健康指导员干预对农村居民慢性病相关知识、态度、行为的影响

Impact of health educators＇ intervention on non-communicable diseases-related knowledge, attitude and behavior among rural residents

目的评估健康指导员干预对居民知识、态度与行为的影响及干预的可行性。方法于2013年2至11月，采用分层整群随机抽样方法，在重庆市永川区抽取3个乡镇，每个乡镇抽取5个行政村，依据自愿报名或推选的原则，在每个行政村招募1-2名健康指导员，共计招募30名并对其进行统一培训，培训合格后对其所在村的居民进行慢性病防治知识、技能的指导干预。每名健康指导员至少干预30名其居住村的年龄≥18岁，生活能自理，能独立完成现场调查的居民，干预前后分别纳入900名居民并对其进行问卷调查。采用χ2检验分析干预前后慢性病防治知识、行为变化情况的差异；采用两独立样本t检验分析干预前后慢性病防控相关态度变化情况的差异。结果干预前后对成年人高血压判断标准的知晓率分别是29．8％（268／900）和67．9％（611／900）（χ2=261．58，P〈0．001）；高血压影响因素的知晓率分别为22．9％（206／900）和78．2％（704／900）（χ2=551．19，P〈0．001）；高血压预防措施的知晓率分别为37．2％（335／900）与88．0％（792／900）（χ2=495．64，P〈0．001）；高血压并发症的知晓率分别为15．4％（139／900）与68．9％（620／900）（x。=527．07，P〈0．001）；糖尿病诊断标准的知晓率分别为12．9％（116／900）与50．3％（453／900）（）（。=291．85，P〈0．001）；糖尿病高危人群标准的知晓率分别为8．6％（77／900）与62．0％（558／900）（x。=562．94，P〈0．001）；糖尿病症状的知晓率分别为29．8％（268／900）与83．3％（750／900）（x。=525．31，P〈0．001）；糖尿病防治措施的知晓率分别为44．7％（402／900）与89．3％（804／900）（χ2=406．06，P〈0．001）；每人每天盐摄人量不超过6g的知晓率分别为28．0％（252／900）与84．3％（759／900）（X。=580．04，P〈0．001）；每人每天食用油摄人量不超过25g的知晓率分别为26．7％（240／900）与71．4％（643／900）（χ2=361．04，P〈0．001）；自我体重的知晓率分别为62．9％（566／900）与91．9％（827／900）（χ2=216．28，P〈0．001）；自我腰围的知晓率分别为54．8％（493／900）与87．7％（789／900）（x。=237．49，P〈0．001）；自我血压的知晓率分别为60．5％（544／900）与70．4％（634／900）（χ2=14．92，P〈0．001）。干预前后居民对大众开展慢性病知识教育必要性的得分分别是（3．1±0．9）、（3．7±0．5）分（t=20．09，P〈0．001）；改善个人不良生活方式必要性的得分分别为（3．0±0．9）、（3．7±0．6）分（t=20．84，P〈0．001）；定期检查血压、血糖必要性的得分分别是（3．O±0．9）、（3．7±0．6）分（t=21．07，P〈0．001）；控制自身体重必要性的得分分别是（2．9±1．0）、（3．6±0．8）分（f=20．04，P〈0．001）；开展高危人群高血压筛查必要性的得分分别是（3．0±0．9）、（3．7±0．5）分（t=22．99，P〈0．001）；开展高危人群糖尿病筛查必要性的得分分别是（3．0±0．9）、（3．7±0．5）分（t=23．22，P〈0．001）；为慢病高危人群提供膳食与运动指导必要性的得分干预前均是（3．0±0．9）分，干预后均是（3．7±0．5）分（t值分别是22．41与22．87，P值均〈0．001）。干预前后居民主动咨询医务人员慢性病防控知识的比例分别为44．0％（396／900）和64．9％（584／900）（χ2=79．17，P〈0．001）；最近6个月内测量过血压的比例分别为43．4％（391／900）和63．1％（568／900）（χ2=69．92，P〈0．001）；最近6个月测量过血糖的比例分别是28．6％（257／900）和48．1％（433／900）（χ2=72．80，P〈0．001）；曾有意识控制过体重的比例分别是34．7％（312／900）和29．3％（264／900）（χ2=5．88，P〈0．05）。结论健康指导员干预可以有效提高农村居民慢性病防控相关知识的认识水平与信心，但在短期干预后对健康相关的行为影响较小。

