While several cross-sectional studies have suggested an association between a body shape index (ABSI) and cognitive decline, the relationship between longitudinal ABSI patterns and cognitive outcomes among older hypertensive patients remains unclear. This study aimed to investigate the association between ABSI trajectories and cognitive outcomes in this population using a longitudinal cohort design. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), with ABSI measurements collected in 2011, 2013, and 2015. Group-based trajectory modeling (GBTM) was used to identify the distinct ABSI trajectories. Cox proportional hazards models and linear mixed-effects models were applied to evaluate the association between ABSI trajectories and cognitive function among older hypertensive patients. A total of 1,065 older hypertensive participants were included in the study (572 males, 53.7

BackgroundBreast cancer has been a serious health problem worldwide. Early detection is undoubtedly effective in combating severe public health problems in developing countries. Meanwhile, primary care physicians play an important role in implementing screening programs. The objective of our study was to evaluate the determinants of primary care physicians’ intention to provide the breast cancer screening services (BCSs) for rural women.MethodsWe conducted a cross-sectional survey in 24 towns in Jiangsu Province. A total of 1,101 primary care physicians participated in and completed the study. The data collection tool was developed based on the theory of planned behavior (TPB), which includes attitude, subjective norms, and perceived behavioral control, as well as extended components including knowledge of BCSs and past providing-BCSs behavior.ResultsThe results of our study showed that subjective norms (β = 0.352, p < 0.001) had the strongest influence on primary care physicians’ intention to engage in breast cancer screening, followed by attitudes and perceived behavioral control. Both screening knowledge and past screening provision behavior had an indirect effect on behavioral intentions.ConclusionThe present study demonstrated that extended TPB is an effective model for explaining primary care physicians’ intention to engage in breast cancer screening programs. Meanwhile, our findings provide a reference for governments, hospitals and policies aiming to increase primary care physicians’ intention to provide rural women with BCSs.

Objective:This study aims to investigate the associations between future, present-hedonistic, and present-fatalistic time perspectives (TP) and body mass index (BMI) among college students, and to examine whether self-control and sugar-sweetened beverage (SSB) consumption mediate these relationships. Methods:A cross-sectional survey was conducted in Jiangsu Province, China, involving 920 college students. The survey collected data on participants' height, weight, future TP, present-hedonistic TP, present-fatalistic TP, self-control, and SSB consumption. Multiple hierarchical regression analysis was employed to identify potential covariates, and three chain mediation models were analyzed using the PROCESS macro (Model 6) in SPSS version 26. Results:The results indicated that future TP was negatively associated with BMI (β = -0.23, 95% CI = [-3.81, -2.24]), and present-hedonistic TP showed a positive association (β = 0.18, 95% CI = [1.47, 2.73]). Present-fatalistic TP was not significantly related to BMI. Furthermore, self-control and SSB consumption mediated the relationships between future TP, present-hedonistic TP, present-fatalistic TP, and BMI (β = -0.02, 95% CI [-0.04, -0.01]; β = 0.02, 95% CI [0.01, 0.02]); β = 0.02, 95% CI = [0.01, 0.02]). Conclusion:TP, self-control, and SSB consumption are important factors associated with BMI among college students. Promoting a future-oriented TP and self-control, while reducing present-oriented TP and SSB intake, may support more effective BMI management. These findings offer theoretical implications for designing targeted health interventions.

