农村地区孕产期保健健康教育技能培训社区干预效果的流行病学和社会学评价

Epidemiology and Sociology Evaluation on Health Education Intervention Effect of Skill Training for Alternative Maternal Health Care in Rural Communities

目的:评价在农村地区对不同孕产期保健服务提供者进行健康教育技能培训社区干预的效果。方法:采用群组随机对照的方法,在项目县分别对乡镇卫生院妇幼保健医生(干预1组)和村级计划生育服务专干(干预2组)进行孕产期保健健康教育技能培训,并设立对照组。干预前收集三组基线资料,干预后采取定量调查和定性研究相结合的方式,分别对干预效果进行流行病学评价和社会学评价。结果:干预后流行病学资料显示,干预1组电话访视率最高(χ2值=12.470,P值=0.002),新生儿产后半小时内、产后24小时内开奶的比例最高(χ2值=13.619,P值=0.034);干预2组早孕检查率、系统产检率的平均增长速度最快,自报婴儿近两周健康状况最好(χ2值=9.120,P值=0.010)。定性资料显示,干预期间当地实施了相关政策和项目促进孕产期保健服务质量的提高。大多利益相关者均表示该健康教育项目推动了孕产期保健服务能力的发展。培训后,乡镇妇幼卫生工作者健康教育主动性增强,村计生专干具备提供基本孕产期期保健知识的能力,服务技能及沟通能力得到改善。产妇非常乐于接受村计生专干灵活的健康教育方式。结论:幼保健部门计划生育系统共同参与是做好农村育龄妇女健康教育的重要方式。卫生项目的评价过程复杂,受外部因素影响较大,应加强过程评价,并将项目的可接受性措施运用于日常母婴保健工作。

Objective：To evaluate the effect of skill training for alternative maternal health care in rural communities.Methods： Group one of township maternal health professionals and group two of village family planning administrators were trained in alternative maternal health care skills and studied with cluster randomized trial.Baseline information of each group was collected before being intervened.And after being intervened,the effect was evaluated quantitatively and qualitatively.Results：Data showed that rate of postnatal telephone visit in group one was the highest,and the ratio of newborns being breastfed within half an hour to 24 hours after delivery was the highest.In group two,there had the quickest average speed of growth of the rate of early and systematic prenatal checkup,with the best status of self-reporting healthy infants in recent two weeks.Qualitative research showed that some related policies and projects initiated by local government had improved maternal health care services.Most stakeholders believed that this project had promoted the development of maternal health care services.Village maternal health professionals had obtained basic knowledge of maternal health care services and improved their communication skills.Their active and flexible methods of health education were acceptable.Conclusion：It is suggested that both maternal health department and family planning system should be involved in health education to rural reproductive women.The process of program evaluation is complex and affected by some outer factors,which needs to be intensified.