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

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. A cross-sectional study was conducted from July to August 2022 in Shandong Province, China. A total of 3164 rural older adults aged 60 years and above were included in the analysis. Multivariable binary logistic regression models and the margins plots were used for the moderating effect analysis. 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 = 1.47, 95% CI = 1.19–1.82). 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. Policymakers should consider targeted educational campaigns and improved outreach for rural older adults. Elevating their understanding of personal health responsibilities and enhancing healthcare geographic accessibility may be important steps to encourage their participation in family doctor services.