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Learn more: PMC Disclaimer | PMC Copyright Notice Front Public Health . 2026 Mar 25;14:1772557. doi: 10.3389/fpubh.2026.1772557 Search in PMC Search in PubMed View in NLM Catalog Add to search The utilization, characteristics, and influencing factors of non-therapeutic traditional Chinese medicine services among middle-aged and older population in Guangzhou, China: a cross-sectional study Jie Ren Jie Ren 1 School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China 2 China Joint Graduate School of Traditional Chinese Medicine, Suzhou, China Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft Find articles by Jie Ren 1, 2 , Jun Hao Jun Hao 1 School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China Data curation, Investigation, Writing – original draft Find articles by Jun Hao 1 , Ziqi Jia Ziqi Jia 3 School of Marxism, Guangzhou University of Chinese Medicine, Guangzhou, China Data curation, Investigation, Writing – original draft Find articles by Ziqi Jia 3 , Chenxu Zheng Chenxu Zheng 3 School of Marxism, Guangzhou University of Chinese Medicine, Guangzhou, China Data curation, Investigation, Writing – original draft Find articles by Chenxu Zheng 3 , Yaozong Zheng Yaozong Zheng 4 First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China Data curation, Investigation, Writing – original draft Find articles by Yaozong Zheng 4 , Zixin Wu Zixin Wu 1 School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China Data curation, Investigation, Writing – original draft Find articles by Zixin Wu 1 , Xiaonan Zhou Xiaonan Zhou 1 School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China Visualization, Writing – review & editing Find articles by Xiaonan Zhou 1 , Huan Wu Huan Wu 1 School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China Data curation, Investigation, Writing – original draft Find articles by Huan Wu 1 , Xintong Ye Xintong Ye 1 School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China Data curation, Investigation, Writing – original draft Find articles by Xintong Ye 1 , Xiaochang Ma Xiaochang Ma 5 Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China Supervision, Writing – review & editing Find articles by Xiaochang Ma 5 , Bin Lin Bin Lin 1 School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China Supervision, Writing – review & editing Find articles by Bin Lin 1, * , Lining Yang Lining Yang 6 Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China Visualization, Writing – review & editing Find articles by Lining Yang 6, * Author information Article notes Copyright and License information 1 School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China 2 China Joint Graduate School of Traditional Chinese Medicine, Suzhou, China 3 School of Marxism, Guangzhou University of Chinese Medicine, Guangzhou, China 4 First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China 5 Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China 6 Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China * Correspondence: Lining Yang, [email protected] ; Bin Lin, [email protected] Roles Jie Ren : Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft Jun Hao : Data curation, Investigation, Writing – original draft Ziqi Jia : Data curation, Investigation, Writing – original draft Chenxu Zheng : Data curation, Investigation, Writing – original draft Yaozong Zheng : Data curation, Investigation, Writing – original draft Zixin Wu : Data curation, Investigation, Writing – original draft Xiaonan Zhou : Visualization, Writing – review & editing Huan Wu : Data curation, Investigation, Writing – original draft Xintong Ye : Data curation, Investigation, Writing – original draft Xiaochang Ma : Supervision, Writing – review & editing Bin Lin : Supervision, Writing – review & editing Lining Yang : Visualization, Writing – review & editing Received 2025 Dec 21; Revised 2026 Feb 25; Accepted 2026 Mar 9; Collection date 2026. Copyright © 2026 Ren, Hao, Jia, Zheng, Zheng, Wu, Zhou, Wu, Ye, Ma, Lin and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. PMC Copyright notice PMCID: PMC13057547 PMID: 41960397 Abstract Background As an integral part of the “Healthy China” strategy, healthy aging emphasizes meeting the non-therapeutic health needs of middle-aged and older populations, which is highly consistent with Traditional Chinese Medicine (TCM) concepts. However, empirical studies focusing on the utilization patterns and determinants of such services among the middle-aged and older population remain limited. This study aims to assess the utilization and influencing factors of non-therapeutic TCM services among middle-aged and older people in Guangzhou. Methods A cross-sectional survey was conducted from June to October 2025 among 557 individuals aged ≥45 years old in Guangzhou using a structured questionnaire. Chi-square tests and binary logistic regression analyses were used to identify influencing factors. Results The overall utilization rate of non-therapeutic TCM services in the past month was 69.7%. Specifically, the utilization rates of health education, preventive health care, chronic disease management, and rehabilitation services were 25.10, 32.70, 28.00, and 30.90%, respectively. Key influencing factors varied by service type: understanding of TCM culture and chronic diseases affected health education utilization; TCM belief, income (≥5,000 yuan/month) and chronic diseases promoted preventive healthcare use; TCM promotion exposure and service satisfaction were associated with chronic disease management; age (≥75 years), regular physical examinations and high-frequency TCM use were associated with rehabilitation service utilization. Conclusion Non-therapeutic TCM service utilization is relatively high among middle-aged and older populations in Guangzhou, with type-specific influencing factors. Targeted measures (expanding TCM culture promotion, strengthening chronic disease management, optimizing subsidy policies, and enhancing primary TCM service supply) are recommended to further improve service accessibility. Keywords: aging populations, China, influencing factors, service utilization, TCM 1. Introduction Traditional Chinese Medicine (TCM) services refer to professional medical services that diagnose and treat patients through the four diagnostic methods (observation, auscultation, inquiry, and pulse-taking) under the guidance of TCM theory ( 1 ). Intervention methods mainly include pharmacological treatments (TCM decoctions and proprietary Chinese medicines) and non-pharmacological therapies (acupuncture, tuina, cupping, and guasha) ( 2 ). TCM applies to a wide range of populations, particularly demonstrating distinct advantages in managing non-communicable chronic diseases and meeting the health needs of the older population ( 3–7 ). Currently, TCM is used in 183 countries and regions around the world ( 8 ), and in most cases, it is categorized under traditional medicine, complementary medicine, or integrative medicine (sCIM) ( 2 ). The issuance of the “Healthy China 2030” Planning Outline has promoted the strategic transformation of China’s health care system from disease-centered to health-centered ( 9 ). Concurrently, China is experiencing an accelerated aging process, and the health needs of the middle-aged and older population have become increasingly diversified—no longer limited to disease treatment but extending to non-therapeutic services such as preventive health care, health preservation, rehabilitation, and health management ( 10 ). “Preventive treatment of diseases”, a core concept of TCM, aligns closely with modern preventive healthcare concepts ( 11 ). It emphasizes disease prevention over treatment, which is highly consistent with the health demands of the middle-aged and older population. This concept encompasses a four-stage continuum of care: predisease prevention (health maintenance for asymptomatic individuals); preclinical intervention (early management of subclinical conditions); acute care and complication prevention (treatment and disease progression control); and post-recovery rehabilitation (functional recovery and recurrence prevention). This framework provides comprehensive coverage across the entire health spectrum—from wellness to