南京地区流动孕产妇产前保健利用状况及其影响因素

目的:了解影响流动人口孕产妇产前保健服务利用现状及其影响因素,为今后制定相关卫生工作政策提供参考依据。方法:分层随机抽取409例流动产妇进行问卷调查,调查内容包括社会人口学特征、孕产史、孕早期检查及产前检查次数等情况。结果:调查结果显示,流动人口中孕产妇初次产前检查平均孕周为(21.1±9.1)周,早期检查率仅为24.9%,平均产前检查次数为(6.2±3.6)次,≥5次的产前检查率为56.2%。影响产前保健利用及时性的主要有月人均收入及是否经产;影响产前保健利用足够程度的因素主要有婚姻、文化程度、配偶有无工作、月人均收入及是否经产。结论:流动孕产妇产前保健利用率低,产前保健利用的主要影响因素为婚姻、文化程度、丈夫有无工作、是否经产及经济因素。     

Health literacy and knowledge of antenatal care among pregnant women

Health literacy has a direct impact on pregnancy from the perspectives of both the mother and the baby. This study aimed to determine the level of health literacy and assess the knowledge of antenatal care among pregnant women. From among all pregnant women who presented to the hospital's obstetric polyclinic during the study's timeline, the study group consisted of 460 women who agreed to take part (492 women were invited and a response rate of 93.5% was achieved). A questionnaire prepared based on the literature in line with the study's objectives was completed by the participants under supervision. The Turkish Health Literacy Scale (THLS-32) was used to assess health literacy. In order to determine the women's prenatal care knowledge levels, a total of 20 knowledge-testing statements prepared using the literature were applied, 14 of which were true and six of which were false. The internal consistency of antenatal information questions during pregnancy was made and the Cronbach alpha coefficient was calculated as 0.77. It was determined that 33.9% of the participants had a sufficient level of health literacy. Health literacy was sufficient in young married women (19 years and less) in their first pregnancy and those who had regular reading habits, participated in healthcare activities and received postpartum care at a family health clinic (p < 0.05 for each). While the most accurately evaluated statement about antenatal care was ‘It is normal to experience nausea/vomiting in the first trimester of pregnancy’, the least accurately evaluated statement was ‘Over 35% of women incorrectly believed it was normal to gain 20 kg of weight during pregnancy’. It was found that pregnant women with sufficient health literacy had higher levels of knowledge about antenatal care (p < 0.05). In this study, it was determined that approximately two-thirds of the participants had insufficient health literacy and the women with insufficient health literacy had low levels of knowledge about antenatal care.     

Breaking the barrier: the Health Belief Model and patient perceptions regarding contraception

Background

The study was conducted to determine the discrepancy between unintended pregnancies and use of contraception is attributed to imperfect use, misconceptions and an inability to adjust therapy to lifestyle.

Study Design

A survey administered at a Federal clinic incorporated the Health Belief Model to determine patient's emphasis in pregnancy prevention. Analysis focused on comparing participant demographics to reasons for contraceptive selection.

Results

Ease of use ranked the most important for contraception as patient's education levels increased (p=.001). As household income increased, emphasis on potential side effects became less (p=.02). Patients with private insurance ranked ease of use most frequently (p=.01). Males emphasized effectiveness and menstrual suppression more than females (p=.04 and .008).

Conclusion

A positive correlation between perceived benefit regarding ease of use as educational level increased and perceived barriers due to side effects as income level decreased immerged. Special counseling by practitioners to improve patient's self-efficacy, ultimately enhancing contraceptive adherence, are warranted.     

