Impact of residents′ health literacy on healthcare choice based on the Andersen model
10.3760/cma.j.cn115624-20250515-00415
- VernacularTitle:基于安德森卫生服务利用模型的居民健康素养对就医选择的影响
- Author:
Yunting CHEN
1
;
Jieru CHEN
;
Zhiyang WANG
;
Chenggang JIN
;
Zou ZHANG
Author Information
1. 北京师范大学政府管理学院，北京 100875
- Publication Type:Journal Article
- Keywords:
Health knowledge, attitudes, practice;
Health literacy;
Healthcare choice;
Anderson Health Service Utilization Model
- From:
Chinese Journal of Health Management
2025;19(12):1013-1019
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the impact of residents′ health literacy on healthcare choices.Methods:This mixed cross-sectional study utilized data from the 2009, 2011, and 2015 waves of the China Health and Nutrition Survey (CHNS), including adults aged≥18 years. Guided by Andersen′s Behavioral Model of Health Services Use and the Knowledge-Attitude-Practice (KAP) framework, variables were collected across three dimensions-predisposing, enabling, and need factors-including gender, marital status, age, education level, employment status, urban/rural residence, health management awareness, income, health insurance coverage, self-rated health, and chronic disease status. A multinomial Logistic regression model was applied to assess the association between health literacy and healthcare choice. Bootstrap analysis was conducted to test the mediating effect of health management awareness.Results:After excluding cases with missing or invalid data, 4 736 valid observations were included. The proportions of choosing township-, county-, and city-level hospitals were 60.60%, 15.08%, and 24.32%, respectively. After adjusting for confounders, health literacy showed a significant effect on healthcare choice ( P<0.05): individuals with higher health literacy were more likely to choose county-level hospitals ( RR=1.035, P<0.05) and city-level hospitals ( RR=1.044, P<0.01). Health management awareness mediated the relationship between health literacy and healthcare choice ( P<0.05). Conclusions:Health literacy significantly influences healthcare choices; individuals with higher health literacy are more inclined to utilize higher-level medical institutions. Furthermore, health literacy affects healthcare choices partly through the mediating role of health management awareness.
