通过TB疑似病人KABP调查研究农村结核病发现的影响因素
摘要
目的:通过对目标人群的结核病相关KABP (knowledge, attitude, belief, practice,知识,态度,信念和行为)和社会支持环境调查,研究阻碍目标地区结核病发现的因素,探索适合提高目标地区结核病发现的健康促进策略。
方法:
1.资料收集方法:采用定量问卷调查和定性访谈(知情者访谈和个人访谈)相结合的方法对资料进行收集;
2.资料分析方法:定量资料用SPSS13.0进行分析,定性资料采用MAX-qda软件利用框架分析法对访谈资料进行分析。
研究结果:
1.结核病疑似病人就诊行为中存在的问题:患有结核病疑似症状时,只有9.0%的人认为可能是结核病,多数人(36.2%)认为是感冒;在有了相应症状之后,只有66.3%的人会选择去看医生,有17.6%则不采取任何措施。不去看医生的原因主要是经济困难(63.2%)和认为症状轻没有必要(28.4%);首次就诊的医疗机构为村卫生室(46.1%)和乡镇卫生院(35.2%),而非专业结防机构。选择首诊医疗机构的原因主要是距离近(55.2%)和价格便宜(19.7%)。首次就诊之后,只有7.4%的人被建议转诊到专业结核病防治机构。影响结核病疑似病人就诊延的因素有:文化程度、首诊距离、信息载体数、有症状后采取的措施和结核病项目知识回答正确率。
2.结核病疑似病人的知识知晓情况:结核病相关知识知晓情况调查显示被调查者的结核病相关知识的知晓情况(回答正确率为36.0%)是比较差的。其中,被调查者的对结核病的认知情况(50.3%)要好于对结核病项目的认知情况(21.7%)。单因素方差分析影响结核病疑似病人结核病相关知识知晓情况的因素分别为:性别、文化程度、是否拥有医疗保险、经济水平、健康宣传关心程度和拥有的信息载体数。逐步回归分析显示拥有信息载体数、健康关心程度和年收入水平具有统计学意义。
3.媒体使用喜好情况:有52.1%的人表示自己对健康知识宣传非常关心,有29.2%表示偶尔关心,有18.4%的人表示自己对健康知识宣传一点都不关心。影响对健康宣传的关心程度的因素为:性别、文化程度、是否有医疗保险、经济水平和信息载体数。最喜欢的健康知识宣传形式主要是卫生人员组织的宣传(45.5%)、电视健康知识栏目(26.8%)、宣传单(13%)。拥有的信息载体主要是电视机(78.9%)、电话(58.9%)、有线电视(54.7%)、DVD/VCD(23.7%)、和手机(11.7%)。最常接触的媒体依次是电视、电话、VCD/DVD。最喜欢看的节目依次是新闻(42.28%)、电视剧(35.29%)。看电视时间主要集中在晚上六点到十点。喜欢看的频道最主要的还是本省电视台(48.1%)和中央电视台(29.6%)。
4.定性研究结果:现有结核病控制政策不适应当地实际;村医生和乡镇卫生院在结核病控制中的作用没有充分体现出来;归口管理的机制尚未完善。
结论:(1)结核病疑似人就诊延迟现象严重;(2)结核病相关知识知晓情况差;(3)健康宣传中对媒体的使用应有针对性;(4)乡镇卫生院和村医生在结核病人发现过程中的作用没有充分发挥。
政策建议:对偏远农村地区结核病人发现提出以下建议:1.充分调动乡镇卫生院和村医生在结核病控制中的作用;2.加强对结核病知识的教育,尤其是针对结核病免费项目关键知识点的教育;3.合理利用传播媒介,政府干预,根据社会学评估结果和使用情况调查结果进行媒体宣传干预。
Objective: To probe IEC strategy to raise the case detection rate according to the research of objective people’s KABP (knowledge, attitude, belief & practice) and social support about tuberculosis control.
Methods: 1 Data collection: several methods were used in data collection including questionnaire study, key informant interview and in-depth interview; 2 Data analysis: quantitative data analysis approach with SPSS13.0; and framework analysis method was used in qualitative data analysis approach with MAX-qda software.
