Adversity Builds Character? Restricted health service utilization and subsequent positive self-care behavior during the early COVID-19 pandemic in China

Background During the COVID-19 pandemic, the reallocation of health resources and the restrictions on daily life imposed by epidemic prevention and control measures to some extent have severely affected the healthcare demand of the general population, but those impacts on adults’ self-care behavior and daily lives remain unclear. This study aimed to investigate the effect of restricted health service utilization arising from the COVID-19 pandemic on self-care behavior among different populations, particularly vulnerable groups, the correlations between restricted health service utilization and self-care behavior were also quantified and compared by subgroup analysis. Methods Data on demographics, socioeconomic, health status, and self-care behavior were collected in “The Early China COVID-19 Survey”, it is a cross-sectional anonymous online survey of the general population in China. Self-care behavior was measured by four indicators: weight control(WC), physical activity(PA), prevention behavior(PB) and Online medical consultation(OMC). The multiple linear models and binary logistic regression were used to examine whether restricted health service utilization (RHSU) is associated with self-care behaviors; also, adjusted multivariate logistic regression was used to analyse subgroup heterogeneity. Results In total, 8,428 adult participants completed the survey, the mean OMC score was 1.51(SD 1.34), the mean PB score was 18.17 (SD 3.44), and the proportion of participants who engaged in WC and PA was 42.30% and 62.57%, respectively. According to the multiple regression model, the RHSU was significantly positively correlated with all four indicators of self-care(WC: OR = 1.34, p < 0.001, PA: OR = 1.34, p < 0.05, MC: OR = 1.30, p < 0.001, PB:coef = 0.16, p < 0.05). Also we observed some significant differences in the intensity of this relationship by subgroup analysis, precisely, OMC(high vs moderate vs. low infection-risk level: OR = 1.48; 1.41; 1.19, p < 0.1), PA(high vs Moderate and low infection-risk level: OR = 1.51, p < 0.05), PB(Chronic disease groups vs no: coef = 0.46;0.1, p < 0.05). Conclusions Restricted health service utilization due to the pandemic had positive correlations with self-care behavior outcomes, and the intensity of partial correlation was significantly different in the subgroups of living area infection risk levels and chronic diseases. These findings have practical value for improving self-care behavior in adult populations during the pandemic.