Contracted residents in Shanghai hold moderate-to-good levels of knowledge, attitude, and practice regarding family doctor contract services, and those who perceive more healthcare barriers tend to score higher on these measures, according to a cross-sectional survey published in BMC Public Health. The study, led by Qi Shen, Weiying Gu, and Shuai Liu with Zhao Liu, surveyed 304 residents of Minhang District who were enrolled with family doctors between January and April 2026.
The questionnaire was designed on the basis of the Andersen Behavioral Model of Health Services Use and assessed knowledge, attitude, and practice (KAP) alongside six dimensions of perceived healthcare barriers: imperceptibility, unavailability, inaccessibility, inadaptability, unaffordability, and unacceptability. The mean total KAP score was 39.37 (SD 7.99), with mean scores of 13.34 (SD 2.74) for knowledge, 13.05 (SD 2.79) for attitude, and 12.97 (SD 3.00) for practice, which the authors describe as moderate-to-high levels.
Univariate analysis revealed significant differences in KAP scores by age, education, household registration, visit frequency, chronic disease status, source of medical expenditure, source of medical care, and level of perceived barriers, all with P values below 0.05. Spearman correlation analysis showed that total perceived barriers and all six subscales were positively correlated with total KAP and each KAP domain, with the strongest correlation observed for the practice domain (rs = 0.298, P < 0.001).
Multivariate linear regression identified age of 35 years or older, education above high school, urban resident basic medical insurance, and self-funded healthcare as factors correlated with higher KAP scores (all P < 0.05; adjusted R² = 0.249, F = 7.694, P < 0.001). Notably, this regression analysis failed to detect a significant association between total perceived healthcare barriers and overall KAP.
To address confounding, the researchers applied propensity score matching using 1:1 nearest-neighbor matching. After matching balanced baseline confounders, total perceived barriers and the inadaptability dimension were positively associated with KAP (ATT = 0.281 and 0.174, both P < 0.05). Higher scores for total barriers, imperceptibility, unavailability, and inadaptability corresponded to higher practice scores, all with P < 0.05.
The authors conclude that contracted residents have moderate-to-good KAP regarding family doctor services, and that this is associated with age, education, and insurance type. Within this specific cohort of actively utilizing contracted residents, perceived healthcare barriers demonstrated a statistically positive, non-causal association with KAP. Information, resource, and process-related barriers showed the strongest correlations with active service use, suggesting they may be potential leverage points for quality improvement, pending validation in longitudinal designs.
The authors caution that the absence of association for traditional barriers, such as geographic, financial, and psychological barriers, should be interpreted cautiously, as it may reflect the unique primary care environment of urban Shanghai rather than universal trends. They also emphasize that all associations reported are statistical, not causal, and that the cross-sectional design cannot determine the direction of causality. Further longitudinal studies are required to verify these findings.
As a cross-sectional survey of a single district in Shanghai, the study’s scope is limited to contracted residents who were actively using family doctor services in that setting, and its results should not be generalized to other populations or interpreted as evidence of causal effects. The findings add to the evidence base on how residents’ perceptions of barriers relate to their engagement with family doctor contract services in urban China’s primary care system.
Subject of Research: Knowledge, attitude, and practice regarding family doctor contract services and their association with perceived healthcare barriers among contracted residents in Shanghai
Article Title: Association between knowledge, attitude, and practice regarding family doctor contract services and perceived healthcare barriers among contracted residents: a cross-sectional study in Shanghai, China
Article References: Shen, Q., Gu, W., Liu, S., & Liu, Z. (2026). Association between knowledge, attitude, and practice regarding family doctor contract services and perceived healthcare barriers among contracted residents: a cross-sectional study in Shanghai, China. BMC Public Health. https://doi.org/10.1186/s12889-026-29879-5
Image Credits: AI Generated
DOI: 10.1186/s12889-026-29879-5
Keywords: family doctor contract services, primary care, Shanghai, cross-sectional study, healthcare barriers, KAP, Andersen Behavioral Model, propensity score matching, BMC Public Health, China, Association, between
News Source: Ophelia Keating. (October 29, 2026). Perceived Healthcare Barriers Show Positive Link to Family Doctor Service Knowledge in Shanghai. Scienmag.
