影响药物流产患者生殖健康相关因素分析及干预效果评价
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摘要
目的
1.了解药物流产患者对生殖健康知识的认知水平；
2.了解药物流产患者对生殖健康知识的利用,接受状况；
3.分析影响药物流产患者掌握生殖健康知识的相关因素；
4.探索适宜药物流产患者的生殖健康服务方式和途径,提高医疗机构对药物流产患者生殖健康服务的综合能力。
方法
采用类实验研究方法,于2009年3月至2009年8月对在山西省长治医学院附属和济医院门诊行药物流产的150名患者用“药物流产女性生殖健康知识问卷”进行调查,通过基线调查了解药物流产患者的生殖健康现状、生殖健康知识及影响因素,以及生殖健康服务的需求和意愿,运用健康促进理论对药物流产患者的生殖健康问题进行干预,采用知识讲座、发放教育材料、组织观看录像和提供生殖健康服务与咨询等干预活动,结束后1个月进行效果评估。用Excel软件创建数据库,用SPSS13统计软件进行一般统计描述、卡方检验、方差分析、t检验及多元线性逐步回归等统计分析。
结果
基线调查共收回133份有效问卷,干预后收回125份有效问卷,有效随访率为93.98%。药物流产患者的平均年龄为25.90±4.95岁,文化程度以大专及以上为主,占55.6%,已婚占64.7%,其中66.3%的已婚者生育过子女。
1.药物流产患者生殖健康现状
(1)经期保健知识及月经情况：经期保健知识得分为12.95±6.12,得分率为53.96%。得分最低的是每月进行乳房自我检查的时间。月经情况正常者只占到调查人数的24.8%,至少有一种月经问题的女性占75.2%,有两种月经问题的占29.3%。
(2)避孕节育、人工流产知识与现状：避孕节育及人工流产知识得分为15.25±7.40,得分率为46.21%,得分最低的是口服避孕药的服用方法。近一年来在性生活中使用避孕措施的占调查人数的76.7%,其中正使用避孕套的占50.0%。此次流产因未使用任何避孕措施而流产占52.6%,因避孕失败的占39.1%,其它原因占8.3%。避孕失败中,以体外排精失败为主,占40.4%。有重复流产史的为33.8%。
(3)生殖道感染／性传播疾病、艾滋病的知识及现状：生殖道感染／性传播疾病知识得分为7.35±3.53,得分率为56.54%。艾滋病知识得分为26.46±8.78,得分率为55.17%。得分最低的是握手拥抱是否会传染艾滋病。有45.1%的患者不知道任何生殖道感染的种类,8.3%的患者不了解任何一种性病。
2.生殖健康知识综合得分影响因素
生殖健康知识综合得分为62.00±19.47,得分率为52.54%。药物流产患者的文化程度、职业、婚姻状况和知晓的避孕方法的种类进入多元线性逐步回归方程,复相关系数R=0.648,R2=0.419。
3.药物流产患者对生殖健康服务的需求和意愿
45.1%的药物流产患者曾咨询过避孕知识,有76.7%药物流产患者将医生作为首选咨询对象,27.1%的药物流产患者最希望了解生殖系统疾病及性传播疾病的知识,在最希望得到生殖健康知识的途径方面,“宣传小册子”是主要的获得途径,占22.6%,80.6%的患者都是自己到药店购买避孕药具。
4.干预后的效果评价
干预后生殖健康知识水平大幅度提高,生殖健康知识总分由干预前的62.00±19.47增加到干预后的98.82±12.02(P=0.000),其他各维度的知识得分干预前后均有统计学差异(P=0.000)。
5.干预后药物流产患者生殖健康服务的需求和意愿
干预后,希望到社区卫生服务站接受服务的比例由干预前的1.5%提高到干预后的46.4%(P=0.000)。93.6%的药物流产患者很满意开展这种活动的形式,同时也很满意知识讲座的内容。
结论
1.研究对象的生殖健康状况不容乐观,有月经问题的人群占有一定比例,重复流产率高,避孕措施使用失败率较高。药物流产患者对经期保健知识、避孕节育、人工流产知识、生殖道感染／性传播疾病及艾滋病知识的掌握水平不高。文化程度、职业、婚姻状况和知晓避孕方法的种类是影响药物流产患者生殖健康现状与知识水平的主要因素。
2.研究对象生殖健康知识的来源渠道狭窄,对生殖健康服务的需求较大,对社区卫生服务的知晓率低,利用率低。
3.干预活动开展以后,研究对象在经期保健知识、避孕节育、人工流产知识、生殖道感染／性传播疾病及艾滋病的知识掌握方面有了很大程度的提高。研究对象对于社区卫生服务的知晓率提高,服务利用的意识改变。
