Social Determinant Model of Utilization of Free Health Check Program at Community Health Centers and Its Impact on the Quality of Life of the Community

Abstract

The Free Health Check (CKG) Program is a promotive and preventive effort to improve early detection of health problems through primary health care services. Although provided free of charge, CKG utilization is not optimal and is influenced by social factors, access, and service delivery. In Surakarta City, as of December 22, 2025, 232,152 of the 588,419 residents had utilized CKG. This condition indicates a gap between service availability and utilization. The utilization of CKG has the potential to improve quality of life through early detection, education, and health follow-up, but research integrating social determinants, CKG utilization, and quality of life is still limited. To analyze the social determinants of CKG utilization, the relationship between CKG utilization and quality of life, and the relationship model between the two in the Surakarta City community. An analytical observational study using a cross-sectional approach involving 500 CKG target respondents from 10 Community Health Centers selected using stratified random sampling. Data were collected through structured interviews using a questionnaire administered directly to respondents. Analysis included univariate, bivariate, and Structural Equation Modeling (SEM) using maximum likelihood with p<0.05. Access to transportation (B=0.271; 95% CI: 0.180–0.362; p<0.001), family support (B=0.345; 95% CI: 0.255–0.435; p<0.001), perceived benefits (B=0.404; 95% CI: 0.312–0.496; p<0.001), and availability of services (B=0.166; 95% CI: 0.048–0.284; p=0.006) were positively associated with CKG utilization, while health needs were negatively associated (B=-0.147; 95% CI: -0.253–-0.041; p=0.007). CKG utilization was positively associated with quality of life (B=1.309; 95% CI: 1.108–1.510; p<0.001). The model showed adequate fit (RMSEA=0.055; CFI=0.915; TLI=0.885; SRMR=0.049). CKG utilization is influenced by access, social factors, perceptions, services, and health needs and is positively associated with quality of life. Strengthening access, family support, education, and facility readiness are needed to increase CKG utilization.