Community-based traditional Chinese medicine health service use among older adults and provider-reported delivery barriers in Wuhan, China: an explanatory sequential mixed-methods study.

Abstract

Background: Population ageing and multimorbidity are increasing the need for accessible community-based care, while service use may vary according to service availability, affordability, and delivery capacity. In China, community-based traditional Chinese medicine (TCM) health services represent one model of primary care support for prevention and chronic disease management, but evidence rarely integrates older adults' service use with frontline providers' delivery experiences within the same setting.

Methods: An explanatory sequential mixed-methods design was used in Wuhan, China, from December 2024 to July 2025. The quantitative phase involved a structured survey of 1,195 adults aged ≥ 60 years who were recruited on site at selected community health service centres. The qualitative phase included in-depth interviews with 11 primary care providers. Quantitative data were analysed using descriptive statistics, Pearson's χ² tests or Fisher's exact test, and multivariable binary logistic regression. Two multivariable binary logistic regression models were fitted: a primary model excluding awareness of services and an exploratory model including it. Firth's penalised likelihood was used as a sensitivity analysis for the small uninsured subgroup.

Results: Among the 1,195 older adults recruited during designated survey sessions at seven selected community health service centres, 729 (61.0%) reported receiving at least one community-based TCM health service during the past 12 months. In bivariate analyses, the proportion reporting use during the past 12 months differed significantly by sex, education level, medical insurance status, monthly household income, smoking status, drinking status, number of chronic conditions, awareness of community-based TCM health services, perceived convenience of access, and perceived complexity of the service process (all P < 0.05). In the primary multivariable model excluding awareness, higher educational attainment, higher monthly household income, and a greater number of chronic conditions were associated with higher odds of reported use. Participants without medical insurance had lower odds of reported use than those covered by urban employee basic medical insurance (aOR = 0.30, 95% CI: 0.11-0.77). The Firth penalised logistic regression sensitivity analysis yielded a directionally consistent estimate for the small uninsured subgroup. Thematic analysis of interviews with primary care providers identified three themes of provider-reported or provider-perceived contextual barriers to service delivery: perceived limitations in policy and support systems, workforce and material resources, and barriers related to community awareness and acceptance.

Conclusions: Among older adults recruited on site at selected community health service centres, reported use of community-based TCM health services during the past 12 months was associated with educational attainment, monthly household income, number of chronic conditions, and medical insurance status. Interviewed primary care providers reported service-delivery challenges related to policy and support systems, workforce and material resources, and their perceptions of community awareness and acceptance. These findings describe individual-level associations within the study sample and provider-reported service-delivery challenges, and may inform further research and local service planning.

Clinical trial number: Not applicable.