Objective: To explore the factors influencing the premarital medical examination in Chinese population and to discuss the related possible intervention strategies.
Methods: Data were collected through self-designed questionnaires on 2572 newly married respondents, selected under a stratified randomized sampling method, at Marriage Registration Office in 12 counties in Zhejiang province. Predictive factors were derived from the integrating complementary constructs of Health Belief Model, Theory of Reasoned Action as well as individual demographic characteristics. Multiple logistic multilevel analyses was used as the main statistical method, with individuals as the 'low' and counties as the 'high' levels.
Results: Behaviors on premarital medical examination showed a clustering trait at the county level (P = 0.018) and variance partition coefficients (VPC) of each variables was between 15.40% and 17.58%. There were no statistical significances found in the rates of premarital medical examination among gender, age, residence of Household Registration, education, income, health insurance and history of premarital medical examination. However, significant correlation was seen on occupation of the respondents. The rate of premarital medical examination among the respondents who had not attended medical examination during the last six moths was 1.31 times (95% confidence intervals, 1.05 - 1.65) more than those who had, with OR (odds ratio) as 1.51 (95%CI: 1.14 - 2.00) for the pregnant respondents in their first marriage and 0.35 (95%CI: 0.23 - 0.51) for remarried respondents, compared with women at first marriage but remained unpregnant. Regarding premarital medical examination, the respondents reported greater benefits, less barriers, greater positive behavioral attitudes and normative beliefs to it, with an ORs as 2.32 (95%CI: 1.18 - 4.60), 0.71 (95%CI: 0.57 - 0.90), 1.69 (95%CI: 1.10 - 2.58) and 1.72 (95%CI: 1.34 - 2.20) respectively, but with no significant association with perceived susceptibility, perceived severity and motivation to comply.
Conclusion: Factors such as individual perceived benefits, barriers, attitudes and normative beliefs etc., were determinants of premarital medical examination accompanied by minor (16%) influence coming from the geographical environment.