The family doctor contract service for elderly people in rural areas faces issues such as a generally poor patient experience and a lack of perceived benefits, as well as phenomena such as "signing up but not fulfilling the contract" and "failure to renew the contract". The underlying causes of these issues require further investigation.

To investigate the status and influencing factors of consistency between expressed and perceived needs for family doctor contracted services among rural older adults in Ningxia Hui Autonomous Region of China.

A cross-sectional study was conducted from July to September 2024. Stratified cluster sampling was applied to find participants. In the 5 prefecture-level cities of the Ningxia Hui Autonomous Region, 2 counties were selected from each city by convenience sampling method, and 1 administrative village was selected from each county. Two counties were selected from each of the five cities in Ningxia, and one village was chosen from each of the counties. A total of 456 rural older people from the 10 villages were invited into the survey. Socio-demographic information and expressed and perceived needs for family doctor contract services were collected using a self-designed questionnaire. Multiple stepwise regression analysis was used to identify influencing factors, while a random forest model was employed to rank the importance of these factors.

The average score for consistency between expressed and perceived needs for family doctor contract services among rural older adults was (11.6±5.3), indicating an overall low level of consistency. The expressed need for basic public health service items (such as establishing health records) was as high as 96.1% (438/456), the perceived need reached 96.7% (441/456), and the satisfaction rate also reached 92.9% (424/456), all of which were at a high level. In contrast, only 5.3% (24/456) of rural older adults expressed a need for special health services (such as home-based care services), 40.1% (183/456) perceived the need, and the satisfaction rate was as low as 5.0% (23/456), all indicating low levels. The results of multiple stepwise linear regression analysis showed that the consistency between expressed and perceived needs for family doctor contract services among rural older adults was affected by multiple factors, including satisfaction with contracted service items, personal health attention, chronic disease status, economic burden, medical treatment experience in primary medical and health institutions in the past year, and smoking habits (P<0.05). Among these factors, satisfaction with contracted service items was the most significant predictor of the consistency of the two needs.

The consistency between expressed and perceived needs for individual health services in the family doctor contract among rural older adults remains low, influenced by both subjective factors and objective factors, such as chronic conditions, satisfaction with services, and awareness of self-health. Therefore, the author suggests designing and providing family doctor contract service packages in a way that is tailored to local contexts, especially focusing on service items that address individual perceived needs. The improvement of consistency between expressed and perceived needs will better meet the diverse health management needs of the rural elderly.