Objective To evaluate the impact of health educators＇ intervention on knowledge, attitude and behavior among rural residents and the feasibility of this intervention mode. Methods Using stratified cluster random sampling method, three towns and five villages in Yongehuan district, Chongqing municipality were selected from February to November, 2013. One or two health educators from each village were recruited by recommendation or voluntary registration. A total of 30 health educators were recruited and trained. Health educators who passed the exam of the training conducted the intervention and training of knowledge and skill about non-communicable disease （NCD） prevention and control for over 30 rural residents who lived nearby aged over 18 years old, could take care of themselves and complete questionnaire independently. 900 residents were selected as the study samples before and after the intervention. Questionnaire surveys were conducted before and after the intervention to evaluate the effect. Changes of knowledge and behavior among participants were compared by Chi-square test. Changes of attitude towards NCD prevention and control among participants were compared by two independent t-test. Results Before and after the intervention, the cognition rate about diagnostic criteria of hypertension among rural adults was 29.8% （268/900） and 67.9% （611/900）, respectively（χ2=261.58, P〈0.001）. The cognition rate about risk factors of hypertension was 22.9% （206/900） and 78.2% （704/900）, respectively（χ2=551.19, P〈0.001）. The cognition rate about the prevention measure of hypertension was 37.2% （335/900） and 88.0% （792/900）, respectively（χ2=495.64, P〈0.001）. The cognition rate about complications of hypertension was 15.4% （139/900） and 68.9% （620/900）, respectively（χ2=527.07, P〈0.001）. The cognition rate about diagnostic criteria of diabetes was 12.9% （116/900） and 50.3% （453/900）, respectively（χ2=291.85, P〈0.001）. The cognition rate about the criteria of risk population of diabetes was 8.6% （77/900） and 62.0% （558/900）, respeetively（χ2=562.94, P〈0.001）. The cognition rate about the symptom of diabetes was 29.8% （268/900） and 83.3% （750/900）, respectively（χ2=525.31, P〈0.001）. The cognition about the preventive measure of diabetes was 44.7%（402/900） and 89.3% （804/900）, respectively（χ2=406.06, P〈0.001）. The cognition rate about 6 g salt intake per person per day among rural adults was 28.0% （252/900） and 84.3% （759/900）, respeetively（xZ=580.04, P〈0.001）. The cognition about 25 g oil intake per person per day among rural aduhs was 26.7% （240/900） and 71.4% （643/900）, respectively（χ2=361.04, P〈0.001）. The cognition about self-perception of body weight among rural adults was 62.9% （566/900） and 91.9% （827/900）, respectively （XZ=216.28, P〈0.001）. The cognition about self-circumference among rural adult was 54.8%（493/900） and 87.7% （789/900）, respectively（χ2=237.49, P〈0.001）. The cognition rate of self-blood pressure was 60.5% （544/900） and 70.4% （634/900）, respectively（χ2=14.92, P〈0.001）. Before and after the intervention, the scores of the necessity about conducting health education for the public among rural adults was （3.1 ±0.9 ） and （3.7±0.5）, respectively（t=20.09, P〈0.001）. The score of the necessity about unhealthy lifestyle change among rural adults was （3.0±0.9） and （3.7±0.6）, respectively（t=20.84, P〈0.001）. The score of the necessity about testing blood pressure and blood glucose regularly among rural adults was （3.0±0.9） and （3.7±0.6）, respectively（t=21.07, P〈0.001）. The score of the necessity about body weight control was （2.9± 1.0） and （3.6± 0.8）, respectively（t=20.04, P〈0.001）. The score of the necessity about conducting hypertension screen among high risk population was （3.0±0.9） and （3.7-±0.5）, respectively（t=22.99, P〈0.001）. The score of the necessity about conducting diabetes screen among high risk population was （3.0 ± 0.9） and （3.7-± 0.5）, respectively（t=23.22, P〈0.001）. The score of the necessity about providing instruction service of diet and physical activity for high risk population was （3.0±0.9） and （3.7±0.5）, respectively（t=22.41 and 22.87, P〈 0.001）. Before and after the intervention, the proportion of rural adults seeking counseling service about NCD was 44.0%（396/900） and 64.9% （584/900）, respectively（χ2=79.17, P〈0.001）. The proportion of rural adults testing blood pressure in the recent six months was 43.4% （391/900） and 63.1% （568/900）, respectively（χ2=69.92, P〈0.001）. The proportion of rural adults who tested blood glucose in the recent six months was 28.6%（257/900） and 48.1% （433/900）, respeetively（χ2=72.80,P〈0.001）. The proportion of rural adults who controlled body weight consciously was 34.7%（312/900） and 29.3% （264/900）, respectively（χ2= 5.88,P〈0.05）. Conclusion Health educators＇ intervention could raise rural participants＇ awareness and confidence about NCD significantly, but this intervention mode might have little impact on healthy behaviors change in a short time.