BACKGROUND:Promoting healthy behaviours among elderly hypertensive patients has become a critical aspect of public health. Perceived health competence (PHC) is thought to influence the health behaviours of individuals with hypertension. Understanding the patterns of PHC will support targeted interventions for these patients. This study employed latent profile analysis to ascertain distinct PHC profiles among elderly hypertensive patients and to explore the demographic factors associated with these profiles. Additionally, the study explored the relationship between these perceived health competence profiles, intertemporal choice, and physical activity levels. METHODS:A cross-sectional study was conducted in Jiangsu, China, with 1352 elderly hypertensive patients completing the socio-demographic questionnaire, perceived health competence scale, delay discounting task, and physical activity questionnaire. Data analyses involved latent profile analysis, ANOVA, χ2-test, and multiple logistic regression. RESULTS:Three PHC profiles were identified: "low self-efficacy and low action capacity" (9.0 %), "moderate PHC" (68.8 %) and "high self-efficacy and high action capacity" (22.2 %). Multiple logistic regression analysis showed that educational level and smoking status significantly predicted profile membership (p < 0.05). The ANOVA and χ2-test indicated significant differences among the three groups in terms of intertemporal choice (F = 8.55, p < 0.01) and physical activity (χ2 = 24.24, p < 0.001). CONCLUSIONS:Our findings indicate the importance of considering variations in PHC among elderly hypertensive patients. The "low self-efficacy and low action capacity" group is associated with increased delay discounting and reduced physical activity in this population. Therefore, interventions targeting enhancing PHC should be tailored to individual profiles.

Medication adherence is essential for the effective management of chronic diseases; however, adherence among patients remains suboptimal in China. Understanding the multidimensional determinants of adherence is critical in designing interventions to improve treatment outcomes. The health ecology model (HEM) provides a comprehensive framework that integrates individual, behavioral, social, and environmental influences on health behaviors. This study aimed to identify the multilevel determinants of medication adherence among Chinese patients with chronic diseases using an ecological framework based on the HEM and to provide evidence to inform pharmacist- and policy-driven strategies to enhance adherence. Data were derived from the 2021 Psychology and Behavior Investigation of Chinese Residents, a nationally representative survey of 1162 adults with chronic diseases. Medication adherence was assessed using the Medication Adherence Rating Scale. Independent variables were categorized into five hierarchical levels according to the HEM: personal traits, behavioral characteristics, interpersonal networks, working and living conditions, and policy environment. Binary logistic regression analyses were performed sequentially to identify factors associated with good medication adherence. Among the participants, 23.8

Excessive consumption of sugar-sweetened beverages (SSBs) poses a significant threat to public health, with college students representing a major consumer group. Using the extended Theory of Planned Behavior (TPB) and Temporal Self-Regulation Theory (TST), this study examined the extent to which attitude, subjective norms, perceived behavioral control, delay discounting, habit, and self-control influence the intention and behavior of SSB consumption. A cross-sectional study was conducted in Jiangsu Province in 2024, involving 1236 college students. Data were collected using instruments based on the TPB-TST model, and delay discounting was assessed with a custom-designed computer program. Structural equation modeling was performed using Smart PLS software. The results showed that the integrated model explained 36.9 % of the variance in intention and 20.4 % in actual behavior. Delay discounting significantly influenced students' intention to consume SSBs. Attitudes, subjective norms, and perceived behavioral control also had significant positive effects on intention. Habit, self-control, and intention directly influenced SSB consumption, with habit moderating the intention-behavior relationship (β = -0.053, p < 0.05), weakening the impact of intention on behavior. In conclusion, the integration of the extended TPB and TST provides a robust framework for understanding SSB consumption among college students. Policy efforts and school-based interventions should target students' cognitive and psychological factors while regulating the availability of SSBs in campus environments to promote healthier behaviors.

Background:Hypertension is a significant global public health concern, and research shows that treatment adherence plays an important role in hypertension control. This study incorporated a novel factor in behavioral economics, delay discounting, into the predisposing factors within the PRECEDE model to explore the factors influencing adherence to treatment of patients with hypertension. Design:This cross-sectional study was conducted in Jiangsu Province, China, in 2023 and included 1,123 patients with hypertension. Methods:Data collection tools included demographic variables and predisposing, reinforcing, and enabling factors. Delay discounting was assessed using a self-designed computer program. The collected data were analyzed using descriptive statistics and hierarchical regression. This study used the STROBE Reporting Checklist. Results:The variables accounted for 30.4% of the total variance in adherence to treatment of patients with hypertension. Hierarchical regression analyses revealed that the predisposing (knowledge, delay discounting, and self-efficacy), reinforcing, and enabling factors were significantly associated with treatment adherence. Conclusions:Delay discounting was associated with hypertension treatment adherence. Enhancing the predisposing, enabling, and reinforcing factors may lead to increased adherence among patients with hypertension. It is recommended that hospitals and healthcare providers offer educational lectures and training sessions, and that some simple delayed discount interventions be added to supplement this. Additionally, government and institutional efforts should be made to increase the availability of community-level resources for patients with hypertension.

