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

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. 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. 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. 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.