农村结直肠癌筛查组织动员模式探讨

Model of Mobilization of Colorectal Cancer Screening in Rural Area

目的探索与农村人群特点相适应的结直肠癌筛查组织动员模式,以提高村民结直肠癌筛查参与率。方法采用社区参与式研究方法 (CBPR),以知信行理论(KAP理论)和社区参与理论为指导设计出基于CBPR的农村结直肠癌筛查组织动员模式,主要包括组建社区筛查小组、基线调查了解需求、社区领袖树立筛查模范、社区领袖协助宣传教育、社区领袖带领社区医务人员入户进行个性化劝导等干预措施。采用社区干预试验来评价基于CBPR的农村结直肠癌筛查组织动员模式效果。2014年3—8月,采用目的抽样法从北京市房山区韩村河镇的27个行政村中选取五侯村、孤山口村作为社区干预试验现场,分为干预组(五侯村)和对照组(孤山口村)。干预组采用基于CBPR的农村结直肠癌筛查组织动员模式,对照组采用一般性组织动员模式。从社区干预试验现场选取有当地户籍的符合纳入标准的村民为筛查对象,对其进行免费结直肠癌筛查。记录两组初筛参与率、便隐血试验(FOBT)第1次完成率、FOBT第2次完成率、初筛完成率。结果干预组911例,对照组936例。干预组和对照组初筛参与率分别为35.6%(324/911)、11.6%(109/936),其中FOBT第1次完成率分别为85.5%(277/324)、87.2%(95/109),FOBT第2次完成率分别为71.3%(231/324)、55.0%(60/109),初筛完成率分别为71.3%(231/324)、55.0%(60/109)。多因素Logistic回归分析结果显示,控制性别、年龄因素后,干预组初筛参与率、FOBT第2次完成率、初筛完成率高于对照组(P<0.05),干预组与对照组FOBT第1次完成率间差异无统计学意义(P>0.05)。结论本研究组设计的基于CBPR的农村结直肠癌筛查组织动员模式有效提高了农村居民结直肠癌筛查的参与率,而且简单方便,适宜于农村结直肠癌筛查的组织动员工作。

Objective To explore the model of mobilization of colorectal cancer（CRC）screening that is suitable for the characteristics of rural populations,and to improve the participation rate of CRC screening of the villagers. Methods By community - based participatory research（CBPR）method,the mobilization model of CRC screening in rural area on the basis of CBPR method was designed under the guidance of knowledge,attitude and practice（KAP）theory,and the theory of community involvement. The model mainly included intervening measures such as establishing the community screening team,identifying the demands by baseline survey,establishing screening models by community leaders,community leaders assisting in promoting education,and community leaders guiding medical staff in offering personalized persuasion for the villagers door to door. Community intervention test was used to evaluate the effectiveness of the model of mobilization of CRC screening. From March to August 2014,two villages（Wuhou Village and Gushankou Village）were selected from 27 administrative villages in Hancunhe Town of Fangshan District in Beijing as research sites by purposive sampling method,and were divided into intervention group （Wuhou Village）and control group（Gushankou Village）. The intervention group adopted the model of mobilization based - on CBPR method while the control group used the routine mobilization method. Free CRC screening was carried out by selecting the eligible villagers who had local household registration from the study site as the screening subjects. Researchers recorded the preliminary participation rates,the completion rates of the first round of FOBT and the second round of FOBT,and the screening completion rate of the two groups. Results There were 911 cases in the intervention group and 936 cases in the control group. The participation rates of preliminary CRC screening for villagers in the intervention group and control group were 35. 6% （324 / 911） and 11. 6% （109 / 936）respectively,the completion rates of the first round of FOBT of the two groups were 85. 5% （277 / 324） and 87. 2% （95 / 109）respectively,the completion rates of the second round of FOBT of the two groups were 71. 3% （231/ 324）and 55. 0% （60 / 109）respectively,the completion rates of preliminary screening of the two groups were 71. 3% （231/ 324）and 55. 0% （ 60 / 109 ） respectively. Multivariate Logistic regression analysis showed that the participation rate of preliminary screening,the completion rate of the second round of FOBT and the completion rate of preliminary screening in intervention group after controlling gender and age were higher than those in control group（P ﹤ 0. 05）,while the completion rate of first round of FOBT was not significantly different between the two groups（P ﹥ 0. 05）. Conclusion The mobilization model of CRC screening in rural area on the basis of CBPR has effectively improved the participation rate of CRC screening,Being simple and convenient,the model is appropriate for mobilization of CRC screening in rural area.