首页> 中文期刊>中国全科医学 >基于社区参与式研究方法的农村结直肠癌筛查组织动员模式效果评价

基于社区参与式研究方法的农村结直肠癌筛查组织动员模式效果评价

摘要

Objective To evaluate the effectiveness of mobilization model of colorectal cancer screening in rural area on the basis of community - based participatory research( CBPR)method. Methods From March to August in 2014,two villages(Wuhou Village and Gushankou Village)were selected from 27 administrative villages in Hancunhe Town of Beijing as sampling sites for community intervention by purposive sampling method. The two villages were randomly assigned to intervention group(Wuhou Village)and control group(Gushankou Village)by simple random sampling method. There were respectively 911 and 936 villagers met the screening requirements in the Wuhou Village and Gushankou Village. The high - risk factors questionnaire and fecal occult blood test( FOBT) ( two times)were used to perform the preliminary screening among these targeted populations,and colonoscopy was given to high - risk populations. Intervention group adopted the model of mobilization based - on CBPR method while control group used the routine mobilization method for intervention. In March 2014,745 villagers who met the inclusion criteria were selected from Wuhou Village and Gushankou Village as research objects,and the self - made questionnaire was used to conduct baseline survey before intervention. In August 2014,740 villagers of Wuhou Village and Gushankou Village who met the inclusion criteria were selected as the research object,and the final - stage investigation was conducted after self - made questionnaire intervention. The general information,the awareness rate of information,acquiring rate of poster foldout,interest rate of propaganda poster,score of knowledge and score of attitude of colorectal cancer screening, participation rate of preliminary screening and participation rate of electron endoscopy were recorded. Results A total of 745 questionnaires(363 in control group and 382 in intervention group)were sent out in the baseline survey,and 707(343 in control group and 364 in intervention group)were valid with an effective response rate of 94. 9% . A total of 740 questionnaires (359 in control group and 381 in intervention group)were sent out in the final - stage survey,and 696(330 in control group and 366 in intervention group)were valid with an effective response rate of 94. 1%. The awareness rate of information,acquiring rate of poster foldout and interest rate of propaganda poster of colorectal cancer screening in intervention group were higher than those in control group(P ﹤ 0. 05). The score of knowledge and score of attitude of colorectal cancer screening after intervention in the control group and intervention group were higher than those before intervention(P ﹤ 0. 05). The scores of knowledge of colorectal cancer screening before and after intervention in intervention group were higher than those in control group( P ﹤0. 05). There was no significant difference in the scores of attitude of colorectal cancer screening before intervention between intervention group and control group( P ﹥ 0. 05);the score of attitude of colorectal cancer screening after intervention in intervention group was higher than that in control group( P ﹤ 0. 05). The results of difference - in - differences model of independent pooled cross - sectional data showed that there was no significant difference in score of knowledge of colorectal cancer screening before and after intervention between the two groups(P ﹥ 0. 05);the difference value of score of attitude of colorectal cancer screening before and after intervention in intervention group was greater than that in control group( P ﹥ 0. 05). The binary non - conditional Logistic regression analysis showed that the participation rate of preliminary screening in intervention group was 23. 8% higher than that in control group(P ﹤ 0. 05);there was no significant difference between intervention group and control group in participation rate of colonoscopy( P ﹥ 0. 05). Conclusion The mobilization model of colorectal cancer screening in rural area on the basis of CBPR has greatly improved the awareness of screening information of colorectal cancer screening and participative behaviors of preliminary screening of the villagers,however,due to the low educational level of the villagers,their knowledge and attitude of colorectal cancer screening are less affected.%目的:评价基于社区参与式研究方法( CBPR)的农村结直肠癌筛查组织动员模式的效果。方法2014年3—8月,采用目的抽样法从北京市韩村河镇的27个行政村中选取2个村(五侯村、孤山口村)作为社区干预试验现场,采用简单随机抽样法将其分为干预组(五侯村)和对照组(孤山口村)。五侯村、孤山口村分别有911、936例村民符合结直肠癌筛查要求,将其作为筛查的目标人群,采用高危因素问卷和便隐血试验(FOBT)(2次)进行初筛,对高危人群进行肠镜检查。干预组采用基于 CBPR 的农村结直肠癌筛查组织动员模式进行干预,对照组采用一般性组织动员模式进行干预。2014年3月,选取五侯村、孤山口村符合纳入标准的村民745例为调查对象,采用自制调查问卷进行干预前的基线调查。2014年8月,再次选取五侯村、孤山口村符合纳入标准的村民740例为调查对象,采用自制调查问卷进行干预后的终末调查。记录两组一般资料,结直肠癌筛查消息知晓率、宣传折页获得率、宣传海报关注率、知识得分、态度得分,初筛参与率,肠镜参与率。结果基线调查共发放调查问卷745份(对照组363份、干预组382份),回收有效问卷707份(对照组343份、干预组364份),有效回收率为94.9%。终末调查共发放调查问卷740份(对照组359份、干预组381份),回收有效问卷696份(对照组330份、干预组366份),有效回收率为94.1%。干预组结直肠癌筛查消息知晓率、宣传折页获得率、宣传海报关注率均高于对照组(P ﹤0.05)。两组干预后结直肠癌筛查知识得分、态度得分均高于本组干预前(P ﹤0.05);干预组干预前后结直肠癌筛查知识得分均高于对照组(P ﹤0.05);干预组干预前结直肠癌筛查态度得分与对照组比较,差异无统计学意义(P ﹥0.05);干预组干预后结直肠癌筛查态度得分高于对照组(P ﹤0.05)。独立混合横截面数据的双重差分模型分析结果显示:两组干预前后结直肠癌筛查知识得分差值比较,差异无统计学意义(P ﹥0.05);干预组干预前后结直肠癌筛查态度得分差值大于对照组(P ﹤0.05)。二分类非条件 Logistic 回归分析结果显示:干预组较对照组初筛参与率高23.8%(P ﹤0.05);两组肠镜参与率比较,差异无统计学意义(P ﹥0.05)。结论基于 CBPR 的农村结直肠癌筛查组织动员模式较大程度提高了村民结直肠癌筛查的消息知晓情况和初筛参与行为;但由于村民文化程度低等原因,其对村民的结直肠癌筛查知识掌握情况、态度影响较小。

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