Result:
1 Problems during health care seeking: only 9.0% suspects thought that they might be caught with TB; most people (36.2%) thought that they might be caught with cold. Only 66.3% suspects chose to seek health care, 17.6% hadn’t done anything. The reasons of not to seek health care were mostly because of financial difficult (63.2%) and ignore. The facility they chose for first visit was village level clinics (46.1%) and the township hospitals (35.2%). The reasons to chose the facilities were near in geography (55.2%) and cheap (19.7%). And of them who seek health cares, only 7.4% people were transferred to TB dispensaries. The factors to affect the health care seeking delay were: culture level, the distance to the health care, the number of information carriers, the measure to treat the symptoms and the knowledge about TB program.
2 The knowledge about TB: the knowledge answer right rate was very low (36.0%). The knowledge answer right rate about TB disease (50.3%) was better than that about TB program (21.7%). ANOVO analysis showed that the factors affect the know rate were gender, culture level, health insurance, financial level, interest about health propagandize and the number of information carriers. The stepwise regression analysis showed that the annual income, the interest about health propagandizes and the numbers of information carriers were statistic significantly.
3 The interest about media using: 52.1% people said that they were very interest in health propagandize. But 29.2% people were less interest and 18.4% people never. The factors affect the interest about health propaganda were gender, culture level, health insurance, financial level and the number of information carriers. The forms of health propagandize they liked were: the one served by doctors (45.5%), the cause of health lecture programs on TV(26.8%). The information carriers they owned were TV (78.9%), phone (58.9%), CATV (54.7%), DVD/VCD (23.7%) and mobile phone (11.7%). The media they used mostly were TV, phone and VCD/DVD. The most favorite programs were news report (42.28%) and TV series (35.29%). The time to watch TV was mainly at 6 pm to 10 pm. The channels they liked were local province level TV station (48.1%) and CCTV (29.6%).
4 Result from qualitive reaserch: current policy wasn’t suit for local situation; the pole of village doctor and township hospital in TB control is limited; the TB transfer policy need revised.
Conclusions: It’s serious that they delayed in seeking health care; The knowledge rate was poor; The media using in health propagandizing should arranged at special time and channels; The role of village doctors and township hospitals in TB control was limited.
Policy suggestions: To raise the TB detection rate in poor traffic rural area, it’s suggested that: 1 enhance the role of village doctors and township hospitals in TB program; 2 enhance the health propagandize about TB knowledge, especially about TB program; 3 using media properly in health propagandize, enhance the role of government in TB program, health propagandizing should follow the result of social evaluation and the investigation of media using.
方法:
1.资料收集方法:采用定量问卷调查和定性访谈(知情者访谈和个人访谈)相结合的方法对资料进行收集;
2.资料分析方法:定量资料用SPSS13.0进行分析,定性资料采用MAX-qda软件利用框架分析法对访谈资料进行分析。
研究结果:
1.结核病疑似病人就诊行为中存在的问题:患有结核病疑似症状时,只有9.0%的人认为可能是结核病,多数人(36.2%)认为是感冒;在有了相应症状之后,只有66.3%的人会选择去看医生,有17.6%则不采取任何措施。不去看医生的原因主要是经济困难(63.2%)和认为症状轻没有必要(28.4%);首次就诊的医疗机构为村卫生室(46.1%)和乡镇卫生院(35.2%),而非专业结防机构。选择首诊医疗机构的原因主要是距离近(55.2%)和价格便宜(19.7%)。首次就诊之后,只有7.4%的人被建议转诊到专业结核病防治机构。影响结核病疑似病人就诊延的因素有:文化程度、首诊距离、信息载体数、有症状后采取的措施和结核病项目知识回答正确率。
2.结核病疑似病人的知识知晓情况:结核病相关知识知晓情况调查显示被调查者的结核病相关知识的知晓情况(回答正确率为36.0%)是比较差的。其中,被调查者的对结核病的认知情况(50.3%)要好于对结核病项目的认知情况(21.7%)。单因素方差分析影响结核病疑似病人结核病相关知识知晓情况的因素分别为:性别、文化程度、是否拥有医疗保险、经济水平、健康宣传关心程度和拥有的信息载体数。逐步回归分析显示拥有信息载体数、健康关心程度和年收入水平具有统计学意义。
3.媒体使用喜好情况:有52.1%的人表示自己对健康知识宣传非常关心,有29.2%表示偶尔关心,有18.4%的人表示自己对健康知识宣传一点都不关心。影响对健康宣传的关心程度的因素为:性别、文化程度、是否有医疗保险、经济水平和信息载体数。最喜欢的健康知识宣传形式主要是卫生人员组织的宣传(45.5%)、电视健康知识栏目(26.8%)、宣传单(13%)。拥有的信息载体主要是电视机(78.9%)、电话(58.9%)、有线电视(54.7%)、DVD/VCD(23.7%)、和手机(11.7%)。最常接触的媒体依次是电视、电话、VCD/DVD。最喜欢看的节目依次是新闻(42.28%)、电视剧(35.29%)。看电视时间主要集中在晚上六点到十点。喜欢看的频道最主要的还是本省电视台(48.1%)和中央电视台(29.6%)。
