中国儿童13价肺炎球菌结合疫苗接种行为阶段现状及影响因素分析

Current status of parental decision-making of childhood 13-valent pneumococcal conjugatevaccine immunization and related factors in China

目的探索中国儿童13价肺炎球菌结合疫苗(PCV13)接种行为阶段现状及影响因素。方法采用多阶段分层抽样, 对我国3个城市20~45岁家中育有≥1名≤5岁儿童家庭的监护人开展问卷调查。问卷题目基于健康信念模型设计。采用无序多分类logistic回归分析危机感、严重感和效果感与无意图阶段、意图阶段和行动阶段的关系。结果本研究获有效问卷1 716份, 有效率89.33%;样本年龄(35.33±4.95)岁;79.60%为女性;父母为儿童接种PCV13的决策处于行动阶段、意图阶段和无意图阶段分别占48.31%、21.79%和29.90%。无序多分类logistic回归分析显示, 与行动阶段相比, 高危机感(OR=0.14, 95%CI:0.09~0.22;OR=0.54, 95%CI:0.39~0.76)、高严重感(OR=0.55, 95%CI:0.42~0.73)和高效果感(OR=0.27, 95%CI:0.18~0.40;OR=0.51, 95%CI:0.32~0.81)与无意图阶段和意图阶段负相关。高效果感会降低低危机感家长处于意图阶段(OR=0.53, 95%CI:0.32~0.87)和处于无意图阶段(OR=0.27, 95%CI:0.18~0.41)的概率。高严重感会降低高危机感家长处于意图阶段的概率(OR=0.43, 95%CI:0.23~0.82)。结论我国儿童PCV13接种意愿与接种水平低, 更多政策和健康促进行动需重视家长对儿童PCV13接种的效果感、严重感和危机感等健康信念的干预, 提高儿童二类疫苗的实际接种率。

Objective To analyze the relationship between health belief and the stages of parental decision-making on childhood 13-valent pneumococcal conjugate vaccine(PCV13)immunization in China.Methods Cross-sectional multistage survey sampling method was used to select study subjects.The study subjects were parents who were aged 20-45 years and had one and more children≤5 years old in three cities in China.A self-administered questionnaire designed based on health belief model was used to collect the information.Multinomial logistic regression analysis was used to assess the relationships between perceived susceptibility,perceived severity of illness,perceived effect of PCV13 and stages of parental decision-making on childhood PCV13 immunization.Results A total of 1716 valid questionnaires were returned(89.33%).The average age of the study subjects was(35.33±4.95)years,and 79.60%of them were women.In the study subjects,48.31%had in action,21.79%were in contemplation and 29.90%were in pre-contemplation.The multinominal logistic regression analysis indicated that high perceived susceptibility(OR=0.14,95%CI:0.09-0.22;OR=0.54,95%CI:0.39-0.76),high perceived severity of illness(OR=0.55,95%CI:0.42-0.73),and high perceived effect of PCV13(OR=0.27,95%CI:0.18-0.40;OR=0.51,95%CI:0.32-0.81)were significantly lower in those who were in contemplation or pre-compared with those who had in action.For study subjects with low perceived susceptibility,high perceived effect of PCV13 might decrease the probabilities of contemplation(OR=0.53,95%CI:0.32-0.87)and pre-contemplation(OR=0.27,95%CI:0.18-0.41).For those with high perceived susceptibility,perceived severity of illness might decrease the probability of contemplation(OR=0.43,95%CI:0.23-0.82).Conclusions Childhood PCV13 vaccination willingness and level is low in China.It is important to pay greater attention to the intervention on health belief in child parents,such as perceived effect of PCV13,perceived severity of illness,and perceived susceptibility,in health policy development and health promotion.