Search

The role of formal volunteering in mental health promotion among older adults in China has been widely discussed during recent decades. However, the relationship connecting mental health with cross‐level interaction (i.e., average levels of participation in the community vs. individual participation) is still unclear. This paper examined the effects of cross‐level formal volunteering on depressive symptoms among older adults living in China. Using two waves of the China Longitudinal Aging Social Survey, a sample of 3128 Chinese older adults was surveyed in 2014 and 2016. Depressive symptoms were measured using the abbreviated CES‐D‐9. Individual fixed‐effects ordinary least squares regression models assessed the associations between individual‐ and community‐level formal volunteering and depressive symptoms in urban and rural areas separately. We found that in the urban sample, formal volunteering activities were negatively associated with depressive symptoms at the individual level (β = −0.49, SE = 0.22, p < 0.05). Higher community‐level formal volunteering was positively associated with depressive symptoms (β = 2.82, SE = 1.42, p < 0.05). When adding interactions between individual and community levels, engagement in individual‐level formal volunteering was associated with lower rates of depressive symptoms as community volunteering participation levels increased (β = −3.07, SE = 1.07, p < 0.01). High community‐level volunteering participation was detrimental for non‐volunteers. In rural areas, neither community‐ nor individual‐level formal volunteering was associated with changes in depressive symptoms. The current findings demonstrate formal volunteering may not always benefit mental health for all. The effects may depend on the community context and individual choices. Social policies aimed to promote mental health through formal volunteering need to be tailored according to the specific community social environment. [ABSTRACT FROM AUTHOR]

Background: Most existing research on rural–urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. Methods: Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015–2019) and 25,849 live births in City B (2018–2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. Results: While there is no statistically significant difference in rural and urban mothers' probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. Conclusions: Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: Low utilization of the family‐oriented community rehabilitation services is a threatening challenge facing low‐ and middle‐ income countries.Family caregiver's trust in community healthcare providers is the precondition of service utilization and is shaped by their perceived quality of primary healthcare services from previous experience.Most of the studies concerning the relationship between perceived quality and institutional trust were conducted in western countries, resulting in limited attention paid to conditions in non‐western countries. Which aspect of quality predicts institutional trust in China has not been studied yet. What the paper adds to existing knowledge: In China's context, institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence.Significant rural–urban disparity was observed: among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief; institutional trust was only associated with worry relief in urban respondents. What are the implications for practice: Mental health nurses training or working with community healthcare workers may improve their technical and communicative competence. Priorities may differ between rural and urban areas.Mental health nurses or community healthcare workers may provide more family‐oriented psycho‐education to rural families, and more emotional support to urban families.Wider public anti‐stigma initiatives are needed to reduce the affiliated stigma of families of persons diagnosed with a severe mental illness. Introduction: Prior studies suggested that caregiver's trust in community healthcare providers is the precondition of the utilization of community‐based rehabilitation services and is shaped by their perceived quality of primary healthcare services. Nevertheless, the research conducted in non‐western countries is scarce, and which aspect of quality is associated with institutional trust in China has not been studied. Aim: To explore the association between perceived quality of primary healthcare services and institutional trust in China's context. Methods: This cross‐sectional study was conducted with 796 family caregivers from Eastern, Central and Western China between August 2018 and October 2019. Perceived quality of primary healthcare services was measured by technical competence, communication, worry relief and risk of privacy leak. Results: Institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief. Contrary finding was observed in urban respondents. Discussion and implications for practice: With rural–urban disparity considered, strategies such as improving the technical and communicative competence of community healthcare workers, providing family‐oriented psycho‐education and emotional support, and promoting public anti‐stigma initiatives may be worth consideration. [ABSTRACT FROM AUTHOR]

Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China. Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method. Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions. Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation. [ABSTRACT FROM AUTHOR]

Traditionally, Chinese families have been the primary provider of care for older adults, and older people expected family care. However, along with the modernization and demographic transition, family functions have been weakened, and state-based care has begun to play an essential role in supporting family care for older people. This paper aims to assess the care preferences of older people and the different responsibilities of individuals and communities in modern China. Using data from the 2014 China Longitudinal Aging Social Survey (CLASS) and multinomial logistic regression modeling, we find that family care remains the cornerstone for older adults and their care preferences are associated with individual and community factors, mainly including the number of children, education level, residential area, the presence of health infrastructure and care facilities, and the values associated with filial piety of older adults. [ABSTRACT FROM AUTHOR]

