‘I’ll ask my fellow villagers first’: peer health consultation among left-behind older adults under transnational separation in rural China

Abstract

Although family members often occupy central positions in older adults’ lay referral networks, most research assumes that they remain geographically nearby. Less is known about how transnational migration reshapes everyday health consultation when adult children live overseas. Drawing on lay referral network theory, this study examines how left-behind older adults in rural China seek health advice and support through local social relationships and transnational family relationships. We used an interpretive qualitative design and conducted 80 days of fieldwork in two transnational migrant-sending villages. Data were collected through participant observation and 35 semi-structured interviews with 22 older adults, and analyzed using reflexive thematic analysis. The findings indicate that minor health concerns were often first discussed with familiar peers in everyday village settings. Some participants minimized or delayed disclosing health concerns to avoid worrying their children and were more willing to discuss these concerns with local peers. Peers helped interpret medical instructions, assess symptoms, encourage healthcare-seeking, and provide practical assistance, although experience-based advice could also lead to delayed care. In addition, adult children abroad could arrange medical appointments and purchase health devices remotely, but some participants still needed nearby contacts to help them operate the devices or travel to appointments. Local peers were more involved in everyday health consultation, whereas children abroad were more involved in major medical decisions. Therefore, transnational separation changed how different relationships participate in health consultation.