上海市社区医生健康教育工作实施现状及培训需求研究

Implementing Situation and Training Needs of Health Education among Community Doctors in Shanghai

目的了解上海市社区医生健康教育工作的实施现状及健康教育培训需求,为今后社区健康教育工作的开展和社区医生健康教育能力的提高提出建议。方法采用分层随机抽样法,在上海市辖区按照地理位置(市区、近郊区、远郊区)进行分层,市区抽取徐汇、虹口、杨浦、闸北、普陀区,近郊区抽取闵行、宝山、浦东新区,远郊区抽取松江、金山区,共10个区;每个区随机抽取4~5家社区卫生服务中心,共抽取42家社区卫生服务中心;每家社区卫生服务中心随机抽取社区医生2~3例,共123例。参考相关文件,采用Delphi专家咨询法编制调查问卷。问卷主要内容包括:社区医生的基本情况、健康教育工作实施情况及健康教育培训的需求情况。于2015年5—8月,采用自填式问卷进行调查,共发放问卷123份,回收有效问卷123份,有效回收率为100.0%。结果健康教育工作量占总工作量的比重平均为(28.0±16.4)%,不同性别、年龄、学历、职称、工作年限、类别的社区医生健康教育工作量占总工作量的比重比较,差异均无统计学意义(P>0.05)。开展社区健康教育的主要形式为:发放宣传资料(91.1%,112/123)、面对面咨询(90.2%,111/123)、群体讲座(89.4%,110/123)。目前开展社区健康教育活动面临的主要问题为:医务人员缺乏时间和精力(79.7%,98/123)、居民配合不足(66.7%,82/123)、开展形式单一(59.3%,73/123)。123例社区医生中,79例(64.2%)曾经接受过健康教育方面的课程或技能培训;105例(85.4%)认为很有/有必要进行健康教育培训,不同性别、年龄、学历、职称、工作年限、类别的社区医生的健康教育培训需求比较,差异均无统计学意义(P>0.05)。对于健康教育培训内容,培训需求依次为:慢性病患者的行为干预(84.6%,104/123)、健康管理及监护(74.8%,92/123)、疾病危险因素预防(70.7%,87/123)。对于健康教育培训方式,需求依次为:授课与课堂练习相结合(51.2%,63/123)、授课与小组讨论相结合(45.5%,56/123)、交流考察(43.9%,54/123)。结论健康教育工作已成为上海市社区医生的重要工作内容之一,社区健康教育开展形式呈多样化。社区医生对于健康教育培训有较大需求,应开展针对性培训,以提高社区医生的健康教育能力。

Objective To investigate the implementing situation and training needs of health education in community in order to improve the quality of health education and the ability of carrying out health education training among community doctors. Methods Using stratified random sampling,The municipal districts in Shanghai were stratified by geographical location（ urban districts,inner suburban districts,outer suburban districts）. Xuhui District,Hongkou District,Yangpu District,Zhabei District and Putuo District from urban districts,Minhang District,Baoshan District and Pudong New Area from inner suburban districts, and Songjiang District and Jinshan District from outer suburban districts, a total of ten districts were selected. Four or five community health service centers were randomly selected from each district,and a total of 42 community health service centers were selected. Two or three community doctors were randomly selected from each community health service center,and therefore a total of 123 community doctors were selected. Based on the relevant documents,the questionnaire was compiled by Delphi expert consultation method and the main contents of the questionnaire were the basic information of community doctors,the implementing situation and training needs of health education. Questionnaires were sent from May to August in2015. A total of 123 questionnaires were collected and the effective recovery rate was 100. 0%. Results The average proportion of health education workload was（ 28. 0 ± 16. 4） % in the total workload of community doctors. There was no significant difference in the proportion of health education workload among community doctors with different gender,age,education level,professional title,work seniority,and doctor category（ P〈0. 05）. The main forms of health education in communities were dissemination of health education materials（ 91. 1%,112/123）, face-to-face consultation（ 90. 2%,111/123）, and group lectures（ 89. 4%,110/123）. At present,the main problems of health education in communities were lack of time and energy（ medical staff）（ 79. 7%,98/123）, lack of coordination（ residents）（ 66. 7%,82/123）, and single form of health education（ 59. 3%,73/123）. Of the 123 community doctors,79（ 64. 2%） had received curricula or skills training of health education and 105（ 85. 4%） considered it necessary to conduct health education training. There was no significant difference in training needs of health education among community doctors with different gender, age, education level, professional title, work seniority,and doctor category（ P〈0. 05）. The content needs of health education training were behavioral interventions for chronic diseases patients（ 84. 6%,104/123）,health management and care（ 74. 8%,92/123）,prevention of risk factors（ 70. 7%,87/123）. The method needs of health education training were combining teaching with classroom practice（ 51. 2%,63/123）,combining teaching with panel discussion（ 45. 5%,56/123）,and academic exchange and investigation（ 43. 9%,54/123）. Conclusion Health education has become part of the important work of community doctors in Shanghai and the forms of community health education are diversified. But community doctors still have a greater demand for health education training and targeted training should be carried out in order to improve community doctors＇ capacity of carrying out health education training.