Abstract: Objective To analyze the willingness of rural residents' primary diagnosis in eastern, central and western provinces of China and relevant influencing factors to further promote primary diagnosis. Methods A total of 6 500 rural residents from Shandong, Henan and Sichuan provinces were selected as survey samples by multi-order sampling method, and questionnaires from July to September were designed by ourselves for field investigation. Univariate analysis and multivariate logistic regression analysis were mainly used. Results There were 97.05% rural residents with minor diseases choosing primary diagnosis, 41.96% rural residents with chronic diseases choosing primary diagnosis, and 4.73% rural residents with serious diseases choosing primary diagnosis. Gender, education level, occupation type, social insurance type, family economic status, experience of not seeking medical treatment for illness and experience of buying drugs by oneself(all P<0.05) were influencing factors of residents' willingness of primary diagnosis. Factors such as age, education level, occupation type, social insurance type, the influence of reimbursement ratio for medical treatment, the cost less than 500 yuan in the past year, and the health status of patients(all P<0.05), etc., affected residents with common diseases on residents' willingness of primary diagnosis. When residents were seriously ill, social insurance type, annual affordable medical expenses, patients' health status and reimbursement ratio(all P<0.05) affected residents' willingness of primary diagnosis. Conclusion Social insurance type and disease burden are important factors affecting residents' willingness of primary diagnosis, family economic status on residents' willingness of primary diagnosis is limited, the reimbursement ratio is the primary influencing factor of residents with common and serious diseases on residents' willingness of primary diagnosis.