prognosis. Beyond conventional disease treatment, such services also integrate non-therapeutic TCM interventions, including health education, preventive healthcare, risk screening, chronic disease management, functional rehabilitation, and lifestyle modification ( 11 ). In recent years, a large number of studies have explored the utilization rate of TCM services and influencing factors. TCM service utilization varies significantly across populations and regions ( 12 ), ranging from 9 to 94.4% ( 13 , 14 ). Key influencing factors include age, income, residential location, health behaviors, educational level, disease type, and disease severity ( 15–17 ). Additionally, patients’ cognition and trust in TCM have attracted growing research attention ( 18 ). However, most existing studies have centered on TCM services applied in therapeutic settings and among patient populations, with insufficient attention devoted to the distinctive characteristics and health-related impacts of non-therapeutic TCM services. This information gap results in insufficient accurate data support for optimizing relevant services, making it challenging to fully meet the personalized health needs of the middle-aged and older population. By the end of 2024, the older population aged 60 and above in Guangzhou accounted for 19.81% of the total population, with the aging degree continuing to deepen ( 19 ). As the birthplace of Lingnan TCM culture, Guangzhou boasts abundant TCM resources and a well-established TCM service system, forming a multi-level TCM service supply network covering Grade A tertiary hospitals to community health service centers ( 20 ). The middle-aged and older populations in Guangzhou generally have a high level of cognition and acceptance of TCM, laying a solid foundation for the popularization and promotion of non-therapeutic TCM services ( 21 ). This study adopts a cross-sectional study method, targeting middle-aged and older residents in Guangzhou to investigate their utilization of non-therapeutic TCM services. It analyzes relevant characteristics, including demographic, sociological, and health-related factors, and identifies key determinants of service utilization. The findings aim to provide a scientific basis for Guangzhou’s health authorities to optimize TCM resource allocation and adjust health strategies, thereby better aligning with the “Healthy China” strategy. 2. Materials and methods 2.1. Study objects From July 1, 2025, to October 1, 2025, a survey was conducted among middle-aged and older populations in Guangzhou through a combination of online and offline methods using the Wenjuanxing platform. All questionnaire distribution, collection, and data collation were completed within this period. Inclusion criteria: aged ≥45 years, living in the community for ≥6 months, conscious, with basic communication skills, capable of understanding the questionnaire content and completing the survey independently or with the assistance of investigators, providing informed consent and voluntarily participating in the study. Exclusion criteria: suffering from severe cognitive impairment or mental illness and unable to cooperate with the survey, having critical diseases or being hospitalized for a long period, refusing to participate in the survey. A multi-stage stratified random sampling method was employed for participant recruitment to ensure the representativeness of the study sample. The specific sampling process was as follows: In the first stage, the 11 administrative districts of Guangzhou were stratified into four groups based on the size of the population aged 60 years and older in each district (<100,000; 100,000–200,000; 200,000–300,000; >300,000). One district was randomly selected from each group. In the second stage, two subdistricts were randomly selected from each selected district, and both online and offline surveys were conducted in these subdistricts to ensure that the sample covered administrative districts with different scales of older population. 2.2. Sample size calculation The sample size was calculated using the formula for cross-sectional studies, n = μ α 2 2 π ( 1 − π ) δ 2 where n is the minimum required sample size, μ α /2 = 1.96 when α = 0.05, π is the estimated utilization rate (41%, referenced from existing TCM service utilization studies), and δ is the allowable error (5%). The minimum sample size was 379 cases. Considering a 20% non-response and invalid response rate, the final sample size was determined to be at least 465 cases. 2.3. Questionnaire design Based on the Anderson Model of Health Service Utilization and relevant previous studies, a questionnaire was developed. Two rounds of expert consultations were conducted to ensure the comprehensiveness, validity, and reliability of the questionnaire. A total of 16 experts with professional titles at or above the intermediate level were invited, with expertise covering TCM clinical practice, medical education, nursing, geriatric health, health policy, health economics, and TCM culture popularization. The questionnaire consisted of five parts: (1) Predisposing characteristics: gender, age, educational level, occupation type, marital status, residential location, living conditions, regular physical examination status, exercise frequency, belief in TCM, understanding of TCM culture, family TCM usage habits, and friend recommendations; (2) Enabling resources: type of medical insurance, monthly income, distance to the nearest TCM-providing medical institution, and community TCM promotion activities; (3) Health needs: self-rated health status, presence of chronic diseases, and comorbidity of chronic diseases; (4) Service utilization: type of service utilized, utilization frequency, type of medical institution visited, trust in doctors, compliance with medical advice, and adjustments to living habits; (5) Health outcomes: satisfaction with TCM services, self-perceived health improvement, willingness to recommend to family and friends, affordability of services, time adequacy, transportation convenience, adequacy of nearby medical resources, and whether health needs were met. All subjective evaluation variables in this study (including attitudes, cognitions, satisfaction, beliefs, and other constructs) were assessed using a standardized single-item 5-point Likert scale. Uniform response categories were applied across all items: scores of 1–5 corresponded to strongly disagree/believe/understand/satisfied to strongly agree/believe/understand/satisfied, with a score of 3 indicating neutrality. Based on the research objectives and conceptual framework, original scores of 1–5 were dichotomized using consistent criteria: scores of 1–3 were coded as 0 (“no,” indicating no positive evaluation), and scores of 4–5 were coded as 1 = (“yes,” indicating positive evaluation). 2.4. Theoretical and operational definitions In this study, TCM services were categorized into therapeutic and non-therapeutic types based on their functional positioning, usage scenarios, and service objectives ( 22 ). Therapeutic TCM services refer to intervention measures with the primary purpose of disease diagnosis and clinical treatment. In contrast, non-therapeutic TCM services focus on health maintenance, disease prevention, and quality-of-life enhancement, targeting healthy and sub-healthy populations as well as individuals in the stable or recovery phases of illness ( 23 ). The core distinctions between these two categories lie in their service orientation (disease treatment versus health maintenance), target population (diagnosed patients versus healthy, sub-healthy, or rehabilitating individuals), and service objectives (disease elimination versus disease prevention and functional improvement) ( 23 ). This study specifically examines four types of non-therapeutic TCM services: health education, preventive healthcare, chronic disease management, and rehabilitation services. TCM health education services encompass health promotion activities delivered by healthcare professionals, including TCM health education programs, offline lectures on TCM knowledge, and online dissemination of TCM-related videos and graphic materials. TCM preventive healthcare services comprise wellness-oriented interventions such as constitution identification, dietary therapy, and medicinal cuisine, conditioning with appropriate TCM techniques, emotional regulation, and guidance in traditional exercises such as Tai Chi and Baduanjin ( 24 ). TCM chronic disease management services provide ongoing preventive and maintenance care for chronic conditions, including condition monitoring, lifestyle intervention, and efficacy evaluation, which are distinct from acute clinical treatment in their focus on disease stabilization and complication prevention ( 25 , 26 ). TCM rehabilitation services involve functional recovery interventions targeting physical dysfunction resulting from disease, trauma, or aging, with the aim of improving quality of life and restoring daily living capabilities ( 27 ). 