Factors Influencing Care-Seeking Behavior among Chinese Older Adults with Knee Osteoarthritis: A Mixed Methods Study
DOI:
https://doi.org/10.60099/prijnr.2025.273569Keywords:
Care-seeking behavior, Chinese older persons, Knee osteoarthritis, Mixed methodsAbstract
Early care-seeking behavior enables older adults to recognize initial symptoms, identify knee osteoarthritis, access appropriate healthcare, and improve health outcomes. A concurrent mixed-methods research design, incorporating cross-sectional and descriptive qualitative study phases, provides valuable insights into the factors influencing and perceptions of care-seeking behavior among Chinese older adults with knee osteoarthritis. Based on Andersen’s behavioral model, this study aimed to examine how factors such as knowledge of knee osteoarthritis symptoms, social support, stoicism, aging expectations, health insurance coverage, past experiences, pain severity, and comorbidities influence care-seeking behavior among 239 Chinese older adults with knee osteoarthritis across three communities in Dalian City, Liaoning Province, China. Data were collected using both questionnaires and in-depth interviews. Quantitative data were examined through descriptive statistics, Pearson's correlation analysis, and hierarchical multiple regression analysis, while qualitative data were analyzed through content analysis. The findings were synthesized using a side-by-side comparison approach.
The converged results confirmed that strong social support and higher pain severity enhance professional care-seeking behavior, while a stoic attitude and lack of health insurance coverage diminished it. Additionally, qualitative findings highlighted unpleasant experiences in past care-seeking as barriers, whereas gaining more knowledge about knee osteoarthritis, having a comorbid condition, and expecting healthy aging emerged as facilitators. Insights from this theoretically grounded research can inspire and inform clinical nurses to promote early and professional care-seeking behavior, thereby preventing the progression of knee osteoarthritis.
References
World Health Organization. Assessment report on ageing and health. World Health Organization. 2015 [cited 2020 February 26]. Available from: https://www.who.int/publications/i/item/9789241509312
Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020;29-30:100587. doi: 10.1016/j.eclinm.2020.100587. DOI: https://doi.org/10.1016/j.eclinm.2020.100587
Sugai K, Takeda-Imai F, Michikawa T, Nakamura T, Takebayashi T, Nishiwaki Y. Association between knee pain, impaired function, and development of depressive symptoms. J Am Geriatr Soc. 2018;66(3):570-6. Epub 20180214. doi: 10.1111/jgs.15259. PubMed PMID: 29441517. DOI: https://doi.org/10.1111/jgs.15259
Yamada K et al. A prospective study of knee pain, low back pain, and risk of dementia: The JAGES Project. Sci Rep. 2019;9(1):10690. doi: 10.1038/s41598-019-47005-x. DOI: https://doi.org/10.1038/s41598-019-47005-x
Xing D, et al. Osteoarthritis and all-cause mortality in worldwide populations: Grading the evidence from a meta-analysis. Sci Rep. 2016;6:24393. doi: 10.1038/srep24393. DOI: https://doi.org/10.1038/srep24393
Institute for Health Metrics and Evaluation. Global health data exchange. 2019 [cited 2023 February 17]. Available from: https://vizhub.healthdata.org/gbd-compare/
Li Y, Xie W, Xiao W, Dou D. Progress in osteoarthritis research by the National Natural Science Foundation of China. Bone Res. 2022;10(1):41. doi: 10.1038/s41413-022-00207-y. DOI: https://doi.org/10.1038/s41413-022-00207-y
Kong LZ. China's medium-to-long term plan for the prevention and treatment of chronic diseases (2017-2025) under the healthy China initiative. Chronic Dis Transl Med. 2017;3(3):135-7. doi: 10.1016/j.cdtm.2017.06.004. DOI: https://doi.org/10.1016/j.cdtm.2017.06.004
Zhu S et al. Chinese guidelines for the rehabilitation treatment of knee osteoarthritis: An CSPMR evidence-based practice guideline. J Evid Based Med. 2023;16(3):376-93. doi: 10.1111/jebm.12555. DOI: https://doi.org/10.1111/jebm.12555
Zou P, Shao J, Luo Y, Huang Y, Zhang H, Sidani S. Menopausal transition experiences and management strategies of Chinese immigrant women: A scoping review. Menopause. 2020;27(12):1434-43. doi: 10.1097/gme.0000000000001623. DOI: https://doi.org/10.1097/GME.0000000000001623
Linden MP et al. Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum. 2010;62(12):3537-46. doi: 10.1002/art.27692. DOI: https://doi.org/10.1002/art.27692
Yang M, Jiang L, Wang Q, Chen H, Xu G. Traditional Chinese medicine for knee osteoarthritis: An overview of systematic review. PLoS One. 2017;12(12):e0189884. doi: 10.1371/journal.pone. 0189884. DOI: https://doi.org/10.1371/journal.pone.0189884
Kanbarkar PN, Chandrika KB. Health care seeking behavior - A theoretical perspective. PIJR. 2017;6.