ObjectiveThis study aimed to evaluate mecapegfilgrastim utilization for the prophylaxis of chemotherapy-induced neutropenia in cancer patients and to assess changes caused by the National Health Insurance Coverage (NHIC) policy.MethodsIndividual patient data, including demographics, medical insurance status, cancer type, and tumor stage, were extracted from electronic medical records in an oncology specialty tertiary hospital in Jiangsu Province, China. An interrupted time series (ITS) analysis with a segmented regression model was applied to evaluate the NHIC policy’s effects, and multivariate binary logistic regression analysis was used to identify key factors influencing mecapegfilgrastim utilization.ResultsThe proportion of cancer patients receiving mecapegfilgrastim increased from 8.17% before the NHIC policy implementation to 36.05% after its implementation (P < 0.001). Utilization rose abruptly following the policy intervention (β = 0.143, P < 0.001) and continued to increase significantly afterward (β = 0.011, P = 0.004). However, inequities were observed in mecapegfilgrastim usage among patient subgroups, with utilization closely associated with patients’ location, cancer type, and tumor stage after the policy implementation.ConclusionThe NHIC policy significantly increased mecapegfilgrastim utilization, enabling more cancer patients to access this medication and effectively benefiting them. To address persistent inequities, the government should consider introducing additional measures, such as increasing the insurance reimbursement cap and separating the cost of expensive innovative anticancer medicines from hospital medical insurance budgets.

Objective:Our study aimed to examine the association between delay discounting (DD) and body mass index (BMI) in individuals with hypertension. Additionally, we sought to explore and compare the potential mediating effects of self-efficacy, physical activity and sedentary behavior in this association. Methods:A cross-sectional survey was conducted in two cities in the Jiangsu province of China, specifically Nanjing and Yangzhou, from March to June 2023. A total of 972 hypertensive patients completed the questionnaire (M age = 64.7 years, SD age = 8.2 years, 54.2% female). Participants engaged in a money choice experiment on computers, provided their height and weight, and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and General Self-Efficacy Scale (GSES). The experimental program was generated using the programming software E-Prime version 2.0. Multiple hierarchical regression analysis was conducted to identify potential covariates. Two serial mediation models were conducted using PROCESS macro 4.1 in SPSS 27.0. Physical activity and sedentary behavior were designated as M2 to investigate and contrast their respective mediating effects in the association between delay discounting and body mass index. Results:Self-efficacy, physical activity, and sedentary behavior served as mediators in the relationship between delay discounting and BMI. Self-efficacy accounted for 14.9% and 14.3% of the total effect in Models 1 and 2, respectively, while physical activity and sedentary behavior each accounted for 14.9% and 9.5% of the total effect, respectively. The serial mediation effects of self-efficacy and physical activity, as well as self-efficacy and sedentary behavior, were significant (B = 0.01, 95% CI [0.01, 0.02]; B = 0.01, 95% CI [0.002, 0.01]), collectively contributing 2.1% and 2.4% of the total effect. Sedentary behavior played a smaller mediating role compared to physical activity in this association. Conclusion:The results indicated that self-efficacy, physical activity and sedentary behavior could act as mediators in the association between delay discounting and BMI, thus potentially mitigating the risk of obesity in hypertensive individuals.