2.5. Statistical analysis IBM SPSS Statistics 26.0 was used for data analysis. Descriptive statistics were presented as frequencies (n) and constituent ratios (%) for categorical data. Univariate analysis was performed using chi-square tests. Multivariate analysis was conducted using binary logistic regression, with odds ratios (OR) and 95% confidence intervals (CI) used to quantify the strength of associations. p- value <0.05 was considered statistically significant. 3. Results 3.1. Participant characteristics A total of 647 questionnaires were distributed, with 647 retrieved (response rate: 100%) and 557 valid (validity rate: 86.09%) ( Figure 1 ). Among these 557 valid participants, 10 individuals had never used TCM services, leading to missing data in service utilization and health outcomes variables. Participants with missing values were excluded from statistical analyses. The characteristics of the 557 participants across the dimensions of predisposing characteristics, enabling resources, health needs, service utilization, and health outcomes are presented in Table 1 . Figure 1. Open in a new tab Participant flow diagram. Table 1. Characteristics of five dimensions. Variables Total ( n = 557) Health education Preventive health care Chronic disease management Rehabilitation No Yes P No Yes P No Yes P No Yes P Gender Male 256 (46.00) 194 62 0.646 163 93 0.090 184 72 0.954 172 84 0.363 Female 301 (54.00) 223 78 212 89 217 84 213 88 Age (Year) 45–59 267 (47.90) 199 68 0.794 173 94 0.253 199 68 0.301 192 75 0.036* 60–74 214 (38.40) 163 51 153 61 152 62 150 64 ≥75 76 (13.60) 55 21 49 27 50 26 43 33 Education level ≤Primary school 129 (23.20) 95 34 0.686 89 40 0.374 92 37 0.994 82 47 0.165 Junior high school 123 (22.10) 88 35 86 37 88 35 94 29 Senior high school 177 (31.80) 137 40 122 55 128 49 120 57 ≥ college degree 128 (23.00) 97 31 78 50 93 35 89 39 Occupation type Personnel of enterprises and institutions 199 (35.70) 148 51 0.949 125 74 0.223 142 57 0.206 134 65 0.708 Workers and agricultural laborers 157 (28.20) 119 38 108 49 121 36 108 49 Self employment, freelance work, and others 201 (36.10) 150 51 142 59 138 63 143 58 Marital status Married 47 (8.40) 37 10 0.524 35 12 0.275 35 12 0.693 38 9 0.069 Unmarried 510 (91.60) 380 130 340 170 366 144 347 163 Residence Rural 180 (32.30) 134 46 0.874 124 56 0.587 135 45 0.275 121 59 0.503 Urban 377 (67.70) 283 94 251 126 266 111 264 113 Living condition Living alone 25 (4.50) 21 4 0.370 17 8 0.794 20 5 0.521 20 5 0.111 Core family 395 (70.90) 298 97 269 126 286 109 279 116 Extended Family 137 (24.60) 98 39 89 48 95 42 86 51 Regular physical examination No 176 (31.60) 134 42 0.638 121 55 0.626 122 54 0.339 135 41 0.008* Yes 381 (68.40) 283 98 254 127 279 102 250 131 Exercise frequency Low (≤ once every two weeks) 153 (27.50) 114 39 0.850 110 43 0.142 109 44 0.829 100 53 0.081 Medium (once a week) 125 (22.40) 96 29 88 37 88 37 80 45 High (≥ twice a week) 279 (50.10) 207 72 177 102 204 75 205 74 Belief in TCM No 233 (41.80) 171 62 0.496 170 63 0.016* 161 72 0.197 143 90 0.001* Yes 324 (58.20) 246 78 205 119 240 84 242 82 Understand TCM culture No 334 (60.00) 263 71 0.010* 241 93 0.003* 246 88 0.286 231 103 0.979 Yes 223 (40.00) 154 69 134 89 155 68 154 69 Family TCM usage habits No 191 (34.30) 147 44 0.410 133 58 0.401 146 45 0.091 131 60 0.844 Yes 366 (65.70) 270 96 242 124 255 111 254 112 Friend recommendations No 276 (49.60) 198 78 0.092 193 83 0.194 188 88 0.043* 187 89 0.489 Yes 281 (50.40) 219 62 182 99 213 68 198 83 Medical insurance Self funded or commercial health insurance 53 (9.50) 39 14 0.821 32 21 0.257 41 12 0.360 34 19 0.410 Medical insurance for urban and rural residents or urban employees 504 (90.50) 378 126 343 161 360 144 351 153 Monthly income (yuan) <2000 121 (21.70) 86 35 0.741 86 35 0.002* 80 41 0.376 81 40 0.797 2000–4,999 249 (44.70) 188 61 182 67 182 67 172 77 5,000–7,999 150 (26.90) 115 35 89 61 110 40 104 46 ≥8,000 37 (6.60) 28 9 18 19 29 8 28 9 Distance to the nearest TCM-providing medical institution <1 km 62 (11.10) 50 12 0.690 43 19 0.080 51 11 0.088 51 11 0.023* 1–3 km 160 (28.70) 119 41 114 46 117 43 113 47 3–5 km 197 (35.40) 144 53 119 78 131 66 123 74 >5 km and unclear 138 (24.80) 104 34 99 39 102 36 98 40 Community TCM promotion activities No 224(40.20) 176 48 0.098 157 67 0.254 176 48 0.005* 158 66 0.553 Yes 333 (59.80) 241 92 218 115 225 108 227 106 Self-rated health status Poor 86 (15.40) 61 25 0.658 60 26 0.846 62 24 0.882 53 33 0.227 Fair 262 (47.00) 198 64 174 88 191 71 182 80 Good 209 (37.50) 158 51 141 68 148 61 150 59 Chronic diseases No 52 (9.30) 50 2 <0.001* 44 8 0.005* 48 4 0.001* 48 4 <0.001* Yes 505 (90.70) 367 138 331 174 353 152 337 168 Comorbidity of chronic diseases No 150 (26.90) 131 19 <0.001* 102 48 0.837 123 27 0.001* 123 27 <0.001* Yes 407 (73.10) 286 121 273 134 278 129 262 145 Utilization frequency Low (≤ 3 times a month) 99 (18,10) 78 21 0.514 64 35 0.355 81 18 0.030* 83 16 0.001* Medium (4–7 times a month) 205 (37.50) 149 56 131 74 138 67 131 74 High (≥ 8 times per month) 243 (44.40) 180 63 170 73 172 71 161 82 Type of medical institution visited Primary level 76 (13.90) 66 10 0.008* 50 26 0.338 61 15 0.441 62 14 0.016* County level 113 (20.70) 88 25 72 41 77 36 66 47 Municipal level 124 (22.70) 81 43 76 48 89 35 84 40 Provincial level 192 (35.10) 138 54 138 54 135 57 136 56 other 42 (7.70) 34 8 29 13 29 13 27 15 Trust in doctors No 232 (42.40) 166 66 0.189 154 78 0.882 168 64 0.678 152 80 0.189 Yes 315 (57.60) 241 74 211 104 223 92 223 92 Compliance with medical advice No 163 (29.80) 117 46 0.359 105 58 0.455 110 53 0.177 108 55 0.451 Yes 384 (70.20) 290 94 260 124 281 103 267 117 Adjustments to living habits No 186 (34.00) 136 50 0.620 123 63 0.831 124 62 0.073 119 67 0.098 Yes 361 (66.00) 271 90 242 119 267 94 256 105 Satisfied with TCM services No 154 (28.20) 111 43 0.435 103 51 0.961 120 34 0.037* 102 52 0.464 Yes 393 (71.80) 296 97 262 131 271 122 273 120 Self-perceived health improvement General and below 203 (37.10) 156 47 0.315 131 72 0.402 140 63 0.317 132 71 0.172 Significant and above 344 (62.90) 251 93 234 110 251 93 243 101 willingness to recommend to family and friends No 161 (29.40) 113 48 0.144 109 52 0.755 112 49 0.522 110 51 0.940 Yes 386 (70.60) 294 92 256 130 279 107 265 121 Able to afford TCM services No 258 (47.20) 195 63 0.552 183 75 0.049* 179 79 0.304 170 88 0.205 Yes 289 (52.80) 212 77 182 107 212 77 205 84 Having sufficient time to receive TCM services No 190 (34.70) 140 50 0.778 135 55 0.117 137 53 0.813 132 58 0.736 Yes 357 (65.30) 267 90 230 127 254 103 243 114 Convenient transportation No 186 (34.00) 144 42 0.246 128 58 0.457 133 53 0.993 123 63 0.380 Yes 361 (66.00) 263 98 237 124 258 103 252 109 Adequate medical resources nearby No 229 (41.90) 166 63 0.383 152 77 0.882 165 64 0.802 158 71 0.851 Yes 318 (58.10) 241 77 213 105 226 92 217 101 Meet health needs No 224 (41.00) 168 56 0.791 144 80 0.313 162 62 0.717 148 76 0.297 Yes 323 (59.00) 239 84 221 102 229 94 227 96 Open in a new tab * = significantly associated factors. 