社区干预项目对未婚青(少)年生殖健康知识和性相关态度的影响

Impact of Community-based Sex Education and Reproductive Health Service Intervention on Unmarried Youths' Reproductive Health Knowledge and Attitudes Towards Sex-Related Issues

目的 评价社区性与生殖健康教育和服务对未婚青(少)年生殖健康知识水平和性相关态度的影响。方法 在上海市某区两个镇开展以社区为基础的干预性研究,干预组和对照组分别有15～24岁未婚青(少)年1220名和1007名。干预活动的形式包括发放宣教材料、播放教育录像、组织讲座和小组讨论、提供咨询和避孕服务。干预持续20个月,随访率为92％。通过干预前后的问卷调查对干预项目的效果进行评价。结果 干预前干预组和对照组的性与生殖健康知识没有显著差别,干预后两组的得分分别为(72.2±10.2)和(43.6±16.9)分,干预组明显高于对照组。对有关生殖生理、避孕、性病/艾滋病的绝大部分问题,干预组的答对率较对照组有明显提高。干预对未婚青(少)年有关性相关问题的态度也有积极影响。此外,干预组对象的安全性行为和自我保护意识增强。多因素分析结果显示,在调整了其他可能的影响因素后,干预仍是影响生殖健康知识得分的一个最重要的因素。结论 在社区开展对未婚青(少)年的性与生殖健康教育和服务是提高青(少)年性与生殖健康知识的一条有效途径,也可在一定程度上改变青(少)年的性观念,使他们对性相关问题持更为积极和理性的态度。

Purpose: To examine the effectiveness of a community-based sex education and reproductive health service program on unmarried youths' reproductive health knowledge and attitudes towards sex-related issues. Methods: Two towns in a district of Shanghai were selected as the research sites, one as the intervention site and the other as the control. The intervention lasted 20 months and comprised by three main areas of activities, i. e., building awareness, offering counseling and services for 15-24 aged unmarried young people. In order to test the feasibility and effectiveness of the intervention, base-line survey was conducted in both sites prior to the implementation of the intervention, and similar survey was conducted in both sites after the intervention had been initiated. Totally, 1 1220 unmarried young people from the intervention site, and 1 007 from the control site were interviewed, and about 92% of them were re-interviewed at follow-up. Results: The average reproductive health knowledge score(the higher the score, the more the knowledge) was no significant difference between the intervention and control groups at baseline, but higher in the intervention group than that in the control group at post-intervention(72.2 ± 10.2 vs 43.6 ± 16.9). For most of the questions on reproduction, contraception and STDs/AIDS in the questionnaire, the correct answer rates in the intervention groups were significantly higher than those in the control group. The intervetion also had positive influence on unmarried youths' attitudes towards sex-related issues. There were more subjects in the intervention group who expressed less favorable attitude to premarital sex than that in the control group, i. e., less subjects in the intervetion group thought young people could have premarital sex even 'it was based on love' or 'they were willing to do so', while there were more subjects in the intervention group who thought the premarital sex was understandable than that in the control group. Besides, there were higher proportions of subjects who thought premarital sex 'had negative impact on male/female youth', premarital pregnancy 'was not good' and induced abortion 'does harm to women's health' and 'influences women's fertility' in the intervention group than those in the control group. Moreover, subjects' perceptions on safe sex and self-protection from sex risk behavior in the intervetion group were improved. Multi-variable analysis indicated that after the factors that might potentially affect the reproductive health knowledge were adjusted, the intervention was still the most important influencing factor of the knowledge. Conclusions: Sex education and reproductive health service in community could increase the reproductive health knowledge, and change the sex-related attitudes of adolescents and unmarried young people and made young people hold more positive and rational attitudes towards sex-related issues.