Supernatural explanatory models of health and illness and healthcare use in China among men who have sex with men

• Authors: Stephen W Pan, Xi'an Jiaotong-Liverpool University; Richard M Carpiano, University of California, Los Angeles; Kumi M Smith, UNC Project-China; Jason J Ong, UNC Project-China; Hongyun Fu, Eastern Virginia Medical School; Wenting Huang, Emory University; Weiming Tang, UNC Project-China; Joseph D Tucker, UNC Project-China
• Journal Title: Global Public Health
• Volume: Volume 15, Number 1
• Publisher: Informa UK Limited | 2020-01-02, Pages 83-96
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1080/17441692.2019.1649445
• Subjects: Health Sciences, Epidemiology; Environmental Sciences; Health Sciences, Public Health
• Keywords: Religion; fatalism; fundamental cause theory; gay men; spirituality; Adolescent; Adult; China; Cross-Sectional Studies; HIV Infections; Homosexuality, Male; Humans; Male; Patient Acceptance of Health Care; Physicians, Primary Care; Religion; Sexual Behavior; Sexual and Gender Minorities; Socioeconomic Factors; Spirituality; Surveys and Questionnaires; Syphilis; Young Adult

Abstract

People’s beliefs in supernatural explanatory models of health and illness–beliefs in divine and/or supernatural forces to inform how they perceive, interpret, and respond to health and illness–may have important implications for their use of healthcare services, especially among individuals with lower socioeconomic status (SES). However, the relevance of such research for contexts with strong Confucian and Buddhist traditions and sexual minority subpopulations remains unclear. We conducted a nation-wide survey in China of 503 men who have sex with men (MSM) to test hypotheses examining how supernatural beliefs impact commitment to a primary healthcare provider and testing history for HIV and syphilis. We also tested hypotheses regarding how SES may moderate such effects. Results indicate that strength of supernatural beliefs is associated with less commitment to a primary care provider and lower likelihood of HIV testing, particularly among men with lower educational attainment. However, among men with low income, supernatural belief was associated with higher likelihood of testing for HIV and syphilis. Belief in supernatural explanatory models of health and illness may have substantial influence on healthcare use among MSM in China. As religion and spirituality evolves within China, additional research concerning supernatural beliefs and healthcare use is warranted.