4.将健康促进活动整合到各医院的常规流产服务的运作流程中是可行的,医院应根据自身的特点形成高效、人性化的服务模式,使之更符合成本效益,并具有可持续性。
Objectives
1. To explore the level of awareness of patients of medical abortion to knowledge of reproductive health.
2. To learn about the status of medical abortion patients' use and acceptance of reproductive health.
3. To analyze the relevant factors which have impact on patients of medical abortion to access to knowledge of reproductive health.
4. To explore the suitable mode of reproductive health service for the patients of medical abortion and improve the medical institution's comprehensive capacity of reproductive health services for the patients of medical abortion.
Method
A base-line survey with "medical abortion women's reproductive health knowledge questionnaire" is conducted to learn the status of reproductive health and factors in the level of knowledge of reproductive health as well as reproductive health demands and desires of outpatients of medical abortion who volunteered to take part in our activity after informed in He Ji Hospital under Changzhi Medical College, in Shanxi Province in quasi-experimental research method of fieldwork during March 2009 and August 2009. The theory of health promotion is applied to intervene besides the other interventional activities including Giving lectures, Distribution of educational materials, Playing educational video, Providing reproductive health services and counseling. We do the evaluation and analysis of the efficacy one month after the interventional activities. During the Process of data collection and Processing, each questionnaire had been checked strictly. The software Excel was used to input the data and found the database. Data of the findings from the investigation is analyzed by SPSS 13 to carry out the Statistical Analysis of general statistical description, chi-square test、analysis of variance、t-test and multiple linear regression.
Results
A total of 133 valid questionnaires were collected after the baseline. And 125 valid questionnaires were collected after the interventional measures. The effective follow-up rate is 96.32%. The average age of patients of medical abortion is 25.90±4.95 years old. Most of them have graduated from college and above, accounting for 55.6%. 64.7% of respondents are married of which 66.3% had children of married birth.
1. The status of reproductive health of medical abortion patients
(1) Menstrual health knowledge and of menstral status
The average score of Menstrual health knowledge is 12.95±6.12, scoring rate is 59.96%. The lowest score is of the monthly breast self-examination time. People of those surveyed with normal menstrual cases account for only 24.8%; people of those surveyed having at least one menstrual problem accounted for 75.2%; people of those surveyed having two kinds of menstrual problems accounted for 29.3%.
(2) The status and people's knowledge of contraception and abortion
The average score of contraception and induced abortion is 15±7.40, scoring rate of 46.21%. The lowest score is the way of taking oral medical contraceptives. In sexual life, the use of contraception accounted for 76.7% of those surveyed over the past year, including the use of condoms which accounted for 50.0%. Abortion for not using any contraceptive measures accounted for 52.6%,39.1% of contraceptive failures, and 8.3% is other reasons. Among these contraceptive failures, 40.4% failed in vitro ejaculation method.33.8% of them had repeated history of abortion.
(3) The status and people's conception of Reproductive Tract Infection (RTI)/Sexual Transmitted Infection (STI) and Acquired Immure Deficiency syndrome (AIDS)
The average score of RTI/STI is 7.35±3.53, scoring rate is 56.54%. The average score of AIDS knowledge is 26.46±8.78, scoring rate is 55.17%. Among them, whether shaking hands and embracing are the transmissions of AIDS gets the lowest score.45.1% of patients of medical abortion do not know any types of reproductive tract infections, 8.3% of patients do not have knowledge of any sexually transmitted diseases.
2. Analysis of factors which impact total score of reproductive health
The average score of total score of reproductive health is 62.00±19.47, scoring rate is 52.54%. Four factors of patients of medical abortion (educational level, occupation, marital status, the types of contraceptive methods) are substituted into multiple linear stepwise regression equation; multiple correlation coefficient R=0.648, R2=0.419.
3. The demands and desires of reproductive health services among patients of medical abortion
45.1% of patients of medical abortion had ever counseled the contraceptive knowledge.76.7% of patients of medical abortion will consult a doctor as the preferred target.27.1% of the patients with medical abortion want to know knowledge of reproductive system diseases and sexually transmitted diseases mostly. The'propaganda pamphlet' is the main access channel, accounting for 22.6%. 80.6% patients of medical abortion would go to the drugstore to buy contraception themselves.