Abstract Purpose: Breast cancer has been a serious health problem all around the world. Early detection is undoubtedly effective in combating severe public health problems in developing countries. Meanwhile, primary care physicians play an important role in implementation of screening programs. The objective of our study was to evaluate the determinates of the primary care physicians’ intention to provide the Breast cancer screening services ( BCSs ) for rural women. Methods: We conducted a cross-sectional survey in 24 towns in Jiangsu. In total, 1,101 primary care physicians entered and completed the study. The data collection tool was developed based on the theory of planned behaviour (i.e., attitude, subjective norms, and perceived behavioral control) and extended components (i.e., knowledge about breast cancer screening services (BCSs), and past providing-BCSs behavior. Results: The results of our study showed that subjective norms (β = 0.352, p < 0.001) had the greatest influence on primary care physicians’ intention to engage in breast cancer screening, followed by attitudes and perceived behavioural control. Both screening knowledge and past screening provision behavior had an indirect effect on behavioural intentions. Conclusions: The present study demonstrated that extended TPB appears to be an efficient model in explaining primary care physicians' intention to engage in Breast cancer screening program. Meanwhile, our findings provide a reference for governments, hospitals and policies aiming to increasing primary care physicians’ intention to provide rural women with BCSs.

Abstract Background Breast cancer has been a serious health problem all around the world. Early detection is undoubtedly effective in combating severe public health problems in developing countries. Meanwhile, primary care physicians play an important role in implementation of screening programs. The objective of our study was to evaluate the determinates of the primary care physicians’ intention to provide the Breast cancer screening services ( BCSs ) for rural women.Methods We conducted a cross-sectional survey in 24 towns in Jiangsu. In total, 1,101 primary care physicians entered and completed the study. The data collection tool was developed based on the theory of planned behaviour (i.e., attitude, subjective norms, and perceived behavioral control) and extended components (i.e., knowledge about breast cancer screening services (BCSs), and past providing-BCSs behavior.Results The results of our study showed that subjective norms (β = 0.352, p < 0.001) had the greatest influence on primary care physicians’ intention to engage in breast cancer screening, followed by attitudes and perceived behavioural control. Both screening knowledge and past screening provision behavior had an indirect effect on behavioural intentions.Conclusions The present study demonstrated that extended TPB appears to be an efficient model in explaining primary care physicians' intention to engage in Breast cancer screening program. Meanwhile, our findings provide a reference for governments, hospitals and policies aiming to increasing primary care physicians’ intention to provide rural women with BCSs.

Background: Improving health-related quality of life (HRQoL) among hypertensive individuals has emerged as a significant public health issue. However, current research has ignored the individual heterogeneity of perceived social support (PSS) among hypertensive patients. The potential mechanism of delay discounting (DD), living alone, and PSS on HRQoL remains unclear, and further exploration is required. Aim: This study aimed to ascertain PSS profiles among hypertensive patients and examine the hypotheses that DD mediates the relationship between PSS and HRQoL and that this mediating process is moderated by living alone in hypertensive patients. Methods: A cross-sectional study was carried out in Jiangsu, China. In total, 1815 hypertensive patients completed sociodemographic and HRQoL questionnaires, a PSS scale, and a DD task. Data analyses included a latent profile analysis, chi(2)-test, 2-test, Spearman correlation analysis, and PROCESS macro for regression analysis. Results: Four potential PSS profiles were identified: lowest (3.2%), moderate-low (26.6%), moderate-high (42.4%), and highest (27.8%). DD mediated the association between PSS and HRQoL. The first half of this mediating process was moderated by living alone. Conclusion: Our findings indicated that PSS, DD, and living alone significantly influence the HRQoL of individuals with hypertension. Healthcare professionals should consider variations in PSS among hypertensive patients and implement interventions to reduce DD by enhancing PSS, in order to improve the HRQoL of this population.

