Factors Associated with Willingness to Enter Long-term Care Facilities among Older Adults in Chengdu, China

The study was approved by the Sichuan University Institutional Review Board. All participants read a statement that explained the purpose of the survey and written informed consents have been received before being involved in the investigation.This cross-sectional study was conducted in the Hezuo community, one of six sub-districts within a recently developed urban district in Chengdu, Sichuan from January to March in 2016. There were a total of 8884 older people (aged 60 and above) in this community as of December 2015. A sample of 670 older people was randomly drawn from the community older adult population using computer “random numbers” generator. MeasuresThe in-person interview questionnaire contains measures on socio-demographics, willingness to enter long-term care facilities, general wellbeing index, and social support.<i> </i>We collected the following information: age, gender, marital status, education, occupation, income (monthly household income per capita), insurance, living condition, being sick in the two weeks before the survey, number and type of chronic diseases, and any hospitalization in the prior year.The interviewer first defined long-term care facilities as institutions that integrate medical and social services in senior care facilities. Second, the interviewer asked whether the respondents are aware of the concept. For those who were not aware, explanations were made to inform them. Respondents were then asked: “Are you willing to enter into one of these facilities to receive integrated medical and social services in the future?” If the answer is “Yes”, additional questions were asked regarding: the most important aspect of choosing a long-term care facility, expectation of travel distance from one’s home to the facility, expectation of monthly costs of the services, expectations of the caregivers, medical staff, services, and quality provided, family support of such care arrangement.<i> </i>The WHO-5 items were used to describe the general wellbeing of the respondents about their rating of five statements considering the last 14 days.The Social Support Rating Scale (SSRS) assesses the level of overall social support that each subject received. All survey data were entered into EpiData 3.0. Statistical analyses were carried out using the IBM SPSS version 21.0. We used Pearson’s χ2 to examine differences in categorical variables. Multivariate logistic regression was used to examine the relationship between the independent variables.

本研究经四川大学伦理审查委员会（Sichuan University Institutional Review Board）批准。所有参与者均已阅读阐明调查目的的告知文本，并在参与调研前签署书面知情同意书。本横断面研究（cross-sectional study）于2016年1月至3月在四川省成都市某新建城区下辖的6个街道之一的合作社区开展。截至2015年12月，该社区共有8884名60岁及以上老年人。研究采用计算机随机数生成器从社区老年人群体中随机抽取670名老年人作为研究样本。

### 测量指标
本面对面访谈问卷涵盖社会人口学特征、入住长期护理机构（long-term care facilities）意愿、总体幸福感指数以及社会支持水平等维度。本次研究收集的信息包括：年龄、性别、婚姻状况、受教育程度、职业、人均月家庭收入、医保参保情况、居住状况、调查前两周内患病情况、慢性病种类与数量、既往一年住院史。

针对长期护理机构入住意愿的调查流程如下：访谈员首先将长期护理机构定义为兼具医疗与社会服务功能的老年照护机构，并询问受访者是否知晓该概念。对于不知情者，访谈员将进行解释说明。随后访谈员提问："您未来是否愿意入住此类机构以获得整合式医疗与社会服务？"若受访者回答"愿意"，则进一步询问以下内容：选择长期护理机构时最看重的方面、对机构距家路程的期望、对服务月均费用的预期、对照护人员、医护人员、服务内容与服务质量的期望，以及家庭对该照护安排的支持情况。

本研究采用WHO-5幸福感量表（WHO-5 Well-being Index）评估受访者过去14天内的总体幸福感；采用社会支持评定量表（Social Support Rating Scale, SSRS）评估研究对象所获得的总体社会支持水平。

所有调查数据均录入EpiData 3.0软件。统计分析采用IBM SPSS 21.0版本软件完成：使用Pearson χ²检验分析分类变量间的组间差异，采用多因素logistic回归分析自变量与因变量间的关联关系。