“十三五”期间我国农村居民结核病健康教育状况及结核病防治核心信息影响因素分析

doi:10.19982/j.issn.1000-6621.20240363

摘要/Abstract

摘要：

目的: 分析“十三五”期间我国农村居民结核病健康教育状况及结核病防治核心信息影响因素,为针对性提升结核病防治健康教育工作提供科学依据。方法: 采用现况调查方法,参照多阶段整群随机抽样方法,从“十三五”全国结核病防治规划终期评估专项调查数据库中抽取居住在全国31个省(市、自治区)和新疆生产建设兵团村级行政单位的26593名15岁及以上常住农村居民行结核病健康教育面对面调查,共获得有效问卷26250份,有效率为98.71%。调查问卷主要包括一般情况(性别、年龄、文化程度等)、结核病防治核心信息(Q₁:肺结核是长期严重危害健康的慢性传染病;Q₂:肺结核主要通过呼吸道传播,人人都有可能被感染;Q₃:咳嗽、咳痰2周以上,应怀疑得了肺结核,要及时就诊;Q₄:不随地吐痰,咳嗽、打喷嚏时掩口鼻,戴口罩可以减少肺结核的传播;Q₅:规范全程治疗,绝大多数患者可以治愈,还可避免传染他人)、健康教育情况(包括接受健康教育途径、希望了解防治信息途径、常用的获取网络科普的途径、喜爱的宣传材料和网络科普材料类型)。采用单因素和多因素logistic回归模型对不同特征调查对象的健康教育情况和结核病防治核心信息知晓情况及其影响因素进行分析。结果: 26250名常住农村居民对结核病防治核心信息总知晓率为81.77%(107323/131250),对Q₁~Q₅核心信息的知晓率分别为76.97%(20205/26250)、88.14%(23138/26250)、88.70%(23285/26250)、84.00%(22049/26250)和71.03%(18646/26250)。其中,接受过结核病健康教育的农村居民结核病防治核心信息总知晓率[85.20%(89062/104535)]及对Q₁~Q₅核心信息的知晓率[80.28%(16785/20907)、92.11%(19258/20907)、92.68%(19377/20907)、86.66%(18117/20907)、74.26%(15525/20907)]均明显高于未接受过结核病健康教育的农村居民[68.35%(18259/26715)、64.01%(3420/5343)、72.62%(3880/5343)、73.14%(3908/5343)、73.55%(3930/5343)、58.41%(3121/5343)],差异均有统计学意义(χ²值分别为4051.600、635.000、1545.700、1619.600、542.160、518.430,P值均<0.001)。相较于15~29岁年龄组、小学及以下文化程度、机关/事业单位和未接受过结核病健康教育的农村居民,45~59岁年龄组、初中及同等学历、高中及同等学历、大专和本科及以上、从事商业/服务业和接受过结核病健康教育的农村居民的结核病防治核心信息知晓情况均更好(OR=1.156,95%CI:1.050~1.273;OR=1.667,95%CI:1.568~1.773;OR=1.882,95%CI:1.716~2.065;OR=1.974,95%CI:1.736~2.245;OR=1.693,95%CI:1.431~2.005;OR=1.242,95%CI:1.035~1.489;OR=2.655,95%CI:2.485~2.839)。农村居民接受结核病健康教育的前3位途径分别为电视/广播[52.02%(13656/26250)]、传单/折页/宣传画[31.49%(8265/26250)]和医生宣传[26.53%(6963/26250)];查询网络健康科普信息的主要途径为微信和微博等自媒体[36.58%(9602/26250)]及搜索引擎[25.28%(6636/26250)];希望获取结核病防治信息的主要途径有电视/广播[62.80%(16484/26250)]、医生宣传[45.95%(12062/26250)]和网络宣传[36.57%(9599/26250)];喜爱有声像[40.98%(10757/26250)]和图文并茂[36.90%(9685/26250)]的宣传材料,以及网络科普视频[60.28%(15824/26250)]和图文[46.82%(12290/26250)]的获取形式。结论: “十三五”规划后我国农村居民结核病防治健康教育状况较“十二五”有明显提升,但对结核病核心信息知晓率的提升仍有较大空间,可在加大网络媒体宣传力度、开发适宜于网络媒体传播的宣传材料的基础上,有针对性地对低文化程度和未接受过结核病健康教育的农村居民开展结核病防治宣传教育。

关键词: 结核, 农村人口, 健康知识,态度,实践, 问卷调查, 因素分析,统计学

Abstract:

