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Association between ethnicity and health knowledge among the floating population in China

Association between ethnicity and health knowledge among the floating population in China Background: Health equity remains a priority concerns by central government in China. This study aimed to explore ethnic gaps in access to health knowledge categories and sources based on the survey data from a publicly available dataset. Methods: Data were from 2015 China Migrants Dynamic Survey issued by The National Health Commission in China. Descriptive analyses were performed to reflect geodemographic differences in the floating population of ethnic minority (EMFP) and Han majority (HMFP) with Chi-square test. Ethnic gaps in access to health knowledge categories and sources were explored with Poisson regressions, logistic regressions, and bivariate ordered probit regressions. Results: In the sample, most of participants had inadequate health information literacy. There were significant dif- ferences regarding geodemographic factors between EMFP and HMFP. Illiterate EMFP had likelihood to obtain less health knowledge categories (IRR = 0.80, 95% CI 0.77–0.84) and sources (IRR = 0.83, 95% CI 0.80–0.86) as compared to illiterate HMFP. Most of correlations between health knowledge categories and sources were weak in the samples of EMFP and HMFP. Conclusion: Ethnic disparities in access to health knowledge categories and sources among the floating population in China were confirmed. Further effective efforts should be provided to reduce ethnic disparities in access to health knowledge under the ethnicity-orientated support of public health resource. Keywords: Health knowledge categories, Health knowledge sources, Floating population, Ethnic minority, Han majority Background in China since the 2000s. Being one of the basic social Since the 1950s, China has adopted ethnic policy with demands, ethnic differences in access to health knowl - official goal of “equality de facto” and given ethnic minor - edge draw increasing attention in China in recent years. ities more political status, which has improved their soci- This study was performed to gain a better understanding oeconomic development [1]. However, ethnic disparities of ethnic access to health knowledge among the floating in disease prevalence and control management in China population in China. have been documented [2–8] in ethnic minority regions During the first decade of the twenty-first century, China’s population has been characterized as geographic diversification of destinations for the interprovincial *Correspondence: hanbingxue0451@163.com floating population in China’s western and interior Xuchang Urban Water Pollution Control and Ecological Restoration regions [9]. The classic theories of population migra - Engineering Technology Research Center, Xuchang University, Xuchang, China tion are found inappropriate for understanding existence Full list of author information is available at the end of the article of floating population [10]. The floating population is © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 2 of 19 characterized by low household healthcare expenditure knowledge categories [28]. Remarkably, lack of knowl- [11], low treatment rate in medical institutions [12], a edge was found to affect health/healthcare service uti - certain percentage of self-treatment behavior [13], and lization [29]. poor awareness of reproductive health [14] in China. A Clinically, a study indicated that orthodontic patients’ systematic review reported unhealthy lifestyle and defi - awareness of their periodontal health was affected by cient hypertension disease management among float - age, attitude and duration of orthodontic treatment ing population in China [15]. Meanwhile, part of China’s [30]. Regarding common persons, sociodemographic floating population might be at increased risk of acquir - factors could affect health knowledge of the elderly in ing the HIV transmission virus [16]. the sample areas of rural China [31]. Factors affect - Furthermore, a study with the data of 1% national pop- ing women’s knowledge of lifestyle-related risk factors ulation sample survey 2005 reported about 70% ethnic during pregnancy were specifically associated with minority floating population (EMFP) were from minor - socioeconomic status [32]. Even more important, the ity autonomous region, three fourth of whom come from socio-economic and educational factors were the fac- rural areas [17]. Currently, EMFP was mostly young tors that determined a greater level of general knowl- adults with deficient education, low incomes, and lack edge on oral health from the pregnant women [33]. of social security [18] and low wages [19, 20]. Accord- However, a systematic scoping review indicated una- ingly, the previous studies indicate that there are geode- vailable health knowledge was reported in the litera- mographic differences between Han and ethnic minority ture [34]. Studies documented lack of requisite health groups in China. knowledge in clinicians [35], Nepal diabetes patients In practice, health inequity among EMFP was neglected [36], paediatricians [37], Australian pharmacists [38], [21]. Prior research documented ethnic disparities in health professionals [39], primary care physicians infant feeding practices [22] and prevalence of smoking [40], and nurses working in heart failure units [41]. [23]. Simultaneously, a study indicated obvious ethnic Even worse, the gaps in oral health knowledge among disparities in self-rated health were mainly affected by a sample of pediatricians were reported [42]. Health socioeconomic factors [24]. Another study indicates that knowledge deficiency poses a serious threat on the health information might help mitigate the mental health improvement of health conditions among the individu- issues Chinese youth experienced [25]. Similarly, a study als of interest. Various sources of health knowledge in a rural Yunnan, China indicated that health education should be used to increase health knowledge categories was shown to be effective in promoting food-health- for them. Thus, we generate the first hypothesis: related knowledge in a rural ethnic minority community [26]. Thus, this study focused on the geodemographic Hypothesis 1: There existed ethnic disparities in access factors associating with health knowledge obtainment. to health knowledge categories among the floating popu - Moreover, it needs to confirm the relationships between lation in China. health knowledge categories and sources among EMFP in China. The motivation for this study is a concern that EMFP in China has differential access to health knowledge than Han majority floating population (HMFP). The second Early studies highlighted education in the health part reviewed current relevant literature and designed knowledge dissemination. For example, a study indi- hypotheses. The third part expounded data source, sam - cated significant positive changes in opinions were pling methods, main variables, and statistical strategies. observed following exposure to the peer education The forth part explored ethnic disparities in access to intervention [43]. Early studies highlighted medical health knowledge categories and sources between EMFP staff in the health knowledge transmission. For exam - and HMFP. The final part discussed the statistical results ple, medical professionals could effectively improve and concluded the paper. the health knowledge of people at high risk of stroke [44]. In addition, multiple studies indicated that health information could be disseminated by WeChat [45, 46], Literature review internet/social media [47, 48], visual messages [49], text Health education is acknowledged as an integral com- books [50], blogs [51], social media [52], iPad-based ponent of disease control and can potentially mitigate app [53], short-video app TikTok [54, 55], Sina Weibo adverse health outcomes for individuals. There was [56], booklet [57], mass media [58], and web-based gender difference with respect to relatively low oral educational film [59]. Consistent with literature, we health knowledge among the university students [27]. therefore hypothesized: Furthermore, there was importance difference in health Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 3 of 19 Hypothesis 2: There existed ethnic disparities in access programmes, face-to-face consultation, online education, to health knowledge sources among the floating popula - community advocacy, bulletin board, and SMS/WeChat. tion in China. Statistical strategies Hypothesis 3: There existed strong correlations between Descriptive analyses were performed to reflect geode - health knowledge categories and sources among EMFP in mographic differences between EMFP and HMFP with China. Chi-square test. Likewise, accessible disparities in health knowledge categories and sources could be exhibited. To investigate the role of ethnicity in health knowl- edge gaps between EMFP and HMFP, interaction terms Method between ethnicity and geodemographic factors were Data source considered as independent variables. Also, health knowl- This study employed the 2015 China Migrants Dynamic edge categories and sources acted as dependent variables. Survey (http:// www. china ldrk. org. cn/) data. The sur - Poisson regressions and logistic regressions with sup- vey employed stratified, multi-stage, scale-oriented pressing constant terms were adopted to reflect the asso - Probability Proportionate to Size method and covered ciations of ethnicity with health knowledge categories approximately 10,000 sample points. There were 35 and sources. provincial-level units in China including 23 provinces, 5 Accordingly, Poisson regressions on number of health autonomous regions, 4 municipalities directly under the knowledge categories and sources were conducted to Central Government, 2 special administrative regions reflect quantitative differences between EMFP and ( h t t p s : // b aik e. s o. c om/ do c / 23635 518- 24188 839. h tml) HMFP. Subsequently, logistic regressions were adopted and Xinjiang Production and Construction Corps. But, to analyze the associations of interactions between EMFP in this study, only 32 provincial-level units were surveyed and geodemographic factors with health knowledge cat- excluding Taiwan, Hong Kong, and Macau. In the sam- egories and sources. ple, EMFP included Mongolia ethnicity, Man ethnicity, To reflect a category of specific health knowledge’ Hui ethnicity, Zang ethnicity, Zhuang ethnicity, Uygur reliance on a specific health knowledge source, correla - ethnicity, Miao ethnicity, Yi ethnicity, Tujia ethnicity, tions between health knowledge categories and sources Buyi ethnicity, Dong ethnicity, Yao ethnicity, Korean eth- were performed with Stata program bioprobit [60]. The nicity, Bai ethnicity, Hani ethnicity, Li ethnicity, Kazakh covariates were age (continuous years) and floating years. ethnicity, Dai ethnicity, and other ethnicity. Three possible correlational results were positive corre - lation, negative correlation, and no correlation. Accord- ing to Evans (1996), the strength of the correlation were Main variables classified by “very weak” (the absolute value of correla - The main socioeconomic variables included gender tion coefficient (rho): 0.00–0.19), “weak” (the absolute (female = 0, male = 1), education level (illiteracy = 0, pri- value of rho: 0.20–0.39), “moderate” (the absolute value mary school, junior high school, high school/technical of rho: 0.40–0.59), “strong” (the absolute value of rho: secondary school, college, undergraduate, and graduate 0.60–0.79), and “very strong” (the absolute value of rho: students = 1), ethnicity (Han majority = 0, ethnic minor- 0.80–1.0) [61]. ity = 1), hukou (other = 0, agricultural = 1), first marriage (no = 0, yes = 1), and interprovincial floating (no = 0, yes = 1). The continuous age was coarsely categorized Results into young group (< 30), middle group (30–60), and old In this section, the original hypotheses will be statistically group (> 60). The main regional variables included Pearl explored. In order to reflect ethnic disparities in access to River Delta, Yangtze River Delta, Bohai Rim, and other health knowledge categories, ethnic disparities in access economic zone. Their response options were binary val - to health knowledge sources, and correlations between ues (no = 0, yes = 1). health knowledge categories and sources, Chi-square Here, health knowledge categories and sources were test, Poisson regressions, logistic regressions, and bivari- a series of dummy variables (no = 0, yes = 1). Health ate ordered probit regressions were performed. Based knowledge categories included occupational diseases, on a series of analyses, the original hypotheses would be nutrition, reproduction, chronic diseases, smoking con- judged whether or not one of them was accepted. trol, mental disorders, tuberculosis, sexually transmitted Totally, mean age of HMFP was 35.579 (± 10.591) years diseases/acquired immunodeficiency syndrome (STD/ old, while mean age of EMFP was 34.497 (± 11.180) years AIDS), and other infectious diseases. Health knowledge old. HMFP was averagely older than EMFP. Mean float - sources included lecture, books/magazine/CD, radio/TV ing time of HMFP was 4.711 (± 4.907) years, while mean Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 4 of 19 compared to HMFP not interprovincial floating. EMFP floating time of EMFP was 4.757 (± 5.146) years. u Th s, without first marriage had likelihood to obtain less health mean floating time of HMFP was shorter than that of knowledge categories (IRR = 0.97, 95% CI 0.95–0.99) EMFP. and more health knowledge sources (IRR = 1.03, 95% CI In Table  1, there were significant differences regarding 1.01–1.04) as compared to HMFP without first marriage. gender, education level, hukou, first marriage, interpro - EMFP not living in Pearl River Delta had likelihood to vincial floating, Pearl River Delta, Yangtze River Delta, obtain more health knowledge categories (IRR = 1.06, Bohai Rim, other economic zone, occupational disease, 95% CI 1.01–1.11) and sources (IRR = 1.13, 95% CI nutrition, reproduction, smoking control, tuberculosis, 1.09–1.18) as compared to HMFP not living in Pearl STD/AIDS, other infectious disease, lecture, radio/TV River Delta. EMFP not living in Yangtze River Delta had programmes, face-to-face consultation, online education, likelihood to obtain more health knowledge categories community advocacy, bulletin board, and SMS/WeChat (IRR = 1.33, 95% CI 1.26–1.39) and sources (IRR = 1.15, between HMFP and EMFP. 95% CI 1.12–1.19) as compared to HMFP not living in Regarding health knowledge categories (n = 205,990), Yangtze River Delta. EMFP not living in Bohai Rim had knowledge of reproduction (66.62%) was the most pop- likelihood to obtain more health knowledge categories ular health knowledge category for the total sample fol- (IRR = 1.33, 95% CI 1.28–1.38) and sources (IRR = 1.24, lowed by knowledge of nutrition (65.18%), smoking 95% CI 1.20–1.28) as compared to HMFP not living in control (60.96%), STD/AIDS (56.33%), chronic diseases Bohai Rim. (42.02%), occupational diseases (39.76%), tuberculosis (37.60%), other infectious diseases (36.97%), and mental Association between ethnicity and health knowledge disorders (19.43%). Knowledge