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Association Between Health Service Utilisation of Internal Migrant Children and Parents’ Acculturation in Guangdong, China: a Cross-Sectional Study

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Association Between Health Service Utilisation of Internal Migrant Children and Parents’ Acculturation in Guangdong, China: a Cross-Sectional Study View metadata, citation and similarDownloaded papers at core.ac.uk from http://bmjopen.bmj.com/ on January 19, 2018 - Published by group.bmj.com brought to you by CORE provided by Queen Margaret University eResearch Open Access Research Association between health service utilisation of internal migrant children and parents’ acculturation in Guangdong, China: a cross-sectional study Bo-li Peng,1 Guan-yang Zou,1,2 Wen Chen,1,3 Yan-wei Lin,1,3 Li Ling1,3 To cite: Peng B, Zou G, Chen W, ABSTRACT Strengths and limitations of this study et al. Association between Objectives To assess the health service utilisation of health service utilisation of internal migrant children in Guangdong, China, and to internal migrant children ► This is the first of its kind study on the association explore the association between children’s health service and parents’ acculturation in between internal migrant children’s health service Guangdong, China: a cross- utilisation and their parents’ acculturation. utilisation and their parents’ acculturation. sectional study. BMJ Open Design Cross-sectional survey between April and May ► This study measured parents’ acculturation more 2018;8:e018844. doi:10.1136/ 2016. comprehensively by using a synthetic variable bmjopen-2017-018844 Setting Six society-run schools of Tianhe and Baiyun calculated from a multidimensional questionnaire, districts in Guangzhou City of China. ► Prepublication history for and parents’ acculturation in this study was this paper is available online. Participants We recruited all students at grade 7 or 8 evaluated by a categorical variable. To view these files, please visit and one of their parents who resided in Guangzhou over ► This study explored the moderation of family the journal online (http:// dx. doi. 6 months without permanent registered residence (hukou) economic status on the association between internal org/ 10. 1136/ bmjopen- 2017- in Guangzhou (1161 pairs completed this survey). 258 migrant children’s health service utilisation and 018844). children were ill within the past 2 weeks or during the parents’ acculturation. This cross-sectional study cannot explore the causal B-P and G-Z contributed equally. last year. ► Main outcome measures The main outcome was relationship between children’s health service Received 25 July 2017 self-reported health service utilisation. Logistic regression utilisation and their parent’s acculturation. Revised 21 November 2017 analysis was conducted to explore the association ► The health service utilisation was measured by self- Accepted 22 November 2017 between children’s unmet needs for outpatient or inpatient reported questions that might have reported bias of service and their parents’ acculturation (categorised into health conditions and utilisation. high, middle and low groups). Results In total, 216 children, or 18.6% of the total INTRODUCTION subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of With rapid economic development in China, the total subjects, were in need of inpatient service. internal migrants (IMs), a population that Among them, 17.6% and 46.8% of the migrant children has been living in a place other than their had unmet needs for outpatient and inpatient services, officially registered residence (hukou) for 1 respectively. After controlling for enabling resources and at least 6 months, has become increasingly predisposing characteristics, migrant children with parents popular in some developed cities. This in the middle-acculturation group (adjusted OR=3.17, population was up to 221 million in 2010 in 1 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an China, among whom there were 35.8 million Center for Migrant Health 2 Policy, Sun Yat-sen University, unmet outpatient need than high-acculturation or low- (16.2%) IM children under 18 years old, and Guangzhou, China acculturation groups, although only statistically significant its number has continued to rise since then. 2Institute for International when comparing with the high-acculturation group. The hukou system in China divided resident Health and Development, Queen Stratified analysis suggested that this association could be status into rural and urban residency. Since Margaret University, Edinburgh, moderated by their family economic status. the social welfare system is tied to (adminis- UK Conclusions Our study suggested that the association 3Faculty of Medical Statistics trated and funded by) the local governments, between migrant children’s health service utilisation and Epidemiology, School of the hukou in China is associated with the local Public Health, Sun Yat-sen and their parents’ acculturation was complex and could social welfare, such as housing, children’s be moderated by family economic status. Increasing University, Guangzhou, China education, stable working, health insurance the service utilisation among migrant children requires and public health services.3 Correspondence to improving the acculturation and economic status of the IMs in China tend to have poorer economic Dr Li Ling; parents of internal migrants. lingli@ mail. sysu. edu. cn status with overtime working4; they are Peng B, et al. BMJ Open 2018;8:e018844. doi:10.1136/bmjopen-2017-018844 1 Downloaded from http://bmjopen.bmj.com/ on January 19, 2018 - Published by group.bmj.com Open Access underinsured and have to return to permanent regis- access to health facilities and poor quality in health tered residence for medical care so as to receive reim- service.3 Previous research in China measured the IMs’ bursement5; and they have limited access to a range of acculturation by language/dialect use (separation state), public services6 provided by the government, including friendship development (integration state), self-identity the health services,7–10 due to their lack of local house- (marginalisation state) and lifestyle (assimilation state)25 hold registration. The utilisation of prenatal examina- based on Berry’s acculturation theory.26 Yang27 and tions and postnatal visit among IMs was about twice and Zhou28 divided the acculturation into four dimensions six times as low as that of the local residents, respectively.9 (relating to culture, social, structure and identity) and The IMs were about two times less likely to use hospitalisa- built an index system of IMs’ acculturation. tion service than the local residents.11 Most of the previous studies on HSU among IMs have Similarly, studies found that international immigrant focused on adults. IM children are currently under children tended to be in poorer access to health service research, while limited access to health service would utilisation (HSU) compared with their native counter- affect their health and school performance.29 Little is parts.12–14 A study in the USA showed that 6% of the also known about HSU of IM children in China, as well local family’s children had no usual source of healthcare, as the association between IM children’s HSU and their compared with a percentage of as high as 26% among parents’ acculturation. This study adopts the Anderson’s the international immigrant children.15 Previous studies Behaviour Model of Health Services Utilization, a popular on HSU among international immigrant children have model to analyse factors associated with the HSU. The reported that parents’ acculturation, conceptualised as model divided these factors associated with HSU into the international immigrants’ ability of adaption to the three dimensions, namely, predisposing characteristics, attitudes, beliefs, values, customs and behaviours of a new enabling resources and needs.30 31 The predisposing char- or different culture,16 17 was an important factor for the acteristics included demographic factors, social structure HSU of their immigrant children. and health belief. The enabling resources included finan- However, results on the association between inter- cial and social resources. Among these factors, enabling national immigrant children’s HSU and their parents’ resources, such as income, health insurance and time, acculturation did not allow drawing the final conclusion. was mutable and profoundly associated with the HSU.31 Most of these studies have demonstrated positive associ- Acculturation is somehow similar to the social structure ations between these two variables.18–23 This was because in the dimension of predisposing characteristics.32 The international immigrant children in more acculturated Anderson’s behaviours model has been widely used in families tended to be more insured and have better access studies on factors associated with HSU,30–32 including to native healthcare system.19 In addition, more accultur- IMs’ HSU.33–36 ated parents usually acquired better English proficiency, Drawing from the studies on international immigrants, which enabled fluent communications with local health we hypothesise that the IM children would also have poor providers and thus better HSU.23 However, some studies health access, and their service utilisation is positively did not find any association between HSU and certain associated with their parents’ acculturation. indicators of acculturation, such as mothers’ language This paper measures the HSU of the IM children and proficiency and length of residence.18 21 This was because explores the association between IM children’ HSU and parents’ limited English proficiency was not associated parents’ acculturation in Guangzhou, China. Through with insurance coverage, which was however positively this study, we hope
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