Receipt of basic public health services and social participation among rural migrants in China: a cross-sectional study

Social participation is an important behavioral dimension through which rural migrants enter urban public life and form social ties. Basic public health services may have social associations that extend beyond health management. This study compared the associations of health record management and health education with social participation among rural migrants and examined population differences and three potential explanatory factors. Data were drawn from the 2017 China Migrants Dynamic Survey and included 127,037 migrants with agricultural hukou who had lived at their destination for more than 6 months. Health record management was used to represent an administrative service centered on registration and inclusion in management, whereas health education represented a substantive service centered on knowledge provision and behavioral guidance. Baseline analyses used ordinary least squares models with city fixed effects and city-clustered robust standard errors. Leave-one-out service receipt rates at the village or residents’ committee level were used in supplementary two-stage least squares sensitivity analyses. Oster omitted-variable sensitivity analysis, alternative-outcome tests, restricted-sample tests, exploratory heterogeneity analyses, and analyses of potential explanatory factors were also conducted. After full adjustment, the coefficients for health record management and health education in relation to the social participation index were 0.0176 (SE = 0.0017) and 0.0293 (SE = 0.0012), respectively, corresponding to 0.16 and 0.26 standard deviations of the outcome. The corresponding coefficients from the supplementary two-stage least squares sensitivity analyses were 0.0274 (SE = 0.0040) and 0.0431 (SE = 0.0025). Other sensitivity and robustness analyses produced directionally consistent results. Between-group tests based on seemingly unrelated estimation showed that the positive association between health education and social participation was larger among men, respondents born in or after 1980, and respondents with a high school education or above. Adjusted analyses also showed that both health record management and health education were positively associated with hygiene-habit similarity, local identity, and local integration intention. All three potential explanatory factors were also positively associated with social participation, although the magnitudes of these associations were small. Receipt of basic public health services was associated with higher levels of social participation among rural migrants, and the magnitude of the association was larger for health education than for health record management. The findings suggest that primary-level public health services may have social value related to institutional contact, information access, and community participation in addition to their health management functions. Policy practice could consider improving the effective reach of health education, using health records as an entry point for continuous services, and attending to differences in service associations across sex, birth-cohort, and education groups.