study.

PURPOSE: This study aimed to explore factors affecting behavioral intention of receiving periodic health examinations (hereafter, BIE) among people aged 60 and over in rural China, namely, Shandong Province, using the extended health belief model (EHBM). PATIENTS AND METHODS: Participants were selected using stratified multi-stage random sampling. Three cities were selected based on economic level. Subsequently, three counties and three villages were selected from each sample city and county. Finally, 30 respondents were selected from each sample village. Face-to-face surveys were conducted using a structured questionnaire between March and September 2017. Multiple linear regression was conducted to investigate the association between BIE and eight dimensions of EHBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, health knowledge, and social support. RESULTS: Of the 509 rural respondents aged 60 years and older, the average score of behavioral intention was 4.43±0.80. Multivariate linear regression analysis demonstrated poor BIE among participants who were men, were current smoker, were current drinker, were aged 70 years or over, had lower social support, and perceived lower self-efficacy, less benefits, and more barriers. Among them, barriers were found to have the strongest association with BIE (B'=-0.556; p<0.001). Qualitative interviews revealed that reasons for not receiving periodic health examinations (PHE) included pain, cost, difficulty in finding a health care provider, time and scheduling, potential lack of trust in the physician, and value of the PHE. CONCLUSION: This study highlighted the importance of psychological variables in the acceptance of PHE among the elderly in rural China and provided insights for further intervention designs targeting identified groups and performed by general practitioners. Addressing medical mistrust, strengthening, and enhancing one's social support network and health communication channels, such as bulletin boards, may serve to facilitate BIE.

An evaluation system for financial compensation in traditional Chinese medicine services.

OBJECTIVES: To describe the major factors influencing financial compensation in traditional Chinese medicine (TCM) and prioritize what TCM services should be compensated for. DESIGN AND SETTING: Two structured questionnaires-a TCM service baseline questionnaire and a service cost questionnaire-were used to collect information from TCM public hospitals on TCM services provided in certain situations and service cost accounting. The cross-sectional study examined 110 TCM services provided in four county TCM public hospitals in Shandong province. From the questionnaire data, a screening index system was established via expert consultation and brainstorming. Comprehensive evaluation of TCM services was performed using the analytic hierarchy process method. MAIN OUTCOME MEASURES: Weighted coefficients were used to measure the importance of each criterion, after which comprehensive evaluation scores for each service were ranked to indicate what services should receive priority for financial compensation. RESULTS: Economy value, social value, and efficacy value were the three main criteria for screening for what TCM services should be compensated for. The economy value local weight had the highest value (0.588), of which the profit sub-criterion (0.278) was the most important for TCM financial compensation. Moxibustion was tied for the highest comprehensive evaluation scores, at 0.65 while Acupuncture and Massage Therapy were tied for the second and third highest, with 0.63 and 0.58, respectively. CONCLUSIONS: Government and policymakers should consider offer financial compensation to Moxibustion, Acupuncture, Massage Therapy, and TCM Orthopedics as priority services. In the meanwhile, it is essential to correct the unreasonable pricing, explore compensation methods, objects and payment, and revise and improve the accounting system for the costs of TCM services.

[Application of 'waist circumference cutoff point' in screening diabetes mellitus among rural residents in mid-western area of Shandong Province, China].

OBJECTIVE: To determine the value and the optimal cutoff point of waist circumference (WC) in screening diabetes mellitus (DM) and to provide evidence for DM prevention and identifying population at risk in mid-western rural areas of Shandong province. METHODS: A sample consisting 16 341 rural residents was selected and studied. All participants were physically examined on height, weight, WC and fasting plasma glucose (FPG). Oral glucose tolerance test (OGTT) was performed for subjects with FPG valued from 6.1 to 7.0 mmol/L. DM was defined according to the criteria set by WHO in 1999. Area under the curve (AUC), sensitivity, specificity and Youden index were computed based on the receiver operating characteristic (ROC) curve analysis. Optimal cutoff point was determined by the maximum of Youden index. RESULTS: The prevalence rates of DM for males and females increased along with the rise of WC (trend test chi2 = 72.01, 122.65, P < 0.01). It appeared significantly higher in those with WC > or = 85 cm in females and > or = 80 cm in males, with those WC < 85 cm for females and < 80 cm for males, in particular. AUCs were 0.639 and 0.655 for males and females respectively and both had significant differences (t = 7.22, 11.07, P < 0.01). However, the AUCs did not show significant difference (t = 0.70, P > 0.05) between males and females. The Youden index reached maximum when WC approached 85 cm for females (24.90%) and 80 cm for males (24.39%). The sensitivity and specificity were 58.04% and 66.86% for males, and 67.08% and 57.31% for females. CONCLUSION: WC seemed to be an effective indicator for screening the DM. The optimal cutoff point of WC would be 85 cm for females and 80 cm for males in screening DM and defining the population at risk in this area.