重庆市某县农村地区孕产期保健服务可及性的影响因素

目的:了解重庆市农村地区孕产期保健服务可及性的影响因素,为提高孕产期保健服务利用率提供参考依据。方法:运用定性研究和定量调查相结合的方法,对重庆市项目县的700名产妇进行问卷调查,对16名卫生服务管理者/提供者以及40名妇女进行个人访谈。结果:孕产期保健服务可及性的影响因素主要包括经济负担、体制障碍和社会环境因素三个方面,其中经济因素和医疗体制是影响母婴保健服务可及性的主要因素。结论:提高农村地区妇女孕产期保健服务的可及性可以从以下几个方面进行改进:加强农村地区三级医疗卫生服务网络的系统建设,深化医疗体制改革,强化公共卫生服务的公益性地位,同时适当增加政府在公共卫生方面的财政投入,并加强政府各部门间的协调。     

陪伴者在贫困农村孕产妇健康促进中的效果分析

目的:评价在贫困农村开展妇女孕产期陪伴者活动的效果,探索促进贫困农村孕产妇保健服务的有效方法。方法:采用整群抽样方法抽取云南省祥云县的两个乡,干预乡开展农村孕产妇孕产期营养保健健康教育及陪伴者活动,为每一位孕妇选择1名陪伴者,陪伴者为孕产妇提供孕产期全程支持;对照乡仅开展农村孕产妇孕产期营养保健健康教育。在产后3个月时采用问卷调查及访谈的方式对产妇及陪伴者进行评估,评价健康教育及陪伴者活动开展的效果。结果:干预组产妇的孕产期营养保健知识知晓率高于对照组,产妇孕期营养保健行为较对照组健康;产妇对不同类型陪伴者的满意度评价,婆婆及丈夫最高,母亲次之,村医最低。结论:在贫困农村开展妇女孕产期陪伴者活动,对孕产妇保健起到了一定的健康促进作用,建议将孕产妇陪伴者活动纳入到孕产妇保健管理系统中。     

中西部贫困地区母亲妇幼保健知识、态度及行为研究

目的:了解西部农村地区3岁以下儿童母亲孕产期保健和儿童保健的知识、态度和行为现状,为今后制定健康教育方案、有效开展健康活动提供依据。方法:在母子系统保健项目9个项目县中随机抽取118名3岁以下儿童母亲进行专题小组访谈。结果:受访者对产前检查的知晓率较高,但能够正确接受产前检查的比例较低;母亲对儿童保健相关知识了解不足,不能对儿童进行正确的喂养、发育监测等相关保健。结论:建议加强对孕产妇和儿童家长的健康教育,特别是参与式健康教育,使其了解更多的孕产期保健和儿童保健相关知识,能够主动接受相关服务和采纳健康行为。     

农村孕产期保健服务需求的定性分析

目的:从需方角度分析中部地区农村孕产期保健的服务需求及其影响因素。方法:采用定性研究的半结构式访谈方法,对当地分管卫生工作的县长,卫生局长、人口与计划生育委员会主任、妇联主任、新型农村合作医疗办公室主任进行个人深入访谈,对乡镇卫生院院长、医护人员、乡村医生、计划生育工作者和3年内有分娩史的育龄妇女进行焦点小组访谈。访谈内容包括农村孕产期保健服务的现况,育龄妇女的孕产期保健服务需求及其影响因素。结果:当地产前检查工作中早孕检查率较低,高危妊娠管理欠佳;产妇基本住院分娩,但产后访视流于形式。孕产妇希望孕产期保健服务质量能够提高。医疗技术低和保健意识薄弱对当地农村孕产妇的保健需求产生主要影响,经济、交通等影响因素次之。结论:农村育龄妇女对孕产期保健服务有强烈的需求,提高孕产期保健服务能力和完善医疗保障体制是满足农村妇女孕产期保健服务需求的关键。     

