Abstract: Background Traditional Chinese medicine（TCM） plays a preventive healthcare role and is valuable for chronic disease management and active aging. Community health service centers（CHCs） are key places for promoting TCM preventive healthcare services，yet elderly utilization remains unsatisfactory. Objective To examine the factors influencing the elderly's utilization of TCM preventive healthcare services in CHCs and evaluate their importance. Methods A face-to-face questionnaire survey was conducted from July to September 2022 using a multi-stage stratified cluster random sampling method in a total of 12 communities of older adults in six cities selected from Zhejiang and Guangxi provinces. The questionnaire was designed based on an integrated framework of Andersen and Social Cognitive Theory（SCT） dual models，aiming to comprehensively collect data on the utilization of TCM preventive healthcare services and their influencing factors among the elderly. A binary logistic regression model was used to analyze the factors influencing the utilization of TCM preventive healthcare services used by older adults，and logistic dominance analysis was applied to determine the importance of these factors. Results A total of 2 081（94.33%） valid questionnaires were retrieved，among them，only 369（17.73%） indicated that they had participated in TCM preventive healthcare services in the past year，and the frequency of utilization was mainly concentrated in 1~2 times per year［196 cases（53.11%）］. The results of binary Logistic regression model analysis showed that：the educational level in predisposing characteristics，the situation of suffering from chronic diseases and the situation of pain/discomfort in need factors，the score of perceived service environment in enabling resources，as well as the scores of cognitive status and self-control in individual factors are the influencing factors for the utilization of primary-level traditional Chinese medicine preventive and health care services（P<0.05）. Further Logistic dominance analysis showed that the weights of the importance of the influencing factors，in descending order，were：individual factors（belief and knowledge，self-regulation） > enabling resources（perceived environment） > predisposing characteristics（educational level） > need factors（chronic disease，pain，or discomfort）. Conclusion Individual factors play a crucial role in the decision-making process of elderly individuals regarding the use of primary care TCM preventive healthcare services. Enhancing the health literacy and self-control abilities of the elderly，along with improving the TCM service environment in CHCs，is expected to promote the widespread adoption of TCM preventive health services among the elderly population.

Key words: Health services for the aged, Traditional Chinese medicine, Services utilization, Community health services, Anderson model, Social cognitive theory, Root cause analysis

摘要： 背景 中医在治未病方面具有独特优势，对慢性病防治和积极老龄化具有重要价值。基层是中医预防保健服务实施和推广的重要阵地，然而老年人对基层中医预防保健服务的利用情况并不理想。目的 了解老年人基层中医预防保健服务利用的影响因素，并对影响因素进行重要性排序。方法 于2022年7—9月，采用多阶段分层随机抽样法在浙江省、广西壮族自治区抽取6个城市的12家社区卫生服务中心，通过拦截方式对2206名到访老年人进行面对面问卷调查。问卷基于安德森（Andersen）模型和社会认知理论（SCT）模型的综合框架进行设计，旨在全面收集老年人基层中医预防保健服务利用情况及其影响因素数据。采用二元Logistic回归模型分析影响老年人利用基层中医预防保健服务利用（行为）的因素，并运用Logistic优势分析法确定这些因素的重要性。结果 共回收有效问卷2081份（94.33%）。369名（17.73%）老年人在过去1年接受过基层中医预防保健服务，利用频次以1~2次居多［196名（53.11%）］。二元Logistic回归分析结果显示：倾向特征中的文化程度，需求因素中的患慢性病情况、疼痛/不适情况，使能资源中的感知服务环境得分，个体因素中的认知情况得分、自我控制得分是老年人基层中医预防保健服务利用的影响因素（P<0.05）。进一步Logistic优势分析结果显示，影响因素重要性权重排序为：个体因素（认知情况、自我控制）>使能资源（感知服务环境）>倾向特征（文化程度）>需求因素（患慢性病情况、疼痛/不适情况）。结论 个体因素在老年人利用基层中医预防保健服务的决策中发挥着关键作用。提升老年人的认知水平和自我控制能力，并改善基层中医药服务环境，将有望推动中医预防保健服务在老年人群体中的广泛普及。

关键词: 老年人保健服务, 中医学, 服务利用, 社区卫生服务, 安德森模型, 社会认知理论, 影响因素分析