4. Evaluation of the effect of interventional activities
After interventional activities, the reproductive health knowledge level of patients of medical abortion has been improved significantly. Total score of reproductive health has been increased from 62.00±19.47 of pre IEC (Information, Education, and Communication) to 98.82±12.02 (P=0.000). The other dimensions of scores of reproductive health knowledge have statistically significant difference before and after interventional activities (P=0.000).
5. The demands and desires of reproductive health services among patients of medical abortion after interventional activities
After interventional activities, the proportion of medical abortion patients who want to go to Community Health Services Center for seeking services increased from 1.5% of pre IEC to 46.4% of post IEC (P=0.000).93.6% of patients of medical abortion are very satisfied with this form of IEC, meanwhile, they are also very satisfied with contents of the IEC.
Conclusions
1. The reproductive health status of patients of medical abortion is not optimistic, people with menstrual problems occupy a relatively high proportion of the population. Repeat abortion rate remains high and the failure rate of using contraception is comparatively high. The level of patients' mastery of knowledge on health care during menstruation, contraception and birth control, induced abortion, reproductive tract infections/sexually transmitted diseases and AIDS is very low. Education level, occupation, marital status and the types of contraceptive methods are known as the main factors which influence the knowledge and status of reproductive health of patients with medical abortion.
2. The channel of receiving reproductive health knowledge is relatively narrow. Patients of medical abortion have greater demands for reproductive health services. The rate of their awareness and the utilization of community health resources are both relatively low.
3. Changes have taken place after interventional activities to a large extent, which include the mastery of the objects' knowledge on health care during menstruation, contraception and birth control, induced abortion, reproductive tract infections/sexually transmitted diseases and AIDS. The rate of awareness of medical-abortion patients to the Community Health Service Resources has been increased, and their consciousness of the utilization of community health services has also been improved.
4. It is feasible to integrate the theory of health promotion into regular hospital abortion services. Hospitals, based on the characteristics of their own, should form a highly-efficient and human-oriented service model to make it more cost-effective and sustainable.
1.了解药物流产患者对生殖健康知识的认知水平；
2.了解药物流产患者对生殖健康知识的利用,接受状况；
3.分析影响药物流产患者掌握生殖健康知识的相关因素；
4.探索适宜药物流产患者的生殖健康服务方式和途径,提高医疗机构对药物流产患者生殖健康服务的综合能力。
方法
采用类实验研究方法,于2009年3月至2009年8月对在山西省长治医学院附属和济医院门诊行药物流产的150名患者用“药物流产女性生殖健康知识问卷”进行调查,通过基线调查了解药物流产患者的生殖健康现状、生殖健康知识及影响因素,以及生殖健康服务的需求和意愿,运用健康促进理论对药物流产患者的生殖健康问题进行干预,采用知识讲座、发放教育材料、组织观看录像和提供生殖健康服务与咨询等干预活动,结束后1个月进行效果评估。用Excel软件创建数据库,用SPSS13统计软件进行一般统计描述、卡方检验、方差分析、t检验及多元线性逐步回归等统计分析。
结果
基线调查共收回133份有效问卷,干预后收回125份有效问卷,有效随访率为93.98%。药物流产患者的平均年龄为25.90±4.95岁,文化程度以大专及以上为主,占55.6%,已婚占64.7%,其中66.3%的已婚者生育过子女。
1.药物流产患者生殖健康现状
(1)经期保健知识及月经情况：经期保健知识得分为12.95±6.12,得分率为53.96%。得分最低的是每月进行乳房自我检查的时间。月经情况正常者只占到调查人数的24.8%,至少有一种月经问题的女性占75.2%,有两种月经问题的占29.3%。
