Demand and Associated Factors for Integrated Medical Care and Preventive Services Among Patients with Type 2 Diabetes postprint

Abstract: Background　The integration of medical care and preventive services is a key strategy in China's response to the growing burden of chronic diseases. However, existing research has predominantly focused on policy design and supply-side reforms, with limited attention to patient-centered demand analysis. Objective　This study aims to assess the demand for integrated medical care and preventive services among patients with type 2 diabetes and to identify associated factors, providing micro-level empirical evidence to inform policy and research. Methods　A cross-sectional survey was conducted between November 13-15 and December 17-20, 2024, using stratified and random sampling in one county-level city in Shandong Province and one county in the Guangxi Zhuang Autonomous Region. A total of 2 004 patients with type 2 diabetes completed structured questionnaires covering socio-demographic characteristics, health status, healthcare utilization, diabetes-related health literacy, attitudes toward health responsibility, and demand for integrated medical care and preventive services. Multivariate linear regression models were employed to examine factors associated with overall and domain-specific demand. Results　The mean score for overall demand was (3.99±0.53) on a 5-point scale. Among the three domains, demand was highest for "medical-preventive-managed care" (4.02±0.57), followed by "patient empowerment care" (4.02±0.55), and lowest for "health determinants-focused care" (3.83±0.68). Significant predictors of overall and domain-specific demand included family doctor contract status, familiarity with community or village doctors, satisfaction with patient-centered care, and levels of agreement with personal, provider, and family's responsibility for health (P<0.05). Geographic region, self-rated health status, and quality of life were also significantly associated with all demand but health determinants-focused care (P<0.05). Higher diabetes health literacy was linked to increased demand in all but patient empowerment care (P<0.05). Agreement with fate-based health responsibility was associated with lower demand for medical-preventive-managed care and patient empowerment care (P<0.05). Conclusion　Patients with type 2 diabetes exhibit strong demand for integrated care and preventive services, particularly for medical-preventive-managed care and patient empowerment care. Policymakers and providers should be attentive to patients' specific demand and service priorities while ensuring adequate attention to relatively underemphasized but essential care targeting health determinants. Interventions to strengthen patients' sense of health responsibility and leverage family doctor contract as a key entry point for integration should be prioritized in future policy design.