of reproduction (5.00%) categories were the most popular health knowledge category for In Table 3, old EMFP was less likely to acquire knowledge the EMFP followed by knowledge of STD/AIDS (4.90%), of occupational diseases (aOR = 0.40, 95% CI 0.28–0.55), nutrition (4.63%), smoking control (4.55%), tuberculosis reproduction (aOR = 0.23, 95% CI 0.17–0.32), chronic (3.52%), chronic diseases (3.32%), other infectious dis- diseases (aOR = 0.22, 95% CI 0.17–0.30), smoking con- eases (3.25%), occupational diseases (2.78%), and mental trol (aOR = 0.55, 95% CI 0.41–0.75), mental disorders disorders (1.55%). (aOR = 0.05, 95% CI 0.04–0.08), tuberculosis (aOR = 0.05, Regarding health knowledge sources (n = 189,345), bul- 95% CI 0.03–0.06), STD/AIDS (aOR = 0.06, 95% CI 0.05– letin board (83.45%) was most utilized by the total sam- 0.08), and other infectious diseases (aOR = 0.13, 95% CI ple, followed by radio/TV programmes (79.74%), SMS/ 0.09–0.17) as compared to young HMFP. Female EMFP WeChat (56.30%), books/magazine/CD (43.23%), online was less likely to acquire knowledge of occupational education (41.91%), community advocacy (38.49%), lec- diseases (aOR = 0.81, 95% CI 0.76–0.87) and smoking ture (30.71%), and face-to-face consultation (27.36%). In control (aOR = 0.63, 95% CI 0.59–0.67) and more likely EMFP, bulletin board (6.57%) was most utilized, followed to acquire knowledge of nutrition (aOR = 1.17, 95% CI by radio/TV programmes (6.25%), SMS/WeChat (4.11%), 1.10–1.25) and reproduction (aOR = 1.58, 95% CI 1.48– books/magazine/CD (3.31%), community advocacy 1.70) as compared to female HMFP. (3.17%), online education (2.84%), lecture (2.42%), and Illiterate EMFP had less likelihood to obtain health face-to-face consultation (2.36%). knowledge of occupational diseases (aOR = 0.53, 95% CI 0.46–0.62), nutrition (aOR = 0.60, 95% CI 0.53–0.69), Association between ethnicity and number of health reproduction (aOR = 0.60, 95% CI 0.53–0.69), chronic knowledge categories and sources diseases (aOR = 0.61, 95% CI 0.53–0.70), smoking con- In Table 2, EMFP was likely to obtain more health knowl- trol (aOR = 0.61, 95% CI 0.53–0.69), mental disorders edge categories and sources as compared to young (aOR = 0.72, 95% CI 0.60–0.86), tuberculosis (aOR = 0.86, HMFP. Illiterate EMFP had likelihood to obtain less 95% CI 0.76–0.98), STD/AIDS (aOR = 0.61, 95% CI 0.53– health knowledge categories [IRR = 0.80, 95% Confi - 0.69), and other infectious diseases (aOR = 0.77, 95% CI dence Interval (CI) 0.77–0.84] and sources (IRR = 0.83, 0.67–0.88) as compared to illiterate HMFP. 95% CI 0.80–0.86) as compared to illiterate HMFP. EMFP EMFP with non-agricultural hukou had more like- with non-agricultural hukou had likelihood to obtain lihood to obtain health knowledge of occupational more health knowledge categories (IRR = 1.08, 95% CI diseases (aOR = 1.28, 95% CI 1.16–1.40), nutri- 1.05–1.11) and sources (IRR = 1.08, 95% CI 1.06–1.11) as tion (aOR = 1.23, 95% CI 1.12–1.35), chronic dis- compared to HMFP with non-agricultural hukou. EMFP eases (aOR = 1.32, 95% CI 1.20–1.44), smoking not interprovincial floating had likelihood to obtain control (aOR = 1.29, 95% CI 1.17–1.42), mental dis- health more knowledge categories (IRR = 1.06, 95% CI orders (aOR = 1.29, 95% CI 1.16–1.44), tuberculosis 1.04–1.09) as and sources (IRR = 1.02, 95% CI 1.00–1.04) Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 5 of 19 Table 1 Sample characteristics of floating population by ethnicity Column Han majority (%) Ethnic Chi-square P value percentage minority (%) Age (N = 206,000) 138.2422 0.000 Young 36.31 33.15 3.16 Middle 61.31 56.83 4.48 Old 2.38 2.16 0.22 Gender (N = 206,000) 20.2281 0.000*** Male 53.07 49.03 4.04 Female 46.93 43.12 3.81 Education level (N = 206,000) 2.0e+03 0.000*** No 1.89 1.38 0.51 Yes 98.11 90.77 7.34 Hukou (N = 206,000) 87.6745 0.000*** Other 16.41 15.33 1.08 Agricultural 83.59 76.81 6.78 First marriage (N = 206,000) 325.7945 0.000*** No 22.59 20.37 2.22 Yes 77.41 71.78 5.63 Interprovincial floating (N = 206,000) 1.4e+03 0.000*** No 50.12 45.08 5.04 Yes 49.88 47.06 2.82 Pearl river delta (N = 206,000) 20.1735 0.000*** No 92.71 85.36 7.35 Yes 7.29 6.79 0.50 Yangtze river delta (N = 206,000) 650.5791 0.000*** No 92.14 76.37 15.77 Yes 7.86 7.12 0.74 Bohai Rim (N = 206,000) 726.1827 0.000*** No 92.15 75.89 16.26 Yes 7.85 7.12 0.73 Other economic zone (N = 206,000) 1.8e+03 0.000*** No 40.77 38.80 1.97 Yes 59.23 53.35 5.88 Knowledge of occupational disease (N = 205,990) 141.4147 0.000*** No 60.24 55.16 5.08 Yes 39.76 36.98 2.78 Knowledge of nutrition (N = 205,990) 299.2678 0.000*** No 34.82 31.60 3.22 Yes 65.18 60.55 4.63 Knowledge of reproduction (N = 205,990) 69.9840 0.000*** No 33.38 30.53 2.86 Yes 66.62 61.62 5.00 Knowledge of chronic disease (N = 205,990) 0.2375 0.626 No 57.98 53.44 4.54 Yes 42.02 38.70 3.32 Knowledge of smoking control (N = 205,990) 70.6805 0.000*** No 39.04 35.73 3.31 Yes 60.96 56.41 4.55 Knowledge of mental disorders (N = 205,990) 0.7932 0.373 No 80.57 74.26 6.31 Yes 19.43 17.88 1.55 Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 6 of 19 Table 1 (continued) Column Han majority (%) Ethnic Chi-square P value percentage minority (%) Knowledge of tuberculosis (N = 205,990) 382.4506 0.000*** No 62.40 58.06 4.34 Yes 37.60 34.09 3.52 Knowledge of STD/AIDS (N = 205,990) 264.1414 0.000*** No 43.67 40.72 2.95 Yes 56.33 51.42 4.90 Knowledge of other infectious disease (N = 205,990) 148.4978 0.000*** No 63.03 58.43 4.60 Yes 36.97 33.72 3.25 Lecture (N = 189,345) 3.2577 0.071* No 69.29 64.00 5.29 Yes 30.71 28.29 2.42 Books/magazine/CD (N = 189,345) 0.3808 0.537 No 56.77 52.37 4.39 Yes 43.23 39.92 3.31 Radio/TV programmes (N = 189,345) 19.2453 0.000*** No 20.26 18.81 1.45 Yes 79.74 73.48 6.25 Face-to-face consultation (N = 189,345) 83.8634 0.000*** No 72.64 67.29 5.35 Yes 27.36 25.00 2.36 Online education (N = 189,345) 164.7912 0.000*** No 58.09 53.22 4.87 Yes 41.91 39.07 2.84 Community advocacy (N = 189,345) 43.9996 0.000*** No 61.51 56.96 4.54 Yes 38.49 35.33 3.17 Bulletin board (N = 189,345) 37.0847 0.000*** No 16.55 15.41 1.14 Yes 83.45 76.88 6.57 SMS/WeChat (N = 189,345) 55.6273 0.000*** No 43.70 40.11 3.60 Yes 56.30 52.19 4.11 * and *** represent 10 and 1%, respectively EMFP without first marriage had less likelihood to (aOR = 1.18, 95% CI 1.07–1.30), and other infectious obtain health knowledge of nutrition (aOR = 0.91, 95% CI diseases (aOR = 1.12, 95% CI 1.02–1.23) as compared 0.84–0.98), reproduction (aOR = 0.45, 95% CI 0.42–0.49) to HMFP with non-agricultural hukou. and had more likelihood to obtain health knowledge of EMFP not interprovincial floating had more likelihood other infectious diseases (aOR = 1.09, 95% CI 1.01–1.18) to obtain health knowledge of nutrition (aOR = 1.14, as compared to HMFP without first marriage. 95% CI 1.05–1.24), chronic diseases (aOR = 1.15, 95% Geographically, EMFP not living in Pearl River Delta CI 1.06–1.25), smoking control (aOR = 1.12, 95% CI had less likelihood to obtain health knowledge of occu 1.03–1.22), mental disorders (aOR = 1.10, 95% CI 1.00– pational diseases (aOR = 0.60, 95% CI 0.52–0.69) 1.22), tuberculosis (aOR = 1.26, 95% CI 1.16–1.37), and reproduction (aOR = 0.82, 95% CI 0.70–0.96) STD/AIDS (aOR = 1.20, 95% CI 1.10–1.31), and other and more likelihood to obtain health knowledge of infectious diseases (aOR = 1.24, 95% CI 1.14–1.34) nutrition (aOR = 1.25, 95% CI 1.09–1.45), chronic compared to HMFP without interprovincial floating. Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 7 of 19 Table 2 Poisson regressions on number of health knowledge diseases (aOR = 1.34, 95% CI 1.15–1.55), smoking control categories and sources, IRR (95% CI) (aOR = 1.23, 95% CI 1.07–1.42), tuberculosis (aOR = 1.59, 95% CI 1.37–1.85), and STD/AIDS (aOR = 1.61, 95% Number of health Number of health knowledge categories knowledge sources CI 1.39–1.86) as compared to HMFP not living in Pearl River Delta. IRR 95% CI IRR 95% CI EMFP not living in Yangtze River Delta had more likeli- eth#agg hood to obtain health knowledge of nutrition (aOR = 1.15, NO, young 1 [Reference] 1 [Reference] 95% CI 1.01–1.30), reproduction (aOR = 1.61, 95% CI NO, middle 0.98*** 0.98–0.99 0.95*** 0.94–0.95 1.41–1.84), chronic diseases (aOR = 1.91, 95% CI 1.67– NO, old 0.83*** 0.81–0.85 0.80*** 0.79–0.81 2.19), smoking control (aOR = 1.30, 95% CI 1.15–1.48), Yes, young 2.37*** 2.19–2.57 2.58*** 2.43–2.73 mental disorders (aOR = 1.67, 95% CI 1.40–2.00), tuber- Yes, middle 2.32*** 2.15–2.51 2.47*** 2.33–2.62 culosis (aOR = 3.38, 95% CI 2.92–3.91), STD/AIDS Yes, old 1.88*** 1.69–2.10 2.12*** 1.96–2.29 (aOR = 2.40, 95% CI 2.11–2.73), and other infectious eth#gender diseases (aOR = 2.01, 95% CI 1.75–2.31) as compared to No, no 1 [Reference] 1 [Reference] HMFP not living in Yangtze River Delta. No, yes 1.00 0.99–1.00 0.99*** 0.99–1.00 EMFP not living in Bohai Rim had less likelihood to Yes, no 1.00 0.98–1.02 1.00 0.99–1.02 obtain health knowledge of nutrition (aOR = 0.82, 95% eth#edu CI 0.73–0.93) and had more likelihood to obtain health No, no 1 [Reference] 1 [Reference] knowledge of reproduction (aOR = 1.85, 95% CI 1.65– No, yes 1.23*** 1.20–1.27 1.24*** 1.21–1.27 2.08), chronic diseases (aOR = 1.73, 95% CI 1.53–1.94), Yes, no 0.80*** 0.77–0.84 0.83*** 0.80–0.86 smoking control (aOR = 1.23, 95% CI 1.09–1.38), mental eth#huk disorders (aOR = 1.98, 95% CI 1.69–2.33), tuberculosis No, no 1 [Reference] 1 [Reference] (aOR = 3.09, 95% CI 2.72–3.50), STD/AIDS (aOR = 3.50, No, yes 0.92*** 0.91–0.93 0.93*** 0.93–0.94 95% CI 3.11–3.94), and other infectious diseases Yes, no 1.08*** 1.05–1.11 1.08*** 1.06–1.11 (aOR = 2.15, 95% CI 1.90–2.44) as compared to HMFP eth#intpv not living in Bohai Rim. Thus, there existed disparities No, no 1 [Reference] 1 [Reference] in association between ethnicity and health knowledge No, yes 0.96*** 0.96–0.97 0.98*** 0.98–0.99 categories among EMFP. Accordingly, Hypothesis 1 was Yes, no 1.06*** 1.04–1.09 1.02** 1.00–1.04 accepted. eth#mar No, no 1 [Reference] 1 [Reference] Association between ethnicity and health knowledge No, yes 1.02*** 1.01–1.03 1.00 0.99–1.00 sources Yes, no 0.97** 0.95–0.99 1.03*** 1.01–1.04 In Table  4, as compared to young HMFP, EMFP was eth#zon1 more likely to use radio/TV programmes and bulletin No, no 1 [Reference] 1 [Reference] board and less likely to use lecture, face-to-face consul- No, yes 3.89*** 3.76–4.01 3.58*** 3.49–3.67 tation, online education, community advocacy, and SMS/ Yes, no 1.06** 1.01–1.11 1.13*** 1.09–1.18 WeChat to obtain health knowledge. eth#zon2 As compared to female HMFP, female EMFP was No, no 1 [Reference] 1 [Reference] more likely to use lecture (aOR = 1.14, 95% CI 1.06– No, yes 3.54*** 3.43–3.65 3.51*** 3.43–3.60 1.23), radio/TV programmes (aOR = 1.08, 95% CI Yes, no 1.33*** 1.26–1.39 1.15*** 1.12–1.19 0.99–1.17), face-to-face consultation (aOR = 1.15, 95% eth#zon3 CI 1.07–1.24), and community advocacy (aOR = 1.13, No, no 1 [Reference] 1 [Reference] 95% CI 1.05–1.20) and were less likely to use books/ No, yes 3.43*** 3.32–3.54 3.39*** 3.31–3.47 magazine/CD (aOR = 0.93, 95% CI 0.87–1.00), online Yes, no 1.33*** 1.28–1.38 1.24*** 1.20–1.28 education (aOR = 0.89, 95% CI 0.83–0.96), and SMS/ eth#zon4 WeChat (aOR = 0.88, 95% CI 0.82–0.94) to obtain health No, no 1 [Reference] 1 [Reference] knowledge. No, yes 3.94*** 3.82–4.07 3.74*** 3.65–3.83 As compared to Illiterate HMFP, illiterate EMFP was N 205,990 189,345 more likely to obtain health knowledge with lecture (aOR = 0.81, 95% CI 0.69–0.95), books/magazine/CD eth ethnicity; agg age group; edu education level; huk hukou; intpv interprovincial floating; mar first marriage; zon1 Pearl River Delta; zon2 Yangtze (aOR = 0.45, 95% CI 0.39–0.53), face-to-face consulta- River Delta; zon3 Bohai Rim; zon4 other economic zone tion (aOR = 0.85, 95% CI 0.73–1.00), online education ** and *** represent 5 and 1%, respectively Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 8 of 19 Table 3 Logistic regression on health knowledge categories (N = 205,990), Odds Ratio [95% Confidence Interval] Occupational Nutrition Reproduction Chronic Smoking Mental Tuberculosis STD/AIDS Other disease disease control disorders infectious disease eth#agg NO, 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] young ence] ence] ence] ence] ence] c c c c b c c NO, mid- 0.93 0.93 0.80 1.12 0.99 0.97 1.07 0.90 0.99 dle (0.91–0.95) (0.90–0.95) (0.78–0.82) (1.09–1.14) (0.96–1.01) (0.94–0.99) (1.05–1.10) (0.88–0.92) (0.97–1.02) c c c c c a c c NO, old 0.44 1.03 0.18 1.60 0.83 0.84 1.06 0.39 0.90 (0.41–0.48) (0.97–1.10) (0.17–0.19) (1.51–1.71) (0.78–0.89) (0.78–0.91) (0.99–1.13) (0.37–0.42) (0.84–0.96) c c c c c Yes, 0.92 (0.72–1.17) 1.18 0.92 (0.72–1.18) 0.17 0.89 0.06 0.05 0.15 0.15 young (0.93–1.49) (0.13–0.21) (0.70–1.13) (0.05–0.09) (0.04–0.06) (0.12–0.19) (0.12–0.19) a a c c c c c Yes, mid- 0.81 1.03 0.79 0.17 0.86 0.06 0.05 0.14 0.15 dle (0.64–1.03) (0.82–1.29) (0.62–1.01) (0.13–0.22) (0.68–1.08) (0.05–0.09) (0.04–0.07) (0.11–0.18) (0.12–0.20) c c c c c c c c Yes, old 0.40 0.82 0.23 0.22 0.55 0.05 0.05 0.06 0.13 (0.28–0.55) (0.61–1.10) (0.17–0.32) (0.17–0.30) (0.41–0.75) (0.04–0.08) (0.03–0.06) (0.05–0.08) (0.09–0.17) eth#gender No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c No, yes 1.24 0.78 0.57 1.00 1.76 0.96 1.01 0.96 0.96 (1.22–1.27) (0.77–0.80) (0.56–0.58) (0.98–1.02) (1.73–1.80) (0.94–0.98) (0.99–1.03) (0.94–0.98) (0.95–0.98) c c c c Yes, no 0.81 1.17 1.58 0.99 0.63 1.05 0.98 1.02 1.03 (0.76–0.87) (1.10–1.25) (1.48–1.70) (0.93–1.06) (0.59–0.67) (0.97–1.14) (0.92–1.04) (0.96–1.10) (0.97–1.10) eth#edu No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c c c No, yes 1.64 1.69 1.79 1.36 1.42 1.35 1.26 1.59 1.34 (1.50–1.79) (1.57–1.82) (1.65–1.94) (1.25–1.47) (1.31–1.53) (1.21–1.50) (1.16–1.36) (1.47–1.72) (1.23–1.45) c c c c c c b c c Yes, no 0.53 0.60 0.60 0.61 0.61 0.72 0.86 0.61 0.77 (0.46–0.62) (0.53–0.69) (0.53–0.69) (0.53–0.70) (0.53–0.69) (0.60–0.86) (0.76–0.98) (0.53–0.69) (0.67–0.88) eth#huk No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c c c No, yes 0.75 0.77 0.92 0.79 0.87 0.77 0.87 0.89 0.87 (0.73–0.77) (0.75–0.79) (0.90–0.95) (0.77–0.81) (0.85–0.89) (0.75–0.80) (0.85–0.89) (0.87–0.91) (0.84–0.89) c c c c c c b Yes, no 1.28 1.23 0.93 (0.85–1.03) 1.32 1.29 1.29 1.18 1.06 1.12 (1.16–1.40) (1.12–1.35) (1.20–1.44) (1.17–1.42) (1.16–1.44) (1.07–1.30) (0.96–1.17) (1.02–1.23) eth#intpv No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c c No, yes 0.86 0.77 0.89 0.92 0.87 0.94 1.00 1.09 0.95 (0.84–0.87) (0.76–0.79) (0.87–0.91) (0.90–0.94) (0.85–0.89) (0.91–0.96) (0.98–1.03) (1.07–1.11) (0.93–0.97) c c c a c c c Yes, no 1.00 (0.92–1.09) 1.14 1.05 (0.96–1.14) 1.15 1.12 1.10 1.26 1.20 1.24 (1.05–1.24) (1.06–1.25) (1.03–1.22) (1.00–1.22) (1.16–1.37) (1.10–1.31) (1.14–1.34) eth#mari No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c b c c c c a c No, yes 0.80 1.03 2.54 0.95 0.99 0.88 0.91 1.02 0.90 (0.78–0.82) (1.01–1.06) (2.48–2.61) (0.93–0.97) (0.96–1.01) (0.86–0.91) (0.89–0.94) (1.00–1.05) (0.88–0.92) b c b Yes, no 1.03 (0.95–1.11) 0.91 0.45 1.03 1.01 1.08 1.05 1.07 1.09 (0.84–0.98) (0.42–0.49) (0.95–1.11) (0.94–1.09) (0.98–1.18) (0.97–1.13) (0.99–1.16) (1.01–1.18) eth#zon1 No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c No, yes 0.95 (0.86–1.05) 1.59 1.40 0.62 0.99 0.28 0.49 0.95 0.64 (1.45–1.74) (1.27–1.55) (0.56–0.68) (0.90–1.08) (0.25–0.32) (0.44–0.53) (0.87–1.04) (0.59–0.71) Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 9 of 19 Table 3 (continued) Occupational Nutrition Reproduction Chronic Smoking Mental Tuberculosis STD/AIDS Other disease disease control disorders infectious disease c c b c c c c Yes, no 0.60 1.25 0.82 1.34 1.23 1.13 1.59 1.61 1.03 (0.52–0.69) (1.09–1.45) (0.70–0.96) (1.15–1.55) (1.07–1.42) (0.94–1.36) (1.37–1.85) (1.39–1.86) (0.89–1.19) eth#zon2 No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c c No, yes 0.70 1.92 0.78 0.57 1.01 0.25 0.38 0.70 0.46 (0.63–0.77) (1.76–2.10) (0.71–0.86) (0.53–0.63) (0.93–1.10) (0.22–0.28) (0.35–0.42) (0.64–0.76) (0.42–0.51) b c c c c c c c Yes, no 1.08 (0.95–1.23) 1.15 1.61 1.91 1.30 1.67 3.38 2.40 2.01 (1.01–1.30) (1.41–1.84) (1.67–2.19) (1.15–1.48) (1.40–2.00) (2.92–3.91) (2.11–2.73) (1.75–2.31) eth#zon3 No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c b c b c c c c No, yes 0.59 2.06 0.90 0.56 0.91 0.19 0.35 0.63 0.42 (0.54–0.65) (1.89–2.24) (0.82–0.99) (0.51–0.61) (0.83–0.99) (0.17–0.21) (0.32–0.39) (0.57–0.68) (0.38–0.46) c c c c c c c c Yes, no 1.08 (0.96–1.21) 0.82 1.85 1.73 1.23 1.98 3.09 3.50 2.15 (0.73–0.93) (1.65–2.08) (1.53–1.94) (1.09–1.38) (1.69–2.33) (2.72–3.50) (3.11–3.94) (1.90–2.44) eth#zon4 No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c b c c c c No, yes 0.60 1.88 1.17 0.72 1.09 0.29 0.66 1.13 0.63 (0.55–0.66) (1.73–2.05) (1.07–1.28) (0.66–0.78) (1.01–1.19) (0.26–0.32) (0.61–0.72) (1.04–1.23) (0.57–0.68) eth ethnicity; agg age group; edu education level; huk hukou; intpv interprovincial floating; mar first marriage; zon1 Pearl River Delta; zon2 Yangtze River Delta; zon3 Bohai Rim; zon4 other economic zone a–c 10, 5, and 1%, respectively (aOR = 0.42, 95% CI 0.35–0.51), community advo- magazine/CD (aOR = 1.15, 95% CI 1.06–1.24), online cacy (aOR = 0.74, 95% CI 0.64–0.86), bulletin board education (aOR = 1.21, 95% CI 1.11–1.31), and SMS/ (aOR = 0.52, 95% CI 0.44–0.62), and SMS/WeChat WeChat (aOR = 1.19, 95% CI 1.09–1.29) and were less (aOR = 0.63, 95% CI 0.54–0.73). likely to use face-to-face consultation (aOR = 0.78, 95% As compared to HMFP with non-agricultural hukou, CI 0.72–0.86) to obtain health knowledge. EMFP with non-agricultural hukou was more likely As compared to HMFP not living in Pearl River Delta, to use lecture (aOR = 1.32, 95% CI 1.19–1.46), books/ EMFP not living in Pearl River Delta was more likely magazine/CD (aOR = 1.34, 95% CI 1.22–1.48), online to use lecture (aOR = 1.80, 95% CI 1.50–2.15), books/ education (aOR = 1.50, 95% CI 1.36–1.66), community magazine/CD (aOR = 1.22, 95% CI 1.05–1.43), radio/ advocacy (aOR = 1.20, 95% CI 1.09–1.32), and SMS/ TV programmes (aOR = 1.20, 95% CI 0.99–1.44), face- WeChat (aOR = 1.46, 95% CI 1.32–1.61) and were less to-face consultation (aOR = 2.25, 95% CI 1.86–2.72), likely to use face-to-face consultation (aOR = 0.86, 95% community advocacy (aOR = 1.44, 95% CI 1.23–1.68), CI 0.77–0.96) to obtain health knowledge. bulletin board (aOR = 1.28, 95% CI 1.03–1.57), and SMS/ Compared with HMFP without interprovincial float - WeChat (aOR = 1.27, 95% CI 1.09–1.48) to obtain health ing, EMFP not interprovincial floating was more likely knowledge. to use lecture (aOR = 1.12, 95% CI 1.02–1.23), face- As compared to HMFP not living in Yangtze River to-face consultation (aOR = 1.23, 95% CI 1.12–1.35), Delta, EMFP not living in Yangtze River Delta was more community advocacy (aOR = 1.19, 95% CI 1.09–1.30), likely to use lecture (aOR = 2.37, 95% CI 1.99–2.82), bulletin board (aOR = 1.12, 95% CI 0.99–1.27), and books/magazine/CD (aOR = 1.16, 95% CI 1.01–1.33), were less likely to use online education (aOR = 0.96, face-to-face consultation (aOR = 2.50, 95% CI 2.09–2.99), 95% CI 0.87–1.05) and SMS/WeChat (aOR = 0.86, 95% community advocacy (aOR = 1.80, 95% CI 1.55–2.09), CI 0.79–0.94) to obtain health knowledge. and bulletin board (aOR = 1.71, 95% CI 1.43–2.05) and As compared to HMFP without first marriage, were less likely to use radio/TV programmes (aOR = 0.84, EMFP without first marriage was more likely to 95% CI 0.70–1.01) to obtain health knowledge. use lecture (aOR = 1.10, 95% CI 1.01–1.20), books/ Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 10 of 19 Table 4 Logistic regression on health knowledge sources, Odds Ratio [95% Conf. Interval] (N = 189,345) Lecture Books/ Radio/TV Face-to-face Online Community Bulletin SMS/WeChat magazine/CD programmes consultation education advocacy board eth#agg NO, young 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] a c c a c c c c NO, middle 1.02 0.86 1.09 0.98 0.60 1.06 1.04 0.67 (0.66–0.69) (1.00–1.04) (0.84–0.88) (1.06–1.12) (0.95–1.00) (0.59–0.62) (1.04–1.09) (1.01–1.07) c c c c c c c NO, old 1.26 0.51 1.58 1.05 (0.97– 0.14 1.22 0.76 0.14 (0.13–0.16) (1.17–1.35) (0.48–0.55) (1.44–1.73) 1.13) (0.13–0.15) (1.14–1.30) (0.70–0.82) c c c c c c a Yes, young 0.08 0.36 2.57 0.04 0.65 0.13 1.31 0.80 (0.62–1.03) (0.06–0.10) (0.28–0.47) (1.88–3.50) (0.03–0.05) (0.50–0.84) (0.10–0.17) (0.93–1.83) c c c c c c a c Yes, middle 0.08 0.33 3.01 0.03 0.44 0.13 1.32 0.58 (0.46–0.75) (0.06–0.10) (0.26–0.42) (2.23–4.07) (0.02–0.05) (0.34–0.56) (0.10–0.17) (0.96–1.83) c c c c c c c Yes, old 0.09 0.23 3.81 0.04 0.10 0.16 0.74 0.15 (0.11–0.21) (0.06–0.12) (0.16–0.32) (2.52–5.77) (0.03–0.06) (0.06–0.15) (0.11–0.22) (0.49–1.12) eth#gender No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c No, yes 0.89 1.04 0.99 (0.97– 0.85 1.10 0.93 0.95 1.09 (1.07–1.11) (0.87–0.90) (1.02–1.06) 1.02) (0.83–0.87) (1.08–1.12) (0.91–0.95) (0.92–0.97) c b a c c c c Yes, no 1.14 0.93 1.08 1.15 0.89 1.13 0.99 0.88 (0.82–0.94) (1.06–1.23) (0.87–1.00) (0.99–1.17) (1.07–1.24) (0.83–0.96) (1.05–1.20) (0.90–1.08) eth#edu No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c No, yes 1.43 1.82 1.00 (0.90– 1.03 (0.94– 2.73 1.31 1.99 2.35 (2.14–2.57) (1.30–1.57) (1.65–1.99) 1.12) 1.14) (2.44–3.05) (1.20–1.43) (1.81–2.18) c c b c c c c Yes, no 0.81 0.45 0.87 (0.73– 0.85 0.42 0.74 0.52 0.63 (0.54–0.73) (0.69–0.95) (0.39–0.53) 1.04) (0.73–1.00) (0.35–0.51) (0.64–0.86) (0.44–0.62) eth#huk No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c b c c c c No, yes 0.75 0.78 0.99 (0.96– 0.97 0.69 0.89 0.91 0.86 (0.83–0.88) (0.73–0.77) (0.76–0.80) 1.03) (0.94–0.99) (0.67–0.71) (0.87–0.91) (0.88–0.94) c c c c c c Yes, no 1.32 1.34 1.00 (0.88– 0.86 1.50 1.20 1.07 1.46 (1.32–1.61) (1.19–1.46) (1.22–1.48) 1.13) (0.77–0.96) (1.36–1.66) (1.09–1.32) (0.93–1.23) eth#intpv No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c No, yes 0.92 0.95 1.04 0.96 0.94 0.90 0.95 0.99 (0.97–1.01) (0.90–0.94) (0.93–0.97) (1.02–1.07) (0.94–0.99) (0.92–0.96) (0.88–0.92) (0.93–0.98) b c c c a c Yes, no 1.12 1.07 (0.98– 1.03 (0.92– 1.23 0.96 1.19 1.12 0.86 (0.79–0.94) (1.02–1.23) 1.17) 1.15) (1.12–1.35) (0.87–1.05) (1.09–1.30) (0.99–1.27) eth#mar No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c No, yes 0.91 0.95 1.11 1.24 0.90 0.98 (0.96– 1.10 0.89 (0.87–0.92) (0.89–0.94) (0.93–0.98) (1.08–1.14) (1.21–1.28) (0.88–0.93) 1.01) (1.07–1.14) b c c c c Yes, no 1.10 1.15 1.02 (0.92– 0.78 1.21 1.00 (0.92– 1.09 1.19 (1.09–1.29) (1.01–1.20) (1.06–1.24) 1.13) (0.72–0.86) (1.11–1.31) 1.08) (0.97–1.22) eth#zon1 No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c c No, yes 0.40 0.58 3.42 0.27 0.61 0.56 2.88 0.84 (0.76–0.94) (0.36–0.45) (0.53–0.65) (3.03–3.86) (0.24–0.30) (0.54–0.69) (0.50–0.62) (2.57–3.23) c c a c c b c Yes, no 1.80 1.22 1.20 2.25 0.93 1.44 1.28 1.27 (1.09–1.48) (1.50–2.15) (1.05–1.43) (0.99–1.44) (1.86–2.72) (0.80–1.09) (1.23–1.68) (1.03–1.57) eth#zon2 No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c No, yes 0.37 0.56 4.02 0.26 0.60 0.46 1.96–2.43 0.95 (0.86–1.05) (0.33–0.41) (0.51–0.62) (3.58–4.52) (0.23–0.28) (0.54–0.68) (0.42–0.51) c b a c c c Yes, no 2.37 1.16 0.84 2.50 1.05 1.80 1.71 1.04 (0.91–1.20) (1.99–2.82) (1.01–1.33) (0.70–1.01) (2.09–2.99) (0.91–1.22) (1.55–2.09) (1.43–2.05) Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 11 of 19 Table 4 (continued) Lecture Books/ Radio/TV Face-to-face Online Community Bulletin SMS/WeChat magazine/CD programmes consultation education advocacy board eth#zon3 No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c c No, yes 0.54 0.52 2.59 0.31 0.47 0.44 1.83 0.74 (0.67–0.82) (0.48–0.59) (0.47–0.58) (2.31–2.91) (0.28–0.34) (0.41–0.53) (0.40–0.48) (1.65–2.04) c c c c c c c c Yes, no 1.26 1.60 1.49 2.42 1.22 1.92 2.30 1.56 (1.39–1.77) (1.11–1.44) (1.42–1.82) (1.29–1.72) (2.08–2.82) (1.08–1.39) (1.69–2.18) (1.98–2.68) eth#zon4 No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c No, yes 0.48 0.64 3.44 0.40 0.56 0.63 3.16 0.93 (0.84–1.03) (0.43–0.53) (0.58–0.71) (3.07–3.85) (0.37–0.45) (0.50–0.63) (0.58–0.69) (2.85–3.50) eth ethnicity; agg age group; edu education level; huk hukou; intpv interprovincial floating; mar first marriage; zon1 Pearl River Delta; zon2 Yangtze River Delta; zon3 Bohai Rim; zon4 other economic zone a–c 10, 5, and 1%, respectively As compared to HMFP not living in Bohai Rim, EMFP mainly used lecture to access occupational diseases infor- not living in Bohai Rim was more likely to use lec- mation in the three economic zones. Thus, Hypothesis 3 ture (aOR = 1.26, 95% CI 1.11–1.44), books/magazine/ was rejected. CD (aOR = 1.60, 95% CI 1.42–1.82), radio/TV pro- grammes (aOR = 1.49, 95% CI 1.29–1.72), face-to-face Discussion consultation (aOR = 2.42, 95% CI 2.08–2.82), online This study identified the associations of ethnicity with education (aOR = 1.22, 95% CI 1.08–1.39), commu- health knowledge categories and sources which varied nity advocacy (aOR = 1.92, 95% CI 1.69–2.18), bulletin by geodemographic factors. In particular, EMFP heav- board (aOR = 2.30, 95% CI 1.98–2.68), and SMS/WeChat ily relied on online health information to acquire health (aOR = 1.56, 95% CI 1.39–1.77) to obtain health knowl- knowledge. Pearl River Delta, Yangtze River Delta, and edge. Thus, Hypothesis 2 was accepted. Bohai Rim had significant associations with parts of health knowledge categories and sources among EMFP. Correlations between health information categories This indicated that there was regional inequity of health and sources knowledge transmission for EMFP in China. Lecture, In Table  5, most of correlations were weak (posi- books/magazine/CD, face-to-face consultation, online tive, > 0.20 and < 0.40). Likewise, rhos between a spe- education, community advocacy, and bulletin boards cific relationship in EMFP and HMFP in a specific zone must be the primary methods of delivering health edu- were not similar. But, there was zero correlation between cation among the floating population in China. The knowledge of nutrition and face-to-face consultation in research results can also provide a better reference for EMFP in Yangtze River Delta. There were negative corre - the governmental health information provision from the lation between knowledge of smoking control and lecture perspective of EMFP. and correlation between knowledge of smoking control Regarding level of health knowledge, the findings in and face-to-face consultation in EMFP in Yangtze River this study were in accord with prior studies. For exam- Delta. Furthermore in EMFP, rho between knowledge ple, a study in Shanghai found that most the floating of mental disorders and online education in other eco- population had an inadequate knowledge of tuberculosis nomic zone, rho between knowledge of tuberculosis and and their education level was associated with the ways radio/TV programmes in Pearl River Delta, rho between of obtaining knowledge [62]. Even worse, another study knowledge of STD/AIDS and online education in Bohai reported low level of health information literacy of Chi- Rim, rho between knowledge of other infectious dis- nese residents [63]. eases and community advocacy in other economic zone With respect to ethnic disparities in level of health were ≥ 0.50. Simultaneously, the other moderate correla- knowledge, the findings in this study were in line with tions in EMFP were reported. For example, correlations prior studies. For example, a study indicated many Yi eth- between knowledge of occupational diseases and lecture nicity women were lack of knowledge of antenatal care in Pearl River Delta, Yangtze River Delta, and other eco- and HIV prevention [64]. Compared to the Han Chinese, nomic zone were moderate (rhos > 0.40). Thus, EMFP another study indicated that the other ethnic groups Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 12 of 19 Table 5 Rho values of combinations of health knowledge categories and sources in four economic zones Category Source Pearl River Delta Yangtze River Delta Bohai Rim Other economic zone EMFP HMFP EMFP HMFP EMFP HMFP EMFP HMFP Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Occupational diseases Lecture 0.44 0.05 0.42 0.01 0.41 0.05 0.36 0.01 0.35 0.04 0.42 0.01 0.47 0.01 0.45 0.00 Books/magazine/CD 0.35 0.05 0.33 0.01 0.30 0.04 0.32 0.01 0.33 0.04 0.38 0.01 0.39 0.01 0.36 0.00 Radio/TV 0.34 0.05 0.19 0.02 0.11 0.05 0.14 0.01 0.19 0.05 0.16 0.01 0.22 0.02 0.23 0.01 Face-to-face consultation 0.17 0.06 0.25 0.01 0.26 0.05 0.25 0.01 0.23 0.05 0.32 0.01 0.37 0.01 0.31 0.00 Online education 0.35 0.05 0.30 0.01 0.38 0.04 0.31 0.01 0.40 0.04 0.36 0.01 0.48 0.01 0.38 0.00 Community advocacy 0.26 0.05 0.25 0.01 0.37 0.04 0.32 0.01 0.20 0.04 0.30 0.01 0.33 0.01 0.34 0.00 Bulletin board 0.12 0.06 0.26 0.02 0.32 0.05 0.26 0.01 0.22 0.05 0.24 0.01 0.29 0.02 0.28 0.01 SMS/WeChat 0.33 0.05 0.27 0.01 0.34 0.04 0.27 0.01 0.30 0.04 0.30 0.01 0.35 0.01 0.30 0.00 Nutrition Lecture 0.29 0.06 0.28 0.01 0.23 0.06 0.21 0.01 0.18 0.05 0.28 0.01 0.39 0.01 0.32 0.01 Books/magazine/CD 0.40 0.05 0.43 0.01 0.40 0.04 0.37 0.01 0.32 0.04 0.37 0.01 0.46 0.01 0.42 0.00 Radio/TV 0.37 0.05 0.33 0.01 0.39 0.05 0.36 0.01 0.24 0.05 0.34 0.01 0.35 0.02 0.35 0.01 Face-to-face consultation 0.13 0.06 0.24 0.02 0.00 0.06 0.17 0.01 0.16 0.05 0.21 0.01 0.31 0.01 0.23 0.01 Online education 0.35 0.05 0.41 0.01 0.39 0.04 0.35 0.01 0.19 0.05 0.35 0.01 0.47 0.01 0.39 0.00 Community advocacy 0.27 0.05 0.30 0.01 0.32 0.05 0.32 0.01 0.31 0.05 0.27 0.01 0.39 0.01 0.33 0.00 Bulletin board 0.22 0.06 0.19 0.02 0.18 0.05 0.22 0.01 0.14 0.05 0.18 0.01 0.30 0.02 0.24 0.01 SMS/WeChat 0.39 0.05 0.39 0.01 0.46 0.04 0.35 0.01 0.34 0.04 0.29 0.01 0.35 0.01 0.35 0.00 Reproduction Lecture 0.11 0.07 0.13 0.02 0.08 0.06 0.16 0.01 0.32 0.04 0.36 0.01 0.23 0.02 0.17 0.01 Books/magazine/CD 0.28 0.06 0.28 0.01 0.15 0.05 0.23 0.01 0.34 0.04 0.30 0.01 0.25 0.02 0.21 0.01 Radio/TV 0.34 0.06 0.19 0.02 0.15 0.06 0.16 0.01 0.14 0.05 0.11 0.01 0.21 0.02 0.12 0.01 Face-to-face consultation 0.30 0.07 0.28 0.02 0.25 0.06 0.30 0.01 0.40 0.05 0.45 0.01 0.38 0.02 0.33 0.01 Online education 0.12 0.06 0.18 0.02 0.18 0.05 0.22 0.01 0.24 0.04 0.18 0.01 0.26 0.02 0.19 0.01 Community advocacy 0.33 0.06 0.36 0.01 0.12 0.05 0.28 0.01 0.36 0.04 0.40 0.01 0.28 0.02 0.27 0.01 Bulletin board 0.47 0.05 0.40 0.02 0.19 0.05 0.27 0.01 0.45 0.04 0.47 0.01 0.25 0.02 0.30 0.01 SMS/WeChat 0.07 0.06 0.16 0.02 0.08 0.05 0.19 0.01 0.27 0.04 0.12 0.01 0.16 0.02 0.16 0.01 Chronic diseases Lecture 0.32 0.05 0.34 0.01 0.35 0.05 0.33 0.01 0.39 0.04 0.43 0.01 0.45 0.01 0.42 0.00 Books/magazine/CD 0.45 0.04 0.40 0.01 0.32 0.04 0.36 0.01 0.38 0.04 0.44 0.01 0.43 0.01 0.38 0.00 Radio/TV 0.34 0.05 0.27 0.02 0.14 0.06 0.22 0.01 0.28 0.05 0.28 0.01 0.29 0.02 0.29 0.01 Face-to-face consultation 0.26 0.06 0.36 0.01 0.34 0.05 0.35 0.01 0.41 