(2)避孕节育、人工流产知识与现状：避孕节育及人工流产知识得分为15.25±7.40,得分率为46.21%,得分最低的是口服避孕药的服用方法。近一年来在性生活中使用避孕措施的占调查人数的76.7%,其中正使用避孕套的占50.0%。此次流产因未使用任何避孕措施而流产占52.6%,因避孕失败的占39.1%,其它原因占8.3%。避孕失败中,以体外排精失败为主,占40.4%。有重复流产史的为33.8%。
(3)生殖道感染／性传播疾病、艾滋病的知识及现状：生殖道感染／性传播疾病知识得分为7.35±3.53,得分率为56.54%。艾滋病知识得分为26.46±8.78,得分率为55.17%。得分最低的是握手拥抱是否会传染艾滋病。有45.1%的患者不知道任何生殖道感染的种类,8.3%的患者不了解任何一种性病。
2.生殖健康知识综合得分影响因素
生殖健康知识综合得分为62.00±19.47,得分率为52.54%。药物流产患者的文化程度、职业、婚姻状况和知晓的避孕方法的种类进入多元线性逐步回归方程,复相关系数R=0.648,R2=0.419。
3.药物流产患者对生殖健康服务的需求和意愿
45.1%的药物流产患者曾咨询过避孕知识,有76.7%药物流产患者将医生作为首选咨询对象,27.1%的药物流产患者最希望了解生殖系统疾病及性传播疾病的知识,在最希望得到生殖健康知识的途径方面,“宣传小册子”是主要的获得途径,占22.6%,80.6%的患者都是自己到药店购买避孕药具。
4.干预后的效果评价
干预后生殖健康知识水平大幅度提高,生殖健康知识总分由干预前的62.00±19.47增加到干预后的98.82±12.02(P=0.000),其他各维度的知识得分干预前后均有统计学差异(P=0.000)。
5.干预后药物流产患者生殖健康服务的需求和意愿
干预后,希望到社区卫生服务站接受服务的比例由干预前的1.5%提高到干预后的46.4%(P=0.000)。93.6%的药物流产患者很满意开展这种活动的形式,同时也很满意知识讲座的内容。
结论
1.研究对象的生殖健康状况不容乐观,有月经问题的人群占有一定比例,重复流产率高,避孕措施使用失败率较高。药物流产患者对经期保健知识、避孕节育、人工流产知识、生殖道感染／性传播疾病及艾滋病知识的掌握水平不高。文化程度、职业、婚姻状况和知晓避孕方法的种类是影响药物流产患者生殖健康现状与知识水平的主要因素。
2.研究对象生殖健康知识的来源渠道狭窄,对生殖健康服务的需求较大,对社区卫生服务的知晓率低,利用率低。
3.干预活动开展以后,研究对象在经期保健知识、避孕节育、人工流产知识、生殖道感染／性传播疾病及艾滋病的知识掌握方面有了很大程度的提高。研究对象对于社区卫生服务的知晓率提高,服务利用的意识改变。
4.将健康促进活动整合到各医院的常规流产服务的运作流程中是可行的,医院应根据自身的特点形成高效、人性化的服务模式,使之更符合成本效益,并具有可持续性。
Objectives
1. To explore the level of awareness of patients of medical abortion to knowledge of reproductive health.
2. To learn about the status of medical abortion patients' use and acceptance of reproductive health.
3. To analyze the relevant factors which have impact on patients of medical abortion to access to knowledge of reproductive health.
4. To explore the suitable mode of reproductive health service for the patients of medical abortion and improve the medical institution's comprehensive capacity of reproductive health services for the patients of medical abortion.
Method
A base-line survey with "medical abortion women's reproductive health knowledge questionnaire" is conducted to learn the status of reproductive health and factors in the level of knowledge of reproductive health as well as reproductive health demands and desires of outpatients of medical abortion who volunteered to take part in our activity after informed in He Ji Hospital under Changzhi Medical College, in Shanxi Province in quasi-experimental research method of fieldwork during March 2009 and August 2009. The theory of health promotion is applied to intervene besides the other interventional activities including Giving lectures, Distribution of educational materials, Playing educational video, Providing reproductive health services and counseling. We do the evaluation and analysis of the efficacy one month after the interventional activities. During the Process of data collection and Processing, each questionnaire had been checked strictly. The software Excel was used to input the data and found the database. Data of the findings from the investigation is analyzed by SPSS 13 to carry out the Statistical Analysis of general statistical description, chi-square test、analysis of variance、t-test and multiple linear regression.
Results
A total of 133 valid questionnaires were collected after the baseline. And 125 valid questionnaires were collected after the interventional measures. The effective follow-up rate is 96.32%. The average age of patients of medical abortion is 25.90±4.95 years old. Most of them have graduated from college and above, accounting for 55.6%. 64.7% of respondents are married of which 66.3% had children of married birth.
