我国六省市流动人口结核病就诊意向分析

Analysis of the medical intention of TB and its influencing factors among floating population in six provinces in China

目的了解流动人口出现肺结核可疑症状时的就医意向，为流动人口结核病防治提供科学依据。方法于2015年59月，采用概率比例规模抽样（probabilityproportionate to size sampling，PPS）方法，从东、中、西部各抽取2个省，依据方便抽样方法，选择流动人口从业比例较高的生产企业工人、建筑工人和服务业从业者三类流动人口作为研究对象，基于健康信念模式设计问卷，对6省12个城市共计3300名流动人口进行问卷调查，收回有效问卷3294份，有效率为99．8％。分析不同特征流动人口在出现结核病可疑症状时的就诊意向，及不同就诊意向的流动人口健康信念模式各模块的得分情况。结果3294名流动人口在出现轻度和中度结核病可疑症状时有延迟就诊意向的分别占22．8％（751／3294）和14．9％（491／3294），建筑业流动人口在轻度症状或中度症状的延迟就诊意向比率均最高，分别为29．7％（341／1149）和22．2％（255／1149）；41～50岁年龄组延迟就诊意向比率均最高，分别为25．6％（212／829）和18．9％（157／829）；西部地区流动人口延迟就诊意向比率均最高，分别为32．7％（342／1046）和23．0％（241／1046）。未接受过结核病宣传教育的调查对象有延迟就诊意向的比率均高于接受过相关宣传教育的调查对象，前者出现轻度和中度结核病可疑症状时分别占26．2％（553／2111）和16．5％（348／2111），后者分别占16．7%（192／1153）和11．7％（135／1153）。健康信念模式各模块中，调查对象结核病知识平均分为（8．51±3．37）分，感知肺结核威胁平均分为（12．28±2．62）分，感知及时就诊益处平均分为（14．27±1．89）分，感知就诊障碍平均分为（13．03±1．12）分。提示因素平均分为（6．45±1．12）分。结论流动人口有延迟就医意向的比率较高，需要大力开展健康教育，西部地区及建筑工人应是其中重点，开展健康教育时应以健康信念模式为基础，将就诊益处及障碍纳入宣传内容。

Objective This study aims to demonstrate the treatment intention of the floating population in the presence of suspicious symptoms of tuberculosis, and to analyze the influencing factors of delayed treatment inten- tion, and to provide scientific basis for the prevention and control of TB in floating population. Methods During May to September in 2015, PPS sampling method was used to select 2 provinces respectively from eastern, central and western regions of China. In these provinces, based on convenience sampling method, a total of 3300 floating people from 3 main types of work place which contains factories, construction sites and service business in 12 cities were chosen to complete the survey, and 3294 valid questionnaires were collected （the effective rate was 99.8 %）. The questionnaire was designed based on the health belief model （HBM）. The medical intention of objectives with different characters were analyzed, and the scores of each HBM module of people with different treatment intentions were calculated and compared, too. Results The proportion of delayed treatment intention of people with mild and moderate tuberculosis symptoms was 22.8% （751/3294） and 14. 9% （491/3294）, respectively. In both mild or moderate symptom groups, the highest proportion of delay was in the construction industry, namely, 29.7% （341/1149） and 22.2%（255/1149） ; people aged 41-50, 25.6% （212/829） and 18. 9% （157/829） ; the western region, 32.7% （342/1046） and 23.0% （241/1046）. The delayed treatment rates in both mild and moderate TB symptoms groups were higher in those who did not receive the education for TB promotion, which was 26.2% （553/2111） and 16.5% （348/2111）, respectively, while in those who once received, the proportions were 16.7% （192/1153） and 11.7% （135/1153） respectively. The average score of knowledge was （8.51±3.37）% perceived TB threat, （12.28±2.62）% perceived value of medical treatment, （14.27± 1.89）% perception of barriers, （13.03± 1.12）, prompt factor, （6.45±1.12）. Conclusion The proportion of delayed treatment intention was high in floating population. It is necessary to enhance health education among the floating people, especially construction workers and people in the western region. The education should be designed based on the health belief model, include the benefits and barriers of timely medical treatment into the publicity.