城市流动与户籍孕产妇产前保健利用状况比较分析

目的:了解流动孕产妇与户籍孕产妇产前保健服务的利用情况,发现两人群的差异,探讨影响因素并为制定干预措施提供依据。方法:采用对比研究,在广州、浙江、福建、北京对379名流动孕产妇和381名户籍孕产妇进行问卷调查,了解其社会人口学因素及产前保健利用情况,包括初检孕周、产检次数及早、中、晚孕期的产检项目等。结果:流动与户籍孕产妇孕早期初检率分别为40.5%和57.1%,产检5次及以上的比率分别为60.4%和80.6%;流动孕产妇孕早、中期各基本项目检查率低于户籍孕产妇,孕晚期差异不大。流动人口、文化程度低、经济收入低、未婚或离异、无保险、经产妇、计划外生育、怀孕后无人通知产检等会影响孕产妇的产检利用情况。结论:城市中流动孕产妇产前保健服务的利用情况与户籍孕产妇相比存在较大差异,孕产妇保健应注重提供普惠性的服务项目及加大服务宣教力度。     

Health Blief Model-based intervention to improve nutritional behavior among elderly women

BACKGROUND/OBJECTIVESNutrition is a determinant factor of health in elderly people. Independent living in elderly people can be maintained or enhanced by improvement of nutritional behavior. Hence, the present study was conducted to determine the impact of Health Belief Model (HBM)-based intervention on the nutritional behavior of elderly women.SUBJECTS/METHODSCluster-random sampling was used to assess the sample of this clinical trial study. The participants of this study attended a 12-week nutrition education program consisting of two (2) sessions per week. There was also a follow-up for another three (3) months. Smart PLS 3.5 and SPSS 19 were used for structural equation modeling, determination of model fitness, and hypotheses testing.RESULTSThe findings indicate that intervention had a significant effect on knowledge improvement as well as the behavior of elderly women. The model explained 5 to 70% of the variance in nutritional behavior. In addition, nutritional behavior was positively affected by the HBM constructs comprised of perceived susceptibility, self-efficacy, perceived benefits, and barriers after the intervention program.CONCLUSIONThe results of this study show that HBM-based educational intervention has a significant effect in improving nutritional knowledge and behavior among elderly women.     

Health Belief Model applied to non-compliance with HPV vaccine among female university students

Objectives

To investigate the reasons for refusal of human papillomavirus (HPV) vaccination, and to explore participants' perceptions and attitudes about Health Belief Model (HBM) constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy) among a sample of female university students.

Study design

Cross-sectional. A self-administered questionnaire based on the HBM was used.

Methods

Confirmatory factor analysis was applied to the data to examine the construct validity of the six factor models extracted from the HBM. The predictors of non-HPV vaccination were determined by logistic regression models, using non-HPV vaccination as the dependent variable.

Results

The sample included 2007 students. The participation rate was 88.9% and the percentage of non-vaccination was 71.65%. Participants who had high scores for ‘general perceived barriers’, ‘perceived barriers to vaccination’, ‘no perceived general benefits’, ‘no perceived specific benefits’ and ‘no general benefits’ were more likely to report being unvaccinated.

Conclusions

The findings demonstrated the utility of HBM constructs in understanding vaccination intention and uptake. There is an urgent need to improve health promotion and information campaigns to enhance the benefits and reduce the barriers to HPV vaccination.     

运用秩和比法对各省2008年孕产妇保健工作质量的综合评价

目的:综合评价全国各省孕产妇保健工作并进行排序分档。方法:收集各省2008年孕产妇保健工作质量相关指标:高危产妇比重、孕产妇建卡率、系统管理率、产前检出率、产后访视率、住院分娩率、新法接生率、孕产妇死亡率等数据,运用秩和比法对各省孕产妇保健工作进行综合评价。结果:秩和比法评为优和良的地区绝大多数为东部经济较发达省份,而评为一般或差的地区多为经济欠发达的中西部地区,与我国的区域经济发展水平和公共卫生事业发展状况基本一致。结论:国家应加大对经济欠发达地区的公共卫生事业、特别是妇幼保健工作的财政支持,促进中西部地区的卫生事业发展和人们的健康水平。     

