Research on the utilization of community health services and its determinants among older adults: a cross-sectional study in Liuzhou City

Abstract

Objective This single-center, cross-sectional study investigates the health management demands, service utilization patterns, and their determinants among the older adults in a community of Liuzhou City, to provide empirical evidence for optimizing community-based older adults health services. With rising retirement ages and the increasing proportion of older workers in China’s labor force, this study also examines how work status and schedule compatibility shape service utilization. Methods Using a convenience sampling method, a questionnaire survey was conducted among 320 older adults individuals aged 60 and above in the jurisdiction of a community health service center in Liuzhou City in 2025. Grounded in Andersen’s Behavioral Model, the survey covered predisposing, enabling, and need factors, alongside service utilization. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression. Results The chronic disease prevalence was 68.4%. While 82.5% were aware of the available community health services, only 45.6% regularly participated. The top three desired services were routine physical examinations (91.2%), chronic disease management (87.5%), and home-based medical services (65.3%). Regression analysis indicated that education level (OR = 2.35, 95% CI: 1.21–4.56), monthly income (OR = 1.98, 95% CI: 1.05–3.73), number of chronic diseases (OR = 3.11, 95% CI: 1.67–5.79), and co-residence with family (OR = 0.45, 95% CI: 0.22–0.92) were significant predictors of active participation. Need factors were the primary driver of participation, while enabling factors acted as critical facilitators or barriers. Conclusion A significant “high demand, low utilization” paradox exists. These findings highlight a need for targeted, locally-tailored strategies focusing on vulnerable groups (e.g., low-income, single-living, less-educated older adults) in Liuzhou. Strengthening health education, diversifying services (especially home-based medical services), and integrating family support may enhance the effectiveness of community health management programs. However, further research in diverse settings is required to confirm the generalizability of these conclusions.