性病患者求医行为影响因素定量及定性研究
|
摘要
随着AIDS出现和蔓延，性病患者正确求医行为在预防控制STD／HIV中的作用将越来越引起世界各国的重视。与性病诊治、危险因素、流行趋势相比，国内外性病患者求医行为研究，无论在理论及实践上都是一薄弱环节。有关求医行为，尤其是以性病患者为对象的研究鲜有报道。随着STD在我国死灰复燃，国内文献已提及患者求医行为，但尚未开展系统性理论性研究。因此，为了促进性病患者正确求医行为，达到控制STD／HIV和完善求医行为研究目的，本调查对我国性病患者三种主要求医途径：正规性病门诊723名确诊患者、4家药店、9家街头广告非法私人诊所、15名非法私人诊所求治性病者进行定量定性研究。性病患者求医行为涉及性行为、多性伴敏感问题，资料收集难度大。本研究采用个人访谈、深入访谈等技术接近访谈对象。结果表明：患者为了获得有效治疗采用不同方式、到达不同地点多次、混合就医。因此提示，应将首诊得到正规治疗做为今后促进正确求医行为的干预目标。济南患者同样体现多次、混合求医模式，但就诊时间、就诊次数比北京患者长且多、选择非法私人诊所比例高。
本研究基于健康信念模式Logistic分析发现，影响患者首诊能否获得正规治疗因素为：初诊是否怀疑得性病、是否知道有治疗性病正规医院、是否不愿去医院治疗性病、是否了解性病危害及首诊就医地点。影响患者就诊时间因素为：性病正规医疗机构知晓度、是否了解性病危害、性病种类、婚姻状态和性伴数。性病预防知识得分较高、初诊知有性防所患者倾向于选择性防所，就近就医选择综合医院皮肤性病科。
本调查将定性定量方法相结合，弥补了门诊患者定量研究在求医途径和求医动机的不足。阐明了非法私人诊所、药店、性病患者隐私心理在求医行为中的作用；阐明了患者选择非法私人诊所的条件及除个人隐私心理以外影响求医行为的其他因素。
总之，本研究一方面从控制STD／HIV角度探讨性病患者求医行为模式及影响因素，另一方面对求医行为，这一尚无多人问津领域，在研究内容、指标和方法上加以完善扩充，并深入到最终解释人们行为的社会心理学模式，为今后促进患者正确求医行为的干预计划确定了目标和理论基础。将社会学、人类学的定性研究引入流行病学领域，是方法学上的新尝试，是生物医学模式向生物—心理—社会医学模式转变方法上的具体实践。定性定量相结合，甚至单独使用定性方法可用于解决医学领域研究课题。
As HIV/AIDS has been worldwide problem, more attention should be paid to the role that health care seeking behavior of patients with STDs plays in the prevention and control of STD/HIV. However, in contrast with the researches focusing on diagnosis, treatment, risk behavior and epidemic tendency of STDs, few theoretical and empirical work has been done to study the health seeking behavior of patients both at home and abroad. With the resurgent of STDs in our country since 1977, health care seeking behavior of STD patients has been seen in the Chinese literature recently, but thorough and theoretical research about it has not been carried out yet. Under the challenging of such background with the remarkably increasing incidence and new cases of STDs and HIV reported in our country, a quantitative study combined with qualitative one has been conducted to elucidate the patterns and influencing factors of health care seeking behavior about STD patients in Beijing and Jinan of Shandong province. Four subjects were included in the study: long distance truck drivers, STD patients attending the special clinics and general hospital, illegally private clinics and persons visiting such clinics for the treatment of STD and suspected STD, drug stores and clients purchasing the drug for the treatment of STD. The methods used to collect data were personal interview, in — depth interview, non — participant observation, et al. Since the health care seeking behavior with STD patients involves the sensitive topics about sexual behavior, multiple sexual partners and social norms about sex, key informants, drug stores and persons visiting illegally private clinics were hard to approach, the data collection in qualitative phase was much more difficult than in quantitative in this study.