流动人口孕产妇保健及分娩调查

目的　了解外地流动人口孕产妇在北京市产前保健及分娩情况 ,提出对流动人口孕产妇保健管理的建议。方法　小组访谈 :在北京市 3个近郊区的城乡结合部 ,做 3次小组访谈 ,共调查 16人 ;问卷调查 ,对 619名妇女进行面对面问卷调查。结果　 2 6 3 %的人建立了《围产保健手册》。产前检查 0次占 6 5% ,1～ 5次占 3 9 3 % ,≥ 6次占54 2 %。 583人住院分娩 ,占 94 2 %。家庭人均月收入≥ 10 0 0元住院分娩率明显高于 <10 0 0元者 (98 9%与90 2 % ,P <0 0 1)。家庭分娩率 5 8%。结论　要加强对外地流动人口孕产妇的保健管理 ,依法管理私人接生员 ,为外地孕产妇提供以人为本的优质服务     

凉山州孕产妇围产保健服务利用现状分析

目的了解凉山州艾滋病感染孕产妇与正常孕产妇围产保健服务利用现状。方法以艾滋病高发区四川省凉山州为样本地区,选取2013~2014年检测确诊并可追踪的212例人类缺陷免疫病毒(human immunodeficiency virus,HIV)感染孕产妇为研究组,随机等距抽取402例正常孕产妇作为对照组,开展围产保健服务利用的问卷调查。结果两组孕产妇在民族、文化程度和家庭年收入比较,差异有统计学意义(P0.05)。HIV感染孕产妇的住院分娩比例、产后访视比例高于对照组,产检次数低于对照组(P0.05)。文化程度和家庭年收入的差异是两组孕产妇利用围产保健服务状况不同的主要原因。结论凉山州HIV感染和正常孕产妇的围产保健服务利用受诸多因素影响,在精准扶贫中应有针对性地推行免费孕产期保健和住院分娩项目,提高边远地区孕产妇系统管理率。     

阳江市1230例孕产妇的孕产期保健状况调查

目的 了解阳江市1230例孕产妇的孕产期保健现状,为提高孕产期保健质量提供依据.方法 采用分层整群随机抽样方法,对阳江市3个县(区)1230例孕产妇的基本情况,孕期保健知识及服务状况、妊娠分娩期健康状况等4个方面进行人户问卷横断面调查,并对结果进行统计分析.结果 本次研究有效问卷1220份,产妇对孕产期保健知识总体知晓...     

新疆、安徽农村地区孕产期保健服务变化趋势分析

目的:了解新疆、安徽两地农村地区孕产期保健服务时间变化情况,及时发现当前我国农村地区孕产期保健服务中存在的问题。方法:自行设计调查问卷,采用整群随机抽样的方法对调查对象在2006年1月由调查员对其进行面对面问卷调查。结果:随着时间推移,调查对象产前检查覆盖率及住院分娩比例等都在不断增加,但仍然存在产前检查开始时间较晚,产前检查次数较少等问题。2000年以来,孕早期检查比例只有52.5%,5次及以上产前检查的比例也只达到54.0%。另外,住院分娩比例也还需进一步提高,非住院分娩妇女中43.8%的人由家人/朋友接生。结论:加强产科建设和培训,进一步提高产前保健服务质量,加大提倡住院分娩的工作力度,以进一步提高我国孕产期保健服务水平。     

高原地区与平原地区孕产妇产前保健及妊娠结局对比分析

目的 调查高原地区及平原地区孕产妇孕期保健及妊娠结局情况的特点,比较高原地区及平原地区孕产妇孕期保健及妊娠结局的差异,为提高产科医疗服务质量提供参考.方法 随机选取西藏山南地区妇幼保健院(高原组)310例产妇及湖北省鄂东医疗集团黄石市妇幼保健院(平原组)302例产妇,对两组孕产妇的围产保健手册及住院病历资料进行登记,进行回顾性对比分析.结果 5次以下产前检查率高原组高于平原组(χ2=192.284,P<0.05);初次产检孕周高原组晚于平原组(χ2=519.388,P<0.05);妊娠并发症发生率及剖宫产发生率高原组均低于平原组(χ2值分别为13.477、99.652,均P<0.05).高原组剖宫产手术指征主要为妊娠期高血压疾病、横位(或臀位)、过期妊娠;平原组主要为胎儿窘迫、巨大胎儿、羊水过少.高原组足月新生儿平均出生体重低于平原组(t=8.672,P<0.05),高原组新生儿窒息发生率高于平原组(χ2=4.414,P<0.05),早产发生率低于平原组(χ2=5.724,P<0.05),巨大胎儿发生率低于平原组(χ2=4.995,P<0.05),足月小于胎龄儿发生率高于平原组(χ2=6.153,P<0.05),差异均有统计学意义.结论 高原地区孕产妇产前保健意识薄弱,产检率低、初次产检时间较晚;高原地区孕产妇的妊娠并发症率及剖宫产发生率显著低于平原地区的孕产妇;高原地区新生儿窒息发生率高于平原地区,新生儿出生体重、早产发生率、巨大胎儿发生率均低于平原地区,足月小于胎龄儿发生率高于平原地区.     

