Is the Family Doctor Contract Service Program widely and equitably known among Chinese community residents? A national cross-sectional survey

Background: The Family Doctor Contract Service Program in China aims to enhance the accessibility and continuity of primary care by fostering ongoing, patient-centered relationships between residents and primary care physicians. This study examines nationwide awareness levels of the program in 2023, with a focus on disparities across different economic development levels, socioeconomic strata, and urban versus rural areas. Methods: A stratified, quota-sampled national survey was conducted from June to August 2023, targeting Chinese residents aged 18 and older across 800 communities in 32 provinces. The survey assessed awareness of the Family Doctor Contract Service Program along with related sociodemographic and health characteristics. Statistical analysis included estimating awareness rates, adjusted for age and gender weighting, and examining the association between sociodemographic factors and awareness using multilevel modeling, with provinces as the first level and residents as the second. Results: The survey included 12,403 respondents, with an overall awareness rate of 49.75%. Awareness rates were 63.7%, 53.24%, and 48.28% in high-, middle-, and low-income provinces, respectively, and 57.23%, 49.42%, and 44.69% across high-, middle-, and low-socioeconomic status (SES) groups. Urban residents had a higher awareness rate (56.78%) compared to rural residents (45.50%). Residents in provinces where the average annual income is less than 40,000 yuan were significantly less likely to be aware of the program (OR=1.70, 95% CI: 1.24-2.31, P=0.001) compared to those in provinces with an average annual income of 60,000 yuan or more. Similarly, individuals in SES levels 1-2 were more likely to be unaware of the program compared to those in SES levels 6-7 (OR=1.47, 95% CI: 1.27-1.71, P≤0.001). Rural residency was also associated with a higher likelihood of being unaware of the program (OR=1.13, 95% CI: 1.03-1.22, P=0.006). Conclusion: Nine years after its implementation, only about half of mainland China's community residents are aware of the Family Doctor Contract Service Program, with particularly low awareness among economically disadvantaged provinces, lower socioeconomic groups, and rural areas. There is a critical need to enhance the dissemination of information about the program and enhance primary care to meet the health service needs of these vulnerable populations.