Associations between spatial access to medical facilities and health-seeking behaviors: A mixed geographically weighted regression analysis in Shanghai, China
Associations between spatial access to medical facilities and health-seeking behaviors: A mixed geographically weighted regression analysis in Shanghai, China
复制标题
医疗设施的空间可及性与寻求健康行为之间的关联：中国上海的混合地理加权回归分析
DOI：
10.1016/j.apgeog.2022.102644
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发表时间：
2022-01-21
影响因子：
4.9
通讯作者：
Tao，Yinhua
中科院分区：
文献类型：
--
作者：
Shen，Yue;Tao，Yinhua
提高医疗设施的空间可达性是许多国家的一项重要公共卫生战略。然而，目前尚不清楚是否提高空间可达性是能够解决医疗保健问题，由于个人的健康寻求行为的复杂性。本研究借鉴Andersen的行为模式，以确定医疗设施的空间可达性和社会制度因素与个人的健康寻求行为的关联的使能因素。使用逻辑回归和混合地理加权回归技术分析在中国上海收集的大规模健康调查数据。研究结果表明，医疗设施的空间可达性对就医行为有显著影响，但其影响机制是复杂的，涉及人们对高等级医院的偏好和对公共交通便捷性的需求。此外，医疗设施的空间可达性与就医行为之间的关系存在空间异质性。特别是居住在上海市内郊区的人，与城市居民相比，更容易获得这些设施，因此更有可能进行自我治疗。此外，由空间可达性和社会制度因素（如户籍）交织形成的本地化背景，使空间可达性与就医行为之间的关联复杂化。
Enhancing the spatial accessibility to medical facilities is an important public health strategy in many countries. However, it is not clear whether enhancing spatial accessibility is capable of addressing medical care issues due to the complexity of individuals' health-seeking behavior. This study draws from Andersen's behavioral model to identify enabling factors in the associations of spatial accessibility to medical facilities and socio-institutional factors with individuals' health-seeking behavior. Logistic regression and mixed geographically weighted regression techniques are used to analyze large-scale health survey data collected in Shanghai, China. The results show that spatial accessibility to medical facilities plays a significant role in health-seeking behaviors, but the mechanism at play is complicated, involving people's preference for high-grade hospitals and the demand for easy access to public transit. Moreover, there is spatial heterogeneity in the relationship between spatial accessibility to medical facilities and health-seeking behaviors. Especially, people who live in the inner suburb of Shanghai have worse access to these facilities and thus are more likely to perform self-treatment compared with urban residents. Moreover, localized contexts formed by the interweaving of spatial accessibility and socio-institutional factors, such as registered residence status (hukou), complicate the association between spatial accessibility and health-seeking behaviors.