Between tolerable uncertainty and unacceptable risks: how health professionals and pregnant women think about the probabilities generated by prenatal screening

Prenatal screening provides a good illustration of the tensions existing between the intention of control associated with standard risk surveillance and the permanence of uncertainty around life processes. During the screening process, health professionals and pregnant women are not only confronted with the limitations of probabilistic thinking, they are also concretely reminded of the extent of uncertain outcomes. We analysed such tensions, emblematic of the notion of manufactured uncertainty, with qualitative data collected in Switzerland from both gynaecologists and mothers-to-be. Doctors experienced difficulties in regard to expectations raised by risk surveillance, the duty to inform and the anxiety surveillance induced. Pregnant women coped in different ways with probabilistic thinking, developing contrasting responses to uncertainty, ranging from scepticism about risk thinking to aspiration for control, leading to over-use of medical procedures. As uncertainty was central to professional as well as lay thinking, both made use of subjective interpretations and cultural meanings in decisions related to future events.     

Buying reassurance: uptake of non-invasive prenatal testing among pregnant women of advanced maternal age in China

Despite much ethical debate concerning non-invasive prenatal testing to abort or to detect genes, research on the experience of those who choose this new technology in China is limited, especially after the introduction of the Two-child Policy. In this article I analyse qualitative data from 25 interviews with pregnant women of advanced maternal age (pregnancy after 35) under the Two-child Policy, conducted in 2014 to 2016, as well as observational data from a 6-month, in-hospital participant observation in 2016. These data were collected with the aim to examine how non-invasive prenatal testing affects pregnant women’s risk perceptions and why this technology is widely accepted by pregnant women of advanced maternal age in China. I conclude that the women in my study accepted their ‘high-risk’ identity within prenatal care, and that non-invasive prenatal testing was integrated in this care. Women’s interactions with genetic counsellors, their husbands and close friends and community doctors produced anxieties, with women feeling responsible for the health of their foetuses. Consequently, the women in my study were willing to ‘buy’ this test for reassurance. The consumption of this new technology by pregnant women after the Two-child Policy lays a foundation for the market development of this technology in urban China.     

孕妇口腔保健知识与行为状况研究

目的：了解孕妇口腔卫生状况及其对口腔保健知识的了解程度和口腔卫生行为养成习惯。方法2013年8至10月,对北京市海淀区两家助产机构接受孕期保健和产前检查的1174名孕妇进行了口腔保健知识和卫生行为的问卷调查。结果调查结果显示,仅80名孕妇(6.8%)回答正确所有4个口腔卫生知识问题,大专以上文化程度的孕妇完全掌握孕期口腔卫生知识能力比中专以下文化程度的孕妇高4.5倍(OR=4.5,95%CI：1.9~10.9),而且随着知识点增多,掌握的程度越高(chi-square=219.4,P<0.05)。被调查孕妇有良好的口腔卫生习惯,71.0%(829/1167)的孕妇每天刷牙2次以上,但是,80%以上的孕妇偶尔或从不用口腔辅助清洁用品。结论孕妇对口腔保健知识普遍缺乏了解,文化程度低的孕妇口腔卫生保健相关知识的认知程度不够或欠缺情况较为明显。建议加强孕期口腔保健工作,口腔卫生行为指导也应加入口腔健康教育培训中,使孕妇掌握正确的刷牙方法和口腔辅助清洁用品使用方法。     