非户籍妇女孕产期保健服务利用影响因素的定性研究

目的:了解非户籍妇女孕产期保健服务利用状况,并分析其影响因素,为研究孕产期保健服务的可及性和公平性提供依据。方法:通过个别深入访谈的方法,选择在上海市南汇区分娩的非户籍人口孕产妇进行调查。结果:非户籍妇女孕产期保健服务利用不足。社会经济地位、本人及她人既往分娩经历、妇女的角色与孩子的性别均不同程度影响非户籍妇女的孕产期保健服务利用。结论:应针对非户籍妇女进行形式多样的孕产期保健宣传教育,包括其家庭成员的教育,在城市建立流动人口平产分娩点对非户籍妇女孕产期保健具有积极意义,政府应支持多部门协作,对非户籍人口实行综合管理,同时在财政上予以支持。     

影响农村妇女孕产期保健的社会因素分析

目的:探讨影响农村妇女孕产期保健的社会因素。方法:采用定性研究方法,根据目的抽样的原则,抽取孕产期保健服务的提供者、利用者以及地方级别的关键知情人士进行焦点小组访谈、个人深入访谈和关键人物访谈。结果:家庭经济贫困的妇女相对经济好的妇女更不容易利用保健服务;新型农村合作医疗可以吸引妇女到医院分娩,提高住院分娩率,降低母婴死亡率;交通对孕产妇利用保健服务有很大的影响;计划生育政策是计划外生育妇女利用孕产期服务最主要的障碍;流动妇女对孕产期保健服务的利用率低;当地农村仍奉行一些关于生孩子的传统习俗。结论:建议政府制定相关政策限制日益增长的医疗费用;加强流动人口和计划外生育妇女的管理;对农村妇女进行孕产期健康教育;扩大新型农村合作医疗的覆盖范围。     

东北两省农村地区预防保健现状调查研究

目的：通过了解东北两省农村地区社会经济状况、卫生事业经济及预防保健工作开展状况，分析当地预防保健影响因素。方法：采用整群、随机抽样方法对黑龙江省和辽宁省的120个乡的预防保健事业展开调查研究。结果：预防保健可及性差，预防保健经费短缺以及乡镇卫生院重医轻防等原因造成预防保健水平低下。结论：通过提高预防保健可及性，加大预防保健经费投入和界定乡镇卫生院功能，提高预防保健的服务功能。     

上海市孕妇对孕产期保健的认知行为现状及影响因素分析

目的:了解上海市嘉定区孕妇对于孕产期保健的知识、态度和行为状况,以及影响它们的因素,为探索孕产期保健干预策略研究提供依据。方法:借鉴健康教育的"知信行"理论,自行设计调查问卷,对上海市嘉定区4个社区的产妇进行了孕产期保健现状调查,采用多重线性回归统计分析产妇保健的影响因素,SPSS 13.0进行统计分析。结果:知晓率在90%以上,但对产后方面知识的知晓率相对较低。与到达医疗点时间、职业、家庭月收入相关;态度认知程度达到95%,与丈夫的文化程度相关;行为发生率为78.4%,与月收入、户口所在地相关。结论:需要加强孕产期健康教育的全程性和社会支持,增强对农村地区保健服务的可及性。     

九江市农村育龄妇女孕产期保健服务需求状况分析

目的:了解九江市农村育龄妇女孕产期保健服务需求的现状,探讨农村育龄妇女孕产期保健服务需求的差异。方法:采用分层-整群抽样方法随机抽取九江市3476例农村育龄妇女作为调查对象进行结构式访谈问卷调查。结果:农村育龄妇女普遍存在孕产期保健意识缺乏现象,孕期保健和住院分娩地点主要选择县、乡两级,农村育龄妇女孕期保健的目的主要是为了了解胎儿的发育情况;半数以上不愿意接受医生指导的孕期常规筛查项目,调查对象认为"没必要"筛查;尚有17.3%的农村育龄妇女在停经4个月后才进行初次产检;1.4%的农村育龄妇女选择家庭、村级卫生所为分娩地点。结论:建议给予县、乡两级孕产期保健服务能力建设以持续和重点支持。建议采用进村入户发放传单、张贴标语、讲解典型事例、与家庭成员商谈等更深入细致的健康教育形式,消除农村育龄期妇女孕产期保健知识的盲点。     

