基于两水平模型评价广东省公众结核病防治核心信息知晓情况

doi:10.19982/j.issn.1000-6621.20250060

摘要/Abstract

摘要：

目的:探讨广东省公众结核病防治核心信息知晓情况及影响因素,提高结核病防治健康教育和健康促进工作的科学性和有效性。方法:采取多阶段分层随机抽样方法选取1403名广东省常住居民为调查对象,采用国家的标准化问卷进行面对面调查。通过构建以人群特征为水平1单位,常住区域为水平2单位的两水平logistic回归模型,分析影响结核病防治核心信息知晓情况的相关因素。结果:1403名常住居民结核病防治核心信息总知晓率为85.10%(5970/7015),5条核心信息单一知晓率及全部知晓率分别为76.76%(1077/1403)、90.38%(1268/1403)、92.16%(1293/1403)、87.53%(1228/1403)、78.69%(1104/1403)和57.80%(811/1403)。其中,75.41%(1058/1403)的居民接受过结核病健康教育,其结核病防治核心信息的总知晓率、单一信息知晓率及全部知晓率均明显高于未接受过健康教育者[92.02% 和 63.88%(χ²=810.22,P<0.001),91.02% 和33.04%(χ²=487.04,P<0.001),95.09% 和 75.94%(χ²=107.44,P<0.001),96.03% 和 80.29%(χ²=87.04,P<0.001),92.06% 和 73.62%(χ²=79.33,P<0.001),85.92% 和 56.52%(χ²=132.30,P<0.001),71.27% 和 16.52%(χ²=317.43,P<0.001)]。零模型检验提示常住区域水平存在聚集性,研究数据适用于建立两水平模型。两水平多因素logistic回归分析显示,女性结核病防治核心信息全部知晓率高于男性(OR=1.344,95%CI:1.045~1.732);中学及同等学历和大学大专及以上学历均高于小学及以下文化程度者(OR=2.106,95%CI:1.402~2.902;OR=1.434,95%CI:1.334~2.322)。户籍为非本县(区)、从事农业劳动及未接受过结核病健康教育者的全部知晓率分别低于户籍为本县(区)、机关/事业单位/企业从业者及接受过结核病健康教育者(OR=0.403,95%CI:0.237~0.683;OR=0.530,95%CI:0.334~0.839;OR=0.075,95%CI:0.054~0.103)。结论:两水平模型适用于评价广东省公众结核病防治核心信息知晓情况,公众对结核病防治知识知晓水平较高,但还应进一步提高对结核病传染性及可治愈性的认知。针对男性、小学及以下文化程度、户籍为非本县(区)、从事农业劳动及未接受过结核病健康教育的常住居民应强化精准性健康教育。同时,应进一步扩大健康教育和健康促进工作的覆盖面,尤其注意要在城市和农村地区均等化开展工作。

关键词: 结核, 健康教育, 健康促进, 广东省

Abstract:

Objective: This study aims to analyze the awareness of core information on tuberculosis (TB) prevention and control among the public in Guangdong Province and to identify its influencing factors, to enhance the scientific basis and effectiveness of health promotion and health education for TB prevention and control. Methods: A multistage stratified random sampling method was employed to select 1403 permanent residents of Guangdong Province as the survey subjects. Nationally standardized questionnaire was used to conduct face-to-face interviews. A two-level logistic regression model was constructed, with individual characteristics as Level 1 units and permanent residential area as Level 2 unit, to analyze the factors associated with the awareness of core information on TB prevention and control. Results: Among 1403 permanent residents, the overall awareness rate of core information on TB prevention and control was 85.10% (5970/7015). The awareness rates for the five individual core messages and the rate for full awareness of all five messages were 76.76% (1077/1403), 90.38% (1268/1403), 92.16% (1293/1403), 87.53% (1228/1403), 78.69% (1104/1403), and 57.80% (811/1403), respectively. 75.41% (1058/1403) of all the residents had received TB health education, who had significantly higher overall awareness rate, individual message awareness rates, and full awareness rate compared with those who had not received such education (92.02% vs. 63.88% (χ²=810.22, P<0.001), 91.02% vs. 33.04% (χ²=487.04, P<0.001),95.09% vs. 75.94% (χ²=107.44,P<0.001), 96.03% vs. 80.29% (χ²=87.04, P<0.001), 92.06% vs. 73.62% (χ²=79.33, P<0.001), 85.92% vs. 56.52% (χ²=132.30, P<0.001), 71.27% vs. 16.52% (χ²=317.43, P<0.001)). Two-level multivariable logistic regression analysis revealed that females had a higher rate of full awareness of TB prevention and control core information than males (OR=1.344, 95%CI: 1.045-1.732). Individuals with middle school education and those with college or higher education had higher full awareness rates than those with primary school education or below (OR=2.106, 95%CI: 1.402-2.902; OR=1.434, 95%CI: 1.334-2.322). Residents with non-local household registration, those engaged in agricultural labor, and those who had not received TB health education had lower full awareness rates compared to their respective counterparts (OR=0.403, 95%CI: 0.237-0.683; OR=0.530, 95%CI: 0.334-0.839; OR=0.075, 95%CI: 0.054-0.103). Conclusion: The two-level model is applicable for evaluating the awareness of TB prevention and control core information among the general public in Guangdong Province. The public in Guangdong Province has a relatively high level of the awareness of core information TB prevention and control. However, further efforts are needed to enhance the public’s understanding of the TB contagiousness and curability. Targeted health education with enhanced precision should be provided to permanent residents who are male, with primary school education or below, with non-local household registration, engaged in agricultural labor, and have not received TB health education. Additionally, the coverage of health education and health promotion activities should be further expanded, with particular attention to ensuring equitable implementation in both urban and rural areas.