The quantitative study showed that of 445 STD patients through personal interview in Beijing, 48.1% of them selected special STD
本研究基于健康信念模式Logistic分析发现，影响患者首诊能否获得正规治疗因素为：初诊是否怀疑得性病、是否知道有治疗性病正规医院、是否不愿去医院治疗性病、是否了解性病危害及首诊就医地点。影响患者就诊时间因素为：性病正规医疗机构知晓度、是否了解性病危害、性病种类、婚姻状态和性伴数。性病预防知识得分较高、初诊知有性防所患者倾向于选择性防所，就近就医选择综合医院皮肤性病科。
本调查将定性定量方法相结合，弥补了门诊患者定量研究在求医途径和求医动机的不足。阐明了非法私人诊所、药店、性病患者隐私心理在求医行为中的作用；阐明了患者选择非法私人诊所的条件及除个人隐私心理以外影响求医行为的其他因素。
总之，本研究一方面从控制STD／HIV角度探讨性病患者求医行为模式及影响因素，另一方面对求医行为，这一尚无多人问津领域，在研究内容、指标和方法上加以完善扩充，并深入到最终解释人们行为的社会心理学模式，为今后促进患者正确求医行为的干预计划确定了目标和理论基础。将社会学、人类学的定性研究引入流行病学领域，是方法学上的新尝试，是生物医学模式向生物—心理—社会医学模式转变方法上的具体实践。定性定量相结合，甚至单独使用定性方法可用于解决医学领域研究课题。
As HIV/AIDS has been worldwide problem, more attention should be paid to the role that health care seeking behavior of patients with STDs plays in the prevention and control of STD/HIV. However, in contrast with the researches focusing on diagnosis, treatment, risk behavior and epidemic tendency of STDs, few theoretical and empirical work has been done to study the health seeking behavior of patients both at home and abroad. With the resurgent of STDs in our country since 1977, health care seeking behavior of STD patients has been seen in the Chinese literature recently, but thorough and theoretical research about it has not been carried out yet. Under the challenging of such background with the remarkably increasing incidence and new cases of STDs and HIV reported in our country, a quantitative study combined with qualitative one has been conducted to elucidate the patterns and influencing factors of health care seeking behavior about STD patients in Beijing and Jinan of Shandong province. Four subjects were included in the study: long distance truck drivers, STD patients attending the special clinics and general hospital, illegally private clinics and persons visiting such clinics for the treatment of STD and suspected STD, drug stores and clients purchasing the drug for the treatment of STD. The methods used to collect data were personal interview, in — depth interview, non — participant observation, et al. Since the health care seeking behavior with STD patients involves the sensitive topics about sexual behavior, multiple sexual partners and social norms about sex, key informants, drug stores and persons visiting illegally private clinics were hard to approach, the data collection in qualitative phase was much more difficult than in quantitative in this study.
The quantitative study showed that of 445 STD patients through personal interview in Beijing, 48.1% of them selected special STD
引文
1. Anne Buve, Marie Laga and Peter Piot Where are we now? Sexually Transmitted Disease Health Policy and Planning 1993;8(3):277—281
2．陈敏章 中国性病艾滋病防治 1996；2(6)：241—243
3. Marie Laga, et al. The Interrelationship of Sexually Transmitted Disease and HIV Infection: Implications for the Control of Both Epidemics in Africa AIDS 1991, 5(Suppl 1): S55-S63
4. A. De Schryver & A. Meheus Reviews/Analyses Epidemioloyg of Sexually Transmitted Diseases:the Global Picture WHO Bulletin OMS 1990; 68:640—653
5. Stephen Moses et al Health Care-Seeking Behavior Related to the Transmission of Sexually Transmitted Diseases in Kenya American Journal of Public Health 1994;12:1947—1951
6．性传播疾病诊疗与预防 1996全国性病学术研讨会论文集 广东科技出版社 1996
7. WHO Global Program on AIDS Policies and Principles for Prevention and Care of Sexually Transmitted Diseases September, 1994
8. Peter Piot Are Sexually Transmitted Diseases a Priority Problem for Public Health Action? Second International Course on the Control of Sexually Transmitted Diseases in Developing Countries
9. David L.Heymaun.Sexually Transmitted Disease as Surrogate Indicators for HIV: Current Possibilities for Their Measurement in the Community World Health Organization/Global Program on AIDS
10．卫生部疾病控制司 性病防治资料汇编 1995
11. Lieve Fransen, et al Health Policies for Controlling AIDS and STDs in Developing Countries Health Policy and Planning 1993; 6(2):148—156
12．中国性病艾滋病防治培训项目 第二届性病／艾滋病控制项目管理培训讲义1995
13. The Transmission and Control of STD/HIV World Health??Organization/Global Program on AIDS Model 1
14. Hortensia Amaro Isolde Gomemann Health Care Utilization for Sexually Transmitted Diseases: Influence of Patient and Provider Characteristics. In Research Issues in Human Behavior and Sexually Transmitted Disease in the AIDS Era. JN Wasserheit, SO AraI, KK Holmes, Editors.American Society for Microbiology,Washington, D.C.
