主动健康视角下上海市55岁以上人群轻度认知障碍疾病认知及就诊意愿研究

Analysis on the Perceptions Toward Mild Cognitive Impairment and Medical Willingness among Population Aged over 55 Years in Shanghai Based on a Proactive Health Perspective

背景主动健康是实施健康中国战略的重要措施。轻度认知障碍(MCI)是认知障碍疾病早期发现和干预的重要切入点,是实现脑健康的关键环节。目的了解上海市55岁以上社区人群对MCI的认知情况、就诊意愿及影响因素,调动人群对MCI的主动健康干预,全面实现健康中国建设。方法2021年10—12月,随机抽取上海市城区、郊区各一区(城区为杨浦区、郊区为嘉定区),每区随机抽取1~2家社区卫生服务中心(杨浦区为大桥社区卫生服务中心、定海社区卫生服务中心,嘉定区为嘉定镇街道社区卫生服务中心),按纳入标准对社区卫生服务中心门诊候诊居民进行现场面对面问卷调查。MCI疾病认知度调查问卷内容包括:(1)一般人口学特征;(2)社区人群MCI疾病认知水平;(3)社区人群疾病就诊意愿。采用Logistic回归分析探讨社区人群MCI就诊意愿的影响因素。结果本调查共发放问卷970份,回收有效问卷951份,有效回收率98.04%。(1)55岁以上社区人群对MCI的认知问卷得分为(14.55±5.24)分。51.3%(488/951)的社区人群知晓“轻度认知障碍”的概念,获知途径以媒体途径为主[61.7%,301/488];59.9%(570/951)的人群认为“年纪大了都会出现轻度认知障碍”;14.1%(134/951)的人群参加过相关筛查活动;6.2%(59/951)的人群曾因记忆障碍或怀疑有认知障碍而就诊。(2)对社区人群的MCI就诊意愿进行单因素及多因素分析发现,认知障碍家族史、对MCI的认识与理解及个人相关经历是社区人群MCI就诊意愿的影响因素(P<0.05)。结论55岁以上社区人群MCI疾病认知水平较差,疾病就诊意愿不强烈。MCI相关知识知晓不佳、对MCI的理解存在偏差及相关实践经历缺乏的人群就诊意愿差。建议多角度宣传,提高社区人群MCI疾病认知度;提供全方位支持,提高主动健康可及性,探索促进主动健康的有效途径。

Background Proactive health is an important measure to implement the Healthy China strategy.Mild cognitive impairment(MCI)is an important breakthrough point for early detection and intervention of cognitive impairment disorders and it is also a key link in the realization of brain health.Objective To activate the initial health intervention among community population and fully realize the construction of a healthy China by understanding the perceptions and medical willingness among community populations aged over 55 years in Shanghai.Methods From October to December 2021,one district of Shanghai's urban and suburban areas was randomly selected(Yangpu District for the urban area and Jiading District for the suburban area),and 1-2 community health service centers were randomly selected from each district(Daqiao Community Health Service Center and Dinghai Community Health Service Center for Yangpu District,and Jiading Town Community Health Service Center for Jiading District).An on-site face-to-face questionnaire survey was conducted among the residents waiting for outpatient consultation at the community health service centers in accordance with the inclusion criteria.The content of community populations'perceptions questionnaire included:(1)general demographic characteristics;(2)the level of MCI disease awareness among the community population;(3)the medical willingness of the community population.Logistic regression analysis was used to explore the factors influencing the medical willingness of the community population.Results A total of 970 questionnaires were distributed and 951 valid questionnaires were recovered,with a valid recovery rate of 98.04%.(1)The total score of the community populations'perceptions questionnaire for MCI was(14.55±5.24),51.3%(488/951)of the community populations were aware of"mild cognitive impairment",mainly through the media(61.7%,301/488);59.9%(570/951)of the populations believede that"mild cognitive impairment occurs in old age";14.1%(134/951)of the population had participated in relevant screening activities;6.2%(59/951)had consulted a doctor for memory impairment or suspected cognitive impairment.(2)Univariate and multivariate analysis showed that family history of cognitive impairment,knowledge and understanding of MCI as well as personal experience were all influencing factors of community populations'medical willingness for MCI.Conclusion Community population aged over 55 years have poor MCI disease perceptions and poor medical willingness.The community populations with poor knowledge,biased understanding of MCI and lack of relevant practical experience had poor medical willingness.It is suggested that multi-angle publicity should be carried out to improve the perceptions of MCI disease in the community and provide comprehensive support,to improve the accessibility of proactive health,and explore effective ways to promote proactive health.