In our cross-sectional online survey of Chinese adults, higher levels of perceived meaning in life were associated with a higher likelihood of obtaining preventive healthcare use. It was found that participants with higher levels of meaning in life were more likely to obtain an X-ray test, B-ultrasound, or blood testing. The associations of meaning in life with these types of preventive healthcare services increased with age and there were no gender differences in the associations.
To the best of our knowledge, this is the first study to examine the association of perceived meaning in life with preventive healthcare use among Chinese, and the first study to look into age and gender differences in the associations. The findings are important and have clinical implications in improving uptake of preventive healthcare services. Meaning in life can positively activate one’s behaviors towards one’s short- and long-term goals . People who have meaningful living can be more engaged with daily activities and selecting activities such as use of preventive healthcare that match one’s long-term aims . It is likely that by boosting one’s meaning in life, people are more likely to take other preventive healthcare services such as preventive cancer screening.
Two studies have been found to investigate the association of meaning in life with preventive healthcare use among young and middle aged women (age from 20 to 42 years) for breast cancer screening [11, 13]. It showed a significant relationship between purpose in life and breast health behaviors in Anglo women but not in Hispanic women. However, positive psychological factor associated with more preventive healthcare use is consistent with previous studies that conducted in middle and old age [12, 13]. A study of a representative sample of American older adults aged 50 + showed that each unit increase in purpose in life (on a six-point scale) was associated with a higher likelihood that people would engage in recommended preventive health care services, such as obtaining a cholesterol test (aOR 1.18, 1.08–1.29) or colonoscopy (aOR 1.06, 0.99–1.14). Another study conducted among 162 members aged 75–95 of the Terman Study of the Gifted in the US showed that higher purpose in life was associated with more regular checkups . Life purpose and meaning in life are slightly different, but life purpose is one of key factors contributing to a meaningful life. In our study we included more health checkup types such as B-ultrasound and blood testing, and the significant associations with meaning in life were remained after adjustment for more important covariates, such as psychological factors. Our data from China have contributed to the literature.
The findings from this study may help explain the growing body of research that has linked higher meaning in life with greater wellbeing, both physically  and psychologically . For example, a meta-analysis which included 66 papers reported that meaning in life and physical health formed weak-to-moderate associations and the strongest associations were found for subjective indicators of physical health . In the context of our study, people with higher levels of meaning in life may have healthier lifestyles (e.g., having better nutritional and dietary habits , engaging in more exercise and relax [33, 34]) and acquire more regular health checkups because they have a greater meaning to live, which gives them more incentive to take preventive measures that may seem costly, time consuming, and against instant hedonism. All of these activities may be prompted by an overarching outlook in which life itself is greatly valued.
Our study found that the association of meaning in life with preventive healthcare use was stronger with age, even though increased age has a significantly negative effect on life satisfaction  and mental health outcomes (e.g., depression ) during the COVID-19 epidemic in many previous studies. This might be because people at later life stages generally reported a greater presence of meaning in their lives, while those at earlier life stages remained searching for their life meaning . Meaning in life is considered modifiable factor and preventive health behavior allow detection of diseases in early phase. Paying more attention to improve experience of meaning in life among young and middle-aged adults is important to promote preventive healthcare use, and thereby prevention of complications and reduction in healthcare cost in their late-life. This is especially important in countries with limited health resources, where the healthcare system is overburdened due to rapidly aging population and widespread inequality in healthcare access [16, 17].
Gender differences in the association of meaning in life with preventive healthcare use is not well studied . In previous literature men with increased meaning in life were more likely to receive a prostate examination (OR 1.31, 1.18–1.45), and women were more likely to receive a mammogram/X-ray (OR 1.27, 1.16–1.39) or pap smear (1.16, 1.06–1.28), but their gender differences have not been evaluated . Our study showed no significant gender differences in the association of meaning in life with preventive healthcare use, suggesting that improving experience of meaning in life to promote preventive healthcare use is equally important for men and women.
Our study identified a linear association between meaning in life and preventive healthcare use in univariate analysis. The main three preventive healthcare use including X-ray, B-ultrasound, and blood testing showed such a linear association. These linear trends seemed to be non-significant after adjustment for all covariates, except for B-ultrasound and blood testing. The high meaning group was associated with B-ultrasound but the moderate meaning group was not. This may be due to the small number of participants in these groups, where their p values for high vs. low meaning in life were approaching statistical significances. We need further studies to focus on this issue in China, including more participants to clarify linear associations between meaning in life and different types of preventive healthcare use.
The current study did not find a significant association of meaning in life with CT scan or genetic testing. One possible explanation is related to their costs; in the public healthcare system, CT scan and genetic testing are categorized under private services and their costs are approximately 3–10 times higher than the other three preventive healthcare services, depending on the body parts involved and the items covered. Furthermore, CT scan and genetic testing are less common or necessary than B-ultrasound and blood testing in a general preventive healthcare service. In general, CT scan will be reserved for circumstances in which there is diagnostic uncertainty (e.g., cancer), while genetic testing would be performed to learn a current or future pregnancy whether or not will be affected by a genetic illness.
Strength and limitations
The current study included a large sample of Chinese population and its strict data validation had ensured data quality. Using a convenience sample method, the well-educated participants probably had a good overall understanding of perceived meaning in life and preventive health checkups. The multivariate analyses had included many important covariables for adjustment such as psychological factors including depression and anxiety, and thus the confounding effect would be minimized. At the same time, the study has several limitations. First, the included sample was self-selected and was biased towards individuals with high education level in urban areas because of the use of online collection method during COVID-19. Therefore, the generalizability of our results to other populations (e.g., low education level, rural areas) was not known. However, during lockdown due to COVID-19 outbreak, other data collection methods such as face-to-face interview were considered infeasible. Second, our data were collected in February 2020; we did not know whether or not the COVID-19 outbreak (since December 2019) might have interfered in the use of the preventive healthcare checkups. These are not taken into account in the models. However, it might be likely the interference would not change the founded significant associations as these health checkups were not COVID-19 specific by that time. Third, causal relationship cannot be confirmed due to our cross-sectional design. Fourth, the study had only applied a single item to test meaning in life due to that long questionnaire was not feasible in online survey. However, a previous systematic review with meta-analysis  found that results remained the same regardless of which questionnaire or if only single-item measure was applied. We had also used this question among another Chinese population and observed its significant associations with physical health, happiness, and healthcare utilization, suggesting it was acceptable to adopt this one-item question . This supports the suitability of using one item to test one’s perceived meaning in life in short surveys.
First, further studies may consider studying the potential causal relationship between meaning in life and preventive healthcare use and identify possible underlying mechanisms, to shed light on exploration of meaning in life as one of the potential interventional targets for improved preventive healthcare service uptake. Second, due to the self-reporting nature of the survey, it was unknown if the used preventive health checkups (e.g., X-ray and CT scan) were evidence-based or not. It should note that use of non-evidence based preventive tests may cause harm and wastage of healthcare resources, instead of being cost-saving. More education and interventions should be taken timely if non-evidence based preventive health checkups were taken among the population with high level of meaning in life. At the same time, health benefits could be further studied after uptake of the needed preventive healthcare services.