15. Newell et al A Population-based Study of Syphilis and Sexually Transmitted Disease Syndromes in North-Western Tanzania.2. Risk Factors and Health Seeking Behavior Genitourin Med 1993; 69:421—426
16．安建民等 关于城镇居民群体就医行为的定量研究 中国社会医学 1995；5：49-50
17．黄鹏钧等 70例最终就诊于精神病医院的抑郁性神经症病人的求医方式调查 中国行为医学科学 1995；1(4)：48—49
18. Friday E. Okonofua H. Kristian Heggenhougen An Intervention Study To Improve STD Service Utilization And Quality For Teenagers In Nigeria
19．赵鹏飞 钱汉竹 廖明敏等 STD病人的社会心理行为学研究中国性病艾滋病防治 1996；2(6)：270—271
20．周曾同、邹峥嵘 影响患者就医行为的部分因素调查 中国医院管理1993：14(2)：28
21. Fishbein M. and S. E. Middlestadt. 1989 Using the Theory of Reasoned Action as a Framework for Understanding and Changing AIDS Related Behavious, P.93-110 In V. M. Mays, G. W. Albee, and S. F. Schneider(ed.)
22. Victoria L. Champion Beliefs About Breast Cancer and Mammography by Behavioral Stage Oncol—Nurs—Forum 1994;21(6) :1009—1014
23. Marshall H. Becker The Health Belief Model and Sick Role Behavior Health Education Monographs 1974; 2:409—419
24. Rosenstock I M: Prevention of Illness and Maintenance of Health, in Poverty and Health, J Kosa et al(eds). Cambridge, Harvard??University Press, 1969
25．袁亚愚等 当代社会学的研究方法 成都：四川大学出版社，1986，9
26．陈胜利等 社会调查的理论基础与实用方法 北京：中国商业出版社，1990，12
27．谢剑等 应用人类学 桂冠图书股份有限公司·台北·1989年10月
28．厦门大学人类学系编 人类学论从 厦门大学出版社出版1987年9月
29. Alan Bryman Quantity and Quality in Social Research, London:Routledge, 1995
30．梁万年等 社会调查研究方法 人民卫生出版社 1996年2月
31．北京大学概率统计系编 SAS统计分析系统使用手册 1991年8月 内部资料
32. Michael H. Merson Slowing the Spread of HIV:Agenda for the 1990s Science 1993;260:1266-1268
33．胡良平 现代统计学与SAS应用 军事医学科学出版社 北京：1996年
34．潘绥铭 中国性现状 北京：光明日报出版社，1995
35. Katarina Hamberg Eva Johansson Gerd Lindgren Scientific Rigour in Qualitative Research-Examples for a Study of Women's Health in Family Practice Family Practices1994; 11 (2): 176-181 Disease Clinic Am J Public Health 1980; 70:997-1000
36. Judith M Green The Views of Single-handed General Practitioners: a Qualitative Study BMJ 1993;307(4): 607—610
37. E. A. Crockford L. M. Holloway J. M Wallker Nurses' Perceptions of Patients' Feelings about Breast Surgery Journal of Advanced Nursing 1993,18,1710-1718
38. Evaluation of Targeted Interventions to Slow the Spread of HIV Caribbean AIDS Prevention Feb.21 95(TUE):26 FHI AIDSCAP
39. Kathy Charmaz Discovering Chronic Illness: Using Grounded Theory Soc.Sci.Med. 1990, 30(11): 1161—117240. Graham Scambler, Anthony Hopkings Generating A Model of Epileptic Stigma: The Role of Qualitative Analysis Soc. Sci. Med. 1990;30(11): 1187—1194
41. Peter Conrad Qualitative Research on Chronic Illness:A Commentary on Method and Conceptual Development Soc. Sci. Med. 1990;30(11):1257—1263
