Infectious disease surveillance, response, and control among rural-to-urban migrant workers in Shanghai: Understanding healthcare-seeking behaviors

Addressing health and healthcare disparities of China's 150-million rural-to-urban migrant workers is fundamentally important for effective response to and control of infectious diseases. Inability to afford care, poor working environments, and inadequate health knowledge, among others, all adversely affect migrants’ care-seeking behaviors, thus posing extra health risks to the individuals as well as entire communities. This paper describes a study on migrant workers' healthcare-seeking behaviors for common symptoms of potential infectious diseases.  Data were collected in 2008 from a multi-stage cluster sampling of 2,371 migrant workers in Shanghai. Analysis revealed that when ill, participants were more likely to seek informal care, mostly self-medication or visits to informal medical practitioners. Migrants utilized informal channels for almost all symptoms except fever and rare symptoms such as bloody sputum and jaundice. The popularity of private, informal clinics due to their accessibility and affordability indicates an urgent need for strengthened regulation, oversight, and safety and quality assurance. Secondly, beliefs that symptoms were inconsequential and easily self-treatable were the most common reasons for forgoing care altogether, highlighting a critical need for educating migrants to recognize symptoms of highly contagious and morbid illnesses, particularly the most prevalent such as tuberculosis and hepatitis B. Thirdly, migrants working in environments with more formalized safety regulation and on-site health resources were more likely to seek timely healthcare when ill.  The strong associations between work place safety, healthcare resources, and healthcare-seeking behaviors suggest that work site access to health resources is an effective way of reaching migrant workers; it is feasible and desirable to implement and enforce migrant-tailored education concurrently with urban insurance pilots. The findings of this study provide useful and timely information to enhance China’s public health infrastructure, intensify infectious disease surveillance, and improve health outcomes for this vulnerable population.