What role does healthcare geographic accessibility play in the association between personal health responsibility and family doctor contract services?

Limited research has examined the nexus between personal health responsibility and family doctor contract services, particularly the moderating role of healthcare geographic accessibility in this relationship. This study aimed to investigate the association between personal health responsibility and family doctor contract services and to determine how healthcare geographic accessibility shapes this relationship among rural older adults in China. A cross-sectional study was conducted from July to August 2022 in Shandong Province, China. A total of 3164 rural older adults aged 60 years and above were included in the analysis. Multivariable binary logistic regression models and the margins plots were used for the moderating effect analysis. The rates of signing up for family doctor contract services and support for personal health responsibility among rural older adults in Shandong Province were 64.85% and 61.54%, respectively. Participants who supported personal health responsibility were more likely to contract for family doctor services (OR = 1.38, 95% CI = 1.13–1.69) after controlling for confounding factors. Only among older adults with good healthcare geographic accessibility, personal health responsibility was associated with higher contracting rates for family doctor services (OR = 1.47, 95% CI = 1.19–1.82). Our findings reveal a correlation between personal health responsibility and engagement with family doctor contract services, with healthcare geographic accessibility serving as a pivotal moderating factor. Policymakers should consider targeted educational campaigns and improved outreach for rural older adults. Elevating their understanding of personal health responsibilities and enhancing healthcare geographic accessibility may be important steps to encourage their participation in family doctor services.

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was reviewed and approved by the Ethics Committee of the School of Public Health, Shandong University (approval number, 20181228; approval date, 28 December 2018). All procedures were in accordance with the ethical standards of the Helsinki Declaration and relevant international guidelines and regulations.

Informed consent

Before data collection, written informed consent was obtained directly from each participant included in the present analysis. Before the consent form was signed, interviewers provided the study information in writing and explained it orally in clear and accessible language. Participants were given an opportunity to ask questions and confirmed their understanding and voluntary agreement to participate before signing the form themselves. All participants included in the present analysis were able to communicate with the interviewers and answer the survey questions independently; no proxy consent was used. The data used in the present cross-sectional analysis were collected from July to August 2022 as part of the 2022 survey wave of the Shandong Rural Elderly Health Cohort (SREHC).