3.2. Utilization status Among the 557 participants, 547 (98.20%) had prior experience with TCM services. Within the past month, 426 (76.50%) had used TCM services, and 388 (69.70%) had utilized non-therapeutic TCM services. Among the non-therapeutic service types, preventive health care services were the most commonly used (182 cases, 32.70%), followed by rehabilitation services (172 cases, 30.90%) and chronic disease management services (156 cases, 28.00%), while health education services had the lowest utilization rate (140 cases, 25.10%). In terms of intervention methods, participants showed a greater preference for appropriate TCM technologies (233 cases, 41.80%) compared to oral Chinese medicines (181 cases, 32.50%). Detailed data are presented in Table 2 . Table 2. The utilization of non-therapeutic TCM services. Main category Classification Frequency (n) Composition ratio (%) Utilization Previously used TCM services 547 98.20 Used TCM services in the past month 426 76.50 Used non-therapeutic TCM services in the past month 388 69.70 Service type TCM health education services 140 25.10 TCM preventive health care services 182 32.70 TCM chronic disease management services 156 28.00 TCM rehabilitation services 172 30.90 Intervention method Oral administration of TCM 181 32.50 Appropriate techniques for TCM 233 41.80 Open in a new tab 3.3. Reasons for prioritizing TCM Among the 557 participants, 533 (95.69%) indicated they would prioritize TCM when having health needs. Belief in TCM was the primary reason for choosing TCM (247 cases, 44.3%), followed by good therapeutic efficacy (225 cases, 40.4%), high quality of Chinese medicines (209 cases, 37.5%), and excellent medical skills of TCM practitioners (208 cases, 37.3%). Regarding disease severity, 28.5% of participants would choose TCM for severe diseases, while 16.5% would prioritize TCM for mild conditions. Twenty-four participants (4.31%) stated they would not prioritize TCM, with the main reasons being the long treatment cycle of Chinese medicines (12 cases, 2.2%) and the inconvenience of administration (10 cases, 1.8%). Detailed data are presented in Table 3 . Table 3. Reasons for prioritizing TCM. Classification Reason Frequency ( n ) Composition ratio (%) Prioritize TCM Believe in TCM 247 44.30 Good effect 225 40.40 Good quality of Chinese herbal medicine 209 37.50 Good technical skills of doctors 208 37.30 Good service attitude of doctors 190 34.10 Convenient transportation 178 32.00 Cheap 178 32.00 Severe illness 159 28.50 Minor side effects of Chinese herbal medicine 159 28.50 Mild illness 92 16.50 Do not prioritize TCM Long cycle of TCM treatment 12 2.20 Difficulty in taking TCM 10 1.80 Relatively high price 7 1.30 Poor effect 6 1.10 Significant side effects of Chinese herbal medicine 6 1.10 Poor quality of Chinese herbal medicine 5 0.90 Do not believe TCM 5 0.90 Mild illness 2 0.40 Severe illness 2 0.40 Poor service attitude of doctors 2 0.40 Poor technical skills of doctors 1 0.20 Poor transportation 1 0.20 Open in a new tab 3.4. Influencing factors Univariate analysis results ( Table 1 ) showed that utilization of TCM health education services differed significantly by understanding of TCM culture ( p = 0.010), presence of chronic diseases ( p < 0.001), comorbidity of chronic diseases ( p < 0.001), and type of medical institution visited ( p = 0.008). Utilization of TCM preventive health care services varied by belief in TCM ( p = 0.016), understanding of TCM culture ( p = 0.003), income level ( p = 0.002), presence of chronic diseases ( p = 0.005), and service affordability ( p = 0.049). Factors influencing utilization of TCM chronic disease management services included friend recommendations ( p = 0.043), community TCM promotion ( p = 0.005), presence of chronic diseases ( p = 0.001), comorbidity of chronic diseases ( p = 0.001), utilization frequency ( p = 0.030), and satisfaction with TCM services ( p = 0.037). Factors affecting utilization of TCM rehabilitation services included age ( p = 0.036), regular physical examinations ( p = 0.008), belief in TCM ( p = 0.001), distance to medical institutions ( p = 0.023), presence of chronic diseases ( p < 0.001), comorbidity of chronic diseases ( p < 0.001), utilization frequency ( p = 0.001), and type of medical institution visited ( p = 0.016). Variables with p < 0.05 in univariate analysis were included in multivariate analysis. Binary logistic multivariate regression analysis was performed using the backward LR method ( Table 4 ). The results indicated that middle-aged and older individuals who understood TCM culture (OR = 1.174, 95%CI: 1.150–2.555, p = 0.008), had chronic diseases (OR = 4.824, 95%CI: 1.057–22.018, p = 0.042), had comorbid chronic diseases (OR = 1.83, 95%CI: 1.029–3.254, p = 0.040), and sought medical care at provincial/municipal hospitals (OR = 1.762, 95%CI: 1.124–2.763, p = 0.014) were more likely to use TCM health education services. Compared to those who did not believe in TCM or understand TCM culture, individuals who believed in TCM (OR = 1.654, 95%CI: 1.126–2.430, p = 0.010) and understood TCM culture (OR = 1.532, 95%CI: 1.055–2.225, p = 0.025) were more inclined to use TCM preventive health care services. Those with chronic diseases (OR = 3.632, 95%CI: 1.619–8.146, p = 0.002) and monthly income ≥5,000 yuan (OR = 1.949, 95%CI: 1.329–2.860, p = 0.001) also had a higher likelihood of utilizing TCM preventive health care services. Presence of chronic diseases (OR = 3.885, 95%CI: 1.338–11.276, p = 0.013), exposure to community TCM promotion activities (OR = 1.637, 95%CI: 1.091–2.457, p = 0.017), and satisfaction with TCM services (OR = 1.815, 95%CI: 1.163–2.834, p = 0.009) were associated with increased utilization of TCM chronic disease management services. The probability of TCM rehabilitation service utilization among individuals aged ≥75 years was twice that of those aged 45–59 years (OR = 2.119, 95%CI: 1.216–3.692, p = 0.008). Individuals who underwent regular physical examinations (OR = 1.727, 95%CI: 1.121–2.659, p = 0.013) and had chronic diseases (OR = 3.183, 95%CI: 1.080–9.384, p = 0.036) were more likely to use TCM rehabilitation services. Compared to those seeking care at primary hospitals, individuals who visited district/county-level hospitals (OR = 2.352, 95%CI: 1.130–4.896, p = 0.022) had a higher likelihood of utilizing TCM rehabilitation services. Additionally, individuals who used TCM services ≥4 times per month were more than twice as likely to use TCM rehabilitation services as those with utilization frequency ≤3 times per month (OR = 2.295, 95%CI: 1.255–4.197, p = 0.007). Table 4. Multivariate analysis of influencing factors. Service type Variables B SE Wald P Exp(B) 95% CI TCM health education services Understand TCM culture No Ref Yes 0.539 0.20 6.99 0.008* 1.714 1.150–2.555 Chronic diseases No Ref Yes 1.574 0.78 4.126 0.042* 4.824 1.057–22.018 Comorbidity of chronic diseases No Ref Yes 0.604 0.29 4.236 0.040* 1.83 1.029–3.254 Type of medical institution visited 6.793 0.0303* Primary or county hospitals Ref Provincial or municipal hospitals 0.567 0.23 6.101 0.014* 1.762 1.124–2.763 Other 0.058 0.45 0.017 0.896 1.06 0.442–2.543 TCM preventive health care services Belief in TCM No Ref Yes 0.503 0.196 6.568 0.010* 1.654 1.126–2.430 Understand TCM culture No Ref Yes 0.427 0.19 5.019 0.025* 1.532 1.055–2.225 Chronic diseases No Ref Yes 1.29 0.412 9.793 0.002* 3.632 1.619–8.146 Monthly income (yuan) <5,000 Ref ≥5,000 0.668 0.195 11.66 0.001* 1.949 1.329–2.860 TCM chronic disease management services Chronic diseases No Ref Yes 1.357 0.544 6.229 0.013* 3.885 1.338–11.276 Community TCM promotion activities No Ref Yes 0.493 0.207 5.67 0.017* 1.637 1.091–2.457 Satisfied with TCM services No Ref Yes 0.596 0.227 6.883 0.009* 1.815 1.163–2.834 Utilization frequency Low Ref Medium and high 0.524 0.289 3.297 0.069 1.689 0.959–2.973 TCM rehabilitation services Age (Year) 7.025 0.030* 45–59 Ref 60–74 0.201 0.213 0.889 0.346 1.223 0.805–1.857 ≥75 0.751 0.283 7.025 0.008* 2.119 1.216–3.692 Regular physical examination No Ref Yes 0.546 0.22 6.143 0.013* 1.727 1.121–2.659 Chronic diseases No Ref Yes 1.158 0.552 4.405 0.036* 3.183 1.080–9.384 Type of medical institution visited 7.085 0.029* Primary Ref County level 0.855 0.374 5.227 0.022* 2.352 1.130–4.896 Provincial, municipal hospitals or others 0.332 0.338 0.962 0.327 1.394 0.718–2.705 Utilization frequency Low Ref Medium and high 0.831 0.308 7.282 0.007* 2.295 1.255–4.197 Open in a new tab Sensitivity analysis was performed using the enter method (including all initial variables) to test the sensitivity of the results to model specifications. The results showed that the consistency rate of the significantly influencing factors screened by the two regressions was 81.25%, and the fluctuation range of OR values was ≤10%. Three variables that were significant in the original regression became non-significant in the sensitivity analysis, with p- values of 0.061, 0.156, and 0.05, respectively. The reason for this fluctuation difference can be attributed to the different specifications of the two models: the original backward LR regression effectively controlled potential collinearity by gradually excluding redundant variables, while the enter method was used in the sensitivity analysis to include all initial variables without excluding redundant variables, which may lead to minor collinearity. However, the above three variables with differences did not have a substantial impact on the effect intensity and direction of the other significant variables. Overall, the multivariable analysis results of this study exhibit a certain degree of robustness. 