Objective: To assess the status of tuberculosis health education and the factors influencing the comprehension of core tuberculosis prevention and control information among rural residents in China during the ‘13th Five-Year Plan’. The analysis aims to enhance tuberculosis health education based on scientific evidence. Methods: Using the prevalence survey method and referring to multi-stage cluster random sampling method, a total of 26593 permanent rural residents aged 15 and above living in village-level administrative units of 31 provinces (municipalities and autonomous regions) and Xinjiang Production and Construction Corps were selected from the special survey database for the final assessment of the National Tuberculosis Prevention and Control Plan in the ‘13th Five-Year Plan’. We collected 26250 valid responses to questionnaires on tuberculosis health education, yielding an effective response rate of 98.71%. The questionnaire covered general demographic information (gender, age, education level), the core information of tuberculosis prevention and control (Q₁: Tuberculosis is a chronic infectious disease that seriously endangers health for a long time; Q₂: Tuberculosis is mainly transmitted through the respiratory tract, and everyone can be infected; Q₃: Cough and sputum for more than 2 weeks should be suspected of tuberculosis, and seek medical treatment in time; Q₄: Not spitting, covering mouth and nose when coughing or sneezing, and wearing a mask can reduce the spread of tuberculosis; Q₅: Standardized full treatment can cure the vast majority of patients and avoid infecting others), and the current status of health education (methods of receiving health education, preferred methods learning about tuberculosis prevention and control information, methods of accessing online science popularization, preferred types of tuberculosis dissemination and online science popularization materials). Both univariate and multivariate logistic regression analyses were employed to assess the relationship between various demographic characteristics and the level of awareness and understanding of core tuberculosis prevention and control information. Results: The total awareness rate of 26250 rural residents on the core information of tuberculosis prevention and control was 81.77% (107323/131250). The awareness rates of Q₁ to Q₅ core information were 76.97% (20205/26250), 88.14% (23138/26250), 88.70% (23285/26250), 84.00% (22049/26250) and 71.03% (18646/26250), respectively. Among them, the total awareness rate (85.20% (89062/104535)) and the awareness rate of Q₁-Q₅ core information (80.28% (16785/20907), 92.11% (19258/20907), 92.68% (19377/20907), 86.66% (18117/20907), 74.26% (15525/20907)) of tuberculosis prevention and control core information of rural residents who had received tuberculosis health education were significantly higher than those of rural residents who had not received tuberculosis health education (68.35% (18259/26715), 64.01% (3420/5343), 72.62% (3880/5343), 73.14% (3908/5343), 73.55% (3930/5343), 58.41% (3121/5343)), the differences were statistically significant (χ²=4051.600, 635.000, 1545.700, 1619.600, 542.160, 518.430, Ps<0.001). Compared with rural residents aged 15-29, with education levels of primary school or below, employed in government or public institutions and who had not received tuberculosis health education, those aged 45-59, with educational achievements ranging from junior high school to bachelor’s degrees or above, employed in business or services, and who had received tuberculosis health education demonstrated superior awareness of the core information related to tuberculosis prevention and control (OR=1.156, 95%CI: 1.050-1.273; OR=1.667, 95%CI: 1.568-1.773; OR=1.882, 95%CI: 1.716-2.065; OR=1.974, 95%CI: 1.736-2.245; OR=1.693, 95%CI: 1.431-2.005; OR=1.242, 95%CI: 1.035-1.489; OR=2.655, 95%CI: 2.485-2.839). The top three methods for rural residents to receive tuberculosis health education were TV/radio (52.02% (13656/26250)), leaflets/folded pages/posters (31.49% (8265/26250)), and direct doctor communication (26.53% (6963/26250)). The main methods of accessing online health science popularization information were WeChat and Weibo (36.58% (9602/26250)) and search engines (25.28% (6636/26250)). Preferred methods learning about tuberculosis prevention and control information included TV/radio (62.80% (16484/26250)), doctor dissemination (45.95% (12062/26250)), and internet dissemination (36.57% (9599/26250)). Audio-visual (40.98% (10757/26250)) and graphic (36.90% (9685/26250)) materials were the preferred types of tuberculosis dissemination, with video (60.28% (15824/26250)) and graphic (46.82% (12290/26250)) being the most popular types of science popularization. Conclusion: During the assessment of the ‘13th Five-Year Plan’, there was a notable enhancement in the health education status related to tuberculosis prevention and control among rural residents in China. However, the awareness of core tuberculosis information had considerable scope for improvement. On the basis of increasing the publicity of network media and developing the dissemination of publicity materials suitable for network media, targeted publicity and education of tuberculosis prevention and control can be carried out for rural residents with low education level and who have not received tuberculosis health education.

Key words: Tuberculosis, Rural population, Health knowledge,attitudes and practice, Questionnaires, Factor analysis, statistics

中图分类号:

R193
R52

倪帅虎, 陈钢, 王嘉, 李玉红, 李雪, 陈伟, 张慧, 屈燕, 罗小峰, 赵雁林. “十三五”期间我国农村居民结核病健康教育状况及结核病防治核心信息影响因素分析[J]. 中国防痨杂志, 2024, 46(12): 1469-1477. doi: 10.19982/j.issn.1000-6621.20240363

