Beyond the Operating Room

A Mixed-Methods Pilot Study on Structural Healthcare Disparities in Rural China

Abstract

Congenital Heart Disease (CHD) is the most common birth defect in China, disproportionately affecting children in rural regions where disparities in healthcare infrastructure, literacy, and access persist. This study investigates how structural, cultural, and economic barriers shape rural families’ experiences navigating CHD care before and after surgical intervention. Using a mixed-methods pilot design, the research integrates existing quantitative data with six semi-structured interviews conducted with rural families, medical professionals, and program coordinators affiliated with the Tianjin TEDA International Cardiovascular Hospital’s charity initiative. Findings reveal a negative correlation between the level of medical specialization required and the likelihood of receiving such care, demonstrating that geographic isolation, limited financial resources, language barriers, and Confucian family decision-making structures significantly hinder equitable access to diagnosis, surgery, and post-operative management. Families often face additional logistical and emotional burdens, including mistrust of charitable programs, difficulties adapting to urban hospital environments, and limited post-surgical guidance due to low health literacy and scarce local medical expertise. The study highlights the limitations of quantitative metrics in capturing lived experiences and emphasizes the importance of culturally sensitive, bottom-up interventions. Proposed solutions include video-based post-operative education in local dialects, prepaid travel vouchers to reduce upfront costs, partnerships with trusted community figures for outreach, and interpreter training to improve rural-urban medical communication. Although constrained by sample size, this study provides a foundational framework for understanding healthcare inequity in rural China and proposes practical pathways toward more inclusive, family-centered pediatric cardiac care.