Key words: Tuberculosis, Health education, Health promotion, Guangdong Province

中图分类号:

R52
R193

周芳静, 梁鸿迪, 李建伟, 陈瑜晖, 温文沛, 吴惠忠. 基于两水平模型评价广东省公众结核病防治核心信息知晓情况[J]. 中国防痨杂志, 2025, 47(7): 863-869. doi: 10.19982/j.issn.1000-6621.20250060

Zhou Fangjing, Liang Hongdi, Li Jianwei, Chen Yuhui, Wen Wenpei, Wu Huizhong. Assessment of the public awareness of core information on tuberculosis prevention and control in Guangdong Province based on a two-level model[J]. Chinese Journal of Antituberculosis, 2025, 47(7): 863-869. doi: 10.19982/j.issn.1000-6621.20250060

图/表 5

表1

表2

表3

零模型检验分析结果

参数	估计值	标准误	χ²值	P值
固定效应参数(β_n)	0.315	0.054	5.823	<0.001
随机效应参数(水平2单位 $σ u 0 2$ )	0.323	0.085	3.781	<0.001

表3

表4

表5

广东省公众结核病防治核心信息全部知晓情况的两水平多因素logistic回归模型分析

变量		β值		s $x ˉ$ 值		Wald χ²值	P值	OR(95%CI)值
水平1
年龄组(岁)
15~29		参考		-		5.672	0.129	1.000
30~44		-0.188		0.246		-0.764	0.445	0.829(0.508~1.334)
45~59		-0.115		0.256		-0.449	0.653	0.891(0.536~1.465)
≥60		-0.316		0.297		-1.065	0.287	0.729(0.405~1.300)
性别
男性		参考		-		-	-	1.000
女性		0.296		0.129		2.296	0.022	1.344(1.045~1.732)
民族
汉族		参考		-		-	-	1.000
少数民族		0.563		0.992		0.568	0.570	1.756(0.276~15.515)
户籍
本县(区)		参考		-		-	-	1.000
非本县(区)		-0.908		0.269		-3.375	0.001	0.403(0.237~0.683)
文化程度
小学及以下		参考		-		23.180	<0.001	1.000
中学及同等学历		0.701		0.185		3.781	<0.001	2.106(1.402~2.902)
大学大专及以上		0.644		0.230		2.797	0.005	1.434(1.334~2.322)
职业状况
机关/事业单位/企业	参考		-		18.599		0.002		1.000
商业/服务业	-0.142		0.202		-0.705		0.481		0.867(0.584~1.288)
农业劳动者	-0.635		0.235		-2.704		0.007		0.530(0.334~0.839)
在校学生	-0.237		0.379		-0.626		0.532		0.789(0.376~1.663)
离退休	0.240		0.300		0.801		0.423		1.271(0.709~2.300)
其他^a	-0.084		0.206		-0.406		0.685		0.920(0.614~1.377)
接受过结核病健康教育
是	参考		-		-		-		1.000
否	-2.589		0.165		-15.677		<0.001		0.075(0.054~0.103)
水平2
常住珠三角发达地区
是	参考		-		-		-		1.000
否	-0.163		0.111		-1.467		0.142		0.850(0.684~1.056)
常住地性质
城市	参考		-		-		-		1.000
农村	0.124		0.110		1.128		0.259		1.132(0.913~1.404)