影响云南省农村地区孕前保健服务利用的定性研究

目的:了解云南省2个项目县计划生育管理者、服务提供者和服务对象对孕前保健服务能力以及服务的供需情况,对影响孕前保健服务利用的因素进行分析。方法:分别于2008年6月和2009年4月对云南省祥云县和元谋县计划生育管理者、服务提供者及服务对象进行小组和个人访谈。结果:农村育龄夫妇有较高的孕前风险因素暴露,还处于被动接受服务阶段,基层服务提供者知识和技能虽然得到了提升,但还需加强服务的规范性。结论:通过健康教育,使计划妊娠夫妇逐步主动寻求孕前保健服务;继续针对县、乡两级服务提供者开展不同层次、不同岗位、有重点的知识和技能培训,保证提供安全、规范和符合服务对象需求的个性化孕前保健服务。     

少数民族地区农村居民卫生服务需求与利用分析(国家第三次卫生服务调查西部扩点四川调查课题组)

目的：通过对少数民族地区农村卫生服务需求与利用分析,为政府卫生资源配置提供依据.方法：分阶段分层整群随机抽样调查.结果：少数民族地区居民潜在健康需求较大,尤其是传染病问题突出;低门诊利用、高门诊费用、高住院利用是少数民族地区卫生服务利用的主要特点;妇幼卫生工作基础薄弱,预防保健服务利用有待改善.建议：加大公共卫生投入,突出抓好传染病的防治;注重乡村两级卫生机构建设,提高门诊服务可及性;充分利用资源,加强预防保健工作.     

Utilization of maternal health care services in Southern India

This paper examines the patterns and determinants of maternal health care utilization across different social settings in South India: in the states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Data from the National Family Health Survey (NFHS) carried out during 1992-93 across most states in India are used. Results show that utilization of maternal health care services is highest in Kerala followed by Tamil Nadu, Andhra Pradesh and Karnataka. Utilization of maternal health care services is not only associated with a range of reproductive, socio-economic, cultural and program factors but also with state and type of health service. The interstate differences in utilization could be partly due to variations in the implementation of maternal health care program as well as differences in availability and accessibility between the states. In the case of antenatal care, there was no significant rural-urban gap, thanks to the role played by the multipurpose health workers posted in the rural areas to provide maternal health care services. The findings of this study provide insights for planning and implementing appropriate maternal health service delivery programs in order to improve the health and well-being of both mother and child.     

A study of maternal and child health care services and private sector in urban Asir Region

The differences in the maternal and child health care services offered by government and private sector in Abha and Khamis Mushayt cities in Asir Region of Saudi Arabia were compared. Self administered questionnaires and observation sheet were used for the study. It was found that the government clinics were more involved in the running of under 5 clinics and giving health education to patients. The private clinics took more care of women general health care but lacked the continuous domiciliary visit to pregnant women. The catchment area which served the government PHCCs made accessibility to service easier to government patients and this was thought to be the reason why government patients kept regular appointments. On the other hand, private patients who have the freedom to choose where they get service have been found to be irregular in keeping clinic appointment. It was suggested that there should be geographical spread in the location of private clinics to facilitate accessibility and that the health education and under 5 clinics should be well incorporated into the services offered by private clinics.     

