摘要
目的对云南省城镇社区艾滋病防制工作中居民参与的现状进行研究,发现艾滋病防制中居民参与存在的问题和不足,探索促进居民参与社区艾滋病防制活动的有效措施,为进一步开展社区艾滋病防制工作提供可行的策略及决策依据。
方法流行病学现况调查,采用定量结构式问卷调查(社区居民)与定性个人深入访谈(艾滋病防制相关部门管理人员、工作人员)相结合的方法,分别从社区支持性网络、社区可利用的资源、艾滋病防制信息的提供、居民决策机会等几大方面了解城镇社区艾滋病防制居民参与的现状。
结果和发现居民社区认同感较强,但社区仍未建立多层次的交往网络;外地户口的居民社区认同明显低于本地居民;低收入者对社区有较高的认同度。社区艾滋病防制可利用资源:社区缺少艾滋病宣传活动必要的经费和设备;社区缺少艾滋病防制的卫生服务人员,其知识、技能亟需提高;多部门合作初具规模,但部门协调仍存在困难,缺乏强有力的政策支持;社区艾滋病防制资料形式以宣传栏、手册、讲座居多;社区艾滋病防制活动时间选择不尽合理。社区艾滋病防制信息的提供:居民对社区艾滋病防制活动评价较高,不同居民对艾滋病宣传资料的需求有显著差异(p＜0.05);居民缺少决策机会,动员性、执行性参与是目前居民参与艾滋病防制的主要形式;社区居民对艾滋病防制有客观了解,心理上认可,但实际参与率不高。居民的职业、认识社区人数、从社区得到帮助程度、对艾滋病宣教活动帮助的认识、对艾滋病宣教活动满意度的认识、了解艾滋病知识必要性的认识居民对艾滋病宣教活动帮助的认识、对艾滋病宣教活动满意度的认识、了解艾滋病知识必要性的认识影响着居民是否参与艾滋病防制活动。
对策和建议完善社区支持性网络:创造良好社区支持环境,增强社区凝聚力;重视“外地户籍”居民的参与权力;重视低收入者的需求,提高其参与社区活动的积极性。调动开发社区一切可利用的资源:纳入当地经费预算,主动开辟筹资渠道;建立稳定的社区队伍,加强人力资源的管理;构建“以卫生部门为主导,多部门参与为辅助”的艾滋病防制格局,把政府多部门参与艾滋病防制工作引入责任考核机制;选择合理的宣教时间;依托民间组织和项目,为社区艾滋病防制谋求经费、资源和永续发展。增强信息传播及沟通:通过参与式需求评估,开发适宜不同人群的艾滋病宣传资料,满足居民真实需求;充分挖掘当地民族文化资源,以居民喜闻乐见的宣传方式,进行艾滋病知识的宣传;从伦理学角度探讨艾滋病防制,引导居民正视艾滋病人和感染者,关心和帮助艾滋病人,形成良好的社区人文环境。给予居民足够的决策机会。提高社区艾滋病防制活动水平和效果;搭建平台让居民参与由“要我参与”变成“我要参与”。
Objective: To investigate the current situation of the resident participation in thecommunity-based AIDS prevention and control works in Yunnan Province to discover and promote the effective methods for encouraging the residents participate in the AIDS prevention and control activities while providing the accessible basis of strategies and decision of further developing community based AIDS Prevention and Control works.
Methods: This research uses the epidemiological status investigation to collect data by the methods of quantitative structured questionnaire (community residents) and qualitative in-depth interviews with individuals (management personnel and staffs of the AIDS Prevention and Control related departments).Bases on the theoretical framework, studying the current urban residents participation situations of the AIDS Prevention and Control works from the network, resources, information providing, decision-making opportunities perspectives respectively. To explore the existing problems and shortcomings of the residents participation of the AIDS Prevention and Control works.
Results and Discoveries: Community residents have strong sense of identity but the multi-level communication network did not being established in the community yet. The sense of identity of the non-local registered permanent residence was significantly lower than the local residents; the residents with lower incomes have relatively higher sense of identity. Accessible resources of community based AIDS prevention and control: Community was lack of funds and facilities which was necessary for AIDS prevention publicity activities; lack of healthcare person with proper knowledge and skills; the level of cross department cooperation was low and there was no efficient supporting policy which caused difficulty between departments coordination. The notice board, handbook, lecture were still the main methods for publicity and the time of the activities was not being properly arranged. The community based AIDS Prevention and Control information providing: The residents' evaluation of the community based AIDS Prevention activities was relatively high; different residents had significantly different requirements of AIDS Prevention publicity materials (p<0.05) ; Residents were lack of decision making opportunities; execution and encouragement were the main mode for residents to be involved in the activities. Residents had objectively understanding of AIDS Prevention and Control works and they acknowledged it psychologically but the actual participation rate reminded low. The occupation of the residents, how many people did they know in the community, the help they received from the community, the acknowledge and satisfaction of the AIDS prevention activities, the sense of necessity of mastering the AIDS knowledge were all affecting if the residents would or would not take part in the AIDS prevention and control activities.
Strategies and suggestions: To optimize the community supporting network: create a good supportive community environment, strengthen the cohesion of the community, emphasize the participation rights of the non-local registered permanent residences and the request of the residents with lower incomes to improve their enthusiasm of taking part in the AIDS prevention activities. To use all the accessible community resources: count the related expenses in the local budget, develop the way of financing actively, build a stable community team and strengthen the human resources management; build a AIDS prevention and control structure "lead by the department of health and assisted by the participation of many other departments." To take the participation status of government departments as part of the performance evaluation, choose reasonable publicity and education time; rely on the non-governmental organizations and projects for more funds and resources and for sustainable development of the activities.To strengthen the communication and information distribution, develop different publicity documents towards different people through Participation Needs Assessment to satisfy the actual needs of the residents. Fully discover the local culture resources publicizing the knowledge of AIDS prevention in the way which the local residents are delighted to hear and see. To discusse the AIDS prevention and treatment in ethics respect, lead the residents to care, to help and to treat the HIV/AIDS patient right, build a harmonious community environment. To Provide enough decision making opportunities. To improve the level and effects of AIDS prevention and control activities, To build a platform to make residents change their attitude from "I have to participate" to "I want to participate".
引文
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