表5

参考文献 20

[1]	胡鑫洋, 高静韬. 世界卫生组织《2024年全球结核病报告》解读. 结核与肺部疾病杂志, 2024, 5(6): 500-504. doi:10.19983/j.issn.2096-8493.2024164.
[2]	刘剑君, 赵雁林, 陈明亭, 等. 中国结核病防治工作技术指南. 北京: 人民卫生出版社, 2021.
[3]	Suárez I, Fünger SM, Kröger S, et al. The Diagnosis and Treatment of Tuberculosis. Dtsch Arztebl Int, 2019, 116(43): 729-735. doi:10.3238/arztebl.2019.0729. pmid: 31755407
[4]	国家疾病预防控制局, 国家卫生健康委员会, 国家发展和改革委员会, 等. 关于印发《全国结核病防治规划(2024—2030年)》的通知. 国疾控传防发〔2024〕19号. 2024-11-28.
[5]	蒋莉, 钟球, 李建伟, 等. 广东省公众结核病防治知识知晓情况调查. 中国防痨杂志, 2012, 34(12): 813-816. doi:10.19982/j.issn.1000-6621.2012.12.015.
[6]	Ni S, Wang J, Li X, et al. Assessment of health promotion action for tuberculosis of end tuberculosis action plan (2019—2022) in China. BMC Public Health, 2024, 24(1): 2051. doi:10.1186/s12889-024-19413-w.
[7]	广东省统计局, 广东省第七次全国人口普查领导小组办公室. 广东省第七次全国人口普查公报. 南方日报. 2021-05-15.
[8]	田本淳, 孟宪鹏, 吕书红, 等. 2006年全国公众结核病防治知识核心信息知晓情况调查. 中国健康教育, 2008, 24(6): 409-412. doi:10.3969/j.issn.1002-9982.2008.06.001.
[9]	周芳静, 吴惠忠, 李建伟, 等. 广东省2016—2020年肺结核流行特征分析. 中华流行病学杂志, 2022, 43(10): 1568-1574. doi:10.3760/cma.j.cn112338-20220121-00059.
[10]	Chen X, Wang W, Wang X, et al. Public Awareness of Tuberculosis in Southeast China: A Population-Based Study. Int J Environ Res Public Health, 2019, 16(21). doi:10.3390/ijerph16214290.
[11]	周芳静, 冯慧莹, 方兰君, 等. 2016—2020年广东省活动性肺结核患者发现延迟的变化趋势及影响因素分析. 中国防痨杂志, 2023, 45(1): 85-95. doi:10.19982/j.issn.1000-6621.20220389.
[12]	中共中央国务院. “健康中国2030”规划纲要. 2016-10-25.
[13]	中共中央国务院. 健康中国行动(2019—2030年). 2019-07-15.
[14]	Artawan Eka Putra IWG, Purnama Dewi NPE, Probandari AN, et al. The Implementation of Comprehensive Health Education to Improve Household Contacts’ Participation in Early Detection of Tuberculosis. Health Educ Behav, 2023, 50(1): 136-143. doi:10.1177/10901981211001829.
[15]	杨蕊, 苏智阳, 刘宜平,等. 2020年云南省结核病防治核心信息知晓情况及影响因素分析. 中国防痨杂志, 2023, 45(11): 1045-1051. doi:10.19982/j.issn.1000-6621.20230209.
[16]	夏雨荷, 张梦娴, 张玉, 等. 2022年湖北省公众结核病防治核心信息知晓率调查分析. 疾病监测, 2023, 38(11): 1324-1329. doi:10.3784/jbjc.202307050323.
[17]	邢健男, 钱莎莎, 王璐. 多水平模型在流行病学研究中的应用进展. 中华流行病学杂志, 2013, 34(1): 98-100. doi:10.3760/cma.j.issn.0254-6450.2013.01.022.
[18]	许琰, 赵瑶, 陈曦, 等. 北京市公众结核病防治知识知晓情况网络调查分析. 首都公共卫生, 2022, 16(2): 101-104. doi:10.16760/j.cnki.sdggws.2022.02.001.
[19]	Zhang R LiY, Yu H, et al. An analysis of public awareness of core information on tuberculosis in Guizhou Province. Ann Palliat Med, 2021, 10(1): 333-339. doi:10.21037/apm-20-2473. pmid: 33545768
[20]	丁松宁, 李晨, 杨晨, 等. 南京市居民结核病防治核心信息知晓率及其影响因素分析. 中国健康教育, 2020, 36(12): 1114-1117. doi:10.16168/j.cnki.issn.1002-9982.2020.12.012.

变量类别	变量名称	赋值规则
因变量	全部知晓	二分类:0=否,1=是
水平1自变量	年龄组(岁)	多分类:1=15~29,2=30~44,3=45~59,4=≥60
	性别	二分类:0=男,1=女
	民族	二分类:0=汉族,1=其他少数民族
	文化程度	多分类:1=小学及以下,2=中学及同等学历,3=大学大专及以上
	户籍所在地	二分类:0=本县(区),1=非本县(区)
	职业	多分类:1=机关/事业单位/企业,2=商业/服务业,3=农业劳动者,4=在校学生,5=离退休,6=其他
	接受过结核病健康教育	二分类:0=是,1=否
水平2自变量	常住珠三角发达地区	二分类:0=是,1=否
	常住地性质	二分类:0=城市,1=农村