“十三五”期间我国农村居民结核病健康教育状况及结核病防治核心信息影响因素分析

Analysis of the health education status of tuberculosis in rural residents and the influencing factors of the core information of tuberculosis prevention and control during the“13th Five-Year Plan”period

目的:分析“十三五”期间我国农村居民结核病健康教育状况及结核病防治核心信息影响因素,为针对性提升结核病防治健康教育工作提供科学依据。方法:采用现况调查方法,参照多阶段整群随机抽样方法,从“十三五”全国结核病防治规划终期评估专项调查数据库中抽取居住在全国31个省(市、自治区)和新疆生产建设兵团村级行政单位的26593名15岁及以上常住农村居民行结核病健康教育面对面调查,共获得有效问卷26250份,有效率为98.71%。调查问卷主要包括一般情况(性别、年龄、文化程度等)、结核病防治核心信息(Q_(1):肺结核是长期严重危害健康的慢性传染病;Q_(2):肺结核主要通过呼吸道传播,人人都有可能被感染;Q_(3):咳嗽、咳痰2周以上,应怀疑得了肺结核,要及时就诊;Q_(4):不随地吐痰,咳嗽、打喷嚏时掩口鼻,戴口罩可以减少肺结核的传播;Q_(5):规范全程治疗,绝大多数患者可以治愈,还可避免传染他人)、健康教育情况(包括接受健康教育途径、希望了解防治信息途径、常用的获取网络科普的途径、喜爱的宣传材料和网络科普材料类型)。采用单因素和多因素logistic回归模型对不同特征调查对象的健康教育情况和结核病防治核心信息知晓情况及其影响因素进行分析。结果:26250名常住农村居民对结核病防治核心信息总知晓率为81.77%(107323/131250),对Q_(1)~Q_(5)核心信息的知晓率分别为76.97%(20205/26250)、88.14%(23138/26250)、88.70%(23285/26250)、84.00%(22049/26250)和71.03%(18646/26250)。其中,接受过结核病健康教育的农村居民结核病防治核心信息总知晓率[85.20%(89062/104535)]及对Q_(1)~Q_(5)核心信息的知晓率[80.28%(16785/20907)、92.11%(19258/20907)、92.68%(19377/20907)、86.66%(18117/20907)、74.26%(15525/20907)]均明显高于未接受过结核病健康教育的农村居民[68.35%(18259/26715)、64.01%(3420/5343)、72.62%(3880/5343)、73.14%(3908/5343)、73.55%(3930/5343)、58.41%(3121/5343)],差异均有统计学意义(χ^(2)值分别为4051.600、635.000、1545.700、1619.600、542.160、518.430,P值均<0.001)。相较于15~29岁年龄组、小学及以下文化程度、机关/事业单位和未接受过结核病健康教育的农村居民,45~59岁年龄组、初中及同等学历、高中及同等学历、大专和本科及以上、从事商业/服务业和接受过结核病健康教育的农村居民的结核病防治核心信息知晓情况均更好(OR=1.156,95%CI:1.050~1.273;OR=1.667,95%CI:1.568~1.773;OR=1.882,95%CI:1.716~2.065;OR=1.974,95%CI:1.736~2.245;OR=1.693,95%CI:1.431~2.005;OR=1.242,95%CI:1.035~1.489;OR=2.655,95%CI:2.485~2.839)。农村居民接受结核病健康教育的前3位途径分别为电视/广播[52.02%(13656/26250)]、传单/折页/宣传画[31.49%(8265/26250)]和医生宣传[26.53%(6963/26250)];查询网络健康科普信息的主要途径为微信和微博等自媒体[36.58%(9602/26250)]及搜索引擎[25.28%(6636/26250)];希望获取结核病防治信息的主要途径有电视/广播[62.80%(16484/26250)]、医生宣传[45.95%(12062/26250)]和网络宣传[36.57%(9599/26250)];喜爱有声像[40.98%(10757/26250)]和图文并茂[36.90%(9685/26250)]的宣传材料,以及网络科普视频[60.28%(15824/26250)]和图文[46.82%(12290/26250)]的获取形式。结论:“十三五”规划后我国农村居民结核病防治健康教育状况较“十二五”有明显提升,但对结核病核心信息知晓率的提升仍有较大空间,可在加大网络媒体宣传力度、开发适宜于网络媒体传播的宣传材料的基础上,有针对性地对低文化程度和未接受过结核病健康教育的农村居民开展结核病防治宣传教育。

