东乡族自治县农村居民传染病健康素养调查

Investigation of infectious disease-specific health literacy among rural residents in Dongxiang Autonomous County

目的分析甘肃省临夏州东乡族自治县(东乡县)农村居民传染病健康素养的影响因素,并构建列线图模型预测居民传染病健康素养具备情况。方法采用分层随机抽样方法抽取东乡县≥15岁农村居民1250人,采用《中国居民传染病健康素养测评量表》进行调查;建立多因素logistic回归模型分析传染病健康素养的影响因素,并在此基础上构建列线图模型,采用受试者操作特征曲线、Hosmer-Lemeshow检验和C-index评价模型效率。结果有效调查1223人,其中男性687人,占56.17%;女性536人,占43.83%。东乡县农村居民传染病健康素养具备率为48.48%。多因素logistic回归分析结果显示,年龄(≥60岁为参照,30~<40岁,OR=4.273,95%CI:2.397~7.617;40~<50岁,OR=3.938,95%CI:2.238~6.928)、文化程度(不识字或少识字为参照,小学,OR=2.140,95%CI:1.456~3.144;高中/高职/中专,OR=2.914,95%CI:1.652~5.138;大专及以上,OR=4.514,95%CI:2.261~9.011)、近2周就诊/服药(是为参照,否,OR=2.025,95%CI:1.346~3.046)、自评健康状况(好为参照,一般,OR=0.603,95%CI:0.376~0.966;不好,OR=0.462,95%CI:0.284~0.751)和日均上网时长(不上网为参照,<1 h,OR=1.859,95%CI:1.306~3.437;1~<2 h,OR=1.996,95%CI:1.344~3.380;2~<3 h,OR=2.132,95%CI:1.109~3.116;≥3 h,OR=2.119,95%CI:1.175~3.390)是东乡县农村居民传染病健康素养的影响因素。列线图模型的曲线下面积为0.774(95%CI:0.741~0.807);Hosmer-Lemeshow检验χ2=13.276,P=0.103;Bootstrap内部验证平均绝对误差为0.019,C-index为0.764,提示模型有较好的校准度和区分度。结论年龄、文化程度、近2周就诊/服药、自评健康状况和日均上网时长是东乡县农村居民传染病健康素养的影响因素;在此基础上构建的列线图模型对该地居民传染病健康素养具备情况有较好的预测效率和适用性。

Objective To investigate the influencing factors of infectious disease-specific health literacy(IDSHL)among rural residents in Dongxiang Autonomous County,and to construct a nomogram-based model for prediction of IDSHL.Methods Totally 1250 rural residents at ages of 15 years and older were sampled from Dongxiang Autonomous County using a stratified random sampling method.Participants’IDSHL was evaluated using the IDSHL Assessment Scale among Chinese Residents,and factors affecting the participants’IDSHL were identified using a multivariable logistic regression model.A nomogram-based model was created,and the predictive effectiveness of this model was evaluated using the receiver operating characteristic(ROC)curve,Hosmer-Lemeshow test and C-index.Results A total of 1223 valid respondents were enrolled,including 687 men(56.17%)and 536 women(43.83%),and the proportion of IDSHL was 48.48%.Multivariable logistic regression analysis identified age(reference:60 years and older;30 to<40 years:OR=4.273,95%CI:2.397-7.617;40 to<50 years:OR=3.938,95%CI:2.238-6.928),education level(reference:illiteracy/semi-illiteracy;primary school:OR=2.140,95%CI:1.456-3.144;high school/vocational high school/technical secondary school:OR=2.914,95%CI:1.652-5.138;junior college and above:OR=4.514,95%CI:2.261-9.011),healthcare seeking/medications in the past 2 weeks(reference:yes;no:OR=2.025,95%CI:1.346-3.046),self-rated health(reference:good;generally:OR=0.603,95%CI:0.376-0.966;poor:OR=0.462,95%CI:0.284-0.751)and daily average duration spent online(reference:no internet access;<1 h:OR=1.859,95%CI:1.306-3.437;1 to<2 h,OR=1.996,95%CI:1.344-3.380;2 to<3 h:OR=2.132,95%CI:1.109-3.116;3 h and longer:OR=2.119,95%CI:1.175-3.390)as factors affecting IDSHL among rural residents in Dongxiang Autonomous County.The area under the ROC curve of the model was 0.774(95%CI:0.741-0.807)and the model had high calibration and differentiation levels[Hosmer-Lemeshow test:χ~2=13.276,P=0.103;internal model validation(bootstrapping):mean absolute error=0.019;C-index=0.764].Conclusions Age,education level,healthcare seeking/medications in the past 2 weeks,self-rated health status and daily average duration spent online are factors affecting IDSHL among rural residents in Dongxiang Autonomous County.The nomogram model created based on these factors has a high efficiency and applicability for prediction of IDSHL among rural residents in Dongxiang Autonomous County.