42. Linda I. Reutter Herbert C. Northcott Making Risk Meaningful: Developing Caring Relationships with AIDS Patients Journal of Advanced Nursing 1993;18:1377—1385
43. Joe Kai Parent's Perception of Taking Babies's Rectal Temperature BMJ 1993;307:660
44. Richard Byng Primary Mental Health Care in Nicaragua Soc. Sci Med 1993;36(5):625—629
45. Pandora Pound Stroke Patients'View on Their Admission to Hospital BMJ 1995;311:18—22
46．邓春勤 何建平 周黎明等 定性研究方法 中国社会医学1994；2(51)：18—19
47．邓达 顾政城 吴开琛等 专题小组讨论在疟疾调查中的应用中国社会医学 1995：3(58)：19—20
48. The International Newsletter on HIV/AIDS Prevention and Care AIDS Action Issue 32 July—September, 1996
49. Patchara Benjarattanaporn Male STD Health Seeking Behavior in Bangkok, Thailand Third International Conference on AIDS in Asia and the Pacific
50．李珊山 沙眼衣原体和奈瑟氏淋球菌感染的生物学处理和预防进展 国外医学皮肤性病学分册 1995：21(44)：229-231
51．何慕陶 医用行为科学 四川科学技术出版社 1987年3月
52．梁浩材 社会医学 湖南科学技术出版社 1988年8月
53. Edward C. Sexually Transmitted Disease, Ethnomedicine and Health Policy in Africa Soc. Sci. Med. 1992; 2(35): 121—130
54. P. E. M. Leenaars et al Service Attributes and the Choice for STD Health Services in Persons Seeking a Medical Examination for as STD??Soc. Sci. Med. 1994;38(2):363—371
55. Mark A. et al Self-Reported Behavior Patterns of Patients Attending a Sexually Transmitted Disease Clinic Am J Public Health 1980;70:997—1000
56．芮国忠 医疗服务范围与消费者类型的研究 中国卫生经济1992：6：17-20
57. P E. Munday Genitourinary Medicine Services; Consumers'Views Genitourn Med 1990;66:108-111
58. Kathleen E. toomey, Willard Cares JR Partner notification for the prevention of HIV infection AIDS 1989;3(Suppl 1): S57-S62
59．中国性病／艾滋病防治培训项目性病／艾滋病流行病学及防治培训班讲义1994
60. AIDS Control and-Prevention Project(AIDSCAP) Family Health International Ramshah Path Kathmandu, Nepal A Qualitative Study of Chemist Shops on the Land Transportation Routes from Naubise to Janakpur and Birgunj (with reference to STD health seeking behavior of STD clients)
2．陈敏章 中国性病艾滋病防治 1996；2(6)：241—243
3. Marie Laga, et al. The Interrelationship of Sexually Transmitted Disease and HIV Infection: Implications for the Control of Both Epidemics in Africa AIDS 1991, 5(Suppl 1): S55-S63
4. A. De Schryver & A. Meheus Reviews/Analyses Epidemioloyg of Sexually Transmitted Diseases:the Global Picture WHO Bulletin OMS 1990; 68:640—653
5. Stephen Moses et al Health Care-Seeking Behavior Related to the Transmission of Sexually Transmitted Diseases in Kenya American Journal of Public Health 1994;12:1947—1951
6．性传播疾病诊疗与预防 1996全国性病学术研讨会论文集 广东科技出版社 1996
7. WHO Global Program on AIDS Policies and Principles for Prevention and Care of Sexually Transmitted Diseases September, 1994
8. Peter Piot Are Sexually Transmitted Diseases a Priority Problem for Public Health Action? Second International Course on the Control of Sexually Transmitted Diseases in Developing Countries