4. Discussion Non-therapeutic TCM services not only play a crucial role in meeting the health needs of the contemporary middle-aged and older population but also align with the key directions of the “Healthy China” strategy. This study found that 98.20% of participants had prior experience with TCM services, which is significantly higher than the utilization rates reported among older populations in Hunan (61.90%) and Zhejiang (29.38%) ( 28 , 29 ). The monthly TCM service utilization rate in this study (76.50%) was also higher than that of home-based older care groups in Hangzhou (48.72%) and Taiwan (7.3%) ( 30 , 31 ). These discrepancies indicate that the middle-aged and older population in Guangzhou has a high level of acceptance of TCM, with TCM use being widespread. The utilization rate of non-therapeutic TCM services (69.70%) was slightly lower than that of TCM services. In contrast, the utilization rate of community non-therapeutic health services among older individuals aged ≥60 years in Shaanxi was 32.31% ( 32 ), while the consumption rate of dietary Chinese medicines in Cantonese-speaking areas of Guangzhou over the past 12 months reached 74.7% ( 33 ). This suggests that TCM usage habits have been integrated into the daily lives of Guangzhou residents, extending beyond TCM services provided by medical institutions. Regarding intervention methods, the utilization rate of appropriate TCM technologies (41.80%) was higher than that of oral Chinese medicines (32.50%) in this study. A previous survey of chronic disease patients in China showed that 73.11% of patients using TCM therapies opted for Chinese medicines, significantly higher than the utilization rate of appropriate TCM technologies such as acupuncture, moxibustion, and cupping ( 2 ). However, among first-time stroke inpatients, the utilization rate of acupuncture was 79.7%, while that of oral Chinese medicines was only 5.1% ( 34 ). These differences were mainly related to variations in utilization purposes driven by population characteristics. A total of 95.69% of participants reported prioritizing TCM for health needs. During the COVID-19 pandemic, the acceptance rate of TCM among asymptomatic infected individuals in Shanghai was 91.35% ( 35 ), which is generally consistent with the findings of this study, though population differences should be considered. Among Chinese immigrants in Canada, 48.8% chose TCM as a preventive measure, while only 20.8% believed that Western medicine could effectively prevent infections ( 36 ). In contrast, a study on medical-seeking tendencies based on the Taiwan Biobank found that 50.8% of participants preferred Western medicine treatment, and only 10.4% preferred TCM ( 37 ). These significant differences are mainly associated with variations in regional and socio-cultural backgrounds ( 15 ). Regarding reasons for choosing TCM, good therapeutic efficacy has been supported by previous studies ( 35 , 38 ). Individuals who did not accept TCM cited time constraints and inconvenience as the main barriers, whereas previous studies identified lack of physician recommendations and concerns about side effects as key factors ( 35 , 38 ). This indicates that the middle-aged and older population in Guangzhou is more concerned with practical barriers during TCM utilization. The utilization rate of TCM preventive health care services was 32.70%, slightly higher than that of urban residents in Chongqing (27.3%) ( 39 ) and similar to that of migrant older populations in China (32.64%) ( 40 ). A study in Shanghai reported that 48.3% of high-risk diabetes populations used such services within the past year ( 41 ). Belief in TCM, understanding of TCM culture, presence of chronic diseases, and monthly income ≥5,000 yuan were identified as factors associated with TCM preventive health care service utilization, which is consistent with previous findings ( 2 , 29 , 35 , 42 ). TCM possesses inherent cultural attributes; individuals who understand TCM culture were associated with a greater likelihood of embracing the concept of “preventive treatment of disease” and were more likely to believe in the effectiveness of TCM interventions for disease prevention. Chronic disease patients typically have a certain understanding of their conditions and more proactive engagement in preventive measures to avoid disease progression or comorbidities. Economic status was related to payment capacity—individuals with lower monthly incomes tended to allocate limited resources to basic living needs and existing health problems, which corresponded to weaker willingness and capacity to pay for non-essential preventive health care services. The utilization rate of TCM rehabilitation services was 30.90%, lower than the utilization rate of appropriate TCM technologies among older rehabilitation patients (41.19%) ( 43 ). Presence of chronic diseases and age ≥75 years were key factors associated with TCM rehabilitation service utilization. A survey in Jiangsu found that age ≥65 years was associated with higher TCM service utilization rates ( 13 ). Individuals aged ≥75 years, belonging to the advanced older group, often experience physical function decline and long-term chronic diseases, which were correlated with a higher risk of sequelae or functional impairments, and thus corresponded to greater rehabilitation needs. Individuals who undergo regular physical examinations showed a higher tendency to use TCM rehabilitation services, as those requiring rehabilitation typically have poor health status and may receive physician recommendations for regular physical examinations to assess their condition. Compared to those seeking medical care at primary hospitals, individuals who visited district/county-level hospitals were more inclined to use TCM rehabilitation services—a finding consistent with a survey of older dementia patients ( 44 ). Currently, the coverage rate of TCM services in primary medical institutions in Guangzhou exceeds 80%, but the supply capacity of systematic and standardized rehabilitation services remains limited. Consequently, individuals with rehabilitation needs were more likely to seek medical care at higher-level hospitals. This study also found that individuals who used TCM services ≥4 times per month showed a higher probability of using TCM rehabilitation services. Previous studies have similarly noted that chronic disease patients who visited medical institutions multiple times per week had higher TCM utilization rates ( 2 ). Additionally, a high frequency of complementary and alternative medicine (CAM) utilization (40.0%) was observed among Parkinson’s patients receiving rehabilitation treatment, compared to 22.9% for CAM utilization unrelated to Parkinson’s disease ( 45 ). High-frequency medical service utilization is typically associated with persistent and complex health problems, which aligns with the health characteristics of the older population. Regular rehabilitation treatment was correlated with significant improvements in motor symptoms and quality of life ( 45 ), and trust accumulation and behavioral inertia resulting from symptom improvement may reduce the threshold for utilizing rehabilitation services. The prevalence of chronic diseases among middle-aged and older populations in Guangzhou was 90.70%, yet the utilization rate of chronic disease management services was only 28.00%. Presence of chronic diseases