Understanding Patterns of Formal Service Utilization Among Community-Dwelling Frail Old People in China (WITHDRAWN)

Background and Purpose: Along with the change of society and economy, the traditional home function of old people has gradually weakened in the contemporary China. Acknowledging these situations, to better meet old people’s needs on formal services and improve the quality of later life, this study seeks to identify patterns of formal service utilizations among frail old people living in the communities, and examined determinants that explain heterogeneous variations in old people’s formal service utilization patterns. Additionally, this study also tested the relationship between culture value and formal service utilization patterns and the mediating role of enabling factors in terms of culture value and formal service utilization patterns.

Methods：Participants were recruited from Haidian District, Beijing, China in 2015. Multi-stage sampling method was adopted to select sub-districts, communities and old people aged 70 years old or older. After screening, 577 old people with limitations in daily life, were successfully interviewed. After data cleaning, 550 samples were included for data analysis. This study establishes a conceptual framework based on the Anderson Model (including predisposing factors, enabling factors and need factors), and further developed it by adding culture value factors (including attitudes towards filial piety and attitudes towards social face). Using a latent class analysis (LCA), this study classifies overall patterns of old people’s formal service utilization. Fourteen types of formal services were taken into account, including housework, voluntary support, transportation, home-delivered meals, and home-delivery medical care, elderly’s canteen and day-care center/respite care and so on. Structural equation modeling (SEM) was used to examine the direct effect of culture value on service use pattern, and the mediating effect of the enabling factors.

Results: The LCA classified a hierarchical structure of service use patterns: high level of formal service use (N=69, 23%), middle level of formal service use (N=129, 23%), and low level of formal service use (N=352, 64%). Through SEM, after controlling predisposing factors and need factors, the results showed the significant direct effect of culture value on older people’s formal service utilization patterns. Enabling factors had a partial mediation effect on the relationship between culture value and old people’s formal service utilization patterns.

Conclusions and Implications: Differentiation of formal services may be important for meeting frail old people’s service needs and distributing program resources by identifying target populations for intervention, which may make reference to specific interventions to better support frail old people. Additionally, culture value had a unique direct effect on the formal service utilization patterns of frail old people in China, enriching our theoretical understanding of sources of culture value and their impacts. The findings also highlighted the mediation effects of enabling factors on the relationship between culture value factors and service utilization patterns. This study suggests that researchers and service providers should pay more attention to the important role of culture value factors in contributing to service use patterns and also be more sensitive to the mediating effect of enabling factors when discussing the relationship between culture value and formal service utilization patterns.