Zeng Y, Xu W, Chen L, Chen F, Fang Y. The influencing factors of health-seeking preference and community health service utilization among patients in primary care reform in Xiamen, China. Patient Prefer Adherence. 2020;14:653-62. doi: 10.2147/ppa.S242141. DOI: https://doi.org/10.2147/PPA.S242141
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1-10. DOI: https://doi.org/10.2307/2137284
Hakmaosa A, Baruah KK, Baruah R, Hajong S. Health seeking behavior of elderly in Rani block, Kamrup (Rural) district, Assam: A community-based cross-sectional study. Int J Community Med Public Health. 2015;2(2):162-6. DOI: https://doi.org/10.5455/2394-6040.ijcmph20150518
Gyasi RM, Phillips DR, Amoah PA. Multidimensional social support and health services utilization among noninstitutionalized older persons in Ghana. J Aging Health. 2020;32(3-4):227-39. doi: 10.1177/0898264318816217. DOI: https://doi.org/10.1177/0898264318816217
Kaukiainen A, Kõlves K. Too tough to ask for help? Stoicism and attitudes to mental health professionals in rural Australia. Rural Remote Health. 2020;20(2):9-16. doi: 10.22605/RRH5399. DOI: https://doi.org/10.22605/RRH5399
Sarkisian CA, Hays RD, Mangione CM. Do older adults expect to age successfully? The association between expectations regarding aging and beliefs regarding healthcare seeking among older adults. J Am Geriatr Soc. 2002;50(11):1837-43. doi: 10.1046/j.1532-5415.2002.50513.x. DOI: https://doi.org/10.1046/j.1532-5415.2002.50513.x
Fung AWT, Lam LCW, Chan SSM, Lee S. Knowledge of mental health symptoms and help seeking attitude in a population-based sample in Hong Kong. Int J Ment Health Syst. 2021;15(1):39. doi: 10.1186/s13033-021-00462-2. DOI: https://doi.org/10.1186/s13033-021-00462-2
Thomas B et al. Understanding health care-seeking behavior of the tribal population in India among those with presumptive TB symptoms. PLoS One. 2021;16:e0250971. doi: 10.1371/journal.pone.0250971. DOI: https://doi.org/10.1371/journal.pone.0250971
Al-Hanawi MK, Mwale ML, Kamninga TM. The effects of health insurance on health-seeking behavior: Evidence from the Kingdom of Saudi Arabia. Risk Manag Health Policy. 2020;13:595-607. doi: 10.2147/RMHP.S257381. DOI: https://doi.org/10.2147/RMHP.S257381
Ivynian SE, Ferguson C, Newton PJ, DiGiacomo M. Factors influencing care-seeking delay or avoidance of heart failure management: A mixed-methods study. Int J Nurs Stud. 2020;108:103603. doi: https://doi.org/10.1016/j.ijnurstu.2020.103603. DOI: https://doi.org/10.1016/j.ijnurstu.2020.103603
Jordan K, Jinks C, Croft P. A prospective study of the consulting behavior of older people with knee pain. Br J Gen Pract. 2006;56(525):269-76.