was an important factor related to the utilization of TCM chronic disease management services. Previous studies have reported TCM service utilization rates among chronic disease patients ranging from 14.0 to 43.3% ( 46–52 ), with differences mainly linked to variations in disease types and service utilization purposes. Satisfaction with TCM services and exposure to community TCM promotion activities were also associated with increased utilization of TCM chronic disease management services, which is consistent with previous findings ( 53 , 54 ). Chronic disease patients who are satisfied with TCM services demonstrated a higher tendency to continue using TCM. Common chronic diseases such as hypertension and diabetes often have no obvious early symptoms, which is related to insufficient patient awareness of the importance of disease management. A previous study found that the awareness rate of regular medication among rural hypertension patients in Heilongjiang was only approximately 60%, and the awareness rate of lifelong medication was even lower ( 52 ). However, increased access to health information was correlated with a higher likelihood of TCM utilization ( 2 ). TCM health education services had the lowest utilization rate (25.10%). Understanding of TCM culture was associated with higher acceptance of TCM health education. Studies among Chinese immigrant groups have emphasized the importance of cultural adaptation for health education programs ( 55 ), and a stronger cultural identity was related to greater trust in health knowledge. TCM’s integration into daily life also contributed to a lower threshold for accepting TCM health education. Presence of chronic diseases and comorbidities was also associated with the utilization of health education services. A study of cardiovascular disease patients found that 50.3% of participants were interested in health education ( 56 ). Additionally, patients with comorbid chronic diseases typically have poorer health status and prognosis, requiring comprehensive management, and physicians may provide more health education to this group. Middle-aged and older individuals who sought care at provincial/municipal hospitals were more likely to use TCM health education services. As regional medical centers, provincial/municipal hospitals offer more professional and systematic TCM-related services compared to lower-level hospitals. Preference for authoritative health information was also linked to greater demand for health education at higher-level medical institutions among the middle-aged and older population ( 57 ). This study has some limitations. First, as a cross-sectional study using self-reported questionnaires, it is inherently subject to recall bias and cannot establish causal relationships. To minimize the impact of information bias, we adopted a standardized questionnaire design. However, certain information bias may still exist, which needs to be considered when interpreting the results. Further longitudinal studies are required to verify the findings and establish potential causal relationships. Second, despite the adoption of scientific sampling methods, potential selection bias may still exist due to the combination of online surveys — for example, online respondents may be more familiar with internet operation, which could lead to certain deviations in sample characteristics. Third, all subjective evaluation variables were measured using single-item scales. Although this approach helps control questionnaire length while preserving data quality in large-scale surveys, it precludes the assessment of internal consistency reliability and may not fully capture the complexity of the constructs. Furthermore, dichotomization of subjective scale scores results in the loss of some detailed information, which may not fully reflect the subtle differences in the subjective attitudes of respondents. Fourth, the study was limited to Guangzhou, and differences in regional and cultural backgrounds may limit the generalizability of the findings. Specifically, most associations identified in this study are consistent with previous studies and may be replicable across similar populations. However, the high baseline engagement and utilization rate observed in this study are context-specific, shaped by Guangzhou’s unique regional culture, residents’ TCM usage habits, and local health service supply characteristics, which may not be directly generalizable to other regions with different cultural and health system backgrounds. In the future, large-scale multi-population and multi-regional surveys should be conducted to better understand the overall trends in non-therapeutic TCM service utilization and provide more targeted references for policy formulation. 5. Conclusion This study investigates the utilization status and influencing factors of non-therapeutic TCM services among middle-aged and older populations in Guangzhou. The overall utilization rate of non-therapeutic TCM services was 69.70%, with utilization rates of 25.10, 32.70, 28.00, and 30.90% for health education, preventive health care, chronic disease management, and rehabilitation services, respectively. Key influencing factors include trust in TCM, understanding of TCM culture, presence of chronic diseases, type of medical institution visited, income level, community TCM promotion, satisfaction with TCM services, utilization frequency, age, and regular physical examination status. Based on these context-specific findings, the following tentative recommendations are proposed for future reference, given that this study does not evaluate intervention effects: (1) Consider expanding the promotion of TCM knowledge and culture through integrated online and offline approaches, particularly in regions with similar cultural backgrounds to Guangzhou; (2) Explore leveraging TCM’s holistic concept to strengthen comprehensive management of comorbid chronic diseases, with reference to the characteristics of the middle-aged and older population in this study; (3) Future policy efforts could consider formulating targeted subsidy policies for low-income groups to reduce potential barriers to accessing preventive health care services, which may be adjusted according to regional economic and cultural differences; (4) Consider enhancing the supply capacity of rehabilitation services in primary medical institutions in Guangzhou to improve local service accessibility, with caution in generalizing this approach to other regions. Acknowledgments The authors acknowledge gratitude to all the staff who participated in this study. Funding Statement The author(s) declared that financial support was not received for this work and/or its publication. Edited by: Mariana Cabral Schveitzer , Universidade Federal de São Paulo, Brazil Reviewed by: Lambert Zixin Li , National University of Singapore, Singapore Rahima Tanbin Tama , Islamic University, Bangladesh Abbreviations: TCM, traditional Chinese medicine; TCIM, traditional, complementary, and integrative medicine; CAM, complementary and alternative medicine; OR, odds ratios; CI, confidence intervals. Data availability statement The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s. Ethics statement The studies involving humans were approved by The Ethics (Review) Committee for Human Life Sciences and Medical Research of Guangzhou University of Chinese Medicine. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Author contributions JR: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft. JH: Data curation, Investigation, Writing – original draft. ZJ: Data curation, Investigation, Writing – original draft. CZ: Data curation, Investigation, Writing – original draft. YZ: Data curation, Investigation, Writing – original draft. ZW: Data curation, Investigation, Writing – original draft. XZ: Visualization, Writing – review & editing. HW: Data curation, Investigation, Writing – original draft. XY: Data curation, Investigation, Writing – original draft. XM: Supervision, Writing – review & editing. BL: Supervision, Writing – review & editing. LY: Supervision, Visualization, Writing – review & editing. Conflict of interest The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Generative AI statement The author(s) declared that Generative AI was used in the creation of this manuscript. During the preparation of this work the authors used Doubao and Grammarly in order to improve the readability and language of the manuscript. After using the tools, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article. Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us. Publisher’s note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. References 1. Wu MB, Wu Y-K, Chen M-H, Kimble B, May B, Chan V, et al. Exploring traditional Chinese medicine tongue diagnosis in potential cancer identification: a scoping review. Integr Med Res. (2026) 15:101265. doi: 10.1016/j.imr.2025.101265, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Cao Y, Huang T, Deng H, Zhang J, Guo F, Yin W, et al. The current situation and factors influencing the use of traditional Chinese medicine therapies among patients with chronic disease in China: a cross-sectional study. Sci Rep. (2025) 15:30947. doi: 10.1038/s41598-025-16933-2, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 3. Hou Y-N, Chimonas S, Patel P, Kantor ED, Traina TA, Yen H-R, et al. Traditional Chinese medicine herbs for breast Cancer prevention and survival: a narrative review of epidemiological studies from Taiwan. Curr Oncol Rep. (2024) 26:1321–33. doi: 10.1007/s11912-024-01595-6, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 4. Cui H-R, Zhang J-Y, Cheng X-H, Zheng J-X, Zhang Q, Zheng R, et al. Immunometabolism at the service of traditional Chinese medicine. Pharmacol Res. (2022) 176:106081. doi: 10.1016/j.phrs.2022.106081, [ DOI ] [ PubMed ] [ Google Scholar ] 5. Hao P, Jiang F, Cheng J, Ma L, Zhang Y, Zhao Y. Traditional Chinese medicine for cardiovascular disease: evidence and potential mechanisms. J Am Coll Cardiol. (2017) 69:2952–66. doi: 10.1016/j.jacc.2017.04.041, [ DOI ] [ PubMed ] [ Google Scholar ] 6. Chen K, Chen H. Traditional Chinese medicine for combating COVID-19. Front Med. (2020) 14:529–32. doi: 10.1007/s11684-020-0802-9, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 7. Tama RT, Hossain MS, Rahaman MA, Alam MA, Rahman M-M, Parvin A, et al. Harnessing the power of natural products against bacterial urinary tract infections: a perspective review for cultivating solutions. Health Sci Rev. (2024) 13:100199. doi: 10.1016/j.hsr.2024.100199 [ DOI ] [ Google Scholar ] 8. Lam WC, Lyu A, Bian Z. ICD-11: impact on traditional Chinese medicine and world healthcare systems. Pharmaceut Med. (2019) 33:373–7. doi: 10.1007/s40290-019-00295-y, [ DOI ] [ PubMed ] [ Google Scholar ] 9. Xinhua News Agency. Healthy China 2030 Planning Outline [Issued by the Central Committee of the Communist Party of China and the State Council]. Chinese Government Network (2016). Available online at: https://www.gov.cn/zhengce/2016-10/25/content_5124174.htm (Accessed November 15, 2025). 10. Zhang Z, Shao H. Thoughts and countermeasures for the development of the elderly health industry: from the perspective of strategic emerging industries. Chinese J Health Policy. (2014) 7:1–6. [ Google Scholar ] 11. Lyu R-T, Ai Y-L, Yang Z-Q, Wang T, Tang J-Y. Research and development of new traditional Chinese medicine (TCM) for “preventive treatment of diseases” and innovation of TCM. Zhongguo Zhong Yao Za Zhi. (2025) 50:3589–95. doi: 10.19540/j.cnki.cjcmm.20250310.603, [ DOI ] [ PubMed ] [ Google Scholar ] 12. Zhang B, Chen J, Li S, Cao Y, Zhang J. Interprovincial spatial distribution patterns and socioeconomic factors on traditional Chinese medicine (TCM) service utilization in China. Soc Sci Med. (2024) 353:117046. doi: 10.1016/j.socscimed.2024.117046, [ DOI ] [ PubMed ] [ Google Scholar ] 13. Lyu Y, Hu M, Xu A. Investigation on the influential factors of TCM service utilized by outpatients in Jiangsu Province. China Pharmacy. (2021) 32:2668–72. doi: 10.6039/j.issn.1001-0408.2021.21.18 [ DOI ] [ Google Scholar ] 14. Dai X, Zhang Y, Yi J, Tang L, He L. Current investigation on demand and utilization of traditional Chinese medicine health services by the demand side in Chongqing. J Sichuan Univ. (2016) 47:431–3. doi: 10.13464/j.scuxbyxb.2016.03.028 [ DOI ] [ Google Scholar ] 15. Aw JYH, Sbirakos Yiengprugsawan V, Gong CH. Utilization of traditional Chinese medicine practitioners in later life in mainland China. Geriatrics (Basel). (2019) 4:49. doi: 10.3390/geriatrics4030049, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 16. Li J-M, Lin C-L, Liao K-R, Liao C-C. Use of traditional Chinese medicine for patients diagnosed with postpartum depression: a Nationwide population-based study. Evid Based Complement Alternat Med. (2020) 2020:7060934. doi: 10.1155/2020/7060934, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Dai MR, Ho DK, Huang L, Quock RL, Flaitz CM. Utilization of Chinese herbal medicine for selected oral conditions in two pediatric populations. Pediatr Dent. (2016) 38:311–6. [ PubMed ] [ Google Scholar ] 18. Xin B, Mu S, Tan T, Yeung A, Gu D, Feng Q. Belief in and use of traditional Chinese medicine in Shanghai older adults: a cross-sectional study. BMC Complement Med Ther. (2020) 20:128. doi: 10.1186/s12906-020-02910-x, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 19. Guangzhou Municipal People’s Government. Data on the Elderly Population and Undertakings: Witnessing the Dynamic Old Age of Guangzhou’s Elderly. Available online at: https://www.gz.gov.cn/xw/zwlb/bmdt/content/post_10288105.html (Accessed November 19, 2025) 20. Guangzhou Municipal Health Commission Notice on issuing the implementation plan of the 14th Five-Year Action Plan for improving the capacity of grassroots traditional Chinese medicine services in Guangzhou. Available online at: https://wjw.gz.gov.cn/zmhd/cjwt/zczy/content/post_9637260.html (Accessed February 9, 2026) 21. Zhong A, Liui A, Zhou S, Gao S, Gao J, Zou G, et al. A study on the knowledge, attitude, practice and influencing factors of community residents towards preventive treatment of disease in traditional Chinese medicine in Guangzhou. Chin Gen Pract. (2024) 27:1886–92. doi: 10.12114/j.issn.1007-9572.2023.0488 [ DOI ] [ Google Scholar ] 22. National Administration of Traditional Chinese Medicine. Notice on issuing the norms for traditional Chinese medicine health preservation and health care services. (2023). Available online at: https://www.gov.cn/zhengce/zhengceku/2023-05/08/content_5754578.htm (Accessed February 12, 2026) 23. National Administration of Traditional Chinese Medicine Notice on issuing the guidelines for the construction and management of preventive treatment of disease departments in traditional Chinese medicine hospitals (2025 revised edition). Available online at: http://www.natcm.gov.cn/zxyjhyssmzyys/zhengcewenjian/2025-07-24/36671.html (Accessed February 12, 2026) 24. Brammer MS. Exploration on “preventive treatment of disease” service pattern of traditional Chinese medicine in Shanghai. OJCAM. (2020) 5:1–3. doi: 10.33552/OJCAM.2020.05.000610 [ DOI ] [ Google Scholar ] 25. Liu H, Xu B. Optimized implementation strategies for traditional Chinese medicine management interventions in sub-healthy elderly population and their impact on quality of life enhancement. CIA. (2025) 20:1481–93. doi: 10.2147/CIA.S536976, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 26. Wang X, Tuohetiaji, Hong J. Research progress of traditional Chinese medicine health management model in community coronary heart disease. Adv Clin Med. (2023) 13:3062. doi: 10.12677/ACM.2023.133435 [ DOI ] [ Google Scholar ] 27. Sung J, Jiang Z, Huang Y. Recent clinical advances and integrative Chinese-Western medicine practices in geriatric care: a review from the perspective of traditional Chinese internal medicine. J Fut Soc Educ. (2025) 2:55–65. doi: 10.3991/jfse.v2i3.58021 [ DOI ] [ Google Scholar ] 28. Xu R, Zhan H, Wang H, Wu Q, Liu Y. Research on the utilization of grassroots traditional Chinese medicine services for the elderly. J Tradit Chin Med Manag. (2023) 31:31–4. doi: 10.16690/j.cnki.1007-9203.2023.22.099 [ DOI ] [ Google Scholar ] 29. Wang B, Wu Y, Mao X, Zheng M, Guo Q. The demand and utilization of traditional Chinese medicine services for urban and rural home-based elderly care groups in Zhejiang Province based on social ecological theory. J Zhejiang Chin Med Univ. (2023) 47:142–7. doi: 10.16466/j.issn1005-5509.2023.02.005 [ DOI ] [ Google