Chinese rural women aged 35–64 years are encouraged to complete breast cancer screening (BCS) free of charge. However, it is challenging to reach a satisfying BCS uptake rate. In this study, rural women’s preferences and preferences heterogeneity were measured for the development of strategies to enhance participation in BCS. A cross-sectional survey with a discrete choice experiment (DCE) was conducted via convenience sampling via face-to-face interviews in Jiangsu, China. Six DCE attributes were identified through a systematic literature review; our previous study of Chinese rural women’s BCS intentions; a qualitative work involving in-depth interviews with rural women (n = 13), medical staff (n = 4), and health care managers (n = 2); and knowledge of realistic and actionable policy. The D-efficient design was generated using Ngene 1.3.0. A mixed logit model (MXL) in Stata 18.0 was used to estimate the main effect of attribute levels on rural women’s preferences. The relative importance and willingness to utilize BCS services (WTU) were also estimated. The heterogeneous preferences were analyzed by a latent class model (LCM). Sociodemographic status was used to predict the characteristics of class membership. The WTU for different classes was also calculated. A total of 451 rural women, aged 35–64 years, were recruited. The MXL results revealed that the screening interval (SI) was the most important attribute for rural women with regard to utilizing BCS services, followed by the level of screening, the attitude of medical staff, ways to get knowledge and information, people who recommend screening, and time spent on screening (TSS). Rural women preferred a BCS service with a shorter TSS; access to knowledge and information through multiple approaches; a shorter SI; a recommendation from medical staff or workers from the village or community, and others; the enthusiasm of medical staff; and medical staff with longer tenures in the field. Two classes named “process driven” and “efficiency driven” were identified by the preference heterogeneity analysis of the LCM. There is a higher uptake of breast cancer screening when services are tailored to women's preferences. The screening interval was the most important attribute for rural women in China with a preference for a yearly screening interval versus longer intervals.

Background: Prosocial behavior is essential for effective patient communication and building a positive doctor-patient relationship in medical students. Research on the factors influencing prosocial behavior in medical students is limited. This research aims to examine how perceived social support influences prosocial behavior among medical students, focusing on the mediating role of empathy and the moderating role of moral identity. Methods: This cross-sectional study included 2425 medical students from central and southern Jiangsu province. Participants were assessed using the Prosocial Behavior Scale, Interpersonal Response Index Scale, Moral Identity Scale, and Perceived Social Support Scale, with data collected through via an online questionnaire. SPSS PROCESS macro model 4.1 was used to examine the mediating effect and the moderating effect. Results: Perceived social support showed a significant positive correlation with prosocial behavior among medical students. The indirect effects of perceived social support on prosocial behavior through perspective taking (beta(indirect) = 0.11, 95% Boot CI [0.09, 0.13]) and empathic concern (beta(indirect) = 0.08, 95% Boot CI [0.06, 0.10]) confirmed the mediating roles of these variables, accounting for 32.05% and 23.82% of the total effect, respectively. However, personal distress did not mediate this relationship (beta(indirect) = -0.004, 95% Boot CI [-0.01, 0.005]). Moral identity significantly moderated the effect of perceived social support on perspective taking (beta = 0.05, p < 0.01) and the relationship between perspective taking and prosocial behavior (beta = 0.12, p < 0.001). Additionally, moral identity also moderated the relationships between perceived social support and empathic concern (beta = -0.05, p < 0.01) and between empathic concern and prosocial behavior (beta = 0.08, p < 0.001). While the interaction between perceived social support and moral identity predicted personal distress (beta = 0.04, p < 0.05), moral identity did not moderate the relationship between personal distress and prosocial behavior (beta = 0.03, p = 0.12). Conclusion: This study underscores the link between perceived social support and prosocial behavior, highlighting the significant roles of perspective taking, empathic concern, and moral identity in this relationship. These findings underscore the potential of cultivating these psychological mechanisms to foster caring and prosocial behaviors among medical students, providing important references for future educational interventions and policy formulation.