Zhang Z et al. Study on medical care-seeking behaviors and chronic comorbidities based on the ecology of the medical care model. Big Data Analytics for Healthcare. 2024;2(1):25-33.
Kamsan SS, Singh DKA, Tan MP, Kumar S. Healthcare utilization and knee osteoarthritis symptoms among urban older Malaysians. Int J Environ Res Public Health. 2021;18(7). doi: 10.3390/ijerph18073777. DOI: https://doi.org/10.3390/ijerph18073777
Tabachnick BG and Fidell LS. Using multivariate statistics, 5th ed. Boston, MA: Allyn & Bacon/Pearson Education; 2007. xxvii, 980-xxvii, p.
Wilson C, Deane F, Ciarrochi J, Rickwood D. Measuring help-seeking intentions: Properties of the general help-seeking questionnaire. CJCP. 2005;39:15-28. DOI: https://doi.org/10.1037/t42876-000
Pathak EB, Wieten SE, Wheldon CW. Stoic beliefs and health: Development and preliminary validation of the Pathak-Wieten Stoicism Ideology Scale. BMJ Open. 2017;7. doi: 10.1136/bmjopen-2016-015137. DOI: https://doi.org/10.1037/t76039-000
Sarkisian CA, Steers WN, Hays RD, Mangione CM. Development of the 12-item Expectations Regarding Aging Survey. Gerontologist. 2005;45(2):240-8. doi: 10.1093/geront/45.2.240. DOI: https://doi.org/10.1093/geront/45.2.240
World Health Organization. Process of translation and adaptation of instruments. 2019 [cited 2021 December 12]. Available from: https://www.who.int/substance_abuse/research_tools/translation/en/
Wardian J, Robbins D, Wolfersteig W, Johnson T, Dustman P. Validation of the DSSI-10 to measure social Support in a general population. Research on Social Work Practice. 2013;23(1):100-6. doi: 10.1177/1049731512464582. DOI: https://doi.org/10.1177/1049731512464582
Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): From joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. doi: 10.1186/1477-7525-1-64. DOI: https://doi.org/10.1186/1477-7525-1-64
Lincoln YS and Guba EG. Naturalistic inquiry. Newbury Park, CA: Sage Publications. 1985 DOI: https://doi.org/10.1016/0147-1767(85)90062-8
Polit, D.F. and Beck, C.T. Nursing Research. Principles and Methods. 15th ed. J.B. Lippincott Company, Philadelphia. 2015
Onwuegbuzie, A.J., and Johnson, R.B. The Routledge reviewer’s guide to mixed methods analysis. 1st ed. Routledge. 2021. doi: https://doi.org/10.4324/9780203729434 DOI: https://doi.org/10.4324/9780203729434-1
Dimkov P. The concept of self in Eastern and Western philosophy. 5th International e-Conference on Studies in Humanities and Social Sciences. 2020:197-204. doi: 10.32591/coas.e-conf.05.17197d. DOI: https://doi.org/10.32591/coas.e-conf.05.17197d
Zheng S et al. Cultural differences in social support seeking: The mediating role of empathic concern. PLoS One. 2021;16(12): 0262001. Epub 20211230. doi: 10.1371/journal.pone.0262001. DOI: https://doi.org/10.1371/journal.pone.0262001
González-Roldán AM, Terrasa JL, Sitges C, van der Meulen M, Anton F, Montoya P. Age-related changes in pain perception are associated with altered functional connectivity during resting state. Front Aging Neurosci. 2020;12:116. DOI: https://doi.org/10.3389/fnagi.2020.00116
Pétrin J, Donnelly C, McColl M-A, Finlayson M. Is it worth it?: The experiences of persons with multiple sclerosis as they access health care to manage their condition. Health Expectations. 2020;23(5):1269-79. doi: https://doi.org/10.1111/hex.13109. DOI: https://doi.org/10.1111/hex.13109
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