Researchers conducted the survey from February 7 to March 27, 2023, in urban and rural areas. Eligible participants were at least 18 years old, had lived in Yunnan for at least six months, and provided informed consent. The researchers received ethical approval from Kunming Medical University and collected data through the online Questionnaire Star platform.

The sampling design was multistage and non-probability. Regional sites were selected purposively, followed by convenience and snowball sampling. The final analysis included 227 valid responses after the researchers excluded incomplete questionnaires, questionnaires completed in under 180 seconds, and responses that failed embedded logic checks.

The design provided information about selected urban and rural populations, but the non-random recruitment and modest sample limit the extent to which the results can be generalized to Yunnan as a whole or to other regions of China. Most respondents were younger than 50, comprising 78% of the sample, and 59% were women. Awareness of the NCDP was also high: 78% of respondents knew of the policy’s existence.

Despite this awareness and the generally positive attitudes recorded in the survey, the analysis revealed a significant knowledge-behavior gap. Respondents could recognize and broadly support the policy while still expressing caution in their medication choices, suggesting that awareness alone did not fully account for their purchasing and utilization decisions. Multiple linear regression identified two factors positively associated with attitudes toward the NCDP.

Cost Reduction Choice, a variable measuring the influence of choosing medication based on cost reduction, was positively associated with attitudes (β = 0.26, p < 0.01). Choosing medication based on policy trust was also positively associated (β = 0.24, p < 0.01). Other variables were negatively associated with attitudes.

Agreement with switching drugs was negatively associated with attitudes toward the policy (β = −0.26, p < 0.01), as was experience of drug shortages (β = −0.28, p < 0.01). These cross-sectional associations do not establish that switching medicines or experiencing shortages caused unfavorable attitudes. They identify the characteristics and reported experiences that were statistically associated with lower acceptance in this sample.

The researchers used several analytical approaches to examine the survey results: analysis of variance, multiple linear regression, exploratory factor analysis, K-means clustering, and a random forest model. The clustering analysis identified distinct population segments with different perspectives. This heterogeneity was reflected in the study’s conclusion that trust in policy implementation and in the quality of selected drugs were critical determinants of public acceptance and medication choices.

Based on these findings, the authors concluded that the knowledge-behavior gap was driven less by a lack of information than by public apprehension regarding generic-drug safety. They characterized trust in the quality and safety of NCDP-selected drugs as the most critical factor for improving policy acceptance and outcomes, and called for targeted communication strategies focused on building trust rather than simply increasing policy awareness. As a cross-sectional survey based on non-probability sampling, the study cannot establish causal relationships or changes in attitudes and behavior over time.

Its findings nevertheless show that awareness of the NCDP and favorable attitudes toward the policy coexisted with concerns reflected in respondents’ medication decisions. The study therefore identifies trust in selected-drug quality and safety, policy implementation, and medication availability as central subjects for evaluating public responses to centralized drug procurement in Yunnan.

Subject of Research: Public knowledge, attitudes, and medicine purchasing and use under China’s centralized drug procurement policy in Yunnan

Article Title: Public knowledge, attitudes, and drug purchasing and utilization behaviors under the National Centralized Drug Procurement (NCDP) policy in Yunnan, China: a regional cross-sectional study

Article References: Yang, J., Zhang, Z., Yang, X., Zhou, J., Zhou, S., Liu, Y., & Gao, W. (2026). Public knowledge, attitudes, and drug purchasing and utilization behaviors under the National Centralized Drug Procurement (NCDP) policy in Yunnan, China: a regional cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15617-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15617-5

Keywords: National Centralized Drug Procurement, Yunnan, China, drug purchasing, medication use, public attitudes, policy awareness, drug shortages, generic drug safety, cross-sectional survey, Public, knowledge