Societal determination of usefulness and utilization wishes of community health services: a population-based survey in Wuhan city, China

BACKGROUND As a developing country with the world's largest population in a state of economic transition, reforms to China's health system, including community health services (CHS), are very complex and difficult. The aim of this study is to provide evidence and policy recommendations for the sustainable development of CHS for China, which could also be applicable to other developing countries. METHODS A cross-sectional survey was conducted door-to-door and face-to-face in Wuhan city, central China with a sample of 1134 individuals aged 15 and older. The independent variables were duration of residence, previous treatment experience, familiarity with health staff, self-reported family economic status and health insurance. The dependent variables were views on the usefulness of CHS and willingness to use them. Sociodemographic variables and health status were used as control variables. Multiple logistic regression analysis was used to analyse the influence of the independent variables on the dependent variables. FINDINGS This study shows that 26.10% of participants reported that the CHSs are not useful and 37.74% reported they did not want to use their CHS. The results found 'familiarity with health staff' and 'previous experience of using services' had a negative influence on their views on usefulness of and willingness to use CHS. CONCLUSION The aim of CHS to see 'minor illnesses treated in the community and serious illness treated in hospital' is not being fully realized. The key to increasing the use of CHS may be to enhance the quality of services and health staff. A policy pathway of targeting older residents and those with higher education levels as the priority population, and using these groups to encourage the rest of the community to seek minor services at CHS, may be an effective and sustainable development mechanism.