This paper considers the impact of variables at three different levels—city, community and individual—on the depression of adults aged 45 years and above in China. Evidence shows that community factors, such as infrastructure and elderly centres, are critical to reduce depression but the effect of city-level factors such as lowering income inequality and improving public health investment is different for the segments of poor and non-poor as well as the rural and urban residents. This highlights the need to consider targeted policy mix options to avoid resource misallocation. Lastly, Chinese females' depression has worsened over time with ageing, particularly those who drink alcohol or are less educated are prone to depression prompting the need for specialist women health centres. [ABSTRACT FROM AUTHOR]

Background: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. Methods: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China's overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. Results: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. Conclusions: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities. [ABSTRACT FROM AUTHOR]

Ex post moral hazard, the additional healthcare utilization induced by health insurance, can be decomposed into an efficient portion generated by the income effect and an inefficient portion caused by the substitution effect, which has been discussed theoretically, but few studies have provided evidence of the efficient moral hazard. In 2016, the Chinese government launched the consolidation of urban and rural resident health insurance at the national level. After the consolidation, insurance benefits for nearly 800 million rural residents got improved. This paper uses a nationally-representative sample of 30,972 individuals from the China Health and Retirement Longitudinal Study (2011–2018) and adopts a 2-step empirical approach with the difference-in-differences method and the fuzzy regression discontinuity design to estimate the efficient moral hazard in the consolidation among rural residents. We find that the price shock contained in the consolidation increases inpatient care utilization, and the corresponding price elasticity is between −0.68 and −0.62. Further analysis shows that the efficient moral hazard resulting in welfare gains accounts for 43.33%–66.36% of the additional healthcare utilization. These findings highlight the necessity of evaluating the efficient moral hazard when analyzing the cost-benefit of health insurance reform. • We provide rare evidence of the efficient moral hazard effect in health insurance. • We focus on low-income groups from developing countries. • We use a 2-step empirical approach to estimate the efficient moral hazard effect. • The efficient moral hazard generated by income effect accounts for 43.33%–66.36%. [ABSTRACT FROM AUTHOR]

Background Welfare for the disabled is becoming an important issue in China and care for people with intellectual disability is challenging because of the inadequacies in formal support and the social service system. Material and Method Based on ethnographic research in two villages in North China, this paper analyses the dilemmas of family care for people with intellectual disability. The essential data is the ethnographic record of three cases. Results Rural families strive to provide care through a set of arrangements and bear tremendous stress in the process. Conclusion Family care for people with intellectual disability in rural China has been increasingly challenged by the forces of labour migration, demographic changes and the ever-growing processes of commoditization. The role of the state has to be strengthened in welfare provision to balance the weakened family care ethos in transforming societies. [ABSTRACT FROM AUTHOR]

• Parental belief is associated with Child social-emotional development. • Parental investments mediate parental belief and child development. • The mediation effects vary across investments and developmental outcomes. • The varieties of play materials and activities are the strongest mediators. Parental investments are associated with early child outcomes, and some evidences outside China suggest that parental belief might affect parental investments. However, the interrelationships of parental belief, parental investments, and early child development has not been well documented in China. This paper aims to study the interrelationships between the caregiver's parental belief, the caregiver's parental investments, and the child's early developmental outcomes in rural China. A total of 1787 sample households in an undeveloped rural area of western China are enrolled in the cross-sectional study. A parental belief questionnaire, the Family Care Indicators (FCI), the Bayley Scales of Infant Development version III (BSID-III), and a socioeconomic questionnaire were used to measure the caregiver's parental belief on parenting practices, the caregiver's parental investments, the child's early developmental outcomes, and the socioeconomic characteristics of sample households, respectively. The mediation model was then applied to estimate the interrelationships. The results find that the caregiver's parental investments significantly mediate in the relationships between the caregiver's parental belief and the child's early developmental outcomes. Through parental investments, one standard deviation (SD) increase in the caregiver's parental belief is corresponding to 3% of one SD increase in the child's four developmental outcomes (cognition, language, motor, and social–emotion) respectively. For future studies aimed at designing targeted interventions on early child development in rural China, the key findings of this paper might be informative. Early interventions aimed at strengthening the caregiver's subjective belief on parenting practices and increasing the parental investments in the household might be effective to improve the development of rural children. [ABSTRACT FROM AUTHOR]