Ni Shuaihu, Chen Gang, Wang Jia, Li Yuhong, Li Xue, Chen Wei, Zhang Hui, Qu Yan, Luo Xiaofeng, Zhao Yanlin. Analysis of the health education status of tuberculosis in rural residents and the influencing factors of the core information of tuberculosis prevention and control during the “13th Five-Year Plan” period[J]. Chinese Journal of Antituberculosis, 2024, 46(12): 1469-1477. doi: 10.19982/j.issn.1000-6621.20240363

图/表 6

表1

表2

表3

表4

影响农村居民结核病防治核心信息全部知晓情况的多因素分析

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
性别
男性					1.000
女性	0.024	0.026	0.899	0.343	1.025(0.974~1.078)
年龄组(岁)
15~29					1.000
30~44	0.087	0.049	3.147	0.076	1.091(0.991~1.201)
45~59	0.145	0.049	8.768	0.003	1.156(1.050~1.273)
≥60	0.004	0.053	0.006	0.936	1.004(0.905~1.115)
文化程度
小学及以下					1.000
初中及同等学历	0.511	0.031	265.853	<0.001	1.667(1.568~1.773)
高中及同等学历	0.632	0.047	178.810	<0.001	1.882(1.716~2.065)
大专	0.680	0.066	107.599	<0.001	1.974(1.736~2.245)
本科及以上	0.527	0.086	37.528	<0.001	1.693(1.431~2.005)
职业
机关/事业单位					1.000
企业	0.180	0.094	3.671	0.055	1.197(0.996~1.439)
商业/服务业	0.217	0.093	5.457	0.019	1.242(1.035~1.489)
在校学生	-0.122	0.102	1.430	0.232	0.885(0.724~1.081)
农业劳动者	0.012	0.082	0.020	0.886	1.012(0.861~1.188)
离退休	0.012	0.116	0.010	0.920	1.012(0.805~1.271)
其他	-0.013	0.085	0.023	0.880	0.987(0.835~1.167)
接受过结核病健康教育
否					1.000
是	0.976	0.034	825.930	<0.001	2.655(2.485~2.839)

表4

表5

表6

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特征	调查人数(名)	构成比(%)	特征	调查人数(名)	构成比(%)
年龄组(岁)			本科及以上	803	3.06
15~29	3489	13.29	职业
30~44	5983	22.79	机关/事业单位	829	3.16
45~59	9326	35.53	企业	1284	4.89
≥60	7452	28.39	商业/服务业	1699	6.47
性别			在校学生	1034	3.94
男性	13288	50.62	农业劳动者	17563	66.91
女性	12962	49.38	离退休	603	2.30
文化程度			其他	3238	12.33
小学及以下	11245	42.84	接受过结核病健康教育
初中及同等学历	9584	36.51	是	20907	79.65
高中及同等学历	3048	11.61	否	5343	20.35
大专	1570	5.98	合计	26250	100.00

特征	调查居民数 (名)	全部知晓		χ²值	P值
特征	调查居民数 (名)	人数(名)	知晓率(%)	χ²值	P值
性别				4.268	0.039
男性	13288	6514	49.02
女性	12962	6188	47.74
年龄组(岁)				269.980	<0.001
15~29	3489	1834	52.57
30~44	5983	3181	53.17
45~59	9326	4662	49.99
≥60	7452	3025	40.59
文化程度				717.580	<0.001
小学及以下	11245	4380	38.95
初中及同等学历	9584	5211	54.37
高中及同等学历	3048	1746	57.28
大专	1570	924	58.85
本科及以上	803	441	54.92
职业				183.718	<0.001
机关/事业单位	829	467	56.33
企业	1284	750	58.41
商业/服务业	1699	993	58.45
在校学生	1034	530	51.26
农业劳动者	17563	8087	46.05
离退休	603	293	48.59
其他	3238	1582	48.86
接受过结核病健康教育				1091.200	<0.001
是	20907	11194	53.54
否	5343	1508	28.22

途径	选择人数 (名)	选择率 (%)
结核病健康教育途径(前5种)
电视/广播	13656	52.02
传单、折页、宣传画	8265	31.49
医生宣传	6963	26.53
网站、微信、微博等网络宣传	6888	26.24
宣传栏、墙报、黑板报	6367	24.26
网络健康科普信息途径
微信、微博等自媒体	9602	36.58
百度、谷歌或其他搜索引擎	6636	25.28
医学专业在线咨询	4157	15.84
医学专业网站	3210	12.23

需求途径	选择人数(名)	选择率(%)	需求途径	选择人数(名)	选择率(%)
结核病健康教育途径需求(前5种)			什么都行	9388	35.76
广播/电视	16484	62.80	文字为主的材料	5970	22.74
医生宣传	12062	45.95	网络宣传材料	4945	18.84
网站、微信、微博等网络宣传	9599	36.57	网络健康科普材料需求
宣传栏、墙报、黑板报	7819	29.79	视频	15824	60.28
居委会/村委会宣传	7149	27.23	文字+图片	12290	46.82
结核病宣传材料类型需求			文字	4834	18.42
视频、动漫等声像材料	10757	40.98	动画	4608	17.55
图文并茂的材料	9685	36.90	其他	795	3.03