0.04 0.41 0.01 0.42 0.01 0.38 0.00 Online education 0.46 0.04 0.38 0.01 0.30 0.04 0.32 0.01 0.39 0.04 0.40 0.01 0.43 0.01 0.37 0.00 Community advocacy 0.44 0.05 0.40 0.01 0.34 0.04 0.36 0.01 0.34 0.04 0.40 0.01 0.45 0.01 0.42 0.00 Bulletin board 0.23 0.06 0.32 0.02 0.33 0.05 0.32 0.01 0.37 0.04 0.37 0.01 0.37 0.02 0.36 0.01 SMS/WeChat 0.47 0.04 0.32 0.01 0.28 0.04 0.28 0.01 0.31 0.04 0.29 0.01 0.36 0.01 0.31 0.00 Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 13 of 19 Table 5 (continued) Category Source Pearl River Delta Yangtze River Delta Bohai Rim Other economic zone EMFP HMFP EMFP HMFP EMFP HMFP EMFP HMFP Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Smoking control Lecture 0.10 0.06 0.12 0.02 − 0.05 0.06 0.05 0.01 0.13 0.05 0.16 0.01 0.24 0.02 0.16 0.01 Books/magazine/CD 0.34 0.05 0.40 0.01 0.29 0.04 0.33 0.01 0.36 0.04 0.36 0.01 0.41 0.01 0.40 0.00 Radio/TV 0.38 0.05 0.39 0.01 0.31 0.05 0.34 0.01 0.37 0.04 0.38 0.01 0.34 0.02 0.40 0.01 Face-to-face consultation 0.21 0.06 0.20 0.02 − 0.02 0.06 0.08 0.01 0.12 0.05 0.17 0.01 0.18 0.02 0.15 0.01 Online education 0.44 0.05 0.41 0.01 0.33 0.04 0.33 0.01 0.45 0.04 0.41 0.01 0.43 0.01 0.40 0.00 Community advocacy 0.29 0.05 0.24 0.01 0.12 0.05 0.21 0.01 0.23 0.04 0.23 0.01 0.29 0.01 0.25 0.00 Bulletin board 0.14 0.06 0.18 0.02 0.23 0.05 0.19 0.01 0.22 0.05 0.21 0.01 0.27 0.02 0.22 0.01 SMS/WeChat 0.44 0.04 0.37 0.01 0.30 0.04 0.35 0.01 0.40 0.04 0.36 0.01 0.41 0.01 0.39 0.00 Mental disorders Lecture 0.31 0.06 0.35 0.01 0.27 0.06 0.29 0.01 0.41 0.05 0.40 0.01 0.39 0.01 0.37 0.01 Books/magazine/CD 0.41 0.05 0.44 0.01 0.40 0.05 0.41 0.01 0.44 0.05 0.48 0.01 0.48 0.01 0.44 0.00 Radio/TV 0.45 0.06 0.33 0.02 0.28 0.07 0.29 0.01 0.33 0.06 0.35 0.01 0.35 0.02 0.34 0.01 Face-to-face consultation 0.21 0.06 0.40 0.01 0.25 0.06 0.34 0.01 0.40 0.05 0.47 0.01 0.42 0.01 0.38 0.01 Online education 0.40 0.05 0.42 0.01 0.38 0.05 0.40 0.01 0.45 0.05 0.48 0.01 0.55 0.01 0.46 0.00 Community advocacy 0.43 0.05 0.42 0.01 0.47 0.05 0.42 0.01 0.49 0.04 0.49 0.01 0.47 0.01 0.46 0.00 Bulletin board 0.20 0.07 0.24 0.02 0.15 0.06 0.25 0.01 0.28 0.06 0.30 0.01 0.28 0.02 0.27 0.01 SMS/WeChat 0.43 0.05 0.40 0.01 0.36 0.05 0.35 0.01 0.39 0.05 0.38 0.01 0.43 0.01 0.38 0.01 Tuberculosis Lecture 0.36 0.05 0.35 0.01 0.31 0.05 0.32 0.01 0.47 0.04 0.45 0.01 0.37 0.01 0.36 0.00 Books/magazine/CD 0.45 0.04 0.40 0.01 0.40 0.04 0.38 0.01 0.41 0.04 0.44 0.01 0.38 0.01 0.38 0.00 Radio/TV 0.50 0.05 0.27 0.02 0.12 0.06 0.22 0.01 0.28 0.05 0.26 0.01 0.30 0.02 0.30 0.01 Face-to-face consultation 0.25 0.06 0.35 0.01 0.34 0.05 0.35 0.01 0.46 0.04 0.47 0.01 0.30 0.01 0.35 0.00 Online education 0.36 0.05 0.33 0.01 0.38 0.04 0.35 0.01 0.35 0.04 0.41 0.01 0.35 0.01 0.36 0.00 Community advocacy 0.38 0.05 0.40 0.01 0.38 0.05 0.40 0.01 0.37 0.04 0.45 0.01 0.40 0.01 0.42 0.00 Bulletin board 0.27 0.06 0.32 0.02 0.33 0.05 0.33 0.01 0.39 0.05 0.40 0.01 0.38 0.02 0.40 0.01 SMS/WeChat 0.43 0.05 0.33 0.01 0.36 0.05 0.33 0.01 0.26 0.04 0.32 0.01 0.33 0.01 0.32 0.00 Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 14 of 19 Table 5 (continued) Category Source Pearl River Delta Yangtze River Delta Bohai Rim Other economic zone EMFP HMFP EMFP HMFP EMFP HMFP EMFP HMFP Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE STD/AIDS Lecture 0.18 0.06 0.18 0.01 0.09 0.05 0.14 0.01 0.37 0.04 0.37 0.01 0.31 0.02 0.22 0.01 Books/magazine/CD 0.39 0.05 0.38 0.01 0.39 0.04 0.40 0.01 0.42 0.04 0.43 0.01 0.37 0.01 0.40 0.00 Radio/TV 0.39 0.05 0.32 0.01 0.34 0.05 0.32 0.01 0.36 0.04 0.31 0.01 0.30 0.02 0.37 0.01 Face-to-face consultation 0.14 0.06 0.27 0.02 0.13 0.05 0.22 0.01 0.39 0.05 0.39 0.01 0.27 0.02 0.27 0.01 Online education 0.41 0.05 0.36 0.01 0.34 0.04 0.35 0.01 0.53 0.04 0.39 0.01 0.36 0.02 0.37 0.00 Community advocacy 0.43 0.05 0.43 0.01 0.25 0.05 0.34 0.01 0.37 0.04 0.41 0.01 0.36 0.01 0.40 0.00 Bulletin board 0.40 0.05 0.32 0.02 0.33 0.05 0.31 0.01 0.45 0.04 0.43 0.01 0.40 0.02 0.36 0.01 SMS/WeChat 0.40 0.05 0.31 0.01 0.33 0.04 0.37 0.01 0.44 0.04 0.34 0.01 0.31 0.02 0.36 0.00 Other infectious diseases Lecture 0.17 0.06 0.23 0.01 0.16 0.05 0.25 0.01 0.25 0.04 0.33 0.01 0.37 0.01 0.30 0.00 Books/magazine/CD 0.40 0.05 0.39 0.01 0.35 0.04 0.34 0.01 0.24 0.04 0.39 0.01 0.37 0.01 0.37 0.00 Radio/TV 0.38 0.05 0.32 0.01 0.33 0.05 0.31 0.01 0.27 0.05 0.31 0.01 0.31 0.02 0.34 0.01 Face-to-face consultation 0.20 0.06 0.30 0.01 0.24 0.05 0.25 0.01 0.30 0.05 0.33 0.01 0.36 0.01 0.31 0.00 Online education 0.37 0.05 0.33 0.01 0.28 0.05 0.30 0.01 0.33 0.04 0.38 0.01 0.37 0.01 0.35 0.00 Community advocacy 0.48 0.04 0.42 0.01 0.46 0.04 0.42 0.01 0.44 0.04 0.48 0.01 0.54 0.01 0.49 0.00 Bulletin board 0.27 0.06 0.25 0.02 0.22 0.05 0.27 0.01 0.35 0.05 0.30 0.01 0.32 0.02 0.32 0.01 SMS/WeChat 0.37 0.05 0.33 0.01 0.28 0.05 0.31 0.01 0.29 0.04 0.34 0.01 0.34 0.01 0.33 0.00 N 940 13,013 1212 28,345 1355 31,350 11,089 102,041 Bold values denote rhos (> or = 0.40) and their standard errors (SE) Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 15 of 19 had lower cervical cancer knowledge levels [65]. Thus, Some health knowledge sources was highlighted in the observed ethnic differences in health knowledge may be sample could be possibly explained by several literature. related to governmental factors, environment, cultural The current state of public health information acquisition customs, or to potential combinations of these factors. via WeChat proved worrisome in China [80]. Actually, Considering health information categories, the find - a comparative study in 26 European countries indicated ings in this study were in agreement with prior studies. there were positive or negative relationships between For instance, a study showed significant disparity of the mobile media and the credibility of health sources [81]. rates of Tuberculosis education among the seven regions EMFP used Radio/TV to obtain knowledge of mental dis- in China [66]. A meta-analysis reported poor HIV-related orders and tuberculosis in Pearl River Delta rather than sexual knowledge among the floating population [67]. Yangtze River Delta, Bohai Rim, and other economic There were obvious differences regarding health informa - zone. The content concerning cardiovascular diseases tion sources related to cardiovascular diseases between in Chinese television health programs could be used to Hui Muslims and Han people [68]. communicate health information in China [82]. This pos - Considering geodemographic factors, the findings in sibly because Radio/TV could be still afforded for EMFP this study were in congruence with prior studies. For to receive health information. Meanwhile, investigations instance, sociodemographic factors were associated with indicated that face-to-face consultation and community the types of online health information sought among the advocacy could be considered as a more effective inter - general Chinese population [69]. Preferred sources of vention to promote health information quality [83, 84]. health information also varied by age and educational Zero and negative correlations between knowledge cate- level [70]. Additionally, a cross-sectional study identified gories and sources might be caused by poor health educa- there was a social gradient for health information literacy tion organizations and health information transmission. among urban older adults aged 60 + years in Western China [71]. Similarly, a cross-sectional survey indicated Strengths and limitations parental education and socioeconomic status were sig- There were two main strengths in this study. First, this nificantly associated with obtaining health information study considered EMFP in the associations of geodemo- among undergraduate nursing students in a medical uni- graphic factors with health knowledge categories and versity in Chongqing, China [72]. sources. The effort was to report ethnic disparities in Poor health awareness in this study could be explained access to health knowledge of the floating population. indirectly by inferior strength of geodemographic fac- Second, regressions with interactions could reflect the tors in place of departure and accuracy of health media. individual characteristics of EMFP in the ethnic dispari- For example, a descriptive study in a remote region of ties in access to health knowledge. Finally, the sample China showed that utilization of maternal health care size could be representative of structure of population services was associated with a range of social, eco- in China. According to Tabulation on 2010 Population nomic, cultural and geographic factors [73]. A system- Census of the People’s Republic of China (http:// www. atic review reported that traditional beliefs, low levels stats. gov. cn/ tjsj/ pcsj/ rkpc/ 6rp/ index ch. htm), Han major- of education, reimbursement difficulties, and language ity accounted for 91.60% in the total population, ethnic barriers limited the willingness of ethnic minority minority accounted for 8.40% in the total population. women to use maternal health services [74]. Another u Th s, the sample size of ethnic minority by and large cross-sectional study concluded ethnic disparities in accorded with proportion of total population in China. benefits distribution of government healthcare subsidies There were three main limitations in this study. First, in rural Chinese ethnic minority areas [75]. Simultane- whether the sample was from non-minority regions or ously, the quality of online health information about ethnic minority regions was not defined in the ques - breast cancer from Chinese language websites was poor tionnaire. Thus, comparative analyses between non- [76]. Because of illiteracy among the Chinese profes- minority regions and ethnic minority regions regarding sionalism, health-related advances in newspapers were policy interventions could not be conducted. Compared lack of accuracy [77]. An empirical evidence show social with non-minority regions, worse spatial healthcare media use for health information might lead to a nega- access, inequality in access to doctors and health pro- tive impact on pregnant women’s mental health [78]. fessionals, and uneven balance among primary, second- The primary reason was possibly that the total funding ary, and tertiary hospitals were documented in a study and funding per student of health professional educa- in ethnic minority region in Sichuan, China [85]. Sec- tion in China remained relatively low compared to other ond, medical and clinical measurements were defined countries from 1998 to 2017 [79]. in the questionnaire. Thus, biomedical explanations for Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 16 of 19 Ming Guan is head of the International Issues Center and Family Issues Center the main associations could not be obtained. For exam- at Xuchang University. He is interested in health care service, health change, ple, a cross-sectional observational study identified eth - and quality of life of migrants and elders in the world. nic differences in body composition and obesity-related Funding risk factors between Chinese and white males living in This project was funded by Multi-dimensional Evaluation of Health Service China [86]. Finally, some associations of interest were not System of Floating Population in Henan Province (in Chinese: 河南省流动人 reported by Poisson and logistic regressions because of 口健康服务体系多维度评价研究; Project number: 2020BSH014) from 2020 Planning of Philosophy and Social Sciences in Henan Province (in Chinese: collinearity. 2020年河南省哲学社会科学规划年度项目). This project was also funded by Construction study and practice of ideological and political teaching in the course of China Geography (in Chinese: 《中国地理》课程思政建设研究 Policy implications 与实践; Project number: 407) from Research and Practice Project of Higher Health education campaigns targeting EMFP should be Education & Pedagogy Reform in Henan Province in 2019 (in Chinese: 2019 actively promoted. To improve the health information 年度河南省高等教育教学改革研究与实践项目). The funding body played no role in the study design, data collection, data analysis, data interpretation literacy, high-quality health information services should and manuscript writing. The content is solely the responsibility of the authors be delivered to EMFP. Even Chinese college students had and does not necessarily represent the official views of the Henan Provincial insufficient knowledge/skills to identify health misinfor - Government. mation and disinformation [87]. u Th s, EMFP should not Availability of data and materials accept unregulated, inaccurate, and unactionable health http:// www. china ldrk. org. cn/. information. Given the floating attributes for the popu - lation, it is important to enrich health knowledge cat- Declarations egories and improve sources of health knowledge for the Ethics approval and consent to participate EMFP in China. Not applicable. Consent for publication Conclusions Not applicable. In conclusions, this study showed ethnic disparities in access to health knowledge categories and sources Competing interests The authors declared no potential competing interests with respect to the among the sample. Geographically, this study reported research, authorship and/or publication of this article. weak correlations between health knowledge catego- ries and sources in EMFP in China. Specially, this study Author details Xuchang Urban Water Pollution Control and Ecological Restoration Engi- reflected ethnic disparities with respect to inaccess neering Technology Research Center, Xuchang University, Xuchang, China. to health knowledge within specific regions of China. 2 College of Urban and Environmental Sciences, Xuchang University, Xuchang, Future interventions to control ethnic disparities and China. Grade 6 Class 7, Xuchang Municipal Xingye Road Primary School, Xuchang, Henan, China. Family Issues Center, Xuchang University, Xuchang, population-biased issues should address geodemo- Henan, China. International Issues Center, Xuchang University, Xuchang, graphic factors. 6 Henan, China. School of Business, Xuchang University, Xuchang, Henan, China. Abbreviations Received: 7 October 2021 Accepted: 8 March 2022 EMFP: Ethnic minority floating population; HMFP: Han majority floating popu- lation; STD/AIDS: Sexually transmitted diseases/acquired immunodeficiency syndrome; CI: Confidence interval; IRR: Incidence rate ratios; aOR: Adjusted odds ratio. References Acknowledgements 1. Ma R. Ethnic relations in contemporary China: cultural tradition and The authors of this paper would like to acknowledge the very helpful com- ethnic policies since 1949. Policy Soc. 2006;25(1):85–108. ments of the reviewers on the original submission. 2. Feng L, Li P, Wang X, Hu Z, Ma Y, Tang W, Ben Y, Mahapatra T, Cao X, Mahapatra S, Ling M, Gou A, Wang Y, Xiao J, Hou M, Wang X, Lin B, Wang Authors’ contributions F. Distribution and determinants of non communicable diseases among MG designed the study, performed the statistical analysis, and completed elderly Uyghur ethnic group in Xinjiang, China. PLoS ONE. 2014;9(8): the original version. 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Association between ethnicity and health knowledge among the floating population in China

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Springer Journals
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Copyright © The Author(s) 2022
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1478-7547
