Consistency between expressed and perceived needs for family doctor contracted services among rural older adults: A survey of 456 residents in Ningxia^☆

Abstract

Objective: To investigate the status and influencing factors of consistency between expressed and perceived needs for family doctor contracted services among rural older adults in Ningxia Autonomous Region of China.

Methods: A cross-sectional study was conducted from July to September 2024. Stratified cluster sampling method was applied for find participants. Two counties were selected from each of the five cities in Ningxia, and one village was chosen from each of the county. A total of 456 rural older people from the 10 villages were invited into the survey. Socio-demographic information and expressed and perceived needs for family doctor contract services were collected using a self-designed questionnaire. Multiple stepwise regression analysis was used to identify influencing factors, while a random forest model was employed to rank the importance of these factors.

Results: The average score for consistency between expressed and perceived needs was (11.64 ± 5.31), indicating an overall low level of consistency. The expressed need for basic public health services (that provided to all signatories, such as establishing health records) reached 96.1%, the perceived need reached 96.7%, and the satisfaction rate also reached 92.9%, all of which are at a high level. In contrast, only 5.3% of participants expressed need for individual health services (that provided according to the specific need patients, such as home-based care), 40.1% perceived the need, and satisfaction was as low as 5.0%, all indicating low levels. Stepwise regression analysis identified several key influencing factors of demand side on the consistency, including satisfaction with services, awareness of self-health, chronic diseases, economic burden, healthcare-seeking habits at primary care facilities, and current smoking. Among these factors, satisfaction with services was the most significant predictor of consistency of the two needs.

Conclusion: The consistency between expressed and perceived needs for individual health services in the family doctor contract among rural older adults remains low, influenced by both subjective factors and objective factors, such as chronic conditions, satisfaction with services and awareness of self-health. Therefore, the author suggests designing and providing the family doctor contract service packages in a way that is tailored to local contexts, especially focusing on service items that address individual perceived needs. The improvement of consistency between expressed and perceived needs will better meet the diverse health management needs of the rural elderly.

Keywords

Rural / Older adults / Family doctor contracted services / Use-need consistency / Influencing factors

Declarations

Not applicable.

Authors' contributions

H.J.-Conceptualization; H.J.-Methodology; H.J., L.L., S.J., L.X., Y.C. and Y.J.-Data curation; H.J. and L.L.-Formal analysis; N.Y.-Funding acquisition; N.Y.-Project administration; N.Y.-Supervision; N.Y.-Validation; H.J.-Writing—original draft; N.Y.-Writing—review and editing.

Ethical approval and consent to participate

The study received approval from Ethics Committee of Ningxia Medical University (Approval No. 2022G018). The research content was agreed upon by all participants.

Consent for publication

This paper has been approved for publication by all the authors.

Availability of data and materials

Not applicable.

Funding

This research received a specific grant from the National Science Foundation of China (72264031).

Limitations

This study has several limitations. First, the questionnaire was developed based on the research team’s perspective, and may ignore certain determinants that are more salient from the users’ standpoint. Future studies could adopt qualitative research methods, such as in-depth or semi-structured interviews, to explore the issue from multiple stakeholder perspectives. Second, the inclusion of all eligible older adults within the same household may introduced intra-household opinion clustering. Third, in an effort to improve the feasibility, a binary (“Yes”/”No”) response format was used to assess service needs and experiences, which may compromise sensitivity. In particular, although the results showed that perceived needs exceeded expressed needs, the survey design was too limited to reveal the specific reasons behind this gap. Fourth, the study focused on older adults, which restricts the generalizability of the findings to other age groups. Finally, although participants were from five cities in the Ningxia, the sample size was insufficient to support subgroup analyses at the city level. Future studies with larger, city-representative samples are warranted to explore geographic disparities.

Declaration of competing interest

All authors declare that there are no competing interests.

Acknowledgements

The authors gratefully acknowledge the financial support by the National Science Foundation of China.

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