Background:This study aimed to explore the levels of anxiety and depression in a sample of home-quarantined college students to identify the risk factors for psychological distress during the COVID-19 lockdown.Methods:A total of 1156 college students studying in Jiangsu, China, participated from August 5 to August 14. A structured questionnaire was used to collect data anonymously, including demographic characteristics, the generalized anxiety disorder-7 (GAD-7) questionnaire, the patient health questionnaire-9 (PHQ-9), a physical activity scale, and items related to COVID-19. The chi-square test and Fisher's exact test were employed to establish the differences in levels of anxiety and depression across sociodemographic characteristics. Binary logistic regression was applied to measure the predictors of levels of anxiety and depression, and associations were considered significant at p <0.05.Results:The estimates of anxiety and depression were 48.1% and 57.6%, respectively. The univariate analysis indicated a significant difference in anxiety levels across student grades, whether the student was an only child, the distance from the worst-hit areas, and physical activity/exercise intensity. Physical activity intensity and living in communities with infected people were statistically correlated with the level of depression. Binary logistic regression results indicated that the predictive factors for anxiety were living within a short distance from the worst-hit areas (10~20 km), engaging in higher education (graduate students), and low-intensity daily exercise. Factors statistically predicting depression symptoms were having siblings, a COVID-19 diagnosis in the community and low-intensity daily exercise.Conclusion:During outbreaks, students in an extremely stressful state are more likely to develop anxiety and depression, particularly postgraduates. Psychological interventions to reduce fears and encourage exercise should be available to home-quarantined college students. Students who live in the worst-hit areas and are not the only child in the family should be prioritized.

Background The disparity between ST-segment and non-ST-segment elevation myocardial infarction without obstructive coronary artery (STE-MINOCA and NSTE-MINOCA) are unclear. Our study aims to compare the clinical features and outcomes in patients with STE-MINOCA and NSTE-MINOCA. Methods This cross-sectional study consecutively enrolled patients diagnosed with acute myocardial infarction (AMI) from January 2013 to January 2020. MINOCA were identified as angiographic stenosis < 50%. Clinical characteristics, angiographic features, and clinical outcomes of STE-MINOCA and NSTE-MINCOA were documented. The primary endpoint was composite events in the different time periods. Results A total of 1966 AMI patients were screened, 107 (5.4%) were diagnosed as MINOCA. Among, there were 34 (31.8%) of STE-MINOCA and 73 (68.2%) of NSTE-MINOCA. STE-MINOCA group were younger, had lower N-terminal pro-brain natriuretic peptide (NT-proBNP), and smaller left atrial diameter ( P < 0.05). Dual antiplatelet therapy (DAPT) was more likely to be prescribed to STE-MINOCA patients ( P = 0.015). During median follow-up time of 24.5 months, STE-MINOCA group also demonstrated lower risks for primary endpoint and cardiovascular-related (CVS) rehospitalization. In univariate Cox regression analyses, NSTE-MINOCA showed an increased risk of long-term primary endpoint (HR 2.57, 95 CI%: 1.10–6.02) and CVS-related rehospitalization (HR 3.14, 95% CI: 1.16–8.48). After adjusting for NT-proBNP and DAPT, NSTE-MINOCA remained an independent risk factor for CVS-related rehospitalization in long-term follow-up (HR 2.78, 95% CI: 1.03–7.49). Conclusion Although STE-MINOCA and NSTE-MINOCA patients showed similar clinical characteristics, NSTE-MINOCA group presented a worse long-term outcome mainly driven by CVS-related hospitalization which suggested that NSTE-MINOCA patients might also require prompt medical attention.

BackgroundsThe optimal blood pressure of elderly people with frailty or prefrailty is still unclear. We aimed to explore the relationship between blood pressure and mortality in the elderly with (pre)frailty.MethodsA total of 528 participants aged 60 years and older were exacted for analyses of the association between blood pressure and mortality from the database of the National Health and Nutrition Examination Survey (NHANES) (1999–2004). Kaplan–Meier curves and log-rank tests were used to investigate the differences in survival between groups. Multivariable Cox regression and restricted cubic spline (RCS) analyses were applied to explore the relationship between blood pressure and mortality.ResultsDuring the median follow-up time of 116.5 [interquartile range (IQR) of 60–186] months, 363 all-cause deaths and 122 cardiac deaths were documented. For all-cause mortality, more participants died with systolic blood pressure (SBP) < 110 mmHg and SBP ≥ 170 mmHg (log-rank p = 0.004). After adjusting for confounders, SBP < 110 mmHg [hazard ratio (HR) 1.52, 95% CI: 0.96–2.41] and SBP ≥ 170 mmHg (HR 1.53, 95% CI: 1.09–2.15) had higher risks of all-cause mortality compared with SBP within 130–150 mmHg. There were no significant differences in all-cause mortality among DBP categories. A J-curve association was identified between the SBP and hazard ratio for all-cause mortality (p for non-linear = 0.028), with 138.6 mmHg as the lowest hazard ratio of all-cause mortality; each 10 mmHg of SBP rise was associated with a 9% increased risk in all-cause mortality (HR 1.09, 95% CI 1.00–1.18). Additionally, a non-linear relationship was determined between SBP and the hazard ratio for cardiac deaths (p for non-linear = 0.030), with 140.1 mmHg as the lowest hazard ratio of cardiac deaths. When SBP was higher than 140.1 mmHg, each 10 mmHg rise in SBP was associated with a 17% increased risk of cardiac deaths (HR 1.17, 95% CI: 1.02–1.34).ConclusionBoth lower and higher SBP levels are associated with higher risks of all-cause mortality in older individuals with (pre)frailty. There are J-shaped associations between SBP and mortality, with the optimal SBP being approximately 140 mmHg for this population specifically.