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10.1186/s12962-022-00349-0
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Abstract

Background: Health equity remains a priority concerns by central government in China. This study aimed to explore ethnic gaps in access to health knowledge categories and sources based on the survey data from a publicly available dataset. Methods: Data were from 2015 China Migrants Dynamic Survey issued by The National Health Commission in China. Descriptive analyses were performed to reflect geodemographic differences in the floating population of ethnic minority (EMFP) and Han majority (HMFP) with Chi-square test. Ethnic gaps in access to health knowledge categories and sources were explored with Poisson regressions, logistic regressions, and bivariate ordered probit regressions. Results: In the sample, most of participants had inadequate health information literacy. There were significant dif- ferences regarding geodemographic factors between EMFP and HMFP. Illiterate EMFP had likelihood to obtain less health knowledge categories (IRR = 0.80, 95% CI 0.77–0.84) and sources (IRR = 0.83, 95% CI 0.80–0.86) as compared to illiterate HMFP. Most of correlations between health knowledge categories and sources were weak in the samples of EMFP and HMFP. Conclusion: Ethnic disparities in access to health knowledge categories and sources among the floating population in China were confirmed. Further effective efforts should be provided to reduce ethnic disparities in access to health knowledge under the ethnicity-orientated support of public health resource. Keywords: Health knowledge categories, Health knowledge sources, Floating population, Ethnic minority, Han majority Background in China since the 2000s. Being one of the basic social Since the 1950s, China has adopted ethnic policy with demands, ethnic differences in access to health knowl - official goal of “equality de facto” and given ethnic minor - edge draw increasing attention in China in recent years. ities more political status, which has improved their soci- This study was performed to gain a better understanding oeconomic development [1]. However, ethnic disparities of ethnic access to health knowledge among the floating in disease prevalence and control management in China population in China. have been documented [2–8] in ethnic minority regions During the first decade of the twenty-first century, China’s population has been characterized as geographic diversification of destinations for the interprovincial *Correspondence: hanbingxue0451@163.com floating population in China’s western and interior Xuchang Urban Water Pollution Control and Ecological Restoration regions [9]. The classic theories of population migra - Engineering Technology Research Center, Xuchang University, Xuchang, China tion are found inappropriate for understanding existence Full list of author information is available at the end of the article of floating population [10]. The floating population is © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 2 of 19 characterized by low household healthcare expenditure knowledge categories [28]. Remarkably, lack of knowl- [11], low treatment rate in medical institutions [12], a edge was found to affect health/healthcare service uti - certain percentage of self-treatment behavior [13], and lization [29]. poor awareness of reproductive health [14] in China. A Clinically, a study indicated that orthodontic patients’ systematic review reported unhealthy lifestyle and defi - awareness of their periodontal health was affected by cient hypertension disease management among float - age, attitude and duration of orthodontic treatment ing population in China [15]. Meanwhile, part of China’s [30]. Regarding common persons, sociodemographic floating population might be at increased risk of acquir - factors could affect health knowledge of the elderly in ing the HIV transmission virus [16]. the sample areas of rural China [31]. Factors affect - Furthermore, a study with the data of 1% national pop- ing women’s knowledge of lifestyle-related risk factors ulation sample survey 2005 reported about 70% ethnic during pregnancy were specifically associated with minority floating population (EMFP) were from minor - socioeconomic status [32]. Even more important, the ity autonomous region, three fourth of whom come from socio-economic and educational factors were the fac- rural areas [17]. Currently, EMFP was mostly young tors that determined a greater level of general knowl- adults with deficient education, low incomes, and lack edge on oral health from the pregnant women [33]. of social security [18] and low wages [19, 20]. Accord- However, a systematic scoping review indicated una- ingly, the previous studies indicate that there are geode- vailable health knowledge was reported in the litera- mographic differences between Han and ethnic minority ture [34]. Studies documented lack of requisite health groups in China. knowledge in clinicians [35], Nepal diabetes patients In practice, health inequity among EMFP was neglected [36], paediatricians [37], Australian pharmacists [38], [21]. Prior research documented ethnic disparities in health professionals [39], primary care physicians infant feeding practices [22] and prevalence of smoking [40], and nurses working in heart failure units [41]. [23]. Simultaneously, a study indicated obvious ethnic Even worse, the gaps in oral health knowledge among disparities in self-rated health were mainly affected by a sample of pediatricians were reported [42]. Health socioeconomic factors [24]. Another study indicates that knowledge deficiency poses a serious threat on the health information might help mitigate the mental health improvement of health conditions among the individu- issues Chinese youth experienced [25]. Similarly, a study als of interest. Various sources of health knowledge in a rural Yunnan, China indicated that health education should be used to increase health knowledge categories was shown to be effective in promoting food-health- for them. Thus, we generate the first hypothesis: related knowledge in a rural ethnic minority community [26]. Thus, this study focused on the geodemographic Hypothesis 1: There existed ethnic disparities in access factors associating with health knowledge obtainment. to health knowledge categories among the floating popu - Moreover, it needs to confirm the relationships between lation in China. health knowledge categories and sources among EMFP in China. The motivation for this study is a concern that EMFP in China has differential access to health knowledge than Han majority floating population (HMFP). The second Early studies highlighted education in the health part reviewed current relevant literature and designed knowledge dissemination. For example, a study indi- hypotheses. The third part expounded data source, sam - cated significant positive changes in opinions were pling methods, main variables, and statistical strategies. observed following exposure to the peer education The forth part explored ethnic disparities in access to intervention [43]. Early studies highlighted medical health knowledge categories and sources between EMFP staff in the health knowledge transmission. For exam - and HMFP. The final part discussed the statistical results ple, medical professionals could effectively improve and concluded the paper. the health knowledge of people at high risk of stroke [44]. In addition, multiple studies indicated that health information could be disseminated by WeChat [45, 46], Literature review internet/social media [47, 48], visual messages [49], text Health education is acknowledged as an integral com- books [50], blogs [51], social media [52], iPad-based ponent of disease control and can potentially mitigate app [53], short-video app TikTok [54, 55], Sina Weibo adverse health outcomes for individuals. There was [56], booklet [57], mass media [58], and web-based gender difference with respect to relatively low oral educational film [59]. Consistent with literature, we health knowledge among the university students [27]. therefore hypothesized: Furthermore, there was importance difference in health Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 3 of 19 Hypothesis 2: There existed ethnic disparities in access programmes, face-to-face consultation, online education, to health knowledge sources among the floating popula - community advocacy, bulletin board, and SMS/WeChat. tion in China. Statistical strategies Hypothesis 3: There existed strong correlations between Descriptive analyses were performed to reflect geode - health knowledge categories and sources among EMFP in mographic differences between EMFP and HMFP with China. Chi-square test. Likewise, accessible disparities in health knowledge categories and sources could be exhibited. To investigate the role of ethnicity in health knowl- edge gaps between EMFP and HMFP, interaction terms Method between ethnicity and geodemographic factors were Data source considered as independent variables. Also, health knowl- This study employed the 2015 China Migrants Dynamic edge categories and sources acted as dependent variables. Survey (http:// www. china ldrk. org. cn/) data. The sur - Poisson regressions and logistic regressions with sup- vey employed stratified, multi-stage, scale-oriented pressing constant terms were adopted to reflect the asso - Probability Proportionate to Size method and covered ciations of ethnicity with health knowledge categories approximately 10,000 sample points. There were 35 and sources. provincial-level units in China including 23 provinces, 5 Accordingly, Poisson regressions on number of health autonomous regions, 4 municipalities directly under the knowledge categories and sources were conducted to Central Government, 2 special administrative regions reflect quantitative differences between EMFP and ( h t t p s : // b aik e. s o. c om/ do c / 23635 518- 24188 839. h tml) HMFP. Subsequently, logistic regressions were adopted and Xinjiang Production and Construction Corps. But, to analyze the associations of interactions between EMFP in this study, only 32 provincial-level units were surveyed and geodemographic factors with health knowledge cat- excluding Taiwan, Hong Kong, and Macau. In the sam- egories and sources. ple, EMFP included Mongolia ethnicity, Man ethnicity, To reflect a category of specific health knowledge’ Hui ethnicity, Zang ethnicity, Zhuang ethnicity, Uygur reliance on a specific health knowledge source, correla - ethnicity, Miao ethnicity, Yi ethnicity, Tujia ethnicity, tions between health knowledge categories and sources Buyi ethnicity, Dong ethnicity, Yao ethnicity, Korean eth- were performed with Stata program bioprobit [60]. The nicity, Bai ethnicity, Hani ethnicity, Li ethnicity, Kazakh covariates were age (continuous years) and floating years. ethnicity, Dai ethnicity, and other ethnicity. Three possible correlational results were positive corre - lation, negative correlation, and no correlation. Accord- ing to Evans (1996), the strength of the correlation were Main variables classified by “very weak” (the absolute value of correla - The main socioeconomic variables included gender tion coefficient (rho): 0.00–0.19), “weak” (the absolute (female = 0, male = 1), education level (illiteracy = 0, pri- value of rho: 0.20–0.39), “moderate” (the absolute value mary school, junior high school, high school/technical of rho: 0.40–0.59), “strong” (the absolute value of rho: secondary school, college, undergraduate, and graduate 0.60–0.79), and “very strong” (the absolute value of rho: students = 1), ethnicity (Han majority = 0, ethnic minor- 0.80–1.0) [61]. ity = 1), hukou (other = 0, agricultural = 1), first marriage (no = 0, yes = 1), and interprovincial floating (no = 0, yes = 1). The continuous age was coarsely categorized Results into young group (< 30), middle group (30–60), and old In this section, the original hypotheses will be statistically group (> 60). The main regional variables included Pearl explored. In order to reflect ethnic disparities in access to River Delta, Yangtze River Delta, Bohai Rim, and other health knowledge categories, ethnic disparities in access economic zone. Their response options were binary val - to health knowledge sources, and correlations between ues (no = 0, yes = 1). health knowledge categories and sources, Chi-square Here, health knowledge categories and sources were test, Poisson regressions, logistic regressions, and bivari- a series of dummy variables (no = 0, yes = 1). Health ate ordered probit regressions were performed. Based knowledge categories included occupational diseases, on a series of analyses, the original hypotheses would be nutrition, reproduction, chronic diseases, smoking con- judged whether or not one of them was accepted. trol, mental disorders, tuberculosis, sexually transmitted Totally, mean age of HMFP was 35.579 (± 10.591) years diseases/acquired immunodeficiency syndrome (STD/ old, while mean age of EMFP was 34.497 (± 11.180) years AIDS), and other infectious diseases. Health knowledge old. HMFP was averagely older than EMFP. Mean float - sources included lecture, books/magazine/CD, radio/TV ing time of HMFP was 4.711 (± 4.907) years, while mean Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 4 of 19 compared to HMFP not interprovincial floating. EMFP floating time of EMFP was 4.757 (± 5.146) years. u Th s, without first marriage had likelihood to obtain less health mean floating time of HMFP was shorter than that of knowledge categories (IRR = 0.97, 95% CI 0.95–0.99) EMFP. and more health knowledge sources (IRR = 1.03, 95% CI In Table  1, there were significant differences regarding 1.01–1.04) as compared to HMFP without first marriage. gender, education level, hukou, first marriage, interpro - EMFP not living in Pearl River Delta had likelihood to vincial floating, Pearl River Delta, Yangtze River Delta, obtain more health knowledge categories (IRR = 1.06, Bohai Rim, other economic zone, occupational disease, 95% CI 1.01–1.11) and sources (IRR = 1.13, 95% CI nutrition, reproduction, smoking control, tuberculosis, 1.09–1.18) as compared to HMFP not living in Pearl STD/AIDS, other infectious disease, lecture, radio/TV River Delta. EMFP not living in Yangtze River Delta had programmes, face-to-face consultation, online education, likelihood to obtain more health knowledge categories community advocacy, bulletin board, and SMS/WeChat (IRR = 1.33, 95% CI 1.26–1.39) and sources (IRR = 1.15, between HMFP and EMFP. 95% CI 1.12–1.19) as compared to HMFP not living in Regarding health knowledge categories (n = 205,990), Yangtze River Delta. EMFP not living in Bohai Rim had knowledge of reproduction (66.62%) was the most pop- likelihood to obtain more health knowledge categories ular health knowledge category for the total sample fol- (IRR = 1.33, 95% CI 1.28–1.38) and sources (IRR = 1.24, lowed by knowledge of nutrition (65.18%), smoking 95% CI 1.20–1.28) as compared to HMFP not living in control (60.96%), STD/AIDS (56.33%), chronic diseases Bohai Rim. (42.02%), occupational diseases (39.76%), tuberculosis (37.60%), other infectious diseases (36.97%), and mental Association between ethnicity and health knowledge disorders (19.43%). Knowledge of reproduction (5.00%) categories were the most popular health knowledge category for In Table 3, old