4.定性研究结果:现有结核病控制政策不适应当地实际;村医生和乡镇卫生院在结核病控制中的作用没有充分体现出来;归口管理的机制尚未完善。
结论:(1)结核病疑似人就诊延迟现象严重;(2)结核病相关知识知晓情况差;(3)健康宣传中对媒体的使用应有针对性;(4)乡镇卫生院和村医生在结核病人发现过程中的作用没有充分发挥。
政策建议:对偏远农村地区结核病人发现提出以下建议:1.充分调动乡镇卫生院和村医生在结核病控制中的作用;2.加强对结核病知识的教育,尤其是针对结核病免费项目关键知识点的教育;3.合理利用传播媒介,政府干预,根据社会学评估结果和使用情况调查结果进行媒体宣传干预。
Objective: To probe IEC strategy to raise the case detection rate according to the research of objective people’s KABP (knowledge, attitude, belief & practice) and social support about tuberculosis control.
Methods: 1 Data collection: several methods were used in data collection including questionnaire study, key informant interview and in-depth interview; 2 Data analysis: quantitative data analysis approach with SPSS13.0; and framework analysis method was used in qualitative data analysis approach with MAX-qda software.
Result:
1 Problems during health care seeking: only 9.0% suspects thought that they might be caught with TB; most people (36.2%) thought that they might be caught with cold. Only 66.3% suspects chose to seek health care, 17.6% hadn’t done anything. The reasons of not to seek health care were mostly because of financial difficult (63.2%) and ignore. The facility they chose for first visit was village level clinics (46.1%) and the township hospitals (35.2%). The reasons to chose the facilities were near in geography (55.2%) and cheap (19.7%). And of them who seek health cares, only 7.4% people were transferred to TB dispensaries. The factors to affect the health care seeking delay were: culture level, the distance to the health care, the number of information carriers, the measure to treat the symptoms and the knowledge about TB program.
2 The knowledge about TB: the knowledge answer right rate was very low (36.0%). The knowledge answer right rate about TB disease (50.3%) was better than that about TB program (21.7%). ANOVO analysis showed that the factors affect the know rate were gender, culture level, health insurance, financial level, interest about health propagandize and the number of information carriers. The stepwise regression analysis showed that the annual income, the interest about health propagandizes and the numbers of information carriers were statistic significantly.
3 The interest about media using: 52.1% people said that they were very interest in health propagandize. But 29.2% people were less interest and 18.4% people never. The factors affect the interest about health propaganda were gender, culture level, health insurance, financial level and the number of information carriers. The forms of health propagandize they liked were: the one served by doctors (45.5%), the cause of health lecture programs on TV(26.8%). The information carriers they owned were TV (78.9%), phone (58.9%), CATV (54.7%), DVD/VCD (23.7%) and mobile phone (11.7%). The media they used mostly were TV, phone and VCD/DVD. The most favorite programs were news report (42.28%) and TV series (35.29%). The time to watch TV was mainly at 6 pm to 10 pm. The channels they liked were local province level TV station (48.1%) and CCTV (29.6%).
4 Result from qualitive reaserch: current policy wasn’t suit for local situation; the pole of village doctor and township hospital in TB control is limited; the TB transfer policy need revised.
Conclusions: It’s serious that they delayed in seeking health care; The knowledge rate was poor; The media using in health propagandizing should arranged at special time and channels; The role of village doctors and township hospitals in TB control was limited.
Policy suggestions: To raise the TB detection rate in poor traffic rural area, it’s suggested that: 1 enhance the role of village doctors and township hospitals in TB program; 2 enhance the health propagandize about TB knowledge, especially about TB program; 3 using media properly in health propagandize, enhance the role of government in TB program, health propagandizing should follow the result of social evaluation and the investigation of media using.
引文
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