Residents' willingness towards first-contact with primary health care under uncertainty in healthcare: a cross-sectional study in rural China

Objective To estimate Chinese rural residents' willingness degree of initially contacting primary healthcare (PHC) under uncertainty in healthcare and to explore its influencing factors. Setting This study collected primary data from rural residents in Dangyang, Hubei Province in China. Participants The study investigated 782 residents and 701 finished the survey. The response rate was 89.64%. A further 27 residents failed the internal consistency test, so the effective sample size was 674. Design In this cross-sectional study, residents' willingness was reflected by the threshold of disease severity for PHC (TDSP), the individual maximal disease scope for considering PHC based on residents' decision-making framework. TDSP was measured through scenario tests. Univariate analysis and unordered multiple logistic regression were used to explore the influencing factors of three-level TDSP: low, general, and high. Results Only 28.2% of respondents had high TDSP and high willingness towards PHC. Compared with general TDSP, respondents who were younger than 40 (OR 7.344, 95%CI 2.463 to 21.894), rich (OR 1.913, 95%CI 1.083 to 3.379), highly risk-averse (OR 1.958, 95%CI 1.016 to 3.774), had substitute medical decision-maker (OR value of parent/child was 2.738, 95%CI 1.386 to 5.411) and had no visits to PHC in the last 6 months (OR 2.098, 95%CI 1.316 to 3.346) tended to have low TDSP and low willingness towards PHC. Compared with general TDSP, no factors were found to significantly influence respondents' high TDSP. Conclusions TDSP can be a good indicator of residents' willingness. TDSP results demonstrate rural residents' generally low willingness towards first-contact with PHC that some residents refuse to consider PHC even for mild diseases. This study provides practical significance for elaborating the underutilisation of PHC from resident decision-making and offers advice to policymakers and researchers for future modifications.