Influencing factors of referral intention among rural residents with contracted family doctor service in Shandong province: a theory of planned behavior-based study

  Objective  To examine the referral intention and its associates among residents with contracted family doctor services (CFDS) in rural Shandong and to provide evidences for developing policies to promote CFDS in rural region.

  Methods  Using random sampling, we conducted a questionnaire survey among 826 residents with CFDS in rural regions of 3 municipalities of Shandong province during May 2018. Based on the theory of planned behavior (TPB), we established theoretical analysis models to explore factors influencing the residents′ referral intention.

  Results  Of the 826 participants, 79.66% expressed their intention to have necessary medication in upper level hospitals referred by the family doctors providing contracted services. Binary logistic regression models demonstrated that the participants having high cognition on CFDS, considering CFDS being helpful for their family members′ healthcare, selecting village clinics first when needing outpatient medication, and having received CFDS were more likely to report the referral intention.

  Conclusion  Behavioral attitude is the most important factor, followed by perceived behavior control, for referral intention among rural residents with contracted family doctor services and the implementation of family doctors-led referral is an effective way to improve the hierarchical medical services.