《中国康复理论与实践》

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (10): 1216-1226.doi: 10.3969/j.issn.1006-9771.2026.10.010

• 应用研究 • 上一篇    下一篇

我国东部和中西部地区居民无障碍设施利用行为影响机制的比较

孙禾奇1,2, 吕军1,3(), 励晓红1,3, 陈添翼1,3, 王柯迪1,3, 孔凡磊4,5,6, 陈刚1,3   

  1. 1 复旦大学中国残疾问题研究中心， 上海市 200032
    2 复旦大学老龄研究院， 上海市 200433
    3 复旦大学公共卫生学院， 上海市 200032
    4 山东大学齐鲁医学院公共卫生学院， 山东济南市 250012
    5 国家卫生健康委员会卫生经济与政策研究重点实验室（山东大学）， 山东济南市 250012
    6 山东大学卫生管理与政策研究中心（山东省重点新型智库）， 山东济南市 250012
  • 收稿日期:2026-01-05 修回日期:2026-01-26 接受日期:2026-01-26 出版日期:2026-10-25 发布日期:2026-10-23
  • 通讯作者: 吕军(1968-)，女，汉族，河北唐山市人，博士，教授，主要研究方向：卫生政策与管理。E-mail： lujun@shmu.edu.cn
  • 作者简介:孙禾奇(1994-)，女，汉族，江苏常州市人，博士，博士后，主要研究方向：人群健康政策与体系优化。
  • 基金资助:
    国家自然科学基金项目(72274038);国家自然科学基金项目(72574130);国家社会科学基金重大项目(17ZDA078)

Comparison of influencing mechanisms of accessible facility utilization behavior in eastern and central-western China

Sun Heqi1,2, Lü Jun1,3(), Li Xiaohong1,3, Chen Tianyi1,3, Wang Kedi1,3, Kong Fanlei4,5,6, Chen Gang1,3   

  1. 1 China Research Center on Disability, Fudan University, Shanghai 200032, China
    2 Fudan Institute on Ageing, Fudan University, Shanghai 200433, China
    3 School of Public Health, Fudan University, Shanghai 200032, China
    4 School of Public Health, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong 250012, China
    5 National Health Commission Key Lab of Health Economics and Policy Research (Shandong University), Ji'nan, Shandong 250012, China
    6 Center for Health Management and Policy Research, Shandong University (Shandong Provincial Key New Think Tank), Ji'nan, Shandong 250012, China
  • Received:2026-01-05 Revised:2026-01-26 Accepted:2026-01-26 Published:2026-10-25 Online:2026-10-23
  • Supported by:
    National Natural Science Foundation of China(72274038);National Natural Science Foundation of China(72574130);National Social Sciences Foundation of China (Major)(17ZDA078)

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摘要：

目的 探讨我国东部地区和中西部地区居民无障碍设施利用行为的影响机制及区域差异。

方法 采用滚雪球抽样法，通过网络填写问卷的方式对中国各地区居民进行数据采集。采用描述性分析、χ2检验分析两地区调查对象基本特征，采用Welch's t检验比较两地区无障碍设施利用行为及其影响因素，采用多组结构方程模型比较两地区无障碍设施利用行为的影响机制。

结果 回收有效问卷1 039份，其中东部地区居民604人，中西部地区居民435人。东部地区居民对无障碍设施的寻找行为(t = 4.057, P< 0.001)和使用行为(t = 4.551, P< 0.001)得分显著高于中西部地区。两地区的结构方程模型拟合指数相同，模型拟合良好(GFI = 0.950, AGFI = 0.932, IFI = 0.947, CFI = 0.947, RMSEA = 0.028)，模型的不变性检验均达到推荐标准。东部地区设施配置对利用行为的影响不显著，在中西部地区有负向影响(β = -0.171, P= 0.047)，其影响主要通过社会认知和使用体验的中介路径间接发挥作用。社会认知、使用体验对利用行为有显著的正向影响(P < 0.001)，同时，社会认知通过使用体验的中介路径间接对利用行为产生作用。中西部地区的直接效应值(社会认知β = 0.406，使用体验β = 0.510)均高于东部地区(社会认知β = 0.369，使用体验β = 0.335)。“配置-认知-体验-行为”的链式中介效应均有统计学意义(P < 0.05)，且中西部地区的间接效应高于东部地区。

结论 设施配置对利用行为的直接作用有限，社会认知和使用体验是改善利用行为的关键因素，且中西部地区更依赖“社会认知-使用体验”驱动机制。建议立足人群需求推进无障碍设施建设与改造，并加强无障碍理念和政策宣传，推动中西部地区从硬件建设到服务管理的无障碍环境治理转变。

关键词: 无障碍设施, 利用行为, 影响机制, 区域比较, 结构方程模型

Abstract:

Objective To examine the influencing mechanisms and regional differences in accessible facility utilization behavior among residents in eastern and central-western China.

Methods Data were collected through the online questionnaire administered to residents across China using snowball sampling. Descriptive analysis and chi-square tests were conducted to compare the basic characteristics of respondents between the two regions. Welch's t test was used to compare accessible facility utilization behavior and its influencing factors. Multigroup structural equation modeling (SEM) was applied to compare the influencing mechanisms of accessible facility utilization behavior between eastern and central-western China.

Results A total of 1 039 valid responses were obtained, including 604 from the eastern region and 435 from the central-western region. Residents in eastern regions scored significantly higher than those in central-western regions on both facility-seeking (t = 4.057, P< 0.001) and actual-using (t = 4.551, P< 0.001) behavior. The structural equation models for both regions showed identical and satisfactory goodness-of-fit indices (GFI = 0.950, AGFI = 0.932, IFI = 0.947, CFI = 0.947, RMSEA = 0.028), and all measurement and structural invariance tests met the recommended criteria. Facility configuration showed no significant direct effect on utilization behavior in eastern China, whereas a negative direct effect was observed in central-western China (β = -0.171, P= 0.047), with its influence mainly exerted indirectly through social cognition and user experience. Social cognition and user experience had significant positive effects on utilization behavior (P < 0.001). Meanwhile, social cognition indirectly influences utilization behavior through the mediating path of usage experience. The direct effects of social cognition (β = 0.406) and user experience (β = 0.510) in central-western China were greater than those in eastern China (β = 0.369 and β = 0.335, respectively). The chain mediation effect of "configuration-cognition-experience-behavior" was statistically significant in both regions (P < 0.05), with larger indirect effects observed in central-western China.

Conclusion Facility configuration has a limited direct effect on accessible facility utilization, whereas social cognition and user experience play a central role, particularly in central-western China. It is recommended that the construction and renovation of accessible facility be guided by population needs, accompanied by strengthened promotion of accessibility concepts and policies, and that a transition from hardware-oriented construction to service- and management-oriented governance of accessible environments should be promoted in central-western China.

Key words: accessible facility, utilization behavior, influencing mechanism, regional differences, structural equation modeling

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