EMFP was less likely to acquire knowledge the EMFP followed by knowledge of STD/AIDS (4.90%), of occupational diseases (aOR = 0.40, 95% CI 0.28–0.55), nutrition (4.63%), smoking control (4.55%), tuberculosis reproduction (aOR = 0.23, 95% CI 0.17–0.32), chronic (3.52%), chronic diseases (3.32%), other infectious dis- diseases (aOR = 0.22, 95% CI 0.17–0.30), smoking con- eases (3.25%), occupational diseases (2.78%), and mental trol (aOR = 0.55, 95% CI 0.41–0.75), mental disorders disorders (1.55%). (aOR = 0.05, 95% CI 0.04–0.08), tuberculosis (aOR = 0.05, Regarding health knowledge sources (n = 189,345), bul- 95% CI 0.03–0.06), STD/AIDS (aOR = 0.06, 95% CI 0.05– letin board (83.45%) was most utilized by the total sam- 0.08), and other infectious diseases (aOR = 0.13, 95% CI ple, followed by radio/TV programmes (79.74%), SMS/ 0.09–0.17) as compared to young HMFP. Female EMFP WeChat (56.30%), books/magazine/CD (43.23%), online was less likely to acquire knowledge of occupational education (41.91%), community advocacy (38.49%), lec- diseases (aOR = 0.81, 95% CI 0.76–0.87) and smoking ture (30.71%), and face-to-face consultation (27.36%). In control (aOR = 0.63, 95% CI 0.59–0.67) and more likely EMFP, bulletin board (6.57%) was most utilized, followed to acquire knowledge of nutrition (aOR = 1.17, 95% CI by radio/TV programmes (6.25%), SMS/WeChat (4.11%), 1.10–1.25) and reproduction (aOR = 1.58, 95% CI 1.48– books/magazine/CD (3.31%), community advocacy 1.70) as compared to female HMFP. (3.17%), online education (2.84%), lecture (2.42%), and Illiterate EMFP had less likelihood to obtain health face-to-face consultation (2.36%). knowledge of occupational diseases (aOR = 0.53, 95% CI 0.46–0.62), nutrition (aOR = 0.60, 95% CI 0.53–0.69), Association between ethnicity and number of health reproduction (aOR = 0.60, 95% CI 0.53–0.69), chronic knowledge categories and sources diseases (aOR = 0.61, 95% CI 0.53–0.70), smoking con- In Table 2, EMFP was likely to obtain more health knowl- trol (aOR = 0.61, 95% CI 0.53–0.69), mental disorders edge categories and sources as compared to young (aOR = 0.72, 95% CI 0.60–0.86), tuberculosis (aOR = 0.86, HMFP. Illiterate EMFP had likelihood to obtain less 95% CI 0.76–0.98), STD/AIDS (aOR = 0.61, 95% CI 0.53– health knowledge categories [IRR = 0.80, 95% Confi - 0.69), and other infectious diseases (aOR = 0.77, 95% CI dence Interval (CI) 0.77–0.84] and sources (IRR = 0.83, 0.67–0.88) as compared to illiterate HMFP. 95% CI 0.80–0.86) as compared to illiterate HMFP. EMFP EMFP with non-agricultural hukou had more like- with non-agricultural hukou had likelihood to obtain lihood to obtain health knowledge of occupational more health knowledge categories (IRR = 1.08, 95% CI diseases (aOR = 1.28, 95% CI 1.16–1.40), nutri- 1.05–1.11) and sources (IRR = 1.08, 95% CI 1.06–1.11) as tion (aOR = 1.23, 95% CI 1.12–1.35), chronic dis- compared to HMFP with non-agricultural hukou. EMFP eases (aOR = 1.32, 95% CI 1.20–1.44), smoking not interprovincial floating had likelihood to obtain control (aOR = 1.29, 95% CI 1.17–1.42), mental dis- health more knowledge categories (IRR = 1.06, 95% CI orders (aOR = 1.29, 95% CI 1.16–1.44), tuberculosis 1.04–1.09) as and sources (IRR = 1.02, 95% CI 1.00–1.04) Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 5 of 19 Table 1 Sample characteristics of floating population by ethnicity Column Han majority (%) Ethnic Chi-square P value percentage minority (%) Age (N = 206,000) 138.2422 0.000 Young 36.31 33.15 3.16 Middle 61.31 56.83 4.48 Old 2.38 2.16 0.22 Gender (N = 206,000) 20.2281 0.000*** Male 53.07 49.03 4.04 Female 46.93 43.12 3.81 Education level (N = 206,000) 2.0e+03 0.000*** No 1.89 1.38 0.51 Yes 98.11 90.77 7.34 Hukou (N = 206,000) 87.6745 0.000*** Other 16.41 15.33 1.08 Agricultural 83.59 76.81 6.78 First marriage (N = 206,000) 325.7945 0.000*** No 22.59 20.37 2.22 Yes 77.41 71.78 5.63 Interprovincial floating (N = 206,000) 1.4e+03 0.000*** No 50.12 45.08 5.04 Yes 49.88 47.06 2.82 Pearl river delta (N = 206,000) 20.1735 0.000*** No 92.71 85.36 7.35 Yes 7.29 6.79 0.50 Yangtze river delta (N = 206,000) 650.5791 0.000*** No 92.14 76.37 15.77 Yes 7.86 7.12 0.74 Bohai Rim (N = 206,000) 726.1827 0.000*** No 92.15 75.89 16.26 Yes 7.85 7.12 0.73 Other economic zone (N = 206,000) 1.8e+03 0.000*** No 40.77 38.80 1.97 Yes 59.23 53.35 5.88 Knowledge of occupational disease (N = 205,990) 141.4147 0.000*** No 60.24 55.16 5.08 Yes 39.76 36.98 2.78 Knowledge of nutrition (N = 205,990) 299.2678 0.000*** No 34.82 31.60 3.22 Yes 65.18 60.55 4.63 Knowledge of reproduction (N = 205,990) 69.9840 0.000*** No 33.38 30.53 2.86 Yes 66.62 61.62 5.00 Knowledge of chronic disease (N = 205,990) 0.2375 0.626 No 57.98 53.44 4.54 Yes 42.02 38.70 3.32 Knowledge of smoking control (N = 205,990) 70.6805 0.000*** No 39.04 35.73 3.31 Yes 60.96 56.41 4.55 Knowledge of mental disorders (N = 205,990) 0.7932 0.373 No 80.57 74.26 6.31 Yes 19.43 17.88 1.55 Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 6 of 19 Table 1 (continued) Column Han majority (%) Ethnic Chi-square P value percentage minority (%) Knowledge of tuberculosis (N = 205,990) 382.4506 0.000*** No 62.40 58.06 4.34 Yes 37.60 34.09 3.52 Knowledge of STD/AIDS (N = 205,990) 264.1414 0.000*** No 43.67 40.72 2.95 Yes 56.33 51.42 4.90 Knowledge of other infectious disease (N = 205,990) 148.4978 0.000*** No 63.03 58.43 4.60 Yes 36.97 33.72 3.25 Lecture (N = 189,345) 3.2577 0.071* No 69.29 64.00 5.29 Yes 30.71 28.29 2.42 Books/magazine/CD (N = 189,345) 0.3808 0.537 No 56.77 52.37 4.39 Yes 43.23 39.92 3.31 Radio/TV programmes (N = 189,345) 19.2453 0.000*** No 20.26 18.81 1.45 Yes 79.74 73.48 6.25 Face-to-face consultation (N = 189,345) 83.8634 0.000*** No 72.64 67.29 5.35 Yes 27.36 25.00 2.36 Online education (N = 189,345) 164.7912 0.000*** No 58.09 53.22 4.87 Yes 41.91 39.07 2.84 Community advocacy (N = 189,345) 43.9996 0.000*** No 61.51 56.96 4.54 Yes 38.49 35.33 3.17 Bulletin board (N = 189,345) 37.0847 0.000*** No 16.55 15.41 1.14 Yes 83.45 76.88 6.57 SMS/WeChat (N = 189,345) 55.6273 0.000*** No 43.70 40.11 3.60 Yes 56.30 52.19 4.11 * and *** represent 10 and 1%, respectively EMFP without first marriage had less likelihood to (aOR = 1.18, 95% CI 1.07–1.30), and other infectious obtain health knowledge of nutrition (aOR = 0.91, 95% CI diseases (aOR = 1.12, 95% CI 1.02–1.23) as compared 0.84–0.98), reproduction (aOR = 0.45, 95% CI 0.42–0.49) to HMFP with non-agricultural hukou. and had more likelihood to obtain health knowledge of EMFP not interprovincial floating had more likelihood other infectious diseases (aOR = 1.09, 95% CI 1.01–1.18) to obtain health knowledge of nutrition (aOR = 1.14, as compared to HMFP without first marriage. 95% CI 1.05–1.24), chronic diseases (aOR = 1.15, 95% Geographically, EMFP not living in Pearl River Delta CI 1.06–1.25), smoking control (aOR = 1.12, 95% CI had less likelihood to obtain health knowledge of occu 1.03–1.22), mental disorders (aOR = 1.10, 95% CI 1.00– pational diseases (aOR = 0.60, 95% CI 0.52–0.69) 1.22), tuberculosis (aOR = 1.26, 95% CI 1.16–1.37), and reproduction (aOR = 0.82, 95% CI 0.70–0.96) STD/AIDS (aOR = 1.20, 95% CI 1.10–1.31), and other and more likelihood to obtain health knowledge of infectious diseases (aOR = 1.24, 95% CI 1.14–1.34) nutrition (aOR = 1.25, 95% CI 1.09–1.45), chronic compared to HMFP without interprovincial floating. Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 7 of 19 Table 2 Poisson regressions on number of health knowledge diseases (aOR = 1.34, 95% CI 1.15–1.55), smoking control categories and sources, IRR (95% CI) (aOR = 1.23, 95% CI 1.07–1.42), tuberculosis (aOR = 1.59, 95% CI 1.37–1.85), and STD/AIDS (aOR = 1.61, 95% Number of health Number of health knowledge categories knowledge sources CI 1.39–1.86) as compared to HMFP not living in Pearl River Delta. IRR 95% CI IRR 95% CI EMFP not living in Yangtze River Delta had more likeli- eth#agg hood to obtain health knowledge of nutrition (aOR = 1.15, NO, young 1 [Reference] 1 [Reference] 95% CI 1.01–1.30), reproduction (aOR = 1.61, 95% CI NO, middle 0.98*** 0.98–0.99 0.95*** 0.94–0.95 1.41–1.84), chronic diseases (aOR = 1.91, 95% CI 1.67– NO, old 0.83*** 0.81–0.85 0.80*** 0.79–0.81 2.19), smoking control (aOR = 1.30, 95% CI 1.15–1.48), Yes, young 2.37*** 2.19–2.57 2.58*** 2.43–2.73 mental disorders (aOR = 1.67, 95% CI 1.40–2.00), tuber- Yes, middle 2.32*** 2.15–2.51 2.47*** 2.33–2.62 culosis (aOR = 3.38, 95% CI 2.92–3.91), STD/AIDS Yes, old 1.88*** 1.69–2.10 2.12*** 1.96–2.29 (aOR = 2.40, 95% CI 2.11–2.73), and other infectious eth#gender diseases (aOR = 2.01, 95% CI 1.75–2.31) as compared to No, no 1 [Reference] 1 [Reference] HMFP not living in Yangtze River Delta. No, yes 1.00 0.99–1.00 0.99*** 0.99–1.00 EMFP not living in Bohai Rim had less likelihood to Yes, no 1.00 0.98–1.02 1.00 0.99–1.02 obtain health knowledge of nutrition (aOR = 0.82, 95% eth#edu CI 0.73–0.93) and had more likelihood to obtain health No, no 1 [Reference] 1 [Reference] knowledge of reproduction (aOR = 1.85, 95% CI 1.65– No, yes 1.23*** 1.20–1.27 1.24*** 1.21–1.27 2.08), chronic diseases (aOR = 1.73, 95% CI 1.53–1.94), Yes, no 0.80*** 0.77–0.84 0.83*** 0.80–0.86 smoking control (aOR = 1.23, 95% CI 1.09–1.38), mental eth#huk disorders (aOR = 1.98, 95% CI 1.69–2.33), tuberculosis No, no 1 [Reference] 1 [Reference] (aOR = 3.09, 95% CI 2.72–3.50), STD/AIDS (aOR = 3.50, No, yes 0.92*** 0.91–0.93 0.93*** 0.93–0.94 95% CI 3.11–3.94), and other infectious diseases Yes, no 1.08*** 1.05–1.11 1.08*** 1.06–1.11 (aOR = 2.15, 95% CI 1.90–2.44) as compared to HMFP eth#intpv not living in Bohai Rim. Thus, there existed disparities No, no 1 [Reference] 1 [Reference] in association between ethnicity and health knowledge No, yes 0.96*** 0.96–0.97 0.98*** 0.98–0.99 categories among EMFP. Accordingly, Hypothesis 1 was Yes, no 1.06*** 1.04–1.09 1.02** 1.00–1.04 accepted. eth#mar No, no 1 [Reference] 1 [Reference] Association between ethnicity and health knowledge No, yes 1.02*** 1.01–1.03 1.00 0.99–1.00 sources Yes, no 0.97** 0.95–0.99 1.03*** 1.01–1.04 In Table  4, as compared to young HMFP, EMFP was eth#zon1 more likely to use radio/TV programmes and bulletin No, no 1 [Reference] 1 [Reference] board and less likely to use lecture, face-to-face consul- No, yes 3.89*** 3.76–4.01 3.58*** 3.49–3.67 tation, online education, community advocacy, and SMS/ Yes, no 1.06** 1.01–1.11 1.13*** 1.09–1.18 WeChat to obtain health knowledge. eth#zon2 As compared to female HMFP, female EMFP was No, no 1 [Reference] 1 [Reference] more likely to use lecture (aOR = 1.14, 95% CI 1.06– No, yes 3.54*** 3.43–3.65 3.51*** 3.43–3.60 1.23), radio/TV programmes (aOR = 1.08, 95% CI Yes, no 1.33*** 1.26–1.39 1.15*** 1.12–1.19 0.99–1.17), face-to-face consultation (aOR = 1.15, 95% eth#zon3 CI 1.07–1.24), and community advocacy (aOR = 1.13, No, no 1 [Reference] 1 [Reference] 95% CI 1.05–1.20) and were less likely to use books/ No, yes 3.43*** 3.32–3.54 3.39*** 3.31–3.47 magazine/CD (aOR = 0.93, 95% CI 0.87–1.00), online Yes, no 1.33*** 1.28–1.38 1.24*** 1.20–1.28 education (aOR = 0.89, 95% CI 0.83–0.96), and SMS/ eth#zon4 WeChat (aOR = 0.88, 95% CI 0.82–0.94) to obtain health No, no 1 [Reference] 1 [Reference] knowledge. No, yes 3.94*** 3.82–4.07 3.74*** 3.65–3.83 As compared to Illiterate HMFP, illiterate EMFP was N 205,990 189,345 more likely to obtain health knowledge with lecture (aOR = 0.81, 95% CI 0.69–0.95), books/magazine/CD eth ethnicity; agg age group; edu education level; huk hukou; intpv interprovincial floating; mar first marriage; zon1 Pearl River Delta; zon2 Yangtze (aOR = 0.45, 95% CI 0.39–0.53), face-to-face consulta- River Delta; zon3 Bohai Rim; zon4 other economic zone tion (aOR = 0.85, 95% CI 0.73–1.00), online education ** and *** represent 5 and 1%, respectively Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 8 of 19 Table 3 Logistic regression on health knowledge categories (N = 205,990), Odds Ratio [95% Confidence Interval] Occupational Nutrition Reproduction Chronic Smoking Mental Tuberculosis STD/AIDS Other disease disease control disorders infectious disease eth#agg NO, 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] young ence] ence] ence] ence] ence] c c c c b c c NO, mid- 0.93 0.93 0.80 1.12 0.99 0.97 1.07 0.90 0.99 dle (0.91–0.95) (0.90–0.95) (0.78–0.82) (1.09–1.14) (0.96–1.01) (0.94–0.99) (1.05–1.10) (0.88–0.92) (0.97–1.02) c c c c c a c c NO, old 0.44 1.03 0.18 1.60 0.83 0.84 1.06 0.39 0.90 (0.41–0.48) (0.97–1.10) (0.17–0.19) (1.51–1.71) (0.78–0.89) (0.78–0.91) (0.99–1.13) (0.37–0.42) (0.84–0.96) c c c c c Yes, 0.92 (0.72–1.17) 1.18 0.92 (0.72–1.18) 0.17 0.89 0.06 0.05 0.15 0.15 young (0.93–1.49) (0.13–0.21) (0.70–1.13) (0.05–0.09) (0.04–0.06) (0.12–0.19) (0.12–0.19) a a c c c c c Yes, mid- 0.81 1.03 0.79 0.17 0.86 0.06 0.05 0.14 0.15 dle (0.64–1.03) (0.82–1.29) (0.62–1.01) (0.13–0.22) (0.68–1.08) (0.05–0.09) (0.04–0.07) (0.11–0.18) (0.12–0.20) c c c c c c c c Yes, old 0.40 0.82 0.23 0.22 0.55 0.05 0.05 0.06 0.13 (0.28–0.55) (0.61–1.10) (0.17–0.32) (0.17–0.30) (0.41–0.75) (0.04–0.08) (0.03–0.06) (0.05–0.08) (0.09–0.17) eth#gender No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c No, yes 1.24 0.78 0.57 1.00 1.76 0.96 1.01 0.96 0.96 (1.22–1.27) (0.77–0.80) (0.56–0.58) (0.98–1.02) (1.73–1.80) (0.94–0.98) (0.99–1.03) (0.94–0.98) (0.95–0.98) c c c c Yes, no 0.81 1.17 1.58 0.99 0.63 1.05 0.98 1.02 1.03 (0.76–0.87) (1.10–1.25) (1.48–1.70) (0.93–1.06) (0.59–0.67) (0.97–1.14) (0.92–1.04) (0.96–1.10) (0.97–1.10) eth#edu No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c c c No, yes 1.64 1.69 1.79 1.36 1.42 1.35 1.26 1.59 1.34 (1.50–1.79) (1.57–1.82) (1.65–1.94) (1.25–1.47) (1.31–1.53) (1.21–1.50) (1.16–1.36) (1.47–1.72) (1.23–1.45) c c c c c c b c c Yes, no 0.53 0.60 0.60 0.61 0.61 0.72 0.86 0.61 0.77 (0.46–0.62) (0.53–0.69) (0.53–0.69) (0.53–0.70) (0.53–0.69) (0.60–0.86) (0.76–0.98) (0.53–0.69) (0.67–0.88) eth#huk No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c c c No, yes 0.75 0.77 0.92 0.79 0.87 0.77 0.87 0.89 0.87 (0.73–0.77) (0.75–0.79) (0.90–0.95) (0.77–0.81) (0.85–0.89) (0.75–0.80) (0.85–0.89) (0.87–0.91) (0.84–0.89) c c c c c c b Yes, no 1.28 1.23 0.93 (0.85–1.03) 1.32 1.29 1.29 1.18 1.06 1.12 (1.16–1.40) (1.12–1.35) (1.20–1.44) (1.17–1.42) (1.16–1.44) (1.07–1.30) (0.96–1.17) (1.02–1.23) eth#intpv No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c c No, yes 0.86 0.77 0.89 0.92 0.87 0.94 1.00 1.09 0.95 (0.84–0.87) (0.76–0.79) (0.87–0.91) (0.90–0.94) (0.85–0.89) (0.91–0.96) (0.98–1.03) (1.07–1.11) (0.93–0.97) c c c a c c c Yes, no 1.00 (0.92–1.09) 1.14 1.05 (0.96–1.14) 1.15 1.12 1.10 1.26 1.20 1.24 (1.05–1.24) (1.06–1.25) (1.03–1.22) (1.00–1.22) (1.16–1.37) (1.10–1.31) (1.14–1.34) eth#mari No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c b c c c c a c No, yes 0.80 1.03 2.54 0.95 0.99 0.88 0.91 1.02 0.90 (0.78–0.82) (1.01–1.06) (2.48–2.61) (0.93–0.97) (0.96–1.01) (0.86–0.91) (0.89–0.94) (1.00–1.05) (0.88–0.92) b c b Yes, no 1.03 (0.95–1.11) 0.91 0.45 1.03 1.01 1.08 1.05 1.07 1.09 (0.84–0.98) (0.42–0.49) (0.95–1.11) (0.94–1.09) (0.98–1.18) (0.97–1.13) (0.99–1.16) (1.01–1.18) eth#zon1 No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c No, yes 0.95 (0.86–1.05) 1.59 1.40 0.62 0.99 0.28 0.49 0.95 0.64 (1.45–1.74) (1.27–1.55) (0.56–0.68) (0.90–1.08) (0.25–0.32) (0.44–0.53) (0.87–1.04) (0.59–0.71) Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 9 of 19 Table 3 (continued) Occupational Nutrition Reproduction Chronic Smoking Mental Tuberculosis STD/AIDS Other disease disease control disorders infectious disease c c b c c c c Yes, no 0.60 1.25 0.82 1.34 1.23 1.13 1.59 1.61 1.03 (0.52–0.69) (1.09–1.45) (0.70–0.96) (1.15–1.55) (1.07–1.42) (0.94–1.36) (1.37–1.85) (1.39–1.86) (0.89–1.19) eth#zon2 No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c c c c c No, yes 0.70 1.92 0.78 0.57 1.01 0.25 0.38 0.70 0.46 (0.63–0.77) (1.76–2.10) (0.71–0.86) (0.53–0.63) (0.93–1.10) (0.22–0.28) (0.35–0.42) (0.64–0.76) (0.42–0.51) b c c c c c c c Yes, no 1.08 (0.95–1.23) 1.15 1.61 1.91 1.30 1.67 3.38 2.40 2.01 (1.01–1.30) (1.41–1.84) (1.67–2.19) (1.15–1.48) (1.40–2.00) (2.92–3.91) (2.11–2.73) (1.75–2.31) eth#zon3 No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c b c b c c c c No, yes 0.59 2.06 0.90 0.56 0.91 0.19 0.35 0.63 0.42 (0.54–0.65) (1.89–2.24) (0.82–0.99) (0.51–0.61) (0.83–0.99) (0.17–0.21) (0.32–0.39) (0.57–0.68) (0.38–0.46) c c c c c c c c Yes, no 1.08 (0.96–1.21) 0.82 1.85 1.73 1.23 1.98 3.09 3.50 2.15 (0.73–0.93) (1.65–2.08) (1.53–1.94) (1.09–1.38) (1.69–2.33) (2.72–3.50) (3.11–3.94) (1.90–2.44) eth#zon4 No, no 1 [Reference] 1 [Refer- 1 [Reference] 1 [Refer- 1 [Refer- 1 [Refer- 1 [Reference] 1 [Refer- 1 [Reference] ence] ence] ence] ence] ence] c c c c b c c c c No, yes 0.60 1.88 1.17 0.72 1.09 0.29 0.66 1.13 0.63 (0.55–0.66) (1.73–2.05) (1.07–1.28) (0.66–0.78) (1.01–1.19) (0.26–0.32) (0.61–0.72) (1.04–1.23) (0.57–0.68) eth ethnicity; agg age group; edu education level; huk hukou; intpv interprovincial floating; mar first marriage; zon1 Pearl River Delta; zon2 Yangtze River Delta; zon3 Bohai Rim; zon4 other economic zone a–c 10, 5, and 1%, respectively (aOR = 0.42, 95% CI 0.35–0.51), community advo- magazine/CD (aOR = 1.15, 95% CI 1.06–1.24), online cacy (aOR = 0.74, 95% CI 0.64–0.86), bulletin board education (aOR = 1.21, 95% CI 1.11–1.31), and SMS/ (aOR = 0.52, 95% CI 0.44–0.62), and SMS/WeChat WeChat (aOR = 1.19, 95% CI 1.09–1.29) and were less (aOR = 0.63, 95% CI 0.54–0.73). likely to use face-to-face consultation (aOR = 0.78, 95% As compared to HMFP with non-agricultural hukou, CI 0.72–0.86) to obtain health knowledge. EMFP with non-agricultural hukou was more likely As compared to HMFP not living in Pearl River Delta, to use lecture (aOR = 1.32, 95% CI 1.19–1.46), books/ EMFP not living in Pearl River Delta was more likely magazine/CD (aOR = 1.34, 95% CI 1.22–1.48), online to use lecture (aOR = 1.80, 95% CI 1.50–2.15), books/ education (aOR = 1.50, 95% CI 1.36–1.66), community magazine/CD (aOR = 1.22, 95% CI 1.05–1.43), radio/ advocacy (aOR = 1.20, 95% CI 1.09–1.32), and SMS/ TV programmes (aOR = 1.20, 95% CI 0.99–1.44), face- WeChat (aOR = 1.46, 95% CI 1.32–1.61) and were less to-face consultation (aOR = 2.25, 95% CI 1.86–2.72), likely to use face-to-face consultation (aOR = 0.86, 95% community advocacy (aOR = 1.44, 95% CI 1.23–1.68), CI 0.77–0.96) to obtain health knowledge. bulletin board (aOR = 1.28, 95% CI 1.03–1.57), and SMS/ Compared with HMFP without interprovincial float - WeChat (aOR = 1.27, 95% CI 1.09–1.48) to obtain health ing, EMFP not interprovincial floating was more likely knowledge. to use lecture (aOR = 1.12, 95% CI 1.02–1.23), face- As compared to HMFP not living in Yangtze River to-face consultation (aOR = 1.23, 95% CI 1.12–1.35), Delta, EMFP not living in Yangtze River Delta was more community advocacy (aOR = 1.19, 95% CI 1.09–1.30), likely to use lecture (aOR = 2.37, 95% CI 1.99–2.82), bulletin board (aOR = 1.12, 95% CI 0.99–1.27), and books/magazine/CD (aOR = 1.16, 95% CI 1.01–1.33), were less likely to use online education (aOR = 0.96, face-to-face consultation (aOR = 2.50, 95% CI 2.09–2.99), 95% CI 0.87–1.05) and SMS/WeChat (aOR = 0.86, 95% community advocacy (aOR = 1.80, 95% CI 1.55–2.09), CI 0.79–0.94) to obtain health knowledge. and bulletin board (aOR = 1.71, 95% CI 1.43–2.05) and As compared to HMFP without first marriage, were less likely to use radio/TV programmes (aOR = 0.84, EMFP without first marriage was more likely to 95% CI 0.70–1.01) to obtain health knowledge. use lecture (aOR = 1.10, 95% CI 1.01–1.20), books/ Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 10 of 19 Table 4 Logistic regression on health knowledge sources, Odds Ratio [95% Conf. Interval] (N = 189,345) Lecture Books/ Radio/TV Face-to-face Online Community Bulletin SMS/WeChat magazine/CD programmes consultation education advocacy board eth#agg NO, young 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] a c c a c c c c NO, middle 1.02 0.86 1.09 0.98 0.60 1.06 1.04 0.67 (0.66–0.69) (1.00–1.04) (0.84–0.88) (1.06–1.12) (0.95–1.00) (0.59–0.62) (1.04–1.09) (1.01–1.07) c c c c c c c NO, old 1.26 0.51 1.58 1.05 (0.97– 0.14 1.22 0.76 0.14 (0.13–0.16) (1.17–1.35) (0.48–0.55) (1.44–1.73) 1.13) (0.13–0.15) (1.14–1.30) (0.70–0.82) c c c c c c a Yes, young 0.08 0.36 2.57 0.04 0.65 0.13 1.31 0.80 (0.62–1.03) (0.06–0.10) (0.28–0.47) (1.88–3.50) (0.03–0.05) (0.50–0.84) (0.10–0.17) (0.93–1.83) c c c c c c a c Yes, middle 0.08 0.33 3.01 0.03 0.44 0.13 1.32 0.58 (0.46–0.75) (0.06–0.10) (0.26–0.42) (2.23–4.07) (0.02–0.05) (0.34–0.56) (0.10–0.17) (0.96–1.83) c c c c c c c Yes, old 0.09 0.23 3.81 0.04 0.10 0.16 0.74 0.15 (0.11–0.21) (0.06–0.12) (0.16–0.32) (2.52–5.77) (0.03–0.06) (0.06–0.15) (0.11–0.22) (0.49–1.12) eth#gender No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c No, yes 0.89 1.04 0.99 (0.97– 0.85 1.10 0.93 0.95 1.09 (1.07–1.11) (0.87–0.90) (1.02–1.06) 1.02) (0.83–0.87) (1.08–1.12) (0.91–0.95) (0.92–0.97) c b a c c c c Yes, no 1.14 0.93 1.08 1.15 0.89 1.13 0.99 0.88 (0.82–0.94) (1.06–1.23) (0.87–1.00) (0.99–1.17) (1.07–1.24) (0.83–0.96) (1.05–1.20) (0.90–1.08) eth#edu No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c No, yes 1.43 1.82 1.00 (0.90– 1.03 (0.94– 2.73 1.31 1.99 2.35 (2.14–2.57) (1.30–1.57) (1.65–1.99) 1.12) 1.14) (2.44–3.05) (1.20–1.43) (1.81–2.18) c c b c c c c Yes, no 0.81 0.45 0.87 (0.73– 0.85 0.42 0.74 0.52 0.63 (0.54–0.73) (0.69–0.95) (0.39–0.53) 1.04) (0.73–1.00) (0.35–0.51) (0.64–0.86) (0.44–0.62) eth#huk No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c b c c c c No, yes 0.75 0.78 0.99 (0.96– 0.97 0.69 0.89 0.91 0.86 (0.83–0.88) (0.73–0.77) (0.76–0.80) 1.03) (0.94–0.99) (0.67–0.71) (0.87–0.91) (0.88–0.94) c c c c c c Yes, no 1.32 1.34 1.00 (0.88– 0.86 1.50 1.20 1.07 1.46 (1.32–1.61) (1.19–1.46) (1.22–1.48) 1.13) (0.77–0.96) (1.36–1.66) (1.09–1.32) (0.93–1.23) eth#intpv No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c No, yes 0.92 0.95 1.04 0.96 0.94 0.90 0.95 0.99 (0.97–1.01) (0.90–0.94) (0.93–0.97) (1.02–1.07) (0.94–0.99) (0.92–0.96) (0.88–0.92) (0.93–0.98) b c c c a c Yes, no 1.12 1.07 (0.98– 1.03 (0.92– 1.23 0.96 1.19 1.12 0.86 (0.79–0.94) (1.02–1.23) 1.17) 1.15) (1.12–1.35) (0.87–1.05) (1.09–1.30) (0.99–1.27) eth#mar No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c No, yes 0.91 0.95 1.11 1.24 0.90 0.98 (0.96– 1.10 0.89 (0.87–0.92) (0.89–0.94) (0.93–0.98) (1.08–1.14) (1.21–1.28) (0.88–0.93) 1.01) (1.07–1.14) b c c c c Yes, no 1.10 1.15 1.02 (0.92– 0.78 1.21 1.00 (0.92– 1.09 1.19 (1.09–1.29) (1.01–1.20) (1.06–1.24) 1.13) (0.72–0.86) (1.11–1.31) 1.08) (0.97–1.22) eth#zon1 No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c c No, yes 0.40 0.58 3.42 0.27 0.61 0.56 2.88 0.84 (0.76–0.94) (0.36–0.45) (0.53–0.65) (3.03–3.86) (0.24–0.30) (0.54–0.69) (0.50–0.62) (2.57–3.23) c c a c c b c Yes, no 1.80 1.22 1.20 2.25 0.93 1.44 1.28 1.27 (1.09–1.48) (1.50–2.15) (1.05–1.43) (0.99–1.44) (1.86–2.72) (0.80–1.09) (1.23–1.68) (1.03–1.57) eth#zon2 No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c No, yes 0.37 0.56 4.02 0.26 0.60 0.46 1.96–2.43 0.95 (0.86–1.05) (0.33–0.41) (0.51–0.62) (3.58–4.52) (0.23–0.28) (0.54–0.68) (0.42–0.51) c b a c c c Yes, no 2.37 1.16 0.84 2.50 1.05 1.80 1.71 1.04 (0.91–1.20) (1.99–2.82) (1.01–1.33) (0.70–1.01) (2.09–2.99) (0.91–1.22) (1.55–2.09) (1.43–2.05) Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 11 of 19 Table 4 (continued) Lecture Books/ Radio/TV Face-to-face Online Community Bulletin SMS/WeChat magazine/CD programmes consultation education advocacy board eth#zon3 No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c c No, yes 0.54 0.52 2.59 0.31 0.47 0.44 1.83 0.74 (0.67–0.82) (0.48–0.59) (0.47–0.58) (2.31–2.91) (0.28–0.34) (0.41–0.53) (0.40–0.48) (1.65–2.04) c c c c c c c c Yes, no 1.26 1.60 1.49 2.42 1.22 1.92 2.30 1.56 (1.39–1.77) (1.11–1.44) (1.42–1.82) (1.29–1.72) (2.08–2.82) (1.08–1.39) (1.69–2.18) (1.98–2.68) eth#zon4 No, no 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference] c c c c c c c No, yes 0.48 0.64 3.44 0.40 0.56 0.63 3.16 0.93 (0.84–1.03) (0.43–0.53) (0.58–0.71) (3.07–3.85) (0.37–0.45) (0.50–0.63) (0.58–0.69) (2.85–3.50) eth ethnicity; agg age group; edu education level; huk hukou; intpv interprovincial floating; mar first marriage; zon1 Pearl River Delta; zon2 Yangtze River Delta; zon3 Bohai Rim; zon4 other economic zone a–c 10, 5, and 1%, respectively As compared to HMFP not living in Bohai Rim, EMFP mainly used lecture to access occupational diseases infor- not living in Bohai Rim was more likely to use lec- mation in the three economic zones. Thus, Hypothesis 3 ture (aOR = 1.26, 95% CI 1.11–1.44), books/magazine/ was rejected. CD (aOR = 1.60, 95% CI 1.42–1.82), radio/TV pro- grammes (aOR = 1.49, 95% CI 1.29–1.72), face-to-face Discussion consultation (aOR = 2.42, 95% CI 2.08–2.82), online This study identified the associations of ethnicity with education (aOR = 1.22, 95% CI 1.08–1.39), commu- health knowledge categories and sources which varied nity advocacy (aOR = 1.92, 95% CI 1.69–2.18), bulletin by geodemographic factors. In particular, EMFP heav- board (aOR = 2.30, 95% CI 1.98–2.68), and SMS/WeChat ily relied on online health information to acquire health (aOR = 1.56, 95% CI 1.39–1.77) to obtain health knowl- knowledge. Pearl River Delta, Yangtze River Delta, and edge. Thus, Hypothesis 2 was accepted. Bohai Rim had significant associations with parts of health knowledge categories and sources among EMFP. Correlations between health information categories This indicated that there was regional inequity of health and sources knowledge transmission for EMFP in China. Lecture, In Table  5, most of correlations were weak (posi- books/magazine/CD, face-to-face consultation, online tive, > 0.20 and < 0.40). Likewise, rhos between a spe- education, community advocacy, and bulletin boards cific relationship in EMFP and HMFP in a specific zone must be the primary methods of delivering health edu- were not similar. But, there was zero correlation between cation among the floating population in China. The knowledge of nutrition and face-to-face consultation in research results can also provide a better reference for EMFP in Yangtze River Delta. There were negative corre - the governmental health information provision from the lation between knowledge of smoking control and lecture perspective of EMFP. and correlation between knowledge of smoking control Regarding level of health knowledge, the findings in and face-to-face consultation in EMFP in Yangtze River this study were in accord with prior studies. For exam- Delta. Furthermore in EMFP, rho between knowledge ple, a study in Shanghai found that most the floating of mental disorders and online education in other eco- population had an inadequate knowledge of tuberculosis nomic zone, rho between knowledge of tuberculosis and and their education level was associated with the ways radio/TV programmes in Pearl River Delta, rho between of obtaining knowledge [62]. Even worse, another study knowledge of STD/AIDS and online education in Bohai reported low level of health information literacy of Chi- Rim, rho between knowledge of other infectious dis- nese residents [63]. eases and community advocacy in other economic zone With respect to ethnic disparities in level of health were ≥ 0.50. Simultaneously, the other moderate correla- knowledge, the findings in this study were in line with tions in EMFP were reported. For example, correlations prior studies. For example, a study indicated many Yi eth- between knowledge of occupational diseases and lecture nicity women were lack of knowledge of antenatal care in Pearl River Delta, Yangtze River Delta, and other eco- and HIV prevention [64]. Compared to the Han Chinese, nomic zone were moderate (rhos > 0.40). Thus, EMFP another study indicated that the other ethnic groups Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 12 of 19 Table 5 Rho values of combinations of health knowledge categories and sources in four economic zones Category Source Pearl River Delta Yangtze River Delta Bohai Rim Other economic zone EMFP HMFP EMFP HMFP EMFP HMFP EMFP HMFP Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Occupational diseases Lecture 0.44 0.05 0.42 0.01 0.41 0.05 0.36 0.01 0.35 0.04 0.42 0.01 0.47 0.01 0.45 0.00 Books/magazine/CD 0.35 0.05 0.33 0.01 0.30 0.04 0.32 0.01 0.33 0.04 0.38 0.01 0.39 0.01 0.36 0.00 Radio/TV 0.34 0.05 0.19 0.02 0.11 0.05 0.14 0.01 0.19 0.05 0.16 0.01 0.22 0.02 0.23 0.01 Face-to-face consultation 0.17 0.06 0.25 0.01 0.26 0.05 0.25 0.01 0.23 0.05 0.32 0.01 0.37 0.01 0.31 0.00 Online education 0.35 0.05 0.30 0.01 0.38 0.04 0.31 0.01 0.40 0.04 0.36 0.01 0.48 0.01 0.38 0.00 Community advocacy 0.26 0.05 0.25 0.01 0.37 0.04 0.32 0.01 0.20 0.04 0.30 0.01 0.33 0.01 0.34 0.00 Bulletin board 0.12 0.06 0.26 0.02 0.32 0.05 0.26 0.01 0.22 0.05 0.24 0.01 0.29 0.02 0.28 0.01 SMS/WeChat 0.33 0.05 0.27 0.01 0.34 0.04 0.27 0.01 0.30 0.04 0.30 0.01 0.35 0.01 0.30 0.00 Nutrition Lecture 0.29 0.06 0.28 0.01 0.23 0.06 0.21 0.01 0.18 0.05 0.28 0.01 0.39 0.01 0.32 0.01 Books/magazine/CD 0.40 0.05 0.43 0.01 0.40 0.04 0.37 0.01 0.32 0.04 0.37 0.01 0.46 0.01 0.42 0.00 Radio/TV 0.37 0.05 0.33 0.01 0.39 0.05 0.36 0.01 0.24 0.05 0.34 0.01 0.35 0.02 0.35 0.01 Face-to-face consultation 0.13 0.06 0.24 0.02 0.00 0.06 0.17 0.01 0.16 0.05 0.21 0.01 0.31 0.01 0.23 0.01 Online education 0.35 0.05 0.41 0.01 0.39 0.04 0.35 0.01 0.19 0.05 0.35 0.01 0.47 0.01 0.39 0.00 Community advocacy 0.27 0.05 0.30 0.01 0.32 0.05 0.32 0.01 0.31 0.05 0.27 0.01 0.39 0.01 0.33 0.00 Bulletin board 0.22 0.06 0.19 0.02 0.18 0.05 0.22 0.01 0.14 0.05 0.18 0.01 0.30 0.02 0.24 0.01 SMS/WeChat 0.39 0.05 0.39 0.01 0.46 0.04 0.35 0.01 0.34 0.04 0.29 0.01 0.35 0.01 0.35 0.00 Reproduction Lecture 0.11 0.07 0.13 0.02 0.08 0.06 0.16 0.01 0.32 0.04 0.36 0.01 0.23 0.02 0.17 0.01 Books/magazine/CD 0.28 0.06 0.28 0.01 0.15 0.05 0.23 0.01 0.34 0.04 0.30 0.01 0.25 0.02 0.21 0.01 Radio/TV 0.34 0.06 0.19 0.02 0.15 0.06 0.16 0.01 0.14 0.05 0.11 0.01 0.21 0.02 0.12 0.01 Face-to-face consultation 0.30 0.07 0.28 0.02 0.25 0.06 0.30 0.01 0.40 0.05 0.45 0.01 0.38 0.02 0.33 0.01 Online education 0.12 0.06 0.18 0.02 0.18 0.05 0.22 0.01 0.24 0.04 0.18 0.01 0.26 0.02 0.19 0.01 Community advocacy 0.33 0.06 0.36 0.01 0.12 0.05 0.28 0.01 0.36 0.04 0.40 0.01 0.28 0.02 0.27 0.01 Bulletin board 0.47 0.05 0.40 0.02 0.19 0.05 0.27 0.01 0.45 0.04 0.47 0.01 0.25 0.02 0.30 0.01 SMS/WeChat 0.07 0.06 0.16 0.02 0.08 0.05 0.19 0.01 0.27 0.04 0.12 0.01 0.16 0.02 0.16 0.01 Chronic diseases Lecture 0.32 0.05 0.34 0.01 0.35 0.05 0.33 0.01 0.39 0.04 0.43 0.01 0.45 0.01 0.42 0.00 Books/magazine/CD 0.45 0.04 0.40 0.01 0.32 0.04 0.36 0.01 0.38 0.04 0.44 0.01 0.43 0.01 0.38 0.00 Radio/TV 0.34 0.05 0.27 0.02 0.14 0.06 0.22 0.01 0.28 0.05 0.28 0.01 0.29 0.02 0.29 0.01 Face-to-face consultation 0.26 0.06 0.36 0.01 0.34 