Social Stratification, Health Beliefs and Regular Check-Ups Among Older Adults in China

Purpose:

Regular check-ups are especially crucial for older adults because of high prevalence of co-occurring health issues including non-communicable diseases and function decline that happened along with the aging process (WHO, 2013). Healthy People 2020 also recommends regular check-ups for preventable and diagnosable medical conditions (Maurer & Smith, 2014).

Health beliefs have an impact on the performance of regular check-ups. In particular, deep-rooted Eastern culture belief plays an important role in the formation of health beliefs among Chinese older adults (Lee & Fan, 2014). This culture based health belief contains attitudes such as fatalism that might be salient barrier of performing regular check-ups (Lee & Fan, 2014; Zhang, Shan, & Jiang, 2014). Previous studies also indicated that social stratification (e.g., age, gender, and education) could impact Chinese adults acceptance of regular check-ups (Kwok, Fethney, & White, 2012; Lu, et al., 2015). However, we have limited knowledge on how social stratification impacts Chinese older adults receiving regular check-ups, and what role health beliefs play in mediating the effect of social stratification on regular check-ups.  The purpose of this study was 1) To explore direct and indirect relationships between social stratification and regular check-ups and 2) To test the mediating effect of health belief on the relationship between social stratification and regular check-ups.

Methods:

We used the 2013 Shanghai Longitudinal Survey of Elderly Life and Opinion data that include 3418 respondents age 60+. Regular check-ups include full blood count (FBC), urine test, and stool examination. Health beliefs were measured by modified 16-item Attitudinal Index (AI) that from four domains— barriers, fatalism, necessity, and detects. Structure equation modeling was performed to examine the association among social stratification (age, gender, health insurance, education level, living condition, and financial status), health beliefs, and regular check-ups. 

Results:

Overall, 64.16% of the respondents performed FBC, 54.15% received urine test, and only 23.11% had stool examination regularly. Results showed that all four health belief domains were related to regular check-ups. People who are younger, have higher education and better financial status, insured, and living in urban were more likely to report positive health beliefs and perform regular check-ups. Health beliefs serve as a mediator between social stratification and performance of regular check-ups. 

Conclusion:

Close to half of the respondents in Shanghai did not perform regular check-ups and only approximately 20% had stool examination. Our study shows the importance of health beliefs in affecting individuals’ health behaviors. It is critical to develop health education programs to improve use of preventive care services for older adults in China.