湖北省孕产妇保健影响因素

目的了解湖北省孕产妇保健状况，探索孕产妇保健的影响因素。方法采用多阶段分层系统抽样方法，抽取湖北省11个县（市）1998年1月1日～2003年10月20日有活产的17～45岁已婚育龄妇女共计687人，对其孕产期保健状况分别进行问卷调查，单因素分析采用70检验法、非参数检验法，多因素分析采用逐步前进法进行非条件Logistic回归分析。结果城市及农村孕产妇产前检查率分别为99．4％，84．7％；住院分娩率95．6％，54．8％；剖宫产率46．1％，10．7％；产后访视率67．3％，53．3％，差异均有统计学意义（P〈0．01）。城市孕产妇保健主要影响因素是经济收入和年龄，农村是生育活产儿数、经济收入、文化程度、是否为农民、是否经常主动获取保健知识。结论湖北省城乡孕产妇保健状况和影响因素差异较大，首次产前检查时间滞后，产后访视率明显低于产前检查率，与全国甲类城市和农村保健服务标准存在一定差距。     

Towards an Effective Health Interventions Design: An Extension of the Health Belief Model

Introduction

The recent years have witnessed a continuous increase in lifestyle related health challenges around the world. As a result, researchers and health practitioners have focused on promoting healthy behavior using various behavior change interventions. The designs of most of these interventions are informed by health behavior models and theories adapted from various disciplines. Several health behavior theories have been used to inform health intervention designs, such as the Theory of Planned Behavior, the Transtheoretical Model, and the Health Belief Model (HBM). However, the Health Belief Model (HBM), developed in the 1950s to investigate why people fail to undertake preventive health measures, remains one of the most widely employed theories of health behavior. However, the effectiveness of this model is limited. The first limitation is the low predictive capacity (R² < 0.21 on average) of existing HBM’s variables coupled with the small effect size of individual variables. The second is lack of clear rules of combination and relationship between the individual variables. In this paper, we propose a solution that aims at addressing these limitations as follows: (1) we extended the Health Belief Model by introducing four new variables: Self-identity, Perceived Importance, Consideration of Future Consequences, and Concern for Appearance as possible determinants of healthy behavior. (2) We exhaustively explored the relationships/interactions between the HBM variables and their effect size. (3) We tested the validity of both our proposed extended model and the original HBM on healthy eating behavior. Finally, we compared the predictive capacity of the original HBM model and our extended model.

Methods:

To achieve the objective of this paper, we conducted a quantitative study of 576 participants’ eating behavior. Data for this study were collected over a period of one year (from August 2011 to August 2012). The questionnaire consisted of validated scales assessing the HBM determinants – perceived benefit, barrier, susceptibility, severity, cue to action, and self-efficacy – using 7-point Likert scale. We also assessed other health determinants such as consideration of future consequences, self-identity, concern for appearance and perceived importance. To analyses our data, we employed factor analysis and Partial Least Square Structural Equation Model (PLS-SEM) to exhaustively explore the interaction/relationship between the determinants and healthy eating behavior. We tested for the validity of both our proposed extended model and the original HBM on healthy eating behavior. Finally, we compared the predictive capacity of the original HBM model and our extended model and investigated possible mediating effects.

Results:

The results show that the three newly added determinants are better predictors of healthy behavior. Our extended HBM model lead to approximately 78% increase (from 40 to 71%) in predictive capacity compared to the old model. This shows the suitability of our extended HBM for use in predicting healthy behavior and in informing health intervention design. The results from examining possible relationships between the determinants in our model lead to an interesting discovery of some mediating relationships between the HBM’s determinants, therefore, shedding light on some possible combinations of determinants that could be employed by intervention designers to increase the effectiveness of their design.

Conclusion:

Consideration of future consequences, self-identity, concern for appearance, perceived importance, self-efficacy, perceived susceptibility are significant determinants of healthy eating behavior that can be manipulated by healthy eating intervention design. Most importantly, the result from our model established the existence of some mediating relationships among the determinants. The knowledge of both the direct and indirect relationships sheds some light on the possible combination rules.