Scholar ] 30. Wang J. Demand and utilization of traditional Chinese medicine services for home-based elderly care based on social ecological theory. J Tradit Chin Med Manag. (2024) 32:42–4. doi: 10.16690/j.cnki.1007-9203.2024.09.066 [ DOI ] [ Google Scholar ] 31. Huang C-J, Chang C-C, Chen T-L, Yeh C-C, Lin J-G, Liu C-H, et al. The long-term trend in utilization of traditional Chinese medicine and associated factors among older people in Taiwan. PLoS One. (2024) 19:e0302658. doi: 10.1371/journal.pone.0302658, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 32. Yu Z, Wang L, Ariyo T. Supply and demand-related decisive factors in the utilization of non-medical community healthcare services among elderly Chinese. Int J Environ Res Public Health. (2021) 18:228. doi: 10.3390/ijerph18010228, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 33. Peng J, Chen S, Wang P, Huang R, Li Q, Chen Z. A field survey on the dietary use of traditional Chinese medicine in selected regions with the Cantonese, Hakka, and Teochew populations in Guangdong province, China. Food Sci Nutr. (2024) 12:7438–48. doi: 10.1002/fsn3.4295, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. Chen W-S, Hsu H-C, Chuang Y-W, Lee M, Lu K-Y, Chen Y-F, et al. Predictors for the use of traditional Chinese medicine among inpatients with first-time stroke: a population-based study. BMC Complementary Med Ther. (2020) 20:244. doi: 10.1186/s12906-020-03037-9, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 35. Pan B, Yin H, Yu Y, Xiang X, Yu C, Yan X-J, et al. Acceptance and attitude towards the traditional chinese medicine among asymptomatic COVID-19 patients in Shanghai Fangcang hospital. BMC Complement Med Ther. (2023) 23:97. doi: 10.1186/s12906-023-03922-z, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 36. Kong Y, Shaver LG, Shi F, Yang L, Zhang W, Wei X, et al. Attitudes of Chinese immigrants in Canada towards the use of traditional Chinese medicine for prevention and management of COVID-19: a cross-sectional survey during the early stages of the pandemic. BMJ Open. (2021) 11:e051499. doi: 10.1136/bmjopen-2021-051499, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 37. Chen P-H, Huang S-M, Lai JC-Y, Lin W-L. Determinants of health-seeking behavior toward Chinese or Western medicine in Taiwan: an analysis of biobank research database. Complement Ther Clin Pract. (2022) 48:101592. doi: 10.1016/j.ctcp.2022.101592, [ DOI ] [ PubMed ] [ Google Scholar ] 38. Hong J, Gong B, Chen Q, Zhai J, Zhang Q, Liu H, et al. Predictors of willingness to accept traditional Chinese medicine among Chinese college students: a cross-sectional study. BMC Complement Med Ther. (2025) 25:410. doi: 10.1186/s12906-025-05156-7, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 39. Guo D, Pu C, Peng Y, Qiu L, Hu X. Utilization of traditional Chinese medicine community services and influencing factors by residents in the Main urban areas of Chongqing. Chin Gen Pract. (2023) 26:2369–75. doi: 10.12114/j.issn.1007-9572.2022.0685 [ DOI ] [ Google Scholar ] 40. Zhao X, Ding B, Wang Y. Preventive medical services and influencing factors for migrant elderly in China from the perspective of household registration differences: a cross-sectional study. Medicine (Baltimore). (2025) 104:e41885. doi: 10.1097/MD.0000000000041885, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 41. Wang Hong-xing, Wang Hong-xing, Wang Qi-kai, Li Jun, Zhu-qin, Lin Jing-jing. Research demand and utilization of traditional Chinese medicine “disease prevention” service among community residents of high-risk diabetes Chin J Gen Pract (2020) 18 797–800 doi: 10.16766/j.cnki.issn.1674-4152.001360 [ DOI ] [ Google Scholar ] 42. Sun L-q, Yan Y-f, Zhang T, Li S-t, Zhu Y-y, Ren J-p. Analysis on the utilization status and influencing factors of traditional Chinese medicine service among Hangzhou residents. Chin Prim Health Care. (2018) 32:76–8. [ Google Scholar ] 43. Shao F, Teng L, Hu J. Practice status and influencing factors analysis of traditional Chinese medicine nursing techniques in geriatric rehabilitation departments. J Tradit Chin Med Manage. (2023) 31:64–6. doi: 10.16690/j.cnki.1007-9203.2023.02.041 [ DOI ] [ Google Scholar ] 44. Dong XX. Analysis on the demand and utilization of medical rehabilitation Services for Elderly People with dementia in Ningbo. Chin Prim Health Care. (2020) 34:46–8. doi: 10.3969/j.issn.1001-568X.2020.08.0012 [ DOI ] [ Google Scholar ] 45. Pan X, Zhang X, Chen X, Lu Q, Hu Y, Han L, et al. A survey of application of complementary and alternative medicine in Chinese patients with Parkinson’s disease: a pilot study. Chin J Integr Med. (2020) 26:168–73. doi: 10.1007/s11655-018-2560-y, [ DOI ] [ PubMed ] [ Google Scholar ] 46. Liu Y, Kong X. Investigation on the utilization of traditional Chinese medicine services and analysis of influencing factors among chronic heart failure patients. Guid J Tradit Chin Med Pharm. (2023) 29:212–4. doi: 10.13862/j.cn43-1446/r.2023.12.045 [ DOI ] [ Google Scholar ] 47. Yu H, Wu Y, Yu J, Zhang C, Wang B. Morbidity and TCM utilization patterns in community-dwelling elderly with chronic diseases: a cross-sectional survey. Zhejiang Clin Med J. (2024) 26:1719–21. [ Google Scholar ] 48. Yang L, Sibbritt D. Factors associated with Chinese herbal medicine use among middle-aged and older women with arthritis: evidence from China. Sci Rep. (2022) 12:12566. doi: 10.1038/s41598-022-16927-4, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 49. Tian H, Zhu X, Liu H, Liao Y, Cui K, Liu J, et al. The prevalence, characteristics, and factors associated with Chinese herbal medicine use among Chinese middle-aged and older adults with chronic lung disease: a cross-sectional study. J Multidiscip Healthc. (2024) 17:5629–39. doi: 10.2147/JMDH.S478120, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 50. Pan Y-J, Cheng I-C, Yeh L-L, Cho Y-M, Feng J. Utilization of traditional Chinese medicine in patients treated for depression: a population-based study in Taiwan. Complement Ther Med. (2013) 21:215–23. doi: 10.1016/j.ctim.2013.03.003, [ DOI ] [ PubMed ] [ Google Scholar ] 51. Lin S-K, Tsai Y-T, Lai J-N, Wu C-T. Demographic and medication characteristics of traditional Chinese medicine users among dementia patients in Taiwan: a nationwide database study. J Ethnopharmacol. (2015) 161:108–15. doi: 10.1016/j.jep.2014.12.015, [ DOI ] [ PubMed ] [ Google Scholar ] 52. Li X, Peng M, Li Y, Kang Z, Hao Y, Sun H, et al. Chinese herbal therapy and Western drug use, belief and adherence for hypertension management in the rural areas of Heilongjiang Province, China. PLoS One. (2015) 10:e0123508. doi: 10.1371/journal.pone.0123508, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 53. Pan L, Jiang L, Xu J. The analysis of current situation and influencing factors of elderly people’ s utilization of community traditional Chinese medicine services in Zhengzhou City. Chinese J Public Health Manage. (2024) 40:01–89-91+99. doi: 10.19568/j.cnki.23-1318.2024.01.0022 [ DOI ] [ Google Scholar ] 54. Lu J, Zhao H, Ji Z, Dong Y. Effect of patient satisfaction on the utilization of mHealth services by patients with chronic disease. Digit Health. (2025) 11:20552076251333983. doi: 10.1177/20552076251333983, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 55. Xu T, Wang Z, Wang T, Shi J, Zhu A, Dong E. Exploring segmented assimilation theory in health education utilization and its influencing factors among internal migrants in China: insights from the 2017 China migrants dynamic survey. Front Public Health. (2024) 12:1529736. doi: 10.3389/fpubh.2024.1529736, [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 56. Eshah NF. Investigating cardiovascular patients’ preferences and expectations regarding the use of social media in health education. Contemp Nurse. (2018) 54:52–63. doi: 10.1080/10376178.2018.1444497, [ DOI ] [ PubMed ] [ Google Scholar ] 57. Lin R, Liu C, Duan L, Wang Q, Zhang X, Wang D, et al. Research progress on authoritative recognition behavior of health information among middle-aged and elderly patients with chronic diseases. Chin J Public Health. (2024) 40:937–42. doi: 10.11847/zgggws1142467 [ DOI ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s. 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