Work

Association between knowledge, attitude, and practice regarding family doctor contract services and perceived healthcare barriers among contracted residents: a cross-sectional study in Shanghai, China

Year: 2026

Type: article

Abstract: Objective Family doctor contract services are a core component of China’s primary healthcare system, aimed at improving service accessibility, continuity, and patient engagement. However, it remains unclear how contracted residents’ knowledge, attitude, and practice (KAP) regarding these services relate to their perceived healthcare barriers, and evidence from population‑based studies is limited. This study aimed to examine the level of KAP among contracted residents, explore its association with perceived healthcare barriers, and identify factors influencing KAP in Shanghai, China. Methods This cross-sectional study surveyed 304 contracted residents of family doctors in Minhang District, Shanghai, between January and April 2026. The questionnaire, designed based on the Andersen Behavioral Model of Health Services Use, assessed KAP and six dimensions of healthcare barriers: imperceptibility, unavailability, inadaptability, inaccessibility, unaffordability, and unacceptability. We used one-way ANOVA, Spearman correlation, and multivariate linear regression to identify factors associated with KAP. Propensity score matching (1:1 nearest-neighbor) was applied to control for confounders and estimate the independent effect of barriers on KAP and service use behaviors. Results The mean total KAP score was 39.37 ( SD 7.99). Mean scores for knowledge, attitude, and practice were 13.34 ( SD 2.74), 13.05 ( SD 2.79), and 12.97 ( SD 3.00), respectively, indicating moderate-to-high levels. Univariate analysis showed significant differences in KAP by age, education, household registration, visit frequency, chronic disease status, source of medical expenditure, source of medical care, and level of barriers (all P <0.05). Spearman correlation showed that total barriers and all subscales were positively correlated with total KAP and each KAP domain (all P <0.05), with the strongest correlation for the practice domain ( r s =0.298, P <0.001). Multivariate linear regression identified age ≥35 years, education above high school, urban resident basic medical insurance, and self‑funded healthcare as positive factors (all P <0.05; adjusted R² =0.249, F =7.694, P <0.001). After propensity score matching, total barriers and the inadaptability dimension showed positive effects on KAP ( ATT =0.281 and 0.174, both P <0.05). Total barriers, imperceptibility, unavailability, and inadaptability significantly improved practice scores (all P <0.05). Conclusion Contracted residents have moderate‑to‑good KAP regarding family doctor services, influenced by age, education, and insurance type. Perceived barriers are positively associated with KAP. Information, resource, and process‑related barriers appear to motivate active service use and are key targets for service improvement.

Source: BMC Public Health

DOI: 10.1186/s12889-026-29879-5

Authors: Qi Shen, Weiying Gu, Shuai Liu, Zhao Liu

Institution: Shanghai Minhang District Health Commission

Language: English

Topic: Primary Care and Health Outcomes

Subfield: Family Practice

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,290