基于PRECEDE模式的居民减盐行为影响因素的混合方法研究

Influencing Factors of Salt-reduction Behavior among Residents:a Mixed Methods Research Based on the PRECEDE Model

背景中国居民高血压患病率高而控制率低,大量流行病学研究表明减少膳食盐的摄入有助于降低血压水平,因此探索居民减盐行为的影响因素对于居民自身的健康管理及减轻社会负担意义重大。目的基于PRECEDE模式,探索山东居民减盐行为的倾向因素、强化因素和促成因素,为后续减盐工作提供科学建议。方法运用混合研究方法,采用目的抽样法,先后于2016年和2018年采访居民共计114名,访谈提纲主要包含对控盐的态度、在控盐过程中遇到的困难以及获得的帮助等。定量数据来源于2016年山东省减盐防控高血压项目终末调查鲁东、鲁中南地区的问卷数据,从数据库中选取与高血压相关调查内容,共纳入研究样本6697份。结果多分类Logistic回归结果显示,在控制其他变量影响下,性别、职业、文化程度对减盐行为依从性有影响(P<0.05)。在控制个人一般情况的影响下,个人口味、减盐知识及对低盐饮食的态度对减盐行为依从性有影响(P<0.05)。医生的干预能强化居民减盐行为。通过医务人员的健康教育,不仅能增强高血压患者的减盐行为与意识,还能加强家人的督促,提升家人的减盐行为与意识,进而达到促进居民减盐的目的。家人在日常生活中的督促能强化居民控盐行为。山东省减盐行动制定了项目推进政策、餐饮业政策、食品业政策以及减盐健康教育政策,打造了浓厚的减盐大环境。低盐产品中对居民影响较大的是限盐勺,低盐食品及低钠盐的可及性相对较低影响了其控盐作用。大众媒体宣传是居民获得减盐信息的主要途径,目前作用较为明显的大众传播方式包括电视和在公共场所的宣传。结论对低盐饮食的态度及知识水平因素是影响居民减盐行为的倾向因素;医生的劝诫和家人的提醒能帮助居民开始减盐,也能强化居民减盐行为,属于强化因素;减盐相关政策、大众传播为居民减盐创造了社会氛围,减盐相关产品则提供了现实条件,属于促成因素。

Background The prevalence of hypertension among Chinese residents is high while the control rate is low.It has been suggested by numerous epidemiologic studies that reducing salt intake could reduce blood pressure level.Therefore,it is significant for health management of residents and reducing social burden to explore determinants of salt-reduction behavior among residents.Objective To explore the predisposing,reinforcing and enabling factors of salt-reduction behavior among Shandong residents based on the PRECEDE model,and provide scientific suggestions for the subsequent salt-reduction campaign.Methods This study was a mixed methods research.A total of 114 residents were interviewed in 2016 and 2018 by using purposive sampling method.The interview guide mainly contained attitudes to salt control,difficulties encountered and assistance received during salt control.The quantitative data were obtained from the database of terminal survey of Shandong and Ministry of Health Action on Salt and Hypertension(SMASH),and the sample of eastern as well as central-southern Shandong from the database was selected into this research.The part related to hypertension among this survey was selected from the database,and a total of 6697 research objects were finally selected.Results The results of multinomial Logistic regression showed that gender,occupation and education level have an impact on the compliance of salt reduction behavior controlling for the effect of other variables(P<0.05).Personal taste,salt reduction knowledge and attitude towards low-salt diet have an impact on salt reduction behavior compliance while controlling for the effect of personal general conditions(P<0.05).Physician intervention could reinforce salt-reduction behavior in residents.The health education of medical personnel could not only enhance the salt-reduction behavior and awareness of hypertensive patients,but also strengthen the supervision of family members.Through enhancing family members'salt-reduction behavior and awareness,and finally promoting salt reduction among residents.Supervision by family members in daily life can strengthen salt-reduction behavior of the residents.SMASH had formulated policies involved in the project promoting,catering industry,food industry and health education about salt-reduction,which playing very important role in creating strong salt-reduction environment.The salt-restriction spoon was the most important low-salt product in affecting residents'salt-reduction behavior,while the impact of low-salt food and low-sodium salt in reducing salt intake was weakened because of the poor accessibility.Mass media promotion was the main way for residents to obtain information on salt reduction.Television and promotion in public places were the more visible forms of mass communication currently.Conclusion Attitude towards low-salt diet and knowledge are predisposing factors of residents'salt-reduction behavior.Exhortation of doctors and reminding from family members were reinforcing factors,which can help residents to start out reducing salt intake and also reinforcing salt-reduction behavior.The salt-reduction environment was created by policies regarding salt-reduction and mass communication,products regarding salt restriction were essential tools for reducing salt intake,which are enabling factors.