Informal payment for medical services is a common phenomenon in China. Patients make informal payments, in cash or in kind, to physicians in addition to official charges billed for medical services. This paper assesses the associations between patients' perceptions of the physician as an agent for the patient's interests (physician agency problem) and informal payment behavior. Using data of 24,000 and 6700 rural households respectively from the Health Development of Rural China Program database (collected in 2008) and Ningxia data source (collected in 2015), we find that patients' concern about physician agency problems is significantly associated with informal payments. The data shows that patients are more likely to make informal payments when they show low trust towards their physicians. For example, in the surgical cases, among patients who strongly distrusted the physicians, 17.9% (95% confidence interval [CI]:]: 13.5, 22.3) initiated informal payments, compared to 8.0% (95% CI: 5.1, 10.9) who expressed "strong trust" in their physicians. Poor communication was also significantly associated with an increase in the informal payment rate. For example, in the non-surgical setting, among the patients who rated the physicians' explaining skills as "poor," 5.9% (95% CI: 5.0, 6.9) of them made informal payments, significantly higher than the patients who rated "excellent" (of whom 1.8% made informal payments 95% CI, 0.9, 2.7). In this study, we provide an explanation for this finding: patients may initiate informal payments to physicians in order to mitigate the physician agency problem. It suggests that to mitigate informal payments, improving alignment between doctors' incentives and patients' interests would be essential. • Informal payments were directly related to patients' concerns about physicians' behavior. • Patients were more likely to make informal payments when they showed low trust towards their physicians. • Poor communication between patients and physicians was related to informal payment rate. • Informal payment might be viewed as an effort by the patients to align the physicians. [ABSTRACT FROM AUTHOR]

• Parental investment and skill mediate caregiver mental health and child development. • Caregiver depression are more harmful to parenting practices and child development. • The variety of play material has significant mediation effect on child development. • Coercive parenting mediate caregiver mental health and child development. Parenting practices are associated with early childhood development (ECD), and some evidences suggest that mental health might affect parenting practices. However, the interrelationships of mental health, parenting practices, and ECD outcomes have not yet been well documented in developing contexts like rural China. This paper aims to investigate the interrelationships between the caregiver's mental health, parenting practices, and the child's ECD outcomes in rural China. A total of 1787 sample households in an undeveloped rural area of western China are enrolled in the study. A socioeconomic questionnaire, the Depression, Anxiety and Stress Scale, the Family Care Indicators, the Parent and Family Adjustment Scales, and the Bayley Scales of Infant Development version III were used to measure the socioeconomic characteristics of sample households, the caregiver's mental health, parental investments and parenting skills, and the child's development outcomes, respectively. Mediation model was then applied to estimate the interrelationships. The results showed that parental practices significantly mediated between the caregiver's mental health and the child's cognition, language, motor, and social–emotion development. Through parental investments, one standard deviation increases in the caregiver's mental health test score was associated with the decline in the child's four development scores by 0.6% standard deviation, respectively. Through parenting skills, one standard deviation increases in the caregiver's mental health test score was associated with the decline in the child's language and social-emotional score by 2% and 5% standard deviation, respectively. Different dimensions of caregiver mental health, parental investments and skills played heterogeneous roles in the interrelationships. Early interventions aimed at improving the caregiver's mental health, parental investments and skills are important and might be effective to improve early childhood development in rural China. [ABSTRACT FROM AUTHOR]

• The gender disparities in DCM vary among different maltreatment subtypes. • DCM's negative effect was more severe for girls than for boys. • Gender heterogeneity is less evident than gender homogeneity in the risk factors. Currently, gender disparities in domestic child maltreatment (DCM) have become an important and highly controversial issue worldwide. This study aims to provide panoramic evidence from China on this issue. Data were derived from a survey of 4,308 children (M age = 12.13, 48.7% were boys) conducted in seven provinces in rural China from June to December 2019. This study used multistage cluster sampling to select respondents, and modified versions of the JVQ Scale and the DSM-5 Scale (11–17 years old) were adopted. This study reached three significant conclusions. First, the gender disparities in DCM vary among different maltreatment subtypes. Compared with girls, boys are more likely to experience physical abuse. A higher prevalence of neglect is observed among girls than among boys. Second, although DCM significantly increased the likelihood of posttraumatic depression for all children, its negative effect was more severe for girls than for boys. Third, gender heterogeneity is less evident than gender homogeneity in the risk factors for DCM. In rural China, children's problematic behaviours, family structure, parents' experiences of childhood violence and family relationships are common predictors of maltreatment for all children. This paper highlights gender differences in the risk of DCM among children in rural China, reveals the Confucian culture behind DCM and gender, and provides Chinese evidence for building an international dialogue. [ABSTRACT FROM AUTHOR]