1. The status of reproductive health of medical abortion patients
(1) Menstrual health knowledge and of menstral status
The average score of Menstrual health knowledge is 12.95±6.12, scoring rate is 59.96%. The lowest score is of the monthly breast self-examination time. People of those surveyed with normal menstrual cases account for only 24.8%; people of those surveyed having at least one menstrual problem accounted for 75.2%; people of those surveyed having two kinds of menstrual problems accounted for 29.3%.
(2) The status and people's knowledge of contraception and abortion
The average score of contraception and induced abortion is 15±7.40, scoring rate of 46.21%. The lowest score is the way of taking oral medical contraceptives. In sexual life, the use of contraception accounted for 76.7% of those surveyed over the past year, including the use of condoms which accounted for 50.0%. Abortion for not using any contraceptive measures accounted for 52.6%,39.1% of contraceptive failures, and 8.3% is other reasons. Among these contraceptive failures, 40.4% failed in vitro ejaculation method.33.8% of them had repeated history of abortion.
(3) The status and people's conception of Reproductive Tract Infection (RTI)/Sexual Transmitted Infection (STI) and Acquired Immure Deficiency syndrome (AIDS)
The average score of RTI/STI is 7.35±3.53, scoring rate is 56.54%. The average score of AIDS knowledge is 26.46±8.78, scoring rate is 55.17%. Among them, whether shaking hands and embracing are the transmissions of AIDS gets the lowest score.45.1% of patients of medical abortion do not know any types of reproductive tract infections, 8.3% of patients do not have knowledge of any sexually transmitted diseases.
2. Analysis of factors which impact total score of reproductive health
The average score of total score of reproductive health is 62.00±19.47, scoring rate is 52.54%. Four factors of patients of medical abortion (educational level, occupation, marital status, the types of contraceptive methods) are substituted into multiple linear stepwise regression equation; multiple correlation coefficient R=0.648, R2=0.419.
3. The demands and desires of reproductive health services among patients of medical abortion
45.1% of patients of medical abortion had ever counseled the contraceptive knowledge.76.7% of patients of medical abortion will consult a doctor as the preferred target.27.1% of the patients with medical abortion want to know knowledge of reproductive system diseases and sexually transmitted diseases mostly. The'propaganda pamphlet' is the main access channel, accounting for 22.6%. 80.6% patients of medical abortion would go to the drugstore to buy contraception themselves.
4. Evaluation of the effect of interventional activities
After interventional activities, the reproductive health knowledge level of patients of medical abortion has been improved significantly. Total score of reproductive health has been increased from 62.00±19.47 of pre IEC (Information, Education, and Communication) to 98.82±12.02 (P=0.000). The other dimensions of scores of reproductive health knowledge have statistically significant difference before and after interventional activities (P=0.000).
5. The demands and desires of reproductive health services among patients of medical abortion after interventional activities
After interventional activities, the proportion of medical abortion patients who want to go to Community Health Services Center for seeking services increased from 1.5% of pre IEC to 46.4% of post IEC (P=0.000).93.6% of patients of medical abortion are very satisfied with this form of IEC, meanwhile, they are also very satisfied with contents of the IEC.
Conclusions
1. The reproductive health status of patients of medical abortion is not optimistic, people with menstrual problems occupy a relatively high proportion of the population. Repeat abortion rate remains high and the failure rate of using contraception is comparatively high. The level of patients' mastery of knowledge on health care during menstruation, contraception and birth control, induced abortion, reproductive tract infections/sexually transmitted diseases and AIDS is very low. Education level, occupation, marital status and the types of contraceptive methods are known as the main factors which influence the knowledge and status of reproductive health of patients with medical abortion.
2. The channel of receiving reproductive health knowledge is relatively narrow. Patients of medical abortion have greater demands for reproductive health services. The rate of their awareness and the utilization of community health resources are both relatively low.
3. Changes have taken place after interventional activities to a large extent, which include the mastery of the objects' knowledge on health care during menstruation, contraception and birth control, induced abortion, reproductive tract infections/sexually transmitted diseases and AIDS. The rate of awareness of medical-abortion patients to the Community Health Service Resources has been increased, and their consciousness of the utilization of community health services has also been improved.
4. It is feasible to integrate the theory of health promotion into regular hospital abortion services. Hospitals, based on the characteristics of their own, should form a highly-efficient and human-oriented service model to make it more cost-effective and sustainable.
引文
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