BackgroundPromoting cervical cancer screening (CCS) is undoubtedly effective in combating severe public health problems in developing countries, but there are challenges to its implementation. Understanding the factors influencing primary care physicians' intentions to provide CCSs to rural women is crucial for the future implementation of screening programs. The aim of this study was to assess the intentions of primary care physicians to provide cervical cancer screening services (CCSSs) to rural women and their determinants.MethodsThis cross-sectional study included 1,308 primary care physicians in rural primary health care, and the data collection tool was developed based on the theory of planned behavior (TPB), which included demographic characteristics, the basic constructs of TPB, and the degree of knowledge of CCSSs as an extended variable of the TPB model. Structural equation modeling was used to analyze the relationships between each factor.ResultsPathway analysis found that TPB is an appropriate theoretical basis for predicting primary care physicians' intent to provide CCSSs (χ2/df = 2.234 < 3, RMSEA = 0.035, and SRMR = 0.034). Meanwhile, the structural equation model showed that attitude (β = 0.251, p < 0.001), subjective norm (β = 0.311, p < 0.001), perceived behavioral control (β = 0.162, p < 0.001), and knowledge level (β = 0.152, p < 0.01) positively predicted primary care physicians' intention to provide CCSSs.ConclusionsTPB model, with the addition of knowledge, was useful in predicting primary care physicians' intention to provide CCSSs for rural Chinese women. The findings of this study provide a reference for the government and hospitals to develop strategies to improve the intent of primary care physicians to provide CCSSs.

采用问卷调查法,收集性别、年龄、受教育水平、工作年限、职称、是否使用过虚拟仿真技术等相关资料,通过多因素Logistics回归分析教师在医学教育中应用虚拟仿真技术的意愿与人口社会学特征的关系,并基于整合型技术接受模型分析应用意愿的影响因素,为提高其应用积极性提供参考.共获得有效样本356个,问卷信效度良好.回归分析结果表明,是否使用过虚拟仿真技术对行为意愿产生影响(OR=2.406,95％CI:1.239～3.379);结构方程模型拟合度良好,社群影响对行为意向的积极影响力最强(b=0.537,P<0.001),绩效期望次之(b=0.313,P<0.001),努力期望(b=-0.104,P>0.05)与促成因素(b=0.094,P>0.05)对行为意向的影响不显著.结果提示,在医学专业教师中要加强绩效期望,加大社群影响,加深合作交流,推动资源共享,并注重使用过和未使用过虚拟仿真技术的两种教师群体的差异.

Background:It was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.Methods:A cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.Results:There were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p < 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p < 0.001), attitude (β = 0.152, p < 0.001), past behavior (PB) (β = 0.150, p < 0.001), knowledge (β = 0.121, p < 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p < 0.05). The advocacy and education (A&E), medical level and service attitude (ML&SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&E and PBC 2 (p < 0.01) and the effect of PB on BI (p < 0.001).Conclusion:The TPB with the addition of PB, knowledge, ML&SA, and A&E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.