9. David L.Heymaun.Sexually Transmitted Disease as Surrogate Indicators for HIV: Current Possibilities for Their Measurement in the Community World Health Organization/Global Program on AIDS
10．卫生部疾病控制司 性病防治资料汇编 1995
11. Lieve Fransen, et al Health Policies for Controlling AIDS and STDs in Developing Countries Health Policy and Planning 1993; 6(2):148—156
12．中国性病艾滋病防治培训项目 第二届性病／艾滋病控制项目管理培训讲义1995
13. The Transmission and Control of STD/HIV World Health??Organization/Global Program on AIDS Model 1
14. Hortensia Amaro Isolde Gomemann Health Care Utilization for Sexually Transmitted Diseases: Influence of Patient and Provider Characteristics. In Research Issues in Human Behavior and Sexually Transmitted Disease in the AIDS Era. JN Wasserheit, SO AraI, KK Holmes, Editors.American Society for Microbiology,Washington, D.C.
15. Newell et al A Population-based Study of Syphilis and Sexually Transmitted Disease Syndromes in North-Western Tanzania.2. Risk Factors and Health Seeking Behavior Genitourin Med 1993; 69:421—426
16．安建民等 关于城镇居民群体就医行为的定量研究 中国社会医学 1995；5：49-50
17．黄鹏钧等 70例最终就诊于精神病医院的抑郁性神经症病人的求医方式调查 中国行为医学科学 1995；1(4)：48—49
18. Friday E. Okonofua H. Kristian Heggenhougen An Intervention Study To Improve STD Service Utilization And Quality For Teenagers In Nigeria
19．赵鹏飞 钱汉竹 廖明敏等 STD病人的社会心理行为学研究中国性病艾滋病防治 1996；2(6)：270—271
20．周曾同、邹峥嵘 影响患者就医行为的部分因素调查 中国医院管理1993：14(2)：28
21. Fishbein M. and S. E. Middlestadt. 1989 Using the Theory of Reasoned Action as a Framework for Understanding and Changing AIDS Related Behavious, P.93-110 In V. M. Mays, G. W. Albee, and S. F. Schneider(ed.)
22. Victoria L. Champion Beliefs About Breast Cancer and Mammography by Behavioral Stage Oncol—Nurs—Forum 1994;21(6) :1009—1014
23. Marshall H. Becker The Health Belief Model and Sick Role Behavior Health Education Monographs 1974; 2:409—419
24. Rosenstock I M: Prevention of Illness and Maintenance of Health, in Poverty and Health, J Kosa et al(eds). Cambridge, Harvard??University Press, 1969
25．袁亚愚等 当代社会学的研究方法 成都：四川大学出版社，1986，9
26．陈胜利等 社会调查的理论基础与实用方法 北京：中国商业出版社，1990，12
27．谢剑等 应用人类学 桂冠图书股份有限公司·台北·1989年10月
28．厦门大学人类学系编 人类学论从 厦门大学出版社出版1987年9月
29. Alan Bryman Quantity and Quality in Social Research, London:Routledge, 1995
30．梁万年等 社会调查研究方法 人民卫生出版社 1996年2月
31．北京大学概率统计系编 SAS统计分析系统使用手册 1991年8月 内部资料
32. Michael H. Merson Slowing the Spread of HIV:Agenda for the 1990s Science 1993;260:1266-1268
33．胡良平 现代统计学与SAS应用 军事医学科学出版社 北京：1996年
34．潘绥铭 中国性现状 北京：光明日报出版社，1995
35. Katarina Hamberg Eva Johansson Gerd Lindgren Scientific Rigour in Qualitative Research-Examples for a Study of Women's Health in Family Practice Family Practices1994; 11 (2): 176-181 Disease Clinic Am J Public Health 1980; 70:997-1000
