不同健康教育模式对上海市中心城区建筑工人艾滋病知信行干预效果评价

Effects of different health interventions on KAP among construction workers in three central districts of Shanghai

目的探索不同的艾滋病健康教育干预模式的干预效果,为制定针对建筑工人的艾滋病防治措施提供依据。方法随机抽取上海市3个区,并采用整群随机抽样,对18个建筑工地共1 873名建筑工人进行问卷调查,并根据干预模式将其随机分为低、中、高三个等级的组别,实施不同模式的健康干预,在干预前和干预后3个月随访,进行问卷调查。结果艾滋病传播知识方面,干预后的平均得分显著高于干预前的平均得分(t=32.7,P≤0.001)。干预前对艾滋病传播知识有一定了解的建筑工人,中度和高度干预组干预后的得分与干预前比较差异有统计学意义(2个干预等级P均≤0.001);干预前对艾滋病传播知识了解较少的建筑工人,干预后的得分与干预前比较差异有统计学意义(3个干预等级P均≤0.001)。对艾滋病态度方面,干预后各组同情艾滋病病人的建筑工人均有增加,害怕、厌恶艾滋病病人的建筑工人有所减少,持"同情","害怕"两个观点的建筑工人数量在干预后于各个干预等级间差异有统计学意义("同情"χ2=7.8,P≤0.05,"害怕"χ2=6.3,P≤0.05),高度干预组有更多的建筑工人对艾滋病病人持同情态度,更少持害怕态度。行为方面,建筑工人安全套使用无明显改变。结论采取多种方式的健康干预措施,可有效提高建筑工人艾滋病传播知识的知晓率,减低对艾滋病病人的歧视,但行为无法在短期内改变,应尝试多次实施健康干预措施,促使其知信行一致。

Objective To explore the application of different models of health education among construction workers,to investigate the effectiveness of the intervention and to provide evidence for the targeted health education policy.Methods Eighteen construction sites in three districts of Shanghai were involved in the study.A face-to-face questionnaire survey was administered among randomly selected 1 873 migrant workers in these sites.Each construction site was randomly assigned to receive one of three interventions（ranging from a single mode of delivery to a multiple model of delivery）.After 3 months of the intervention,a follow-up survey was conducted to measure the variation of knowledge,attitude and practice（KAP） status among the subjects.Results The variations of HIV transmission knowledge among all subjects showed statistical difference（t=32.7,P≤0.001）.Among the subjects,who had certain HIV transmission knowledge pre-intervention,the variations of knowledge score showed statistical difference at medium and high intervention level（P≤0.001）.Among those without pre-intervention,the variations of knowledge score showed statistical difference at three intervention levels（P≤0.001 for three rankings）.After intervention,the proportion of ＂fear＂,＂disgusting＂ towards HIV-infected people decreased,and the number of subjects holding＂sympathetic＂ and ＂fear＂ opinions after intervention,had statistical significance at different intervention levels（＂sympathetic＂χ2=7.8,P≤0.05,＂fear＂χ2=6.3,P≤0.05）,the subjects in high intervention group had more sympathy and less fear to HIV-infected people compared to other two intervention groups.Condom use among the subjects when having sex with non-marital sex partners showed no change before and after intervention.Conclusions It is feasible and effective to increase KAP and reduce stigma in construction workers by using multiple health education interventions.Behavior cannot change in a short period.Repeated intervention should be carried out to promote the coherence of HIV related KAP,and to protect the health of construction workers.