流动老人基本公共卫生服务利用及影响因素研究

目的:了解流动老人基本公共卫生服务利用情况及其影响因素,为促进公共卫生服务均等化提供数据支持。方法:以安德森卫生服务利用模型为理论基础,使用2015年全国流动人口动态监测数据,结合深度访谈,对影响流动老人卫生服务利用的人群特征及环境因素进行分析。结果:流动老人基本公共卫生服务利用率偏低并在群体内存在差异;户籍类型、居住时长、流动范围是影响流动老人卫生服务利用的主要因素;基层卫生服务机构存在经费拨付与工作量不一致、数据不清、工作不被理解等方面的困难。结论:流动老人基本公共卫生服务可及性较差、健康意识薄弱,应加强健康教育宣传;对农村户籍、居住时间短和流动跨度大的老人给予重点关注;卫生部门应加强针对流动老人的数据统计,改变基本公共卫生服务经费拨付方式,优化信息化建设顶层设计,促进流动老人基本公共卫生服务利用。     

四川省农村孕产妇住院分娩补助项目效果评价

目的探讨四川省农村孕产妇住院分娩补助项目运行情况及取得的成效和不足。方法对省内项目管理情况,住院分娩率、孕产妇和新生儿死亡率,孕产妇保健进行分析。结果 2009~2012年,四川省农村孕产妇住院分娩补助项目顺利实施,全省住院分娩率逐年提高,孕产妇和新生儿死亡率下降明显,孕产妇保健进一步加强。结论通过项目实施,全省妇幼卫生指标改善明显;但仍存在部分地区项目执行进度较慢,地区间不平衡等问题。应通过探索民族地区免费住院分娩、推进基础设施建设等措施,促进妇幼卫生服务更好的利用。     

中西部农村地区妇女保健发展的制约因素

在经济落后地区农村妇女保健服务状况堪忧,主要表现在孕产期保健服务质量不高;育龄妇女面临较高的生育风险;生殖系统疾病的困扰.影响这些地区妇女保健发展的因素涉及社会、经济以及妇幼保健服务能力等.通过加强基层医疗服务技术,完善妇幼保健网络,促进健康教育,新型合作医疗的覆盖等不同层次措施的开展,将会改善经济落后地区农村妇女保健的状况.     

Accessibility of primary health care workforce in rural china

This study aims to develop an accessibility index to illustrate the status of the accessibility of primary health care workers in remote and rural areas in China. Relevant county-level data were used to analyze the number and distribution of primary health care workforce in rural China, and relevant provincial-level data were used to analyze the accessibility index. The study found that the development of rural primary health care workers is suboptimal. The rural Primary Health Care Worker Accessibility index shows that the accessibility to primary health care workers in western rural areas is poor. The correlation between PHCWA index and maternal mortality rate is more significant than that between primary health care workers density and maternal mortality rate. In addition to increasing the number of primary health care workers, strategies addressing the challenge of distance are also required.     

Urban versus rural populations' views of health care in Scotland

OBJECTIVES: To compare satisfaction with, and expectations of, health care of people in rural and urban areas of Scotland. METHODS: Questions were included in the 2002 Scottish Social Attitudes Survey (SSAS). The Scottish House-hold Survey urban-rural classification was used to categorize locations. A random sample of 2707 people was contacted to participate in a face-to-face interview and a self-completion questionnaire survey. SPSS (v.10) was used to analyse the data. Relationships between location category and responses were explored using logistic regression analysis. RESULTS: In all, 1665 (61.5%) interviews were conducted and 1507 (56.0%) respondents returned self-completion questionnaires. Satisfaction with local doctors and hospital services was higher in rural locations. While around 40% of those living in remote areas thought A&E services too distant, this did not rank as a top priority for health service improvement. This could be due to expectations that general practitioners would assist in out-of-hours emergencies. Most Scots thought services should be good in rural areas even if this was costly, and that older people should not be discouraged from moving to rural areas because of their likely health care needs. In all, 79% of respondents thought that care should be as good in rural as urban areas. Responses to many questions were independently significantly affected by rural/urban location. CONCLUSIONS: Most Scots want rural health care to continue to be good, but the new UK National Health Service (NHS) general practitioner contract and service redesign will impact on provision. Current high satisfaction, likely to be due to access and expectations about local help, could be affected. This study provides baseline data on attitudes and expectations before potential service redesign, which should be monitored at intervals in future.