Objective:To assess the status of tuberculosis health education and the factors influencing the comprehension of core tuberculosis prevention and control information among rural residents in China during the‘13th Five-Year Plan’.The analysis aims to enhance tuberculosis health education based on scientific evidence.Methods:Using the prevalence survey method and referring to multi-stage cluster random sampling method,a total of 26593 permanent rural residents aged 15 and above living in village-level administrative units of 31 provinces(municipalities and autonomous regions)and Xinjiang Production and Construction Corps were selected from the special survey database for the final assessment of the National Tuberculosis Prevention and Control Plan in the‘13th Five-Year Plan’.We collected 26250 valid responses to questionnaires on tuberculosis health education,yielding an effective response rate of 98.71%.The questionnaire covered general demographic information(gender,age,education level),the core information of tuberculosis prevention and control(Q_(1):Tuberculosis is a chronic infectious disease that seriously endangers health for a long time;Q_(2):Tuberculosis is mainly transmitted through the respiratory tract,and everyone can be infected;Q_(3):Cough and sputum for more than 2 weeks should be suspected of tuberculosis,and seek medical treatment in time;Q_(4):Not spitting,covering mouth and nose when coughing or sneezing,and wearing a mask can reduce the spread of tuberculosis;Q_(5):Standardized full treatment can cure the vast majority of patients and avoid infecting others),and the current status of health education(methods of receiving health education,preferred methods learning about tuberculosis prevention and control information,methods of accessing online science popularization,preferred types of tuberculosis dissemination and online science popularization materials).Both univariate and multivariate logistic regression analyses were employed to assess the relationship between various demographic characteristics and the level of awareness and understanding of core tuberculosis prevention and control information.Results:The total awareness rate of 26250 rural residents on the core information of tuberculosis prevention and control was 81.77%(107323/131250).The awareness rates of Q_(1)to Q_(5)core information were 76.97%(20205/26250),88.14%(23138/26250),88.70%(23285/26250),84.00%(22049/26250)and 71.03%(18646/26250),respectively.Among them,the total awareness rate(85.20%(89062/104535))and the awareness rate of Q_(1)-Q_(5)core information(80.28%(16785/20907),92.11%(19258/20907),92.68%(19377/20907),86.66%(18117/20907),74.26%(15525/20907))of tuberculosis prevention and control core information of rural residents who had received tuberculosis health education were significantly higher than those of rural residents who had not received tuberculosis health education(68.35%(18259/26715),64.01%(3420/5343),72.62%(3880/5343),73.14%(3908/5343),73.55%(3930/5343),58.41%(3121/5343)),the differences were statistically significant(χ^(2)=4051.600,635.000,1545.700,1619.600,542.160,518.430,Ps<0.001).Compared with rural residents aged 15-29,with education levels of primary school or below,employed in government or public institutions and who had not received tuberculosis health education,those aged 45-59,with educational achievements ranging from junior high school to bachelor’s degrees or above,employed in business or services,and who had received tuberculosis health education demonstrated superior awareness of the core information related to tuberculosis prevention and control(OR=1.156,95%CI:1.050-1.273;OR=1.667,95%CI:1.568-1.773;OR=1.882,95%CI:1.716-2.065;OR=1.974,95%CI:1.736-2.245;OR=1.693,95%CI:1.431-2.005;OR=1.242,95%CI:1.035-1.489;OR=2.655,95%CI:2.485-2.839).The top three methods for rural residents to receive tuberculosis health education were TV/radio(52.02%(13656/26250)),leaflets/folded pages/posters(31.49%(8265/26250)),and direct doctor communication(26.53%(6963/26250)).The main methods of accessing online health science popularization information were WeChat and Weibo(36.58%(9602/26250))and search engines(25.28%(6636/26250)).Preferred methods learning about tuberculosis prevention and control information included TV/radio(62.80%(16484/26250)),doctor dissemination(45.95%(12062/26250)),and internet dissemination(36.57%(9599/26250)).Audio-visual(40.98%(10757/26250))and graphic(36.90%(9685/26250))materials were the preferred types of tuberculosis dissemination,with video(60.28%(15824/26250))and graphic(46.82%(12290/26250))being the most popular types of science popularization.Conclusion:During the assessment of the‘13th Five-Year Plan’,there was a notable enhancement in the health education status related to tuberculosis prevention and control among rural residents in China.However,the awareness of core tuberculosis information had considerable scope for improvement.On the basis of increasing the publicity of network media and developing the dissemination of publicity materials suitable for network media,targeted publicity and education of tuberculosis prevention and control can be carried out for rural residents with low education level and who have not received tuberculosis health education.