What role does healthcare geographic accessibility play in the association between personal health responsibility and family doctor contract services?

Background Limited research has examined the nexus between personal health responsibility and family doctor contract services, particularly the moderating role of healthcare geographic accessibility in this relationship. This study aimed to investigate the association between personal health responsibility and family doctor contract services and to determine how healthcare geographic accessibility shapes this relationship among rural older adults in China. Methods A cross-sectional study was conducted from July to August 2022 in Shandong Province in China. A total of 3,164 rural older adults were included in the analysis. Multivariable binary logistic regression models and the margins plot were used for the moderating effect analysis. Results The rates of signing up for family doctor contract services and support for personal health responsibility among rural older adults in Shandong Province were 64.85% and 61.54%, respectively. Participants who supported personal health responsibility were more likely to contract for family doctor services (OR = 1.38, 95% CI = 1.13–1.69) after controlling for confounding factors. Only among older adults with good healthcare geographic accessibility, personal health responsibility was associated with higher contracting rates for family doctor services (OR = 1.48, 95% CI = 1.20–1.82). Conclusions Our findings reveal a correlation between personal health responsibility and engagement with family doctor contract services, with healthcare geographic accessibility serving as a pivotal moderating factor. It is imperative for governmental authorities to amplify targeted educational campaigns and outreach for rural older adults. Elevating their understanding of personal health responsibilities and enhancing healthcare geographic accessibility are crucial steps to encourage their participation in family doctor services.