36. Judith M Green The Views of Single-handed General Practitioners: a Qualitative Study BMJ 1993;307(4): 607—610
37. E. A. Crockford L. M. Holloway J. M Wallker Nurses' Perceptions of Patients' Feelings about Breast Surgery Journal of Advanced Nursing 1993,18,1710-1718
38. Evaluation of Targeted Interventions to Slow the Spread of HIV Caribbean AIDS Prevention Feb.21 95(TUE):26 FHI AIDSCAP
39. Kathy Charmaz Discovering Chronic Illness: Using Grounded Theory Soc.Sci.Med. 1990, 30(11): 1161—117240. Graham Scambler, Anthony Hopkings Generating A Model of Epileptic Stigma: The Role of Qualitative Analysis Soc. Sci. Med. 1990;30(11): 1187—1194
41. Peter Conrad Qualitative Research on Chronic Illness:A Commentary on Method and Conceptual Development Soc. Sci. Med. 1990;30(11):1257—1263
42. Linda I. Reutter Herbert C. Northcott Making Risk Meaningful: Developing Caring Relationships with AIDS Patients Journal of Advanced Nursing 1993;18:1377—1385
43. Joe Kai Parent's Perception of Taking Babies's Rectal Temperature BMJ 1993;307:660
44. Richard Byng Primary Mental Health Care in Nicaragua Soc. Sci Med 1993;36(5):625—629
45. Pandora Pound Stroke Patients'View on Their Admission to Hospital BMJ 1995;311:18—22
46．邓春勤 何建平 周黎明等 定性研究方法 中国社会医学1994；2(51)：18—19
47．邓达 顾政城 吴开琛等 专题小组讨论在疟疾调查中的应用中国社会医学 1995：3(58)：19—20
48. The International Newsletter on HIV/AIDS Prevention and Care AIDS Action Issue 32 July—September, 1996
49. Patchara Benjarattanaporn Male STD Health Seeking Behavior in Bangkok, Thailand Third International Conference on AIDS in Asia and the Pacific
50．李珊山 沙眼衣原体和奈瑟氏淋球菌感染的生物学处理和预防进展 国外医学皮肤性病学分册 1995：21(44)：229-231
51．何慕陶 医用行为科学 四川科学技术出版社 1987年3月
52．梁浩材 社会医学 湖南科学技术出版社 1988年8月
53. Edward C. Sexually Transmitted Disease, Ethnomedicine and Health Policy in Africa Soc. Sci. Med. 1992; 2(35): 121—130
54. P. E. M. Leenaars et al Service Attributes and the Choice for STD Health Services in Persons Seeking a Medical Examination for as STD??Soc. Sci. Med. 1994;38(2):363—371
55. Mark A. et al Self-Reported Behavior Patterns of Patients Attending a Sexually Transmitted Disease Clinic Am J Public Health 1980;70:997—1000
56．芮国忠 医疗服务范围与消费者类型的研究 中国卫生经济1992：6：17-20
57. P E. Munday Genitourinary Medicine Services; Consumers'Views Genitourn Med 1990;66:108-111
58. Kathleen E. toomey, Willard Cares JR Partner notification for the prevention of HIV infection AIDS 1989;3(Suppl 1): S57-S62
59．中国性病／艾滋病防治培训项目性病／艾滋病流行病学及防治培训班讲义1994
60. AIDS Control and-Prevention Project(AIDSCAP) Family Health International Ramshah Path Kathmandu, Nepal A Qualitative Study of Chemist Shops on the Land Transportation Routes from Naubise to Janakpur and Birgunj (with reference to STD health seeking behavior of STD clients)