0.05 0.35 0.01 0.41 0.04 0.41 0.01 0.42 0.01 0.38 0.00 Online education 0.46 0.04 0.38 0.01 0.30 0.04 0.32 0.01 0.39 0.04 0.40 0.01 0.43 0.01 0.37 0.00 Community advocacy 0.44 0.05 0.40 0.01 0.34 0.04 0.36 0.01 0.34 0.04 0.40 0.01 0.45 0.01 0.42 0.00 Bulletin board 0.23 0.06 0.32 0.02 0.33 0.05 0.32 0.01 0.37 0.04 0.37 0.01 0.37 0.02 0.36 0.01 SMS/WeChat 0.47 0.04 0.32 0.01 0.28 0.04 0.28 0.01 0.31 0.04 0.29 0.01 0.36 0.01 0.31 0.00 Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 13 of 19 Table 5 (continued) Category Source Pearl River Delta Yangtze River Delta Bohai Rim Other economic zone EMFP HMFP EMFP HMFP EMFP HMFP EMFP HMFP Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Smoking control Lecture 0.10 0.06 0.12 0.02 − 0.05 0.06 0.05 0.01 0.13 0.05 0.16 0.01 0.24 0.02 0.16 0.01 Books/magazine/CD 0.34 0.05 0.40 0.01 0.29 0.04 0.33 0.01 0.36 0.04 0.36 0.01 0.41 0.01 0.40 0.00 Radio/TV 0.38 0.05 0.39 0.01 0.31 0.05 0.34 0.01 0.37 0.04 0.38 0.01 0.34 0.02 0.40 0.01 Face-to-face consultation 0.21 0.06 0.20 0.02 − 0.02 0.06 0.08 0.01 0.12 0.05 0.17 0.01 0.18 0.02 0.15 0.01 Online education 0.44 0.05 0.41 0.01 0.33 0.04 0.33 0.01 0.45 0.04 0.41 0.01 0.43 0.01 0.40 0.00 Community advocacy 0.29 0.05 0.24 0.01 0.12 0.05 0.21 0.01 0.23 0.04 0.23 0.01 0.29 0.01 0.25 0.00 Bulletin board 0.14 0.06 0.18 0.02 0.23 0.05 0.19 0.01 0.22 0.05 0.21 0.01 0.27 0.02 0.22 0.01 SMS/WeChat 0.44 0.04 0.37 0.01 0.30 0.04 0.35 0.01 0.40 0.04 0.36 0.01 0.41 0.01 0.39 0.00 Mental disorders Lecture 0.31 0.06 0.35 0.01 0.27 0.06 0.29 0.01 0.41 0.05 0.40 0.01 0.39 0.01 0.37 0.01 Books/magazine/CD 0.41 0.05 0.44 0.01 0.40 0.05 0.41 0.01 0.44 0.05 0.48 0.01 0.48 0.01 0.44 0.00 Radio/TV 0.45 0.06 0.33 0.02 0.28 0.07 0.29 0.01 0.33 0.06 0.35 0.01 0.35 0.02 0.34 0.01 Face-to-face consultation 0.21 0.06 0.40 0.01 0.25 0.06 0.34 0.01 0.40 0.05 0.47 0.01 0.42 0.01 0.38 0.01 Online education 0.40 0.05 0.42 0.01 0.38 0.05 0.40 0.01 0.45 0.05 0.48 0.01 0.55 0.01 0.46 0.00 Community advocacy 0.43 0.05 0.42 0.01 0.47 0.05 0.42 0.01 0.49 0.04 0.49 0.01 0.47 0.01 0.46 0.00 Bulletin board 0.20 0.07 0.24 0.02 0.15 0.06 0.25 0.01 0.28 0.06 0.30 0.01 0.28 0.02 0.27 0.01 SMS/WeChat 0.43 0.05 0.40 0.01 0.36 0.05 0.35 0.01 0.39 0.05 0.38 0.01 0.43 0.01 0.38 0.01 Tuberculosis Lecture 0.36 0.05 0.35 0.01 0.31 0.05 0.32 0.01 0.47 0.04 0.45 0.01 0.37 0.01 0.36 0.00 Books/magazine/CD 0.45 0.04 0.40 0.01 0.40 0.04 0.38 0.01 0.41 0.04 0.44 0.01 0.38 0.01 0.38 0.00 Radio/TV 0.50 0.05 0.27 0.02 0.12 0.06 0.22 0.01 0.28 0.05 0.26 0.01 0.30 0.02 0.30 0.01 Face-to-face consultation 0.25 0.06 0.35 0.01 0.34 0.05 0.35 0.01 0.46 0.04 0.47 0.01 0.30 0.01 0.35 0.00 Online education 0.36 0.05 0.33 0.01 0.38 0.04 0.35 0.01 0.35 0.04 0.41 0.01 0.35 0.01 0.36 0.00 Community advocacy 0.38 0.05 0.40 0.01 0.38 0.05 0.40 0.01 0.37 0.04 0.45 0.01 0.40 0.01 0.42 0.00 Bulletin board 0.27 0.06 0.32 0.02 0.33 0.05 0.33 0.01 0.39 0.05 0.40 0.01 0.38 0.02 0.40 0.01 SMS/WeChat 0.43 0.05 0.33 0.01 0.36 0.05 0.33 0.01 0.26 0.04 0.32 0.01 0.33 0.01 0.32 0.00 Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 14 of 19 Table 5 (continued) Category Source Pearl River Delta Yangtze River Delta Bohai Rim Other economic zone EMFP HMFP EMFP HMFP EMFP HMFP EMFP HMFP Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE Rho SE STD/AIDS Lecture 0.18 0.06 0.18 0.01 0.09 0.05 0.14 0.01 0.37 0.04 0.37 0.01 0.31 0.02 0.22 0.01 Books/magazine/CD 0.39 0.05 0.38 0.01 0.39 0.04 0.40 0.01 0.42 0.04 0.43 0.01 0.37 0.01 0.40 0.00 Radio/TV 0.39 0.05 0.32 0.01 0.34 0.05 0.32 0.01 0.36 0.04 0.31 0.01 0.30 0.02 0.37 0.01 Face-to-face consultation 0.14 0.06 0.27 0.02 0.13 0.05 0.22 0.01 0.39 0.05 0.39 0.01 0.27 0.02 0.27 0.01 Online education 0.41 0.05 0.36 0.01 0.34 0.04 0.35 0.01 0.53 0.04 0.39 0.01 0.36 0.02 0.37 0.00 Community advocacy 0.43 0.05 0.43 0.01 0.25 0.05 0.34 0.01 0.37 0.04 0.41 0.01 0.36 0.01 0.40 0.00 Bulletin board 0.40 0.05 0.32 0.02 0.33 0.05 0.31 0.01 0.45 0.04 0.43 0.01 0.40 0.02 0.36 0.01 SMS/WeChat 0.40 0.05 0.31 0.01 0.33 0.04 0.37 0.01 0.44 0.04 0.34 0.01 0.31 0.02 0.36 0.00 Other infectious diseases Lecture 0.17 0.06 0.23 0.01 0.16 0.05 0.25 0.01 0.25 0.04 0.33 0.01 0.37 0.01 0.30 0.00 Books/magazine/CD 0.40 0.05 0.39 0.01 0.35 0.04 0.34 0.01 0.24 0.04 0.39 0.01 0.37 0.01 0.37 0.00 Radio/TV 0.38 0.05 0.32 0.01 0.33 0.05 0.31 0.01 0.27 0.05 0.31 0.01 0.31 0.02 0.34 0.01 Face-to-face consultation 0.20 0.06 0.30 0.01 0.24 0.05 0.25 0.01 0.30 0.05 0.33 0.01 0.36 0.01 0.31 0.00 Online education 0.37 0.05 0.33 0.01 0.28 0.05 0.30 0.01 0.33 0.04 0.38 0.01 0.37 0.01 0.35 0.00 Community advocacy 0.48 0.04 0.42 0.01 0.46 0.04 0.42 0.01 0.44 0.04 0.48 0.01 0.54 0.01 0.49 0.00 Bulletin board 0.27 0.06 0.25 0.02 0.22 0.05 0.27 0.01 0.35 0.05 0.30 0.01 0.32 0.02 0.32 0.01 SMS/WeChat 0.37 0.05 0.33 0.01 0.28 0.05 0.31 0.01 0.29 0.04 0.34 0.01 0.34 0.01 0.33 0.00 N 940 13,013 1212 28,345 1355 31,350 11,089 102,041 Bold values denote rhos (> or = 0.40) and their standard errors (SE) Han  et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 15 of 19 had lower cervical cancer knowledge levels [65]. Thus, Some health knowledge sources was highlighted in the observed ethnic differences in health knowledge may be sample could be possibly explained by several literature. related to governmental factors, environment, cultural The current state of public health information acquisition customs, or to potential combinations of these factors. via WeChat proved worrisome in China [80]. Actually, Considering health information categories, the find - a comparative study in 26 European countries indicated ings in this study were in agreement with prior studies. there were positive or negative relationships between For instance, a study showed significant disparity of the mobile media and the credibility of health sources [81]. rates of Tuberculosis education among the seven regions EMFP used Radio/TV to obtain knowledge of mental dis- in China [66]. A meta-analysis reported poor HIV-related orders and tuberculosis in Pearl River Delta rather than sexual knowledge among the floating population [67]. Yangtze River Delta, Bohai Rim, and other economic There were obvious differences regarding health informa - zone. The content concerning cardiovascular diseases tion sources related to cardiovascular diseases between in Chinese television health programs could be used to Hui Muslims and Han people [68]. communicate health information in China [82]. This pos - Considering geodemographic factors, the findings in sibly because Radio/TV could be still afforded for EMFP this study were in congruence with prior studies. For to receive health information. Meanwhile, investigations instance, sociodemographic factors were associated with indicated that face-to-face consultation and community the types of online health information sought among the advocacy could be considered as a more effective inter - general Chinese population [69]. Preferred sources of vention to promote health information quality [83, 84]. health information also varied by age and educational Zero and negative correlations between knowledge cate- level [70]. Additionally, a cross-sectional study identified gories and sources might be caused by poor health educa- there was a social gradient for health information literacy tion organizations and health information transmission. among urban older adults aged 60 + years in Western China [71]. Similarly, a cross-sectional survey indicated Strengths and limitations parental education and socioeconomic status were sig- There were two main strengths in this study. First, this nificantly associated with obtaining health information study considered EMFP in the associations of geodemo- among undergraduate nursing students in a medical uni- graphic factors with health knowledge categories and versity in Chongqing, China [72]. sources. The effort was to report ethnic disparities in Poor health awareness in this study could be explained access to health knowledge of the floating population. indirectly by inferior strength of geodemographic fac- Second, regressions with interactions could reflect the tors in place of departure and accuracy of health media. individual characteristics of EMFP in the ethnic dispari- For example, a descriptive study in a remote region of ties in access to health knowledge. Finally, the sample China showed that utilization of maternal health care size could be representative of structure of population services was associated with a range of social, eco- in China. According to Tabulation on 2010 Population nomic, cultural and geographic factors [73]. A system- Census of the People’s Republic of China (http:// www. atic review reported that traditional beliefs, low levels stats. gov. cn/ tjsj/ pcsj/ rkpc/ 6rp/ index ch. htm), Han major- of education, reimbursement difficulties, and language ity accounted for 91.60% in the total population, ethnic barriers limited the willingness of ethnic minority minority accounted for 8.40% in the total population. women to use maternal health services [74]. Another u Th s, the sample size of ethnic minority by and large cross-sectional study concluded ethnic disparities in accorded with proportion of total population in China. benefits distribution of government healthcare subsidies There were three main limitations in this study. First, in rural Chinese ethnic minority areas [75]. Simultane- whether the sample was from non-minority regions or ously, the quality of online health information about ethnic minority regions was not defined in the ques - breast cancer from Chinese language websites was poor tionnaire. Thus, comparative analyses between non- [76]. Because of illiteracy among the Chinese profes- minority regions and ethnic minority regions regarding sionalism, health-related advances in newspapers were policy interventions could not be conducted. Compared lack of accuracy [77]. An empirical evidence show social with non-minority regions, worse spatial healthcare media use for health information might lead to a nega- access, inequality in access to doctors and health pro- tive impact on pregnant women’s mental health [78]. fessionals, and uneven balance among primary, second- The primary reason was possibly that the total funding ary, and tertiary hospitals were documented in a study and funding per student of health professional educa- in ethnic minority region in Sichuan, China [85]. Sec- tion in China remained relatively low compared to other ond, medical and clinical measurements were defined countries from 1998 to 2017 [79]. in the questionnaire. Thus, biomedical explanations for Han et al. Cost Effectiveness and Resource Allocation (2022) 20:15 Page 16 of 19 Ming Guan is head of the International Issues Center and Family Issues Center the main associations could not be obtained. For exam- at Xuchang University. He is interested in health care service, health change, ple, a cross-sectional observational study identified eth - and quality of life of migrants and elders in the world. nic differences in body composition and obesity-related Funding risk factors between Chinese and white males living in This project was funded by Multi-dimensional Evaluation of Health Service China [86]. Finally, some associations of interest were not System of Floating Population in Henan Province (in Chinese: 河南省流动人 reported by Poisson and logistic regressions because of 口健康服务体系多维度评价研究; Project number: 2020BSH014) from 2020 Planning of Philosophy and Social Sciences in Henan Province (in Chinese: collinearity. 2020年河南省哲学社会科学规划年度项目). This project was also funded by Construction study and practice of ideological and political teaching in the course of China Geography (in Chinese: 《中国地理》课程思政建设研究 Policy implications 与实践; Project number: 407) from Research and Practice Project of Higher Health education campaigns targeting EMFP should be Education & Pedagogy Reform in Henan Province in 2019 (in Chinese: 2019 actively promoted. To improve the health information 年度河南省高等教育教学改革研究与实践项目). The funding body played no role in the study design, data collection, data analysis, data interpretation literacy, high-quality health information services should and manuscript writing. The content is solely the responsibility of the authors be delivered to EMFP. Even Chinese college students had and does not necessarily represent the official views of the Henan Provincial insufficient knowledge/skills to identify health misinfor - Government. mation and disinformation [87]. u Th s, EMFP should not Availability of data and materials accept unregulated, inaccurate, and unactionable health http:// www. china ldrk. org. cn/. information. Given the floating attributes for the popu - lation, it is important to enrich health knowledge cat- Declarations egories and improve sources of health knowledge for the Ethics approval and consent to participate EMFP in China. Not applicable. Consent for publication Conclusions Not applicable. In conclusions, this study showed ethnic disparities in access to health knowledge categories and sources Competing interests The authors declared no potential competing interests with respect to the among the sample. Geographically, this study reported research, authorship and/or publication of this article. weak correlations between health knowledge catego- ries and sources in EMFP in China. Specially, this study Author details Xuchang Urban Water Pollution Control and Ecological Restoration Engi- reflected ethnic disparities with respect to inaccess neering Technology Research Center, Xuchang University, Xuchang, China. to health knowledge within specific regions of China. 2 College of Urban and Environmental Sciences, Xuchang University, Xuchang, Future interventions to control ethnic disparities and China. Grade 6 Class 7, Xuchang Municipal Xingye Road Primary School, Xuchang, Henan, China. Family Issues Center, Xuchang University, Xuchang, population-biased issues should address geodemo- Henan, China. International Issues Center, Xuchang University, Xuchang, graphic factors. 6 Henan, China. School of Business, Xuchang University, Xuchang, Henan, China. Abbreviations Received: 7 October 2021 Accepted: 8 March 2022 EMFP: Ethnic minority floating population; HMFP: Han majority floating popu- lation; STD/AIDS: Sexually transmitted diseases/acquired immunodeficiency syndrome; CI: Confidence interval; IRR: Incidence rate ratios; aOR: Adjusted odds ratio. References Acknowledgements 1. Ma R. Ethnic relations in contemporary China: cultural tradition and The authors of this paper would like to acknowledge the very helpful com- ethnic policies since 1949. Policy Soc. 2006;25(1):85–108. ments of the reviewers on the original submission. 2. Feng L, Li P, Wang X, Hu Z, Ma Y, Tang W, Ben Y, Mahapatra T, Cao X, Mahapatra S, Ling M, Gou A, Wang Y, Xiao J, Hou M, Wang X, Lin B, Wang Authors’ contributions F. Distribution and determinants of non communicable diseases among MG designed the study, performed the statistical analysis, and completed elderly Uyghur ethnic group in Xinjiang, China. PLoS ONE. 2014;9(8): the original version. 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Journal

Cost Effectiveness and Resource AllocationSpringer Journals

Published: Apr 2, 2022

Keywords: Health knowledge categories; Health knowledge sources; Floating population; Ethnic minority; Han majority

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