title: What Contributes to the Activeness of Ethnic Minority Patients with Chronic Illnesses Seeking Allied Health Services? A Cross-Sectional Study in Rural Western China.
abstract: Actively seeking health services lies at the core of effective models of chronic disease self-management and contributes to promoting the utilization of allied health services (AHS). However, the use of AHS by ethnic minority Chinese, especially the elderly living in rural areas, has not received much attention. This study, therefore, aims to explore the association between personal characteristics and the activeness of ethnic minority patients with chronic diseases in rural areas of western China seeking AHS. A cross-sectional study was conducted to collect data on the socio-demographic and economic characteristics, health knowledge level and health communication channels of the sampled patients. A logistic regression model was used to examine the association of these predictors with the activeness of the surveyed patients in seeking AHS. A total of 1078 ethnic minorities over 45 years old who had chronic conditions were randomly selected from three western provinces in China and were interviewed in 2014. It is found that the New Cooperative Medical Scheme (NCMS) is the most salient predictor affecting the activeness of Chinese ethnic minorities in seeking AHS. The probability is 8.51 times greater for those insured with NCMS to actively seek AHS than those without (95% Confidence Interval (CI) 4.76-15.21; p < 0.001). Moreover, participants between 60 and 70 years old and those who have five to six household members are more likely to seek AHS compared with other social groups (Odds Ratio (OR) = 1.64, 95% CI 1.28-2.97, p = 0.007; OR = 1.95, 95% CI 1.15-2.36, p = 0.002). However, the activeness of patients seeking AHS is lower for those who have better household economic conditions. Besides socio-demographic predictors, the Chinese ethnic minorities' activeness in seeking AHS is clearly associated with the communication channels used for receiving health information, which include direct communication with doctors (OR = 5.18, 95% CI 3.58-7.50, p < 0.001) and dissemination of elementary public health knowledge posted on bulletin boards (OR = 2.30, 95% CI 1.61-3.27, p < 0.001) and traditional mass media (OR = 1.74, 95% CI 1.22-2.48, p = 0.002). First, the government should further improve the coverage of NCMS to households suffering from chronic diseases and satisfy the requirements of social groups at different income levels and various ages in their health care to improve their activeness in AHS utilization. Second, doctors' advice, bulletin boards and traditional media are common health communication channels for those seeking AHS and thus should be continuously employed in rural western China. Third, specified healthcare services should be designed to meet the needs of different patient segmentations.
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Shangfenghust@sina.com.
authors.forename: Shangfeng
authors.initials: S
authors.lastname: Tang
authors.affiliation: David C. Lam Institute for East-West Studies, Hong Kong Baptist University, Hong Kong, China. dongdong@hkbu.edu.hk.
authors.forename: Dong
authors.initials: D
authors.lastname: Dong
authors.affiliation: Cancer Center, Sun Yat-sen University, Guangdong 510060, China. jlhust1990@sina.com.
authors.forename: Lu
authors.initials: L
authors.lastname: Ji
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. tongjifh@163.com.
authors.forename: Hang
authors.initials: H
authors.lastname: Fu
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. zcf@hust.edu.cn.
authors.forename: Zhanchun
authors.initials: Z
authors.lastname: Feng
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Brammaputram@gmail.com.
authors.forename: Ghose
authors.initials: G
authors.lastname: Bishwajit
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. houis123@163.com.
authors.forename: Zhifei
authors.initials: Z
authors.lastname: He
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. minghuitj@sina.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Ming
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. sofureqian@hotmail.com.
authors.forename: Qian
authors.initials: Q
authors.lastname: Fu
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. xianyue911109@163.com.
authors.forename: Yue
authors.initials: Y
authors.lastname: Xian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D002908:Chronic Disease / Q000208:ethnology*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics* / Q000208:ethnology*; D005006:Ethnicity; D005191:Family Characteristics; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D012424:Rural Population / Q000706:statistics & numerical data*; D012648:Self Care; D011795:Surveys and Questionnaires